[House Hearing, 111 Congress] [From the U.S. Government Publishing Office] DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 2010 _______________________________________________________________________ HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION ________ SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES DAVID R. OBEY, Wisconsin, Chairman NITA M. LOWEY, New York TODD TIAHRT, Kansas ROSA L. DeLAURO, Connecticut DENNIS R. REHBERG, Montana JESSE L. JACKSON, Jr., Illinois RODNEY ALEXANDER, Louisiana PATRICK J. KENNEDY, Rhode Island JO BONNER, Alabama LUCILLE ROYBAL-ALLARD, California TOM COLE, Oklahoma BARBARA LEE, California MICHAEL HONDA, California BETTY McCOLLUM, Minnesota TIM RYAN, Ohio JAMES P. MORAN, Virginia NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. Cheryl Smith, Sue Quantius, Nicole Kunko, Stephen Steigleder, and Albert Lee, Subcommittee Staff ________ PART 6 STATEMENTS OF MEMBERS OF CONGRESS AND OTHER INTERESTED INDIVIDUALS AND ORGANIZATIONS S ________ Printed for the use of the Committee on Appropriations Part 6 DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 2010 DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 2010 _______________________________________________________________________ HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION ________ ________ SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES DAVID R. OBEY, Wisconsin, Chairman NITA M. LOWEY, New York TODD TIAHRT, Kansas ROSA L. DeLAURO, Connecticut DENNIS R. REHBERG, Montana JESSE L. JACKSON, Jr., Illinois RODNEY ALEXANDER, Louisiana PATRICK J. KENNEDY, Rhode Island JO BONNER, Alabama LUCILLE ROYBAL-ALLARD, California TOM COLE, Oklahoma BARBARA LEE, California MICHAEL HONDA, California BETTY McCOLLUM, Minnesota TIM RYAN, Ohio JAMES P. MORAN, Virginia NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. Cheryl Smith, Sue Quantius, Nicole Kunko, Stephen Steigleder, and Albert Lee, Subcommittee Staff ________ PART 6 STATEMENTS OF MEMBERS OF CONGRESS AND OTHER INTERESTED INDIVIDUALS AND ORGANIZATIONS S ________ Printed for the use of the Committee on Appropriations ________ U.S. GOVERNMENT PRINTING OFFICE 50-545 WASHINGTON : 2009 COMMITTEE ON APPROPRIATIONS DAVID R. OBEY, Wisconsin, Chairman JOHN P. MURTHA, Pennsylvania JERRY LEWIS, California NORMAN D. DICKS, Washington C. W. BILL YOUNG, Florida ALAN B. MOLLOHAN, West Virginia HAROLD ROGERS, Kentucky MARCY KAPTUR, Ohio FRANK R. WOLF, Virginia PETER J. VISCLOSKY, Indiana JACK KINGSTON, Georgia NITA M. LOWEY, New York RODNEY P. FRELINGHUYSEN, New JOSE E. SERRANO, New York Jersey ROSA L. DeLAURO, Connecticut TODD TIAHRT, Kansas JAMES P. MORAN, Virginia ZACH WAMP, Tennessee JOHN W. OLVER, Massachusetts TOM LATHAM, Iowa ED PASTOR, Arizona ROBERT B. ADERHOLT, Alabama DAVID E. PRICE, North Carolina JO ANN EMERSON, Missouri CHET EDWARDS, Texas KAY GRANGER, Texas PATRICK J. KENNEDY, Rhode Island MICHAEL K. SIMPSON, Idaho MAURICE D. HINCHEY, New York JOHN ABNEY CULBERSON, Texas LUCILLE ROYBAL-ALLARD, California MARK STEVEN KIRK, Illinois SAM FARR, California ANDER CRENSHAW, Florida JESSE L. JACKSON, Jr., Illinois DENNIS R. REHBERG, Montana CAROLYN C. KILPATRICK, Michigan JOHN R. CARTER, Texas ALLEN BOYD, Florida RODNEY ALEXANDER, Louisiana CHAKA FATTAH, Pennsylvania KEN CALVERT, California STEVEN R. ROTHMAN, New Jersey JