[House Hearing, 116 Congress] [From the U.S. Government Publishing Office] GROWING A HEALTHY NEXT GENERATION: EXAMINING FEDERAL CHILD NUTRITION PROGRAMS ======================================================================= HEARING BEFORE THE SUBCOMMITTEE ON CIVIL RIGHTS AND HUMAN SERVICES COMMITTEE ON EDUCATION AND LABOR U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED SIXTEENTH CONGRESS FIRST SESSION __________ HEARING HELD IN WASHINGTON, DC, MARCH 12, 2019 __________ Serial No. 116-8 __________ Printed for the use of the Committee on Education and Labor [GRAPHIC NOT AVAILABLE IN TIFF FORMAT] Available via the World Wide Web: www.govinfo.gov or Committee address: https://edlabor.house.gov __________ U.S. GOVERNMENT PUBLISHING OFFICE 35-662 PDF WASHINGTON : 2019 -------------------------------------------------------------------------------------- For sale by the Superintendent of Documents, U.S. Government Publishing Office, http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center, U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free). E-mail, [email protected]. COMMITTEE ON EDUCATION AND LABOR ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman Susan A. Davis, California Virginia Foxx, North Carolina, Raul M. Grijalva, Arizona Ranking Member Joe Courtney, Connecticut David P. Roe, Tennessee Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan Northern Mariana Islands Brett Guthrie, Kentucky Frederica S. Wilson, Florida Bradley Byrne, Alabama Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin Mark Takano, California Elise M. Stefanik, New York Alma S. Adams, North Carolina Rick W. Allen, Georgia Mark DeSaulnier, California Francis Rooney, Florida Donald Norcross, New Jersey Lloyd Smucker, Pennsylvania Pramila Jayapal, Washington Jim Banks, Indiana Joseph D. Morelle, New York Mark Walker, North Carolina Susan Wild, Pennsylvania James Comer, Kentucky Josh Harder, California Ben Cline, Virginia Lucy McBath, Georgia Russ Fulcher, Idaho Kim Schrier, Washington Van Taylor, Texas Lauren Underwood, Illinois Steve Watkins, Kansas Jahana Hayes, Connecticut Ron Wright, Texas Donna E. Shalala, Florida Daniel Meuser, Pennsylvania Andy Levin, Michigan* William R. Timmons, IV, South Ilhan Omar, Minnesota Carolina David J. Trone, Maryland Dusty Johnson, South Dakota Haley M. Stevens, Michigan Susie Lee, Nevada Lori Trahan, Massachusetts Joaquin Castro, Texas * Vice-Chair Veronique Pluviose, Staff Director Brandon Renz, Minority Staff Director ------ SUBCOMMITTEE ON CIVIL RIGHTS AND HUMAN SERVICES SUZANNE BONAMICI, OREGON, Chairwoman Raul M. Grijalva, Arizona James Comer, Kentucky, Marcia L. Fudge, Ohio Ranking Member Kim Schrier, Washington Glenn ``GT'' Thompson, Jahana Hayes, Connecticut Pennsylvania David Trone, Maryland Elise M. Stefanik, New York Susie Lee, Nevada Dusty Johnson, South Dakota C O N T E N T S ---------- Page Hearing held on March 12, 2019................................... 1 Statement of Members: Bonamici, Hon. Suzanne, Chairwoman, Subcommittee on Civil Rights and Human Services.................................. 1 Prepared statement of.................................... 3 Comer, Hon. James, Ranking Member, Subcommittee on Civil Rights and Human Services.................................. 3 Prepared statement of.................................... 5 Statement of Witnesses: Berlew-O'Meara, Ms. Nikki, Wilkes-Barre, PA.................. 29 Prepared statement of.................................... 31 Johnson, Ms. Cheryl, MS, RD, LD, Director of Child Nutrition and Wellness, Kansas State Department of Education......... 17 Prepared statement of.................................... 19 Martin, Ms. Donna, EdS, RDN, LD, SNS, FAND, Director of School Nutrition Programs, Burke County, Georgia Public Schools.................................................... 23 Prepared statement of.................................... 25 Ochoa, Dr. Eddie Jr., M.D., Associate Professor of Pediatrics, University of Arkansas for Medical Sciences Community Pediatrics Medical Director, Arkansas Children's Hospital................................................... 8 Prepared statement of.................................... 11 Additional Submissions: Mr. Comer: Letter dated March 11, 2019, from the Council of the Great City Schools..................................... 53 Letter dated March 12, 2019, from the Council of the National School Boards Association (nsba).............. 54 Dr. Ochoa: Appendix 2: Estimating the Health-Related Costs of Food Insecurity and Hunger.................................. 56 Preventing Chronic Disease............................... 74 Scott, Hon. Robert C. ``Bobby'', a Representative in Congress from the State of Virginia: Article: Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Selected by Students and School Lunch Participation Rates....... 87 Letter dated January 29, 2018............................ 93 Questions submitted for the record Thompson, Hon. Glenn, a Representative in Congress from the State of Pennsylvania: Article: The Guardian.................................... 97 Article: Full-fat Dairy May Reduce Obesity Risk.......... 100 Article: Full-fat Dairy May Actually Benefit Heart Health 101 Questions submitted for the record by: Chairwoman Bonamici...................................... 107 Schrier, Hon. Kim, a Representative in Congress from the State of Washington.................................... 110 Shalala, Hon. Donna E., a Representative in Congress from the State of Florida Omar, Hon. Ilhan, a Representative in Congress from the State of Minnesota..................................... 108 Responses to questions submitted for the record by: Ms. Martin............................................... 112 Dr. Ochoa................................................ 117 GROWING A HEALTHY NEXT GENERATION: EXAMINING FEDERAL CHILD NUTRITION PROGRAMS ---------- Tuesday, March 12, 2019 House of Representatives Committee on Education and Labor, Subcommittee on Civil Rights and Human Services Washington, DC ---------- The Subcommittee met, pursuant to notice, at 10:15 a.m., in room 2175, Rayburn House Office Building. Hon. Suzanne Bonamici [chairwoman of the subcommittee] presiding. Present: Representatives Bonamici, Schrier, Hayes, Trone, Lee, Comer, Thompson, Stefanik, and Johnson. Also present: Representatives Shalala, Grothman, Allen, Watkins, Omar, Scott, and Foxx. Staff present: Tylease Alli, Chief Clerk; Nekea Brown, Deputy Clerk; Ilana Brunner, General Counsel Health and Labor; Emma Eatman, Press Aide; Alison Hard, Professional Staff Member; Carrie Hughes, Director of Health and Human Services; Stephanie Lalle, Deputy Communications Director; Andre Lindsay, Staff Assistant; Richard Miller, Director of Labor Policy; Max Moore, Office Aid; Veronique Pluviose, Staff Director; Banyon Vassar, Deputy Director of Information Technology; Katelyn Walker, Counsel; Cyrus Artz, Minority Parliamentarian, Marty Boughton, Minority Press Secretary; Courtney Butcher, Minority Coalitions and Members Services Coordinator; Bridget Handy, Minority Legislative Assistant; Blake Johnson, Minority Staff Assistant; Amy Raaf Jones, Minority Director of Education and Human Resources Policy; Hannah Matesic, Minority Legislative Operations Manager; Kelley McNabb, Minority Communications Director; Jake Middlebrooks, Minority Professional Staff Member; Brandon Renz, Minority Staff Director; Mandy Schaumburg, Minority Chief Counsel and Deputy Director of Education Policy; and Meredith Schellin, Minority Deputy Press Secretary and Digital Advisor. Chairwoman BONAMICI. The committee on Education and Labor will come to order. Welcome, everyone. I note that a quorum is present. I ask unanimous consent that Representative Shalala of Florida, Representative Omar of Minnesota, and Representative Grothman of Wisconsin be permitted to participate in today's subcommittee hearing with the understand that their questions will come only after all members of the Subcommittee on Civil Rights and Human Services on both sides of the aisle who are present have had an opportunity to question the witnesses. Without objection, so ordered. The committee is meeting today in a hearing to hear testimony on Growing a Healthy Next Generation, Examining Federal Child Nutrition Programs. Pursuant to committee rule 7C opening statements are limited to the chair and ranking member. This allows us to hear from our witnesses sooner and provides all members with adequate time to ask questions. I recognize myself now for the purpose of making an opening statement. We are here today to discuss our responsibility to make sure that all children have access to healthy food, all year round in and out of the classroom, and to discuss why doing so is a good investment. More than 70 years ago, Congress passed the National School Lunch Act as, and I quote, ``a measure of national security, to safeguard the health and well-being of the Nation's children.'' Through the enactment of this first Federal child nutrition program, Congress recognized that feeding hungry children was a moral imperative and a vital tool to protect the health and security of our Nation. Kids, families, and communities all do better when kids have nutritious food that helps them learn, grown, and thrive. Studies have found that healthier students are likely to have fewer absences and disciplinary issues. When children have consistent access to nutritious food it improves their health and wellbeing from early childhood through adulthood. This, in turn, results in substantial long- term savings in healthcare and education. Roughly 15 million households face food insecurity today. In my home State of Oregon, one in five kids live in a household where financial hardship makes it difficult to put food on the table. Child nutrition programs remain critical to preventing child hunger and setting a strong foundation for the next generation. Today, child nutrition standards and programs like the National School Lunch Program, School Breakfast Program, and Child and Adult Care Feeding Program, and the Summer Food Service Program provide healthy meals for more than 30 million children in all 50 States all throughout the year. In Oregon, nearly 300,000 students participated in the National School Lunch Program, and nearly 150,000 students participated in the School Breakfast program in the school year 2017 to `18. These programs have historically enjoyed bipartisan support in Congress and in communities across the country. We know that many communities do face challenges in feeding their children, and as a Congress, we should do more, not less, to address these issues. Unfortunately, yesterday the President made clear that he does not share these goals. Under the President's budget proposal, roughly 1.3 million additional children would go without free school meals. That is a lot of hungry children. This hearing will be an opportunity for all Members to hear about why these programs are vital to the health and success of communities across the country from Oregon to Kentucky and everywhere in between. I hope this hearing is a first step toward renewing the historically bipartisan commitment to childhood nutrition, and I look forward to hearing more about these important programs. Congress and this Committee have a responsibility to make sure that every child has access to a quality education. Child nutrition programs are an important part of making sure that education results in every child having the foundation for a healthy and productive future. I want to thank all of our witnesses for being with us here today and I look forward to your testimony. I now recognize the distinguished Ranking Member Mr. Comer for the purpose of making an opening statement. [The statement of Chairwoman Bonamici follows:] Prepared Statement of Hon. Suzanne Bonamici, Chairwoman, Subcommittee on Civil Rights and Human Services We are here today to discuss our responsibility to make sure that all children have access to healthy food, all year long, in and out of the classroom, and to discuss why doing so is a good investment. More than 70 years ago, Congress passed the National School Lunch Act as and I quote ``a measure of national security, to safeguard the health and well-being of the Nation's children.'' Through the enactment of this first Federal child nutrition program, Congress recognized that feeding hungry children was a moral imperative and a vital tool to protect the health and security of our Nation. Kids, families, and communities all do better when kids have nutritious food that helps them learn, grown, and thrive. Studies have found that healthier students are likely to have fewer absences and disciplinary issues. When children have consistent access to nutritious food, it improves their health and wellbeing from early childhood through adulthood. This, in turn, results in substantial long-term savings in health care and education. Roughly 15 million households face food insecurity today. In my home State of Oregon, 1 in 5 kids live in a household where financial hardship makes it difficult to put food on the table. Child nutrition programs remain critical to preventing child hunger and setting a strong foundation for the next generation. Today, child nutrition standards and programs like the National School Lunch Program, School Breakfast Program, the Child and Adult Care Feeding Program, and the Summer Food Service Program provide healthy meals for more than 30 million children, in all 50 States, all throughout the year. In Oregon, nearly 300,000 students participated in the National School Lunch Program, and nearly 150,000 students participated in the School Breakfast program in school year 2017 to 2018. These programs have historically enjoyed bipartisan support in Congress and in communities across the country. We know that many communities do face challenges in feeding their children, and as a Congress, we should do more not less to address these issues. Unfortunately, yesterday the President made clear he does not share these goals. Under the president's budget proposal, roughly 1.3 million children would go without free school meals. That is a lot of hungry children. This hearing will be an opportunity for all Members to hear about why these programs are vital to the health and success of communities across the country from Oregon to Kentucky and everywhere in between. I hope this hearing is a first step toward renewing the historically bipartisan commitment to childhood nutrition, and I look forward to hearing more about these important programs. Congress and this Committee have a responsibility to make sure that every child has access to a quality education. Child nutrition programs are an important part of making sure that education results in every child having the foundation for a healthy and productive future. I want to thank all of our witnesses for being with us today; I look forward to your testimony. I now yield to the Ranking Member, Mr. Comer. ______ Mr. COMER. Thank you, Madam Chairman. I would like to thank my colleagues across the aisle for holding today's hearing. Before coming to Congress I served as Kentucky's Commissioner of Agriculture where I worked with school food service personnel from school districts across the Commonwealth to promote initiatives, including the Farm to School Program, encouraging fresh Kentucky proud foods to be served in local cafeterias. As I met with these local administrators they consistently emphasized the crucial role that child nutrition programs play in supporting kids' health development, especially the free and reduced price meals offered through the Federal School Meal Programs. Free and reduced prices meals ensure that children from low income households have reliable access to nutritious breakfasts and lunches while at school. Each school year nearly 30 million lunches are served to students each day with most participants receiving a free or reduced price meal. Program participation has been steadily rising for decades, but in 2012 the Obama Administration finalized an onslaught of Federal mandates on school nutrition, delivering a blow to many cafeteria operations. Schools had to overhaul their menu programming, including meeting new requirements that limit the kind of milk they can offer, mandate the color of vegetables they must serve and limit the type of grains they must use. Since the Obama Administration enacted the regulations housed in the Healthy and Hunger-Free Kids Act school lunch program operating costs have risen while National program participation has dropped. While we would hope that means there are fewer hungry children in this country we have reason to believe that is not the case. School districts already tasked with operating on a tight budget now face higher cafeteria operation costs, onerous compliance rules, and mounting food waste problem as students pass up the food that cafeterias are now required to serve. When kids are at school they do not have a parent there encouraging them to eat the green peas on their plate. And while I know cafeteria professionals are doing all they can to get kids to eat their vegetables the truth is some kids just are not going to try them. However well-intentioned these requirements may be they are limiting program effectiveness and causing students to forgo the meals they need. Kids deserve health and nutritious meals at school, but if the Federal Government mandates meals that students will not eat than Washington is categorically failing to combat hunger. For these reasons Agriculture Secretary Sonny Perdue recently finalized new rules easing requirements on sodium, milk, and whole grains. School districts will benefit from these eased requirements and Congress should take note. While many folks found ways to help limit waste and increase participation I hope this new limited flexibility from USDA will boost meaningful participation in these programs and result in less tax payer dollars being thrown straight into the cafeteria trashcan. Congress should work with these States to provide school districts with greater latitude over their offerings. By delivering this flexibility and limiting burdensome paperwork school districts will be able to customize their cafeteria menus to give the students they know and serve health options they will enjoy. As a farmer myself, I understand the importance of supporting local farmers by providing school access to local farm fresh ingredients, and with three young children in public schools I certainly understand the duty we have to educate our growing children about eating balanced meals. I look forward to today's conversation and am hopeful we can find a solution that helps lower program costs, eliminates food waste, and ensures that students have access to nutritious, enjoyable meals. [The statement of Mr. Comer follows:] Prepared Statement of Hon. James Comer, Ranking Member, Subcommittee on Civil Rights and Human Services Thank you for yielding. I'd like to thank my colleagues across the aisle for holding today's hearing. Before coming to Congress, I served as Kentucky's Agriculture Commissioner where I worked with school food service personnel from school districts across the commonwealth to promote initiatives including the Farm to School Program, encouraging fresh, ``Kentucky Proud'' foods to be served in local cafeterias. As I met with these local administrators, they consistently emphasized the crucial role that child nutrition programs play in supporting kids' healthy development, especially the free and reduced-priced meals offered through the Federal school meal programs. Free and reduced-price meals ensure that children from low-income households have reliable access to nutritious breakfasts and lunches while at school. Each school year, nearly 30 million lunches are served to students each day, with most participants receiving a free or reduced-price meal. Program participation has been steadily rising for decades, but in 2012, the Obama Administration finalized an onslaught of Federal mandates on school nutrition, delivering a blow to many cafeteria operations. Schools had to overhaul their menu programming, including meeting new requirements that limit the kind of milk they can offer, mandate the color of vegetables they must serve, and limit the types of grains they must use. Since the Obama Administration enacted the regulations housed in the Healthy and Hunger-Free Kids Act, School Lunch Program operating costs have risen while national program participation has dropped. While we would hope that means there are fewer hungry children in this country, we have reason to believe that's not the case. School districts, already tasked with operating on a tight budget, now face higher cafeteria operation costs, onerous compliance rules, and a mounting food waste problem as students pass up the food that cafeterias are now required to serve. When kids are at school, they don't have a parent there encouraging them to eat the green peas on their plate. And while I know cafeteria professionals are doing all they can to get kids to eat their vegetables, the truth is some kids just aren't going to try them. However well-intentioned these requirements may be, they are limiting program effectiveness and causing students to forgo the meals they need. Kids deserve healthy and nutritious meals at school, but if the Federal Government mandates meals that students won't eat, then Washington is categorically failing to combat hunger. For these reasons, Agriculture Secretary Sonny Perdue recently finalized new rules easing requirements on sodium, milk, and whole grains. School districts and students will benefit from these eased requirements, and Congress should take note. While many folks found ways to help limit waste and increase participation, I hope this new, limited flexibility from USDA will boost meaningful participation in these programs and result in less taxpayer dollars being thrown straight into the cafeteria trashcan. Congress should work with the States to provide school districts with greater latitude over their offerings. By delivering this flexibility and limiting burdensome paperwork, school districts will be able to customize their cafeteria menus to give the students they know and serve healthy options they will enjoy. As a farmer myself I understand the importance of supporting local farmers by providing schools access to local, farm-fresh ingredients, and with three young children in public schools, I certainly understand the duty we have to educate our growing children about eating balanced meals. I look forward to today's conversation and am hopeful we can find a solution that helps lower program costs, eliminates food waste, and ensures that students have access to nutritious, enjoyable meals. ______ Mr. COMER. Madam Chairman, I ask unanimous consent to insert two letters into the record. One from the council of the Great City Schools and the National School Board Association supporting the new school meal regulatory flexibility. Chairwoman BONAMICI. Without objection. Mr. COMER. And with that I yield back. Chairwoman BONAMICI. Thank you, Mr. Ranking Member. Without objection all other members who wish to insert written statements into the record may do so by submitting them to the Committee clerk electronically in Microsoft Word format by 5 p.m. on March 25, 2019. I will now introduce our witnesses. Dr. Eduardo Ochoa is the principle investigator for the Children's Health Watch Little Rock site at Arkansas Children's Hospital. His research interests include Latino health, health disparities, children with special health needs, and community engagement. He is a fellow of the American Academy of Pediatrics and a tenured associate professor of pediatrics at the University of Arkansas for Medical Sciences. Nikki Berlew O'Meara is a 33-year old mother of two who lives in Wilkes Barre, Pennsylvania. Her son James is in the third grade and her daughter Natalie is in kindergarten. They both love to do Cub Scouts, read books, and go swimming. An active volunteer, Berlew-O'Meara is secretary of her children's parent/teacher association, assistant den leader for a lion scout den, and a board member for Queer Northeastern Pennsylvania Acts. Berlew-O'Meara holds a bachelor of science in psychology from, this is going to be hard, Misericordia. Was I close? Ms. BERLEW-O'MEARA. Very close, ma'am. Misericordia. Chairwoman BONAMICI. Misericordia University. Ms. BERLEW-O'MEARA. It is tiny. Chairwoman BONAMICI. Now, I am pleased to recognize my colleague Representative Allen to introduce his constituent who is appearing before us as a witness today. Mr. ALLEN. Thank you, Chairwoman Bonamici and Ranking Member Comer for allowing me to cross committees. I am on two other subcommittees here on the Educational Labor Committee, but I had to be here this morning, and when I say I had to be here I was not going to miss this because one of my favorite people are here. I am pleased to introduce my friend Donna Martin who is a registered dietician and nutritionist and is currently the director of Burke County School Nutrition Program in Waynesboro, Georgia. And the past president of the Academy of Nutrition and Dietetics. She has worked in the area of school nutrition for over 25 years in both large systems with over 38,000 students, and currently in a small system with 4,500 students. Donna's school system operates the National School Breakfast Program, the National School Lunch Program, the After School at Risk Snack Program, the Fresh and Fruit, Vegetable Grant Program, the Supper Program, and the Summer Feeding Program. Donna has long been dedicated to improving the health of her students at school by offering nutritionally balances meals that also teach the students about good nutrition. Donna has a master's degree in clinical nutrition from the University of Alabama in Birmingham, and a specialist degree in administration and supervision from Augusta University in Augusta, Georgia. In 2006 Donna received a Summer Sunshine Award for the southeast region of the United States from USDA for innovation in implementing the Summer Food Service Program. Burke County is a very large rural county. In fact, it's the largest county in our district. They decided to serve the children over the summer out of school buses that made stops throughout the county so that kids would have access to summer meals. Donna was also awarded the 2016 Golden Radish Award for the State of Georgia because of her efforts in the farm to school movement. I have visited Donna's district on numerous occasions to eat lunch and to participate in her farm to school events. In fact, as a Member of Congress I have never missed that event, and good lord willing I will never miss that event. It is my favorite time. Obviously, you can tell that I do love good food, and it is the best. And these students are just, I mean, in fact, they grow their own food there. I mean, it is just incredible. But I have seen first-hand how the students love her program. Thank you, Donna, for sharing your testimony today, and it is always great to see you. Chairwoman BONAMICI. Thank you, Representative Allen. I am pleased to recognize my colleague Representative Watkins to briefly introduce his constituent who is appearing before us as a witness today. Mr. WATKINS. Thank you, Chair, and thank you ranking members for allowing me to introduce my constituent. It is a better panel because of you, Ms. Johnson, and we are a healthier state because of you. Thank you for being here and god bless you. Ms. Johnson is the director of child nutrition and wellness for the Kansas State Department of Education. As director, she serves as the liaison between the State Department of Education and the Food and Nutrition Service at the USDA. Cheryl and her team administer the nutrition programs in Kansas and then provide leadership and training and monitoring for over 800 local sponsors who provide over 102 million meals and snacks to Kansas children in 2018 alone. They strive to make nutrition and wellness an integral part of a student's success. Cheryl has worked as Director of Nutrition Services at the Kansas Neurological Institute, and as a consultant dietician, and as an adjunct professor at Topeka's own Washburn University, Go Ichabods. She holds a B.S. in food and nutrition and a master's in dietetics and institutional management from Kansas State University. Go Cats. She is a registered and licensed dietician and a Kansas Health Foundation leadership fellow. She has served on the School Nutrition Association's Governance Board, the Governor's Council on Fitness, the USDA Professional Standards Work Group, and KSU Human Ecology Alumni Board, and Dietetics Advisory Board. My mother is Barbara Watkins and taught Cheryl's son Craig at Logan Junior High and taught her other son Kyle at Seaman High School in Topeka. However, my mother did not teach your youngest son Mark who he, himself, is now a teacher, as I understand. Needless to say, thank you for being here, Ms. Johnson. It is a pleasure to have you and it is a pleasure to introduce you. Chairwoman BONAMICI. Thank you, Mr. Watkins. We appreciate all of the witnesses for being here today and we look forward to your testimony. Let me remind the witnesses that we have read your written statements and they will appear in full in the hearing record. Pursuant to Committee Rule 70 and committee practice, each of you is asked to limit your oral presentation to a 5-minute summary of your written statement. I will also remind the witnesses that pursuant to Title 18 of the U.S. Code Section 1001 it is illegal to knowingly and willfully falsify any statement, representation, writing document or material fact presented to Congress or otherwise conceal or cover up a material fact. Before you begin your testimony please remember to press the button on the microphone in front of you so it will turn on and the Members can hear you. As you begin to speak the light in front of you will turn green. After 4 minutes the light will turn yellow to signal that you have 1 minute remaining. When the light turns red your 5 minutes have expired and we ask that you please wrap up your testimony. We will let the entire panel make their presentations before we move to Member questions. When answering a question please remember to, once again, turn on your microphone. I first recognize Dr. Ochoa. STATEMENT OF DR. EDDIE OCHOA, ASSOCIATE PROFESSOR OF PEDIATRICS, UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COMMUNITY PEDIATRICS MEDICAL DIRECTOR, ARKANSAS CHILDREN'S HOSPITAL Dr. OCHOA. Thank you very much, Madam Chair Bonamici and other members of the House Committee on Education and Labor for the opportunity to submit this testimony. My name is Dr. Eduardo Ochoa and I am a general pediatrician practicing at Arkansas Children's Hospital in Little Rock. I am also a faculty member at the University of Arkansas for Medical Sciences, and a principle investigator with Children's Health Watch, a non-partisan network of pediatricians and public health researchers committed to improving the health of young children and their families by informing policies that address and alleviate economic hardships. I am also a member of the American Academy of Pediatrics, a non-profit professional membership organization of 67,000 primary care pediatricians and medical and surgical pediatric sub-specialists dedicated to the health and well-being of all infants, children, adolescents and young adults. The testimony I give today is on behalf of Children's Health Watch and the American Academy of Pediatrics. As a practicing pediatrician I know the importance of consistent access to nutritious foods for healthy growth and development among my young patients. This is one of the main reasons why we have been screening for food insecurity and other social needs for several years in the primary care clinics at Arkansas Children's Hospital. Through this effort we have found that about a quarter of our patients are food insecure. Decades of research has documented the adverse health effects of food insecurity on the health, growth, development, and educational outcomes of children from infancy through adolescence. Naomi is one such patient who we identified as having food insecurity. I talked with her mother who did not know that I also work at the clinic where Naomi was seen recently. Naomi's mom recounted that she was in clinic for Naomi's checkup and was surprised that she was asked to complete a questionnaire that asked about social needs. She responded with two affirmative answers to the hunger vital sign, a measure validated by Children's Health Watch and endorsed as a best practice by the American Academy of Pediatrics. Naomi's mother's earnings at work are stretched thin, and even though Naomi is fed at her head start program there's still worry about whether the food at home will run out before she has money to buy more. They left our clinic with a full grocery bag and a list of local resources to get more when she needed it. It is great that we could help Naomi and her family, but this help is very short term and childhood hunger and its sequelae of adverse health consequences should not have to persist in this country. Federal nutrition programs that feed millions of children every day are an effective solution for both reducing hunger and food insecurity, and improving the health and well-being of growing minds and bodies. For these reasons I am pleased to discuss the importance of child nutrition programs in the United States, including the National School Lunch Program and School Breakfast Program, the Child and Adult Care Food Program, and the Summer Food Service Program. This committee has a unique opportunity to invest in our Nation's children by investing in programs that feed children from their earliest days through the end of high school, setting them up for a health start in life. The National School Lunch and School Breakfast Programs feed 30 million children healthy meals each school day across the country. Research shows NSLP and SBP are associated with numerous benefits for children, including reduced food insecurity, improved test scores, lower rates of absences and tardiness, improved dietary intake, and lower risk of obesity. I know the value of proper nutrition in schools for my patients. Many children, especially those from low income families, consume up to half of their daily calories at school. And for some children, including those whom I see in my clinic, the meals they eat at school may be the only meals they eat in a day. This is why evidence-based meal standards that are age appropriate for growing bodies and brains are necessary. In a country where obesity affects nearly one in five children which places children at greater risk of cardiovascular disease and diabetes, healthy school meal are necessary for reversing this concerning health trend. In fact, just recently in my home State of Arkansas, results were released from a Centers for Disease Control funded study on sodium reduction in school meals. The study was conducted in partnership with 30 schools in northwest Arkansas with the goal of reducing dietary sodium intake in food service procurement and preparation. The study found an 11 percent decrease in sodium content in the meals served over the course of a year, and underscored that a comprehensive approach to healthier diets through reduced sodium is feasible. Given the wealth of evidence on the need to increase intake of nutritious foods for health weights and prevention of chronic illness I hope this Committee will continue to ensure the retention of nutrition standards set according to prevailing science. Since 2013 Arkansas Children's Hospital has provided lunches year round to children as a sponsor site of the Summer Food Service Program and the Child and Adult Care Food Program. From August 2017 to `18 we provided approximately 27,000 meals to children and their siblings seen in our clinics. Because I know that many of the children in our service area receive care in the primary care clinics at Children's I take comfort in knowing that we are asking about food insecurity and have several tools, including CACFP and Summer Feeding to help alleviate this experience over the summer. For young children, WIC and CACFP play an important role in ensuring that children have nutritious, age appropriate food, and have the best opportunity for brain and body growth. In Arkansas my department at the University of Arkansas for Medical Sciences runs the Head Start Program in our county and gives nearly 2,500 meals per day to children across 13 sites. I can tell you that our nutrition director has said that children are asking for more vegetables like spinach that they've eaten at Head Start for the first time to be purchased at home. In summary, Federal child nutrition programs feed children every day, preventing them from going hungry and ensuring they have a healthy start in life, no matter where they live. Investing in these programs is an investment in the future health and well-being of our country. I look forward to discussing potential policy solutions for strengthening and improving these programs so they reach more children. Thank you for your time. [The statement of Dr. Ochoa follows:] [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] Chairwoman BONAMICI. Thank you, Dr. Ochoa, for your testimony. I know recognize Ms. Johnson for 5 minutes for your testimony. STATEMENT OF CHERYL JOHNSON, DIRECTOR OF CHILD NUTRITION AND WELLNESS, KANSAS STATE DEPARTMENT OF EDUCATION Ms. JOHNSON. Good morning, Madam Chair, Ranking Member Comer, and members of the Committee. I appreciate Congressman Watkins for his kind introduction. Thank you for inviting me today and for your interest in making sure students have access to healthy meals that impact student success. Child nutrition programs provide a strong safety net for children by ensuring their nutrition needs are met while providing nutrition education, and they contribute to growing a health next generation which lead the lifelong benefits. Decisions about the specific foods to serve and the methods of preparation are made by the local school food authorities. The USDA final rule child nutrition programs, flexibilities for milk, whole grains, and sodium requirements increased many planning flexibilities for school year 1920. They include providing the option to offer flavored low fat milk, requiring that half of the weekly grains be whole grain rich, and provide more time to reduce sodium levels. Kansas schools are doing an excellent job implementing the nutrition standards and serving tasty meals, and have expressed appreciation for these small tweaks. Many have indicated they will continue to offer more than the minimum required 50 percent whole grain rich products, but welcome the opportunity to reintroduce some favorite items of students such as homemade macaroni and cheese, and homemade chicken and noodles. Industry has been working hard to reduce sodium levels in food products. This final rule provides more time for research and development of tasty options that students will eat. Allowing flavored low fat milk to be offered as a milk choice may result in increased consumption. As direct of the State agency it is appreciated when flexibilities are put into permanent regulation, as opposed to being allowed via a waiver. Waivers take a great deal of State agency and local educational agency resources to write, process, review for approval, and then collect and report data. The Health Hunger-Free Kids Act gave USDA the authority to regulate other foods in the school environment. Monitoring foods outside the school nutrition program has increased time required to complete the administrative review, and increase the record keeping burden for schools to track that nutritional content of foods sold outside the school meal programs. Currently, not all food items served as a part of the reimbursable meal can be served a la carte. One example as school food service director uses frequently is they can serve broccoli with limited cheese, a little cheese to make kids consume it, but it cannot be sold separately on the a la carte serving line. Two sets of standards are confusing. USDFNS has adopted customer service as a strategic priority and listened to concerns from State agency directors. The recent policy memo flexibility for administrative review cycle requirements will allow State agencies to request waivers of the 3-year requirement and extend the review cycle if it hinders State effective allocation of State agency resources. This is another instance where a waiver is required, and it would reduce State agency burden if it could be put into regulation. In Kansas, an increasing number of local educational agencies are now also implementing the Summer Food Service Program and the Child and Adult Care Food Program. To decrease burden we are working to develop one application for multiple programs instead of three separate applications. Schools administering multiple programs have indicated they could operate more efficiently if their site review and reporting requirements could be streamlined. Burden could also be reduced in administering the Summer Food Service Program in rural communities and access increased if there were flexibilities available regarding congruent meal requirements. While many of the child nutrition program regulations are the same for all of the three major programs it is challenging to streamline when there are miniscule program differences. For example, in the Child and Adult Care Food Program meal pattern for per-K it requires 1.5 ounce meat alternate. Yet, the meal pattern for K-5 in school nutrition programs only requires 1 point meal equivalent, 1 ounce meal equivalent. Milk, fat, and flavor requirements are also not consistent between the programs. It is possible to serve a granola bar for school breakfast and in the after school meal program, but you cannot serve those as a part of the Child and Adult Care Program at Risk after School Meal Program. It is essential to have a sufficient lead time to work with local educational agencies once regulatory guidance is received. For example, many schools write menus and begin the procurement process for the next school year in the winter of the current school year. When policy memos and guidance are provided in the spring or summer for the upcoming school year it is challenging to implement these and able to have competitive procurement and pricing. If USDA is continuing their willingness to listen to other folks, including State agencies and local education agencies, including food service directors, administrators, school boards, and parents, and obtain input I do think that this makes the reality of policy implementation more effective. Schools are leading culture change in instill health habits for a lifetime, and child nutrition professionals are leading this change to instill the health habits. And we do appreciate your willingness to help them efficiently and effectively serve the children. [The statement of Ms. Johnson follows:] [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] Chairwoman BONAMICI. Thank you, Ms. Johnson, for your testimony. I now recognize Ms. Martin for 5 minutes for your testimony. STATEMENT OF DONNA MARTIN, DIRECTOR OF SCHOOL NUTRITION PROGRAMS, BURKE COUNTY, GEORGIA PUBLIC SCHOOLS Ms. MARTIN. Thank you, Chairperson Bonamici, Ranking Member Comer, Committee members, and my fellow distinguished panelists. I am honored to have the opportunity to speak before you today. My name is Donna Martin and I am the director of the School Nutrition Program for Burke County Public Schools, a small rural district in Georgia. I am also the immediate past president of the Academy of Nutrition and Dietetics, and we are committed to strong nutrition standards for school meal programs. School nutrition programs are essentially like running a restaurant, a PR agency, and a nutrition education campaign all while operating under a tight budget with minimal time and resources. Being as school food service director is a complex, demanding profession, and I think it is the best job on earth. I will stress three important points today. First, school meal programs can have high nutrition standards and be financially solvent. Second, school nutrition professionals need access to equipment and training resources. And, third, good nutrition for students is critical for our Nation's children to succeed. Our program serves five schools, offering breakfast in the classroom, lunch, and after school snack, and supper, the Fresh Fruit and Vegetable Program, and a Summer Feeding Program. We serve nearly 4,000 meals a day, and our lunch participation rate is 89 percent, and our breakfast participation rate is 78 percent. We operate under the community eligibility provision which has made running my program more efficient by eliminating unnecessary administrative time, paperwork, and cost. We started moving to healthier foods in our district even before the new standards were required, and you can bet that I was nervous. You know we take our fried chicken and grits very seriously in Georgia, so we went to work and developed a health, nutritious herb-baked chicken, scratch whole grain rolls, and locally grown whole grain grits that are absolutely awesome. I brought each of you a bag, and I know you'll agree that these grits are delicious. I am incredibly proud of our farm to school program that provides farm fresh produce to our students. We found that when we started offering local fresh produce like collards, berries, and peaches, our fruit and vegetable consumption rates doubled. From scheduling recess before lunch, to providing choices so students can select the food they like, we manage to keep our food waste low, but we would love to see children have more time to eat their meals. My own grandson tells me he doesn't have enough time to finish his food in school. Since the last time I spoke before the committee the Smart Snacks rule has been implemented. In Burke County I have been able to find almost any product that you can image to meet the criteria. We even offer items like ice cream and cookies that meet the standards and the children love them. We need to protect our nutrition standards from loopholes that would undermine the intent of the Smart Snack Program. I am proud of how we have meet the needs of our community. When our high school football coach came to me with concerns about his players not getting the fuel they need to be successful, we worked together to provide dinner after school while our tutoring enrichment programs were running to make sure the athletes and other students were well-nourished. Not to say it was not challenging. The supper program can be administratively burdensome since the lunch and supper programs are overseen by two different State agencies. Like many communities around the country our rural community faced challenges in delivering summer meals to kids. Traditional feeding sites simply did not meet all of our needs. The community and district worked together to find solutions and we now run 15 summer bus routes feeding over 2,500 children daily. We also provide the food for programs in the community that are operating summer enrichment programs like vacation bible schools and the public library. So what is the cost of running a successfull program you ask? I am not here to tell you that it is easy. Feeling the strain of labor and insurance costs myself, but I am here to tell you that it is possible to meet nutrition standards and be financially solvent. We are fiscally sound because we offer seasonal fresh produce. We work with the Burke County farmers to provide local fruits and vegetables at very competitive prices. In fact, I have had local farmers beating down my door to set up contracts with me. In the school nutrition world we call this a win, win, win. A win for the farmer, a win for the kids, and a win for our local economy. In Burke County I am lucky to have up to date equipment and staff with nutrition expertise. While president of the Academy I have visited many school districts that did not have the same level of resources as me. The Academy created a video and held a briefing for Members of Congress to communicate the real need for modern equipment. I have provided the video link in my written comments so you can see the equipment needs for yourself. We could do more for our students nationally if reimbursement was increased to accommodate rising food costs, and if there were supplemental funding for equipment and training needs. But we will do worse for students if we lower the bar to accommodate costs by not serving kids what they need to thrive. Thank you for listening to my story and for your commitment to our Nation's students. I respectfully ask each of you to keep children's best interests in mind if you plan to move forward with the reauthorization of child nutrition programs. Thank you once again, Chairman Bonamici, Ranking Member Comer, and all the committee members. I will be happy to respond to any questions that you may have. [The statement of Ms. Martin follows:] [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] Chairwoman BONAMICI. Thank you, Ms. Martin for your testimony and for the grits. And I now recognize Ms. O'Meara for 5 minutes for your testimony. STATEMENT OF NIKKI BERLEW-O'MEARA; WILKES-BARRE, PA Ms. BERLEW-O'MEARA. Good morning, Madam Chair Bonamici, Ranking Member Comer, and members of the Subcommittee, and my fellow panelists. My name is Nikki Berlew-O'Meara and I'm a proud member of MomsRising from Wilks Barre, Pennsylvania. Thank you for inviting me to testify today about the vital role school lunches play in my family's life and my children's nutrition. I am the mother of a 9-year-old named James and a 6-year- old named Natalie. As a single mom, money is tight for my family. Thankfully, both of my children receive free lunch at school which is a huge help for us. The National School Lunch Program has been a crucial lifeline as I strive to give my children the strong, healthy start they deserve. One of my top priorities is giving my kids balanced diets to help grow their minds and bodies. The National School Lunch Program's nutrition standards are a huge help. When I drop my kids off at school each morning I know they will get a healthy lunch with the vegetables, fruit, whole grains, and lean proteins that are essential for their health. The lunch they get at school every day is healthier and more substantial than the lunch I would be able to pack for them. And because enough students in my children's district qualify for free lunch, everyone at their school gets them, meaning no children have to feel singled out. The National School Lunch Program benefits my children's nutrition outside of school too. Because I am not paying for lunch every day I have a little more money to spend on their dinners. Every penny counts in our household. It means I can afford healthier options like fresh produce, as well as introduce them to new foods. I am always trying to get my kids to try new things, which any parent will tell you can be difficult, doubly so for kids on the autism spectrum like my son. The National School Lunch Program gives me the buffer I need to do so. As a result, my children eat better and more diverse food, both at school and at home. They love turkey tacos and chuck roast with potatoes at home, and at school they like to eat chicken sandwiches, meatloaf, and mandarin oranges. I have been trying for years to get my daughter to try salad and she finally tried it at school with her friends. It is good, mom, she tells me. We all know sometimes kids listen to their friends first before they listen to their parents. If we did not have the National School Lunch Program my kids' meals would be simpler and less nutritious. We also would not be able to afford the occasional discounted movie night, or even going out to eat for their birthdays which create precious memories for my family. I know what it is like to have to cut costs like that. We have endured more difficult periods where we had to cut these expenses are more. After my divorce things were really tough. The three of used SNAP benefits for a while, and I was wearing just two hoodies at home when the kids were with their father, setting the heat at 55 degrees to save on utilities. During these periods the National School Lunch Program was even more crucial for us. Simply put, without it my kids would have eaten much less at that time in our lives, and they would have eaten more meals like pasta and white rice which keep their bellies full, but do not provide the adequate nutrition they need to grow. The National School Lunch Program provides essential support for my children's education as well. It is so important to me that they get the best education possible so that they can reach their potential and pursue their dreams, and these programs are a huge part of that. If my kids did not get the food and nutrition they need they would be much more distracted at school. They would not be thinking about upcoming vocabulary tests or science projects, but instead they would be thinking about and wishing for their next meal. Simply put, kids cannot learn if they are not getting proper nutrition. Because my children get well-balanced meals at school they can focus on what matters most, feeding their minds and broadening their horizons by working hard in their classes. My son has always dreamed of being a teacher, and my daughter wants to be both a pediatrician and a veterinarian. They need the proper nutritious to realize all of their dreams. As the committee discusses the reauthorization of child nutrition programs I hope you remember James, Natalie, and other families like mine. The decisions this committee makes will have a significant impact on working families and whether we will be able to set our children up for future success. Child nutrition programs need to continue to be well-funded, supported, and improved, not only for my kids but for the other children at their school who have fallen on much tougher times. My kids deserve healthy food and all kids deserve healthy food regardless of how much money their parents make. These programs are a crucial part of ensuring their very basic needs are met. Thank you for remembering the importance of healthy food for our Nation's next generation of children. [The statement of Ms. Berlew-O'Meara follows:] [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] Chairwoman BONAMICI. Thank you so much for your testimony. Under Committee Rule 8A we will now question witnesses under the 5-minute rule. As chair, I will recognize myself first, followed by the ranking member of the full committee, and then we will alternate between the parties. I now recognize myself for 5 minutes. Ms. Berlew-O'Meara, thank you for sharing your story. I know from working at Legal Aid that families do not struggle by choice, and children should not suffer because families are struggling. In your testimony you state that because enough students in the district qualify for free lunch everyone at school gets them, meaning your children do not feel singled out. This describes a provision added in the Health Hunger-Free Kids Act of 2010 known as community eligibility. Why is that important to you and your children? Ms. BERLEW-O'MEARA. It is important to me and definitely to my children as well because I do not want them to feel singled out. I do not want any child to feel singled out because kids talk, and they may find out, oh, this child gets a free lunch. This kid's parents cannot afford to pay for it. They have enough to worry about. We don't--I just do not feel we need to have them be worried about what their parents make and do they qualify for these things. I know just from my own experiences at school and from my mother's experience at school that can be really difficult for children to deal with, and they have already got enough on their plate. We do not need to be adding more. Chairwoman BONAMICI. Thank you. And I am going to followup with Dr. Ochoa about this issue too. We heard, Dr. Ochoa, we heard a little bit about school meal participation rates, and I want to highlight a study conducted by the University of Washington's School of Public Health, itound that new standards put in place after Healthy Hungry Free Kids Act increased access to whole grains, vegetables and fruits, they found that while the nutritional qualify of school meals improved after new requirements went into effect, the standards did not affect school lunch participation. So we know that there are many complicated factors that impact participation rates, and it is important to examine the entire picture. And I have to say I am pretty alarmed by the President's budget proposal to cut 1.7 billion dollars from child nutrition programs. A cut of that magnitude will certainly affect participation rates and result in fewer children accessing meals. Can you comment on how changes to community eligibility might impact participation? Dr. OCHOA. Yes. I would think that community eligibility is important not just to keep more kids fed and keep them out of food insecurity, but also to prevent healthcare costs in the long run. Children's Health Watch has done research showing that the longer that food insecurity persists there are chronic health issues that are worse and developmental issues that are higher in kids that are food insecure than those that are not. My colleagues at Children's Health Watch, Drs. John Cook and Anna Poblacion created an economic simulation model where they showed that CEP alone moved about three quarters of a million people from food insecurity to food security. And so we know that if food insecurity costs our Nation nearly $178 billion a year it would make sense to invest in that as a preventive measure to prevent health care costs in the future. Chairwoman BONAMICI. Thank you. I am going to move to another question, but thank you so much for that. Ms. Martin, in Oregon there are more than 800 summer food service sites. Thank you for talking about the Summer Meals Program. I visited one that serves 30,000 summer meals, but even with that number the district knew they were not reaching all the families in need, and that kids were going hungry over the summer. There has been a pilot program in Oregon that has been very effective helping to bridge the gap. Can you describe some of the challenges your community faces in rural areas and serving summer meals, and what more can we do to make sure that students do not go hungry during the summer months? Ms. MARTIN. Well, thank you for that question. I think food security in my district is a huge issue and we find out that when kids come back from just the weekends or a holiday they are racing into the cafeteria to eat breakfast or eat lunch. They are so hungry. We had teachers who were putting kids into summer school not because they needed to go to summer school, but to make sure they had healthy meals over the summer. So because we have a large rural community we had a need, and we did not have any way of reaching the kids. They did not have transportation to come to our schools or come to our site so we came up with the idea of doing these school busses. So the school busses go out all over the community. They stop at about 105 different stops. The kids get on the bus. They eat the healthy meal. They finish their meal and they love the fact that their bus is air conditioned because a lot of our kids do not even have air conditioning in the summer. So they get on the busses. We provide some books for them on the bus so that they have an opportunity to read on the bus. They get off the bus and they go home. Chairwoman BONAMICI. That is a great model. I want to try to get one more question in. Dr. Ochoa, how do strategies like the Summer EBT Program work in concert with the Summer Food Service Program to improve access to nutritious meals? Dr. OCHOA. It does work very well to improve access, and I think the point that Donna was making is a good one. We know that only one in seven kids that participate in school lunch during the year participate during the summer. So we know that anything that can increase access over the summer is good because there are nearly 17 million kids who are eating free and reduced lunch at school during the school year that do not get it during the summer. Chairwoman BONAMICI. Thank you. And thank you for also recognizing that this is a health care issue, and that it is a good investment and we are actually preventing more expenses in addressing health care later, so appreciate that long term approach. And I now recognize the Ranking Member of the full committee, Dr. Foxx for her questions. Mrs. FOXX. Thank you, Ms. Bonamici, and I want to thank the witnesses for being here today and presenting their testimony. Ms. Johnson, every time I am in a school, and I am in the schools a lot, I am always careful to go by the cafeteria and say thank you to the food nutrition people because I know they struggle to keep up with the rules and regulations, and provide those good meals to the students every day. So please convey to them my thanks. I do that myself personally when I can. I want to thank you for helping us get a better idea of what all the requirements and rules mean for people doing the real work. While some of the paperwork is necessary for compliance and accountability I think you implied there is too much paperwork, but if you would talk a little bit more about that? And could you share some examples of paperwork that makes the program overly burdensome? Ms. JOHNSON. Yes, I would be happy to do that because our focus is on feeding kids, and there are somethings that I think could be reduced paperwork wise and still maintain integrity. Things like waiver. Having waivers takes a lot of time for us to write waiver applications, approve waivers, and then we have to collect data on waivers, and then we write reports on waivers. CEP reporting, community eligibility is a great program, but there is a reporting requirement for schools even below the 40 percent ISP threshold that could never apply. They still have to do notification reporting. That could ease some burden. The site monitoring. When multiple child nutrition programs are being administered, like at our Wichita school district. They have hundreds of monitoring reviews that they have to complete because they run every single program that we have in many, many sites. Summer reporting data is extensive. I know it is helpful, but it quite a chore for the State agency. Illuminating those nuances between the child nutrition programs. There is this little thing, about 80 percent of regulations are the same for all programs. There is this 20 percent difference that makes it so difficult for a director of multiple programs. They want to be in compliance. They want to do the right thing, but just to streamline that would be so helpful. And then we do have a paid lunch equity tool that also can cause some burden. The flexibility that was recently enacted for school districts in a positive financial status is extremely helpful in Kansas, and I do appreciate that. So there are a few examples. Mrs. FOXX. Thank you. You also mentioned that USDA seems to be more customer friendly and really listen to you and your colleagues. Can you tell us a little bit more about what you mean and discuss why that mindset's important for the success of the programs? Ms. Johnson. Absolutely. USDA has been taking a very customer service stance in the last few years, especially. They are listening. They have put together a committee of State agency directors who are giving input on how paperwork can be reduced. Extremely helpful. They are more accessible at conferences. I was just at the Legislative Action Committee. They met with State directors for 2 hours, and they allowed us to ask questions and listened. They have had work groups prior to final rules being enacted for the Child and Adult Care Food Program, also professional standards done and I work both on that group. When they listen I do think it helps with implementation. When they hear from the stakeholders, not just school food service directors and State agency, but also parents and administrators, school boards, all those folks that have an interest. So there have been a lot of examples recently and I applaud them for that. Mrs. FOXX. Well, thank you very much and I hope it is not just listening, but taking action, particularly on those minor little differences that occur. It seems to me that you all would be able to convince them to make those modifications so that you can devote more of your time to serving the children. Ms. JOHNSON. I do think they are listening and I think there are, just like with the Summer Food Service Program, waivers. They know how important it was to get those approved prior to summer starting. In Kansas we had ours in first and we got those back quickly. We did not have to change our computer systems and then change them back. I do feel like they are being very responsive and listening and helping. Mrs. FOXX. Thank you, Madam Chairman. I yield back. Chairwoman BONAMICI. Thank you, Dr. Foxx. I now call on Dr. Schrier from Washington for 5 minutes for your questions. Ms. SCHRIER. Thank you, Madam Chairwoman, and thank you to all of our witnesses. I am thrilled to have you all here. First of all, Ms. O'Meara, I want to tell you that veterinary medicine and pediatrics, in many ways, are very similar that in that first year our patients cannot talk to us. I am sure Dr. Ochoa will appreciate that. Also, nutrition is one of the big topics that comes up at every well child check, and so I am super grateful for this whole discussion and grateful for the food insecurity questions that I also ask. And one thing I just wanted to mention because I look at these school nutrition programs as having three big goals, and forgive me if I am leaving one out. But one is simply addressing food insecurity and hunger. The other is helping kids do better in school and have better behavior which I do not even think we talked about, but that has been proven too. But the third is really setting them up for a lifetime of success and health. And a lot of the conversations that I have with patients or with the parents involve how to make kids like food. And my typical answer to that is just make food that tastes good and there should not be kid meals and adult meals, like, feed them curry, feed them Thai food. Give them whatever tastes good, and that usually works. So I wanted to applaud you, Ms. Martin, for your work in making sure food tastes good and wanted to talk to you about really having a focus on that because if we can make spinach taste good for kids then that means when they are adults and they go do their shopping they will buy spinach and know how to make it. So could you talk a little bit about that, maybe even if any school districts are experimenting with having chefs? And even, I was just at a school the other day, I am using up all my time. I was in a school the other day where they have a school garden, but they are not allowed to eat the food from the garden. Ms. MARTIN. Yes. Ms. SCHRIER. And so could you talk about that a little bit? Ms. MARTIN. No, absolutely. So we have three things that we say in school nutrition. We say if the kids taste it they will eat it, so you have got to do a lot of taste testing. So when our kids come through the line, and we have hummus on the line. They are like what the heck is that, but if you do a taste test with it they like it and they eat it, so taste testing is really key. If they grow it they will eat it. So we have tower gardens and we have outside gardens, and our kids plant the seeds, they grow the food, and they do get to eat it in the classroom. We just cannot serve it school-wide, so if they grow it they will eat it. And if they cook it they will eat it. So we have this Charlie Cart where we do all these cooking classes. So we take what they have grown and turn it into a cooking class, and we get kids to eat brussel sprouts and asparagus and all these things that nobody thinks they will eat, but they have cooked it. And I had a middle school student the other day in the cooking class said, this was the best day of my life. I could have died. A middle school student, really? So it is all about getting them involved. So you have got to, you know, talk to them about what they want, and you also have to do nutrition education. That is what we are not doing enough of. And so my very favorite program for that is the Fresh Fruit and Vegetable Grant Program where right now we offer 65 different fruits and vegetables fresh every day, not at breakfast, not at lunch, but in the afternoon. And our kids run in off the bus, come into the lunchroom to see the Lucite placard to find out whether it's blood oranges or jicama or mushrooms or red bell peppers or whatever, what they are getting for the snack that afternoon. And they go home and their parents call me and they say, what is that star shaped fruit you served today? And I said starfruit, and then the grocery stars call me and say, would you please let me know what you are serving because the kids are running in here asking for it and we do not have it. So that program needs to be expanded, and it also teaches the parents about nutrition. So nutrition education and remember those, taste it, cook it, and I cannot remember the third one, but anyway. Ms. SCHRIER. Prepare it. Ms. MARTIN. You got it. Thank you. Ms. SCHRIER. Yes, preparing it together. And by the way, preparing it together is a great way to connect-- Ms. MARTIN. Preparing it, right. Ms. SCHRIER [continuing]. with teenagers who will not talk to you otherwise. So thank you for that perspective, and, also, cutting up fruits and vegetables increase consumption for people. Ms. MARTIN. Oh my gosh. And the other thing is time to eat, and people do not really focus on that enough, and they look at the trash cans and they say, oh, they threw all this food away. It is because they do not have enough time to eat, and so if we do not give them enough time to eat. Salads take a lot longer to eat than a piece of pizza, and, also, the kids need to go to recess before lunch because if you put recess between a meal and a kid, recess is going to win every single time. So they go to recess. They are hungry. They are thirsty and they eat better. Ms. SCHRIER. Thank you very much, appreciate it. I only have 10 seconds left, maybe next time or at some point we could talk about milk, 20 calorie difference between 2 percent and whole. Why is whole milk getting such a bad rap? But you do not have time to answer so we will talk later. Chairwoman BONAMICI. Thank you, Dr. Schrier. I now recognize Ranking Member Comer from Kentucky for 5 minutes. Mr. COMER. Thank you, Madam Chairman. Ms. Johnson, I know most of the food service directors in the First congressional District. I worked with a lot of them, as I said in my opening statement, when I was Commissioner of Agriculture, and they want to serve healthy, tasty food to their students. They are very passionate about it and do a very good job, but many complain about the excessive regulatory environment, especially the changes that were made during the Obama Administration. Do you believe the new regulations on grains, sodium, and milk help more programs find this balance in their offerings? Ms. JOHNSON. I believe that the final rule with the flexibilities really are just small tweaks and I do not think they undermine the intent of the nutrition standards. I do feel that more time is needed by industry to develop products lower in sodium so they are tasty and so students will eat them, so I really appreciate that flexibility. The milk flavoring I think it is nice to have that additional choice, although I will be honest, in Kansas, the students do consume the skim chocolate and flavored skim fine. That does not seem to be a problem. I did not have any waiver requests for that when it was a possibility, thankfully. It was one thing. But we did get a lot of whole grain rich waivers because we have communities in western Kansas in those small rural communities who actually make homemade noodles still, and you cannot do that with whole grain flour. And we have a lot of folks of different cultures. Whole grain tortillas are not accepted well by some of the students, so some of them had waivers in for just a plain tortilla. We had some waivers for pasta because whole grain pasta is still not holding well on the serving line. It gets mushy and students do not eat mushy, brown macaroni and cheese. I mean, I think that as there is more product development happening and pasta, whole grain pasta maybe gets to the point that it will stand up better. Maybe that will be a good choice. And some schools, if they do not have to transport foods long distance, I mean, I think it could work for them, but having this flexibility is helpful to our rural, small school districts, especially. Mr. COMER. Ms. Johnson, as we begin the work on the reauthorization of the child nutrition programs can you recommend a few principles for us to keep in mind to guide our work as we move forward? Ms. JOHNSON. Yes. Stay the course. I do not think that our food service directors and our school food authorities and our Child and Adult Care Food Program sponsors and summer sponsors, any of them, need the additional chaos of change. They are just now starting to feel comfortable and having good understanding of those multitude of regulations with the Health Hunger-Free Kids Act. They are now being able to start innovative breakfast methods. They are now working on farm to plate. They are able to expand and try to reach more children in rural communities in the summer because they are feeling like, oh, we are understanding this and we can do it. So please think about that. Also, reducing the differences between the child nutrition programs so that operators of multiple programs can operate them with integrity, and helping them increase access, but yet, decreasing their paperwork burden. I truly believe you can do that and still operate programs of integrity. And stability, by reauthorizing our programs our child nutrition program operators they know what the future holds. It is really difficult to operate on waivers. Say, for instance, for me as a State agency the new 5 year waiver. I do not want to reinvent my staff and do all of that when I am actually doing fine with resources when I do not even know if it would last more than a year. It affects people and that is really difficult. So stability is extremely important. Mr. COMER. Well, thank you very much and I yield back. Chairwoman BONAMICI. Thank you, Mr. Comer. I now recognize Representative Hayes from Connecticut for 5 minutes for your questions. Ms. HAYES. Thank you, Madam Chair, and thank you to all of the witnesses who are here today. I am so happy that we are holding this hearing because this is a challenge that I have dealt with at the local level, at the State level, and now, I guess, at the Federal level. I come from a district. I was a educator in Waterbury Public Schools for almost 15 years and this is something that is very personal for me. My district had more than 70 percent of the students who were eligible for free or reduced lunch so we participated in the community eligibility provision. One of only 13 districts in my State who did that, so I know what it means. I know what that looks like in the school setting. I know what it means for children and families. I guess my question would be to Ms. Martin. What would you--I mean, we constantly see this provision under attack. It was in the last budget there were proposed cuts. We saw in the draft of this budget $1.7 billion in proposed cuts to food security nutrition programs, and I can imagine that the community eligibly provision would fall under this. What would you propose to districts who are not taking advantage? We have over 160 districts and only 13 of them use the community eligibility provision. Ms. MARTIN. Well, it is very confusing to me that we offer free busing, free books, free computers, free teaching, but school lunch is not free to all our students. Why is that any different than the rest of the school day? One of my biggest jobs as school nutrition director is to provide students to the teachers ready to learn. So I have got to make sure they have breakfast, and I have got to make sure they have lunch. And I have watched what the kids bring in their lunch box, and I almost think those are the kids that need to be shamed. We have this fabulous school nutrition program and we have got, you know, a lot of people think it is just for the free kids and it is just for the reduced kids, so what she said is so true. When it is community eligibility it is for all the kids, and we have got to reduce our burdens on our future healthcare costs with obesity and diabetes, and heart disease and all these things. And I think if we do not get these kids and these future generations to start eating better we are never going to get there. So the administrative burden for the teachers, the teachers have the hardest job in the school. I would last 10 minutes as a teacher. But they love community eligibility because they do not have to collect applications. They do not have to decide whether the kid is paid, free, reduced, or has lunch money. They do not have to worry about the kid that did not bring their lunch money and take money out of their pocket to pay for the kids. They do not have to worry about lunch boxes being stolen or lunches being stolen. So we have the opportunity to make a huge difference in these children's lives, and they take it home and make a difference in their families' lives. So I say we just need to make sure that all programs have the opportunity to do CEP do not go back. It is such a profound impact in my district and every other district that does it. Ms. HAYES. I mean, so once again, I know what I bring to this conversation. I was the teacher who had a closet who kids came to my room in the morning or I emptied out my own lunch or-- Ms. MARTIN. Right. Ms. HAYES [continuing]. my own wallet-- Ms. MARTIN. Right. Ms. HAYES [continuing]. to give them money to go buy a snack in the morning. Ms. MARTIN. Right. Ms. HAYES. This is before we moved to this community eligibility provision. Is there anything, because I only know what I bring, on the flip side, is there any benefit to cutting this provision in the communities where we have, like mine, 70 percent of our students already receive free or reduced lunch? I know what it meant to try to collect these forms where a kid was not eligible for $5. Ms. MARTIN. Right. Ms. HAYES. Not even a huge span. Ms. MARTIN. Right. Ms. HAYES. You were $1 over the eligibility and it made all of the difference. Is there any benefit that I am just not seeing to cutting this provision? Ms. MARTIN. Zip. Zero. Zilch benefit of cutting this program. It would do more harm. And my teachers in the school would be devastated, and to get the teachers in support of a program is huge. So, no, there is absolutely no advantage and our kids deserve healthy meals. And we are a nutrition program, not just a feeding program. Ms. HAYES. I guess, Ms. Johnson, you talked about in your statement about planning for next year and some of the challenges with planning that budgetary insecurity means for you and the communities that you serve. How would that impact the way you plan for the future of your district or the communities that you serve, not knowing what is in the budget? Ms. JOHNSON. OK. So you mean if community eligibility was-- Ms. HAYES. Yes. Ms. JOHNSON [continuing]. rolled back? Well, we are dealing with that right now in the Kansas City, Kansas school district they are coming up to the last year that they can go ahead and have the program. Their identified student percentages have decreased in that school district, and so they are not going to be able to offer community eligibility or they are trying to figure out a way, but they just really are not going to be able to do it financially. And so there is a lot of work that is going to have to be done in educating-- Ms. HAYES. So without the community eligibility the food program goes away? Ms. JOHNSON. The food program will not go away, but it will, again, be based upon their free, reduced eligibility status. And so now we are educating parents about what that means. So, again, that stability is important and the changes, it really is an issue that we have to deal with at the State and local level. Ms. HAYES. Thank you. I yield back. Chairwoman BONAMICI. Thank you. I now recognize Representative Thompson from Pennsylvania for 5 minutes for your questions. Mr. THOMPSON. Chairwoman, thank you so much. Thank you for hosting this very important hearing too. Thanks for all the witnesses here providing your testimony. I have found it all very helpful. Nutrition is important to me. Last term I was the chairman of the nutrition subcommittee on our agriculture committee, and I am a former, or as I like to say it, a recovering school board member. And I know that, you know, from all different perspectives. You know, my family, my wife and I when we were first pregnant with our first child we were in the WIC program and we were eligible for that and we needed it. It was important. And I just want to speak to the whole issue of kids standing out. There is no excuse for that today with EBT cards. School districts are failing and In fact, the legislation we put forward to reform the current law, and it did not, unfortunately, did not go anywhere a few years ago we addressed that because there are technologies today that whether you are paying yourself or free or reduced that there are ways to do that and school districts should be doing that in a way that, you know, we do not allow kids to stand out and to be discriminated against. There is no excuse for that when schools do that today. Also, I understand the challenges of administering a school nutrition program. I mean, I think it is the only part of our school budgets where we expect you to cover all your own costs, and yet, we hold you to these high standards dictated from Washington, not all bad, but it is just it does not work, frequently does not work. And quite frankly, I believe that hunger is preventable. And so we need a significant review and changes to the Health Hunger-Free Kids Act that was passed in 2010. I was here for that. That review is long overdue. Some of the lessons we have learned from it, quite frankly, I don't care how you set the nutritional standards. If the food is not eaten it is not nutritional, period. Caloric intake, portion size varies by kids. Sixty pound girls and 200 pound linebackers and there is a difference there, so the cookie cutter approach with Washington standards have failed a lot of kids. We have, you know, standards that deny science can have devastating consequences. We have seen that on milk. Empowering our school-level nutrition professionals with flexibility will, I believe, best meet the children's nutritional needs. You know, one of those unintended consequences from the 2010 standards was the impact on milk consumption, and I am glad to hear observations that some of you some of you--have not seen a decrease in consumption, but let me share you what has happened Nation-wide. You know, milk, as we know, is the No. 1 source of nine essential nutrients in young Americans' lives, and provides more health benefits, including better bone health, lower blood pressure, reduced risk of cardiovascular disease, reduced type 2 diabetes, and now we know that milk fat in whole milk, in particular, can help to reduce obesity. I actually believe since 2010 with what did out of this Committee, we decreased milk consumption to the point--and it is always going to get replaced with something, but today, most of it is replaced with empty calories, really contributing toward greater childhood obesity. So that is why it is really important that we have this conversation and we look at these standards, and that we let science guide us and make sure that it is good science. Milk is a source of three out of the four under consumed nutrients: calcium, potassium, and vitamin D. And no other berries naturally comes closer to this level of nutritional value. But since from 2014 to 2016 schools served 213 million fewer half pints of milk, you know, despite the fact that the public enrollment was growing. Now, I actually think they counted some of the half pints that were taken that we force our kids on free and reduced to take, but after their first milk experience with non-fat milk, and that is great that some kids might like that, but quite frankly, it is chalk water, as a milk drinker, and non-fat chocolate is just disgusting. Some of those things that got counted as consumed did wind up in the garbage can, based on a bad milk experience. We know that children over 4 years or older not meeting the recommended daily servings of dairy in the dietary guidelines. And I have three articles just I want to submit, ask unanimous consent to submit for the record. These are studies from TUFT, from Harvard, and one from McMaster University dealing with that. Chairwoman BONAMICI. Without objection. Mr. THOMPSON. Actually, I apologize. I acted like I was in the Senate. I filibustered on this. I did not even get around to asking my question on it, but my point is that I am glad we are looking at this. Madam Chair, I really appreciate your leadership on this, and we need to let science guide us because hunger is preventable, nutrition matters, and I think we can do a better job opening up these standards and updating them. Chairwoman BONAMICI. Thank you for your questions. I now recognize Representative Lee from Nevada for 5 minutes for your questions. Ms. LEE. Thank you, Madam Chairwoman, and thank you all for coming here. You know, with a significant amount of our Nation's kids participating in the school lunch and school breakfast program, I represent Clark County, Nevada, the fifth largest school district. Over 68 percent of the students qualify for free and reduced lunch, so I certainly appreciate, first of all, how important it is that the calories that our children consume pack as much nutritional punch as possible, but also understand I met with many food service employees this week how incredibly complicated the process is, especially on a limited budget. And not only that, especially with respect to the breakfast program where it is done, at least in Clark County, in the classroom, making it as convenient as possible. But currently our standards right now do not address sugar content in school breakfast and do not require a protein. And when you look at the various breakfast meals that are served to children it is not uncommon to find breakfast that can deliver between 40 and 50 grams of sugar in one sitting which translates to ten to 12 teaspoons of sugar, far greater than the two to three teaspoons that is recommended for children by the American Heart Association. So, Dr. Ochoa, I wanted to ask you, can you speak to the importance of limiting added sugar within the diets of our Nation's young children, and how increased sugar intake is linked to serious health issues during subsequent development? Dr. OCHOA. Yes, absolutely. Our Academy of Pediatrics recommends, going back to the milk issue and talking about sugar, that low fat or non-fat unflavored milk is really the way to go because it removes two things, sugar and saturated fat, that we know are leading risk factors for a whole host of adult problems like obesity, cardiovascular disease, stroke, high cholesterol and things like that. So, the sugar content in food that is served at school is certainly a contributor to excess calories that kids do not need. We talk about the first 1,000 days of life and the scaffolding effect that the nervous system goes through to develop to get a child from zero to three ready to go to school. I like to think of the different meals that we provide at different ages through these programs that we are talking about as a scaffolding as well that we have to adjust both the nutrient and caloric makeup of those meals to have kids get the right things at the right time so they can thrive through school, not just for grade-level reading, decreased behavior problems like Ms. Schrier mentioned earlier, but just overall better performance in school. And I think taking the sugar, the excess sugar out where we can is very important. Ms. LEE. Yes. Thank you. I was going to ask about, obviously, the rollback, the regulatory actions on the rollback which now allow for flavored milk, low-fat milk instead of milk which, in some cases, can add another 18 grams of unnecessary sugar to a child's diet. Dr. Ochoa, in line with what you mentioned in your testimony about ensuring the benefits of consistent access to nutritious meals for children, do you have any recommendations for this legislative body on how we can do a better job of regulating sugar intake within these nutrition programs, again, also recognizing the complexity that Ms. Johnson and Ms. Martin have in actually implementing this as well? Dr. OCHOA. Yes. Well, I will agree with Mr. Thompson that science is very important, and so the prevailing science that is out there to undergird what we serve our children in these various programs that we are talking about is very important. The science that is developed is from the National Academies, and as somebody who has served on a National Academy review before I can tell you that the makeup of those committees is done very carefully, and the input that those committees get is very wide and deep. Our committee went to places like Arkansas, Louisiana, Chicago to get input from the community on adolescent care, and so I know that the science that is coming out of the National Academies, just like the guidance that came out last week on sodium and potassium is really rooted in the prevailing science of the times. So, I think, if anything, the committee should look at the science that comes out of bodies like the National Academies in addressing the composition of what we feed kids. Ms. LEE. Thank you. I agree. I think that definitely it is crucial that our nutrition standards are aligned with science and research, so thank you very much. Dr. OCHOA. You are welcome. Ms. LEE. Thank you all for your testimony. I yield. Chairwoman BONAMICI. Thank you, Representative Lee. I now recognize Representative Johnson from South Dakota for 5 minutes for your questions. Mr. JOHNSON of South Dakota. Thank you, Madam Chairman, and I would just note to the panelists that, I mean, I grew up in a family that was of modest means, and certainly there were times when we availed ourselves of the free and reduced school lunch program, so thank you to the efforts that a number of you have made in making sure that we have got programs that do a good job of delivering those nutritional benefits to families like mine. Both the gentleman from Pennsylvania, as well as the honorable doctor from Washington started to ask about whole milk, but ran a little short on time, so I'll lend my voice to theirs. Mrs. Johnson, can whole milk be part of a nutritional toolbox at the school level? Ms. JOHNSON. Whole milk is allowed in the Child and Adult Care Food Program up to 2 years where the science supports that. Again, our program regulations are based on the current science, and so that we follow what the science standards regulate. So I do not know that I can tell you personally what I feel as a State agency representative, but I can tell you we do allow whole milk up to 2 years of age. Mr. JOHNSON of South Dakota. So I know there has been some studies and the gentleman from Pennsylvania referred to them that whole milk, when used properly, can be a part of driving down childhood obesity. Is that literature maybe just not mature enough yet? And if you prefer I ask Dr. Ochoa I certainly can. Ms. JOHNSON. I think that would be a good question for the Dr.-- Mr. JOHNSON of South Dakota. Yes. All right, Doc, I mean, is this just not a mature level of literature yet? Dr. OCHOA. I think that is one way to talk about it. I am not aware of the literature that shows a direct connection between whole milk and obesity prevention. Mr. JOHNSON of South Dakota. OK. Very good. Thank you. And then maybe back to you, Ms. Johnson. We have talked a little bit about flexibility and how that can help with these nutritional programs, but what about in rural areas are there any unique challenges that rural areas, rural school districts face where flexibility is helpful? Ms. JOHNSON. Yes, and I was not able in my time limit to talk about the professional standards of rural. The flexibility we just received a couple weeks ago now. But I was on the same committee as Donna when the professional standards went into place and I kept saying, I was one of the few folks from a rural area and I kept saying, yes, but how about western Kansas or South Dakota or North Dakota. We need strong, talented people to run our programs, well- educated, but reality is in some of the small districts that you cannot find people who are able to provide the leadership as a school nutrition director that have 3 years of school food service experience. So the recent flexibility really does help those rural areas. We go in and we train and we encourage them to take a lot of professional development classes. We encourage them to go ahead and further their education when possible, but just to have someone able to be out there feeding kids is really important in rural areas. So I appreciate that flexibility very much. Mr. JOHNSON of South Dakota. Excellent. And then maybe for Ms. Johnson and Ms. Martin, we have talked about how, you know, 2 million fewer, I think it is 2 million fewer school children are taking school lunches in recent years. I think there has been some supposition that is directly linked to these more stringent nutritional standards. Is that a fair assumption? Maybe Ms. Martin first. Ms. MARTIN. I disagree with that assumption. I think that, you know, in our district we really worked hard to get the kids ready for the standards, and I think a lot of school districts did not think that they were going to come about, and so they just kind of threw it on the kids. Changes should be gradual, like with milk, what we did with milk was we went from whole to low fat to 1 percent to skim, and we made sure with our milk that we have cold milk. We use plastic bottles and did things to encourage the kids to drink the milk. So I think with the standards doing it gradually was the big difference, but I think what hurt participation was the lunch paid equity situation where the meal cost went up and up and up and you have a family of four and they were having to pay $3 for a meal and that is $12 a day. They could not afford it. So I think that is where we saw the decrease in participation much more, and I think our kids are getting used to the food, our schools and our industry are doing a much better job of coming up with innovative ways of preparing an innovative food for us to purchase, and so I think that is turning around, but I think it was the paid lunch equity more than the food. Mr. JOHNSON of South Dakota. Ms. Johnson, did she miss anything? Ms. JOHNSON. I agree completely that it is the paid lunch equity regulation. It has outpriced some of our folks who do not qualify for free and reduced that are not able then to purchase meals at the paid price. That is what we saw in Kansas. Mr. JOHNSON of South Dakota. Well, Madam Chair, I would just note as my time expires that these are great panelists who answered in such nice, short, direct bursts that let me get through my questions. So thank you very much and I yield back the time I no longer have. Chairwoman BONAMICI. I appreciate that and I now recognize Representative Trone from Maryland for 5 minutes for your questions. Mr. TRONE. Good morning, everybody. I would just thank you guys, again. As Dusty said, these are wonderful, wonderful panelists and we have really enjoyed this presentation. It is great to see folks thinking long term. I mean, the most important thing in long term thinking is about our kids and thinking about the next generation, and so often we in this body are kind of thinking about today and only today and that is not where we need to be, so thank you. Parts of my district like Washington County over 60 percent of the kids are on free and reduced lunches, and it is not just the economic hardship, but it is often single parents. And there is no coincidence that area is the real heart of this opioid epidemic. So many tragedies have befallen these families one after another. As you said earlier, so eloquently, it is free books, it is free computers, it is free teachers. How would we not have free lunch? I mean, my goodness, I mean the engine of a young child is running on food, and I have four at home and they eat a lot of food. So we really need this, but yesterday we saw the administration, you know, cut CEP. It could lead to 1.3 million kids not having those free lunches or breakfast. What do you see, Dr. Ochoa, as far as the long term issues of this food insecurity, but not enough nutrition for their development? And what are some of those health consequences that later on will manifest themselves? Dr. OCHOA. Thank you. Our research from Children's Health Watch shows that food insecurity not only exacerbates problems that maybe have started in birth, but then will lead to bigger consequences in the long term, more hospitalizations more emergency department visits, more chronic health conditions. And what we are talking about in this hearing to improve the reach of these programs not only reduces food insecurity, but also promotes healthy growth and development, as you mentioned. The door for our hospital to begin to offer food to kids who are coming to our clinics was CEP. Our hospital, like many academic health centers across the country is in a low income part of Little Rock in the shadow of Central High School. So, because of the community eligibility provision we are able to start with summer feeding and have expanded that to CACFP as well, and offer up to 25,000 meals to kids that are at our clinics. Our kids sometimes wait three and 4 hours during an appointment for a complex health issue. They bring siblings with them. So if we can alleviate the food insecurity that they have the day they come all the better, but we do know that starting early with WIC and all through school, the better that you can feed the engine, as you said, kids will not only do better in school and be ready to enter the work force later, but other chronic health conditions that we can all agree are bad like high blood pressure and obesity could hopefully be prevented. Mr. TRONE. Anything you would like to add, Ms. Johnson or Ms. Martin? Ms. JOHNSON. I would just like to add that for a period in my life when my children were small and I did not work in school nutrition but was a consultant dietitian I consulted in nursing homes and for hospices, and we kept having to get larger wheelchairs, beds of bigger size, dining room table chairs bigger, and I was seeing more and more patients under 50 with obesity, sometimes on dialysis, heart problems, diabetes. I have a real passion for child nutrition and public health because of that. I do want to prevent that for my grandchildren. Ms. MARTIN. And I would just like to say we have the opportunity to change future generations, and if we wait shame on us. Shame on us. I mean, those of us that are in school nutrition who see these kids come to school so excited to have school lunch, and some of them only come to school because of school lunch, and we have got to educate these kids to become productive citizens. And with our supper program the only reason they stay after school to be tutored is because of our supper program. And the reason our athletes are performing well, we had malnourished athletes and because we were able to offer them supper they won their first ever State football championship, and that coach credited the school nutrition program. Imagine that, with that fact that they were able to perform on the field, and for some of our kids that is the only way they are going to get a scholarship to go to school. Mr. TRONE. Excellent. Ms. MARTIN. So nutrition just impacts much, much more. Mr. TRONE. So that is the whole key. That is why so many of us love being on this education committee because it is all about the investment upfront, the investment in our kids, and then the long term payback on better health, better productive jobs, tax revenues. All that money comes back multiple times. Thank you for your time. Chairwoman BONAMICI. Thank you very much Representative. We are going to finish the questions from members on this subcommittee, including Chair of the full Committee Representative Scott before we move to questions from the members who are not on the subcommittee. But I did want to note that Representative Stefanik was here and is not able to join us now. I did want to note that Representative Stefanik and I have been working on and continue to work on a Child and Adult Care Food Program bill that does extend meals to children who are in care, but it also addresses paperwork reductions and simplifies participation eligibility requirements. So I want to just note that because I am sure that Representative Stefanik would have discussed that had she been here. So I now recognize the Chairman of the full Committee, Representative Scott from Virginia for 5 minutes for your questions. Mr. SCOTT. Thank you, Madam Chair. Ms. Martin, as a Registered Dietitian you understand the importance of prioritizing diets. Can you share some innovative strategies that schools are using to serve meals that are nutritious and come up to the standards and also delicious? Ms. MARTIN. Well, I tell you what, we have been very, very creative in doing our meals, and we have worked with the students to get input from them, and so we are now doing things like walking tacos and Asian bowls and hummus. And we actually are trying to fight with these kinds that bring these Lunchables that can be less than appealing, and so we have started making our own healthy lunchables to compete with them. So we offer lots and lots of choices, and when you offer lots and lots of choices they pick what they want to eat so nothing goes into the trashcan. We also make sure that we cut up the fruit so that they have time to eat it, and we make sure that we have enough time. So sometimes we have had to add vending machines because we do not have enough serving lines, and not enough time to get the kids through so we have added vending machines to speed up the process. We prepackage our salads. People are doing salad bars. Salad bars have been huge in the schools. The kids, to see them go through the salad bars. They just pile up their plate with all these fruits and vegetables and they eat ever bite of it because they have chosen it. So it can be done, but we need strong nutritional standards. You have to be passionate about what you do as a school nutrition director and you have to be creative, and so we have got to do a lot of training and we have got to get those people in there that want to do it. And not because they were a principal that got reassigned to be the school nutrition director. Sorry if any of-- Mr. SCOTT. Thank you. No, we have heard a lot of comment about if you have nutritious food it is going to get thrown away and I think if you have food that is nutritious but not tasty people will be throwing it away, but you have shown how you can do both. And can you say another word about why strong professional standards are important? The administration has given flexibility on professional standards. Why is it important to be a fully qualified professional? Ms. MARTIN. Well, when you were talking about sugars and some of these other things and we talked about whole milk and things like this, as a Registered Dietitian Nutritionist I understand nutrition, and so it is easy for me to plan meals that are low in sugar and are low in fat and saturated fat, and I understand the importance of the dietary guidelines. And so I know how to do menu planning, but if you bring somebody in that does not have those skill sets, honestly, when I am out talking about our program and I have parents tell me, well, all I get is pizza and french fries and juice is what my kids drink and eat every day. It is because they did not have a professional that knew how to plan healthy meals, and that is cheap and easy and they know the kids are going to eat it so that get away with that. So I think it is just so important to have, and I think it is a huge burden on the State staff to have to train those people that do not know anything about nutrition and do not meet the standards and do not meet the regulations. And that is why I do like a little bit of flexibility with administrative reviews. I have been doing this for 25 years. I know what I am doing. Do not come see me every 3 years. Go see that new director who was the principal and does not know what they are doing and give them the help. So I think we need to stay strong. In Georgia we are hearing a lot of districts get together and have one qualified person be over numerous districts, small districts, and that way everybody gets the benefit of having somebody qualified. Mr. SCOTT. Thank you. Dr. Ochoa, you said you were in an area with a summer meal program. We have seen evidence that low income students if they do not have activities during the summer will actually regress several months, so when they come back in September they are worse off than they started. Can you say a word about the importance of nutrition programs during the summer months to prevent the summer slide? Dr. OCHOA. Yes, Chairman Scott, definitely. We know that lots of programs that offer educational opportunities for kids in the summer are also summer feeding sites. And so the fact that they can offer both of those things simultaneously will prevent those kids from, A, going hungry for a longer time during the summer, and, B, preventing that educational slide that you mentioned as well. We have a shelter in Little Rock that also has a early childhood program that has a very robust education component and also offers meals to those kids. Mr. SCOTT. And has the summer EBT program helped in food insecurity? Dr. OCHOA. Yes, absolutely. Anything that makes it easier for the kids to access those programs is helpful. Mr. SCOTT. Thank you. The Chairwoman discussed in her opening remarks that the National School Lunch Program actually began as a national security program. We are still having the same problems, 71 percent of young Americans are ineligible to serve in the military, some for inadequate education, some for criminal records, but a lot for nutritional programs. And I will not ask a question, I will just make the statement that these kinds of programs can address a national security need as well as education and nutrition. So thank you, Madam Chair. I yield back. Chairwoman BONAMICI. Thank you, Chairman Scott. I now recognize Representative Grothman from Wisconsin for 5 minutes for your questions. Mr. GROTHMAN. Thanks. We will start by asking Ms. Martin, but you can pitch in if you want. We have other hearings on this Committee and you are asking for higher reimbursement rates. The Federal Government, as you all know, is very broke. You know, I think we are borrowing 19 percent of our budget, and while we certainly have to make sure all children all adequately fed I am going to ask you why or to what degree, you are from Georgia, right? Ms. MARTIN. Yes, yes. Mr. GROTHMAN. To what degree have you communicated with the Georgia Legislature or your local school districts as far as putting money into this program instead of the Federal Government, and if you are primarily asking the Federal Government why don't you ask the State or local government? Ms. MARTIN. Well, you know, I think all school systems will tell you they are struggling to pay teachers, and buy books, and have busses that are safe, and have public security officers, and the requirements upon them are increasing every single day. And so I communicate all the time to our school board and they see the value of school meals. And I understand about the deficit. I am a taxpayer, but I go back to the statement I made earlier. We are either going to pay now to change our children's eating habits or we are going to pay later in health care costs. And I honestly do not feel like we are going to have enough physicians to meet the needs of the diabetics, heart disease, renal failure, high blood pressure and all these issues, cancer. All that are related to eating habits, and if we do not do it now we cannot afford to do it later. We already have-- Mr. GROTHMAN. Let me cut you off. Ms. MARTIN [continuing]. a great number-- Mr. GROTHMAN. I mean, I know in Wisconsin we ended last year anticipating ending with hundreds of millions of dollars of surplus, and when I Google it that is not unique to Wisconsin. Because the booming economy, high State sales tax receipts, high income tax receipts it is not unusual for States to be running big surpluses, and I just wondered why you are here asking us for our money rather than the, first of all, units of government that are going to have less regulation for you. You need less regulation. And, second, that are running surpluses. I mean, does the Georgia Legislature not appreciate this crisis or do the local school districts not appreciate it or why are you not leading with them? Ms. MARTIN. Well, I think Cheryl Johnson will tell you there are a lot of school districts in the country that are running in the red because of economic costs and their school boards are having to pick up for the program, and so I think that is a struggle. But I think that the State does provide some money for health insurance benefits and does provide us with guidance and stuff, but I feel like it is a Federal responsibility. Mr. GROTHMAN. OK. Next question. Doesn't, in general, more Federal money mean more regulations? I mean, you kind of breathed a sigh of relief when you heard that we were doing kind of a little working group on less regulations, and my school districts, and I talk about them, all are kind of irritated with the Federal regulations. They feel the Federal regulations are causing children to throw away their food. Would you, Obviously-- Ms. MARTIN. Yes. Mr. GROTHMAN [continuing]. that is part of the Federal problem, but would you prefer it if we just took this program, found out how much Georgia or any other State received last year, give them a check and go away and assume that the local people know how to buy nutritious food or do you think we cannot trust the local people and we should continue to do something other than just write a check? And I will ask Ms. Johnson the question. Ms. MARTIN. Well, let me absolutely just tell you that, no, absolutely, I am totally against that because you cannot have 50 different States deciding what kind of food they are going to serve. The manufacturers could not deal with that. You have got to have national standards with all the programs, and you do not have qualified people always running these programs, so I would be very, very much against that. Mr. GROTHMAN. So you do not trust the locals? Ms. MARTIN. I don't trust--It is not that I do not trust them. It is just that nationally our food manufacturers are struggling now because-- Mr. GROTHMAN. OK. Ms. MARTIN [continuing]. the stability that she talked about-- Mr. GROTHMAN. Well, we will switch to Ms. Johnson. Ms. MARTIN. Go ahead. Ms. JOHNSON. I would have the most concern about the effect on our students because if a school district was given just a certain amount of money there would be no reason to try to do innovative school breakfast. There would be no reason to try to feed more kids. They would just want to preserve the funds they had. Or say we had a disaster. Mr. GROTHMAN. OK. Ms. JOHNSON. That would be my major concern too. Mr. GROTHMAN. OK. Now I want to get my final thing in here. I was so relieved because I was here when President Obama was President. I was so relieved when President Trump got in there and his folks began to allow flavored milk so people would not throw away the milk as much. Are you supportive of President Trump, his Administration's initiative to include flavored milk as an option for the kids? Ms. JOHNSON. I am in favor of children drinking more milk in whatever way that happens because I do believe that calcium is a nutrient that is not consumed in enough quantity in the American diet, especially in teenagers. So that is my stance, personally, as a Registered Dietitian. Ms. MARTIN. And they never took away the possibility of serving flavored milk. We have always been able to serve flavored milk. That has never gone away, just for a point of reference. Chairwoman BONAMICI. Thank you, Mr. Grothman. I now remind my colleagues that pursuant to committee practice materials for submission for the hearing record must be submitted to the committee clerk within 14 days following the last day of the hearing, preferably in Microsoft Word format. The material submitted must address the subject matter of the hearing. Only a member of the committee or invited witness may submit materials for inclusion in the hearing record, and documents are limited to 50 pages each. Documents longer than 50 pages will be incorporated into the record via an internet link that you must provide to the committee clerk within the required timeframe, but please recognize that years from now that link may no longer work. Again, I want to thank the witnesses for their participation today. This has been an excellent discussion and what we have heard has been very valuable. Members of the committee may have some additional questions for you, 5 minutes goes by quickly, and we ask the witnesses to please respond to those questions in writing. The hearing record will be held open for 14 days to receive those responses. And I remind my colleagues that pursuant to committee practice, witness questions for the hearing record must be submitted to the majority committee staff or committee clerk within 7 days. The questions submitted must address the subject matter of the hearing. I now recognize the distinguished ranking member for his closing statement. Mr. COMER. Well, thank you very much for being here today. It is very clear from this testimony and all of our past experiences that these programs are critical to students and families. We know students cannot learn if they are hungry. We also know how important these programs are to parents who want to give their kids the best opportunities. Thank you, Ms. O'Meara for sharing your story and support for these programs. We also heard how the paperwork burden and complicated compliance issues can cause significant time and money from programs that do not have much of either. As we begin reauthorization it is critical we make sure the program works on the ground, in our school, and for the students. That means commonsense rules that are not overly complicated and limited paperwork that ensures that the taxpayer dollars are protected without wasting them. Thank you, again, for being here. Thank you for being on the frontlines and I yield back. Chairwoman BONAMICI. Thank you, Mr. Comer. I now recognize myself for the purpose of making my closing statement. Thank you, again, to all of our witnesses for being here and sharing your statement stories and your expertise. Today we heard about the importance of childhood nutrition programs in combating hunger and malnutrition across the country. We heard how for too many families the struggle to put healthy food in the table undermines their financial stability and their children's ability to reach their full potential. We also heard about how research and experience demonstrate that child nutrition standards and programs are among our most effective tools for preventing child hunger and making sure that students are able to focus on learning. With these child nutrition programs, including the National School Lunch Program, the School Breakfast Program, the Summer Food Service Program, the Child and Adult Care Food Program, and more, Congress has consistently recognized through bipartisan support that a quality education includes making sure that every child has access to healthy and nutritious food. And my list was not exclusive. The Farm to School Program, all of those are wonderful programs. But our choices are clear. We can either invest in these important programs now and support healthy eating in schools and do what is best for our Nation's children, or we can cut corners and put the well-being of our children and our Nation's future at risk. I hope that for everyone here the answer is simple. We must continue to strengthen child nutrition programs and protect the progress we have made toward providing all children with the nutritious food that fuels their health and their futures. And this is something that I am convinced we can do on a bipartisan basis. The United States is a wealthy country. We have the resources to reduce hunger and food insecurity. This is a way to break the cycle of poverty. This is a matter of basic humanity and equity, and it is also a good investment. So I look forward to working with all of my colleagues on this important issue, and if there is no further business, without objection, the committee stands adjourned. [Additional submission by Mr. Comer follows:] [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] [Whereupon, at 11:56 a.m., the subcommittees was adjourned.] [all]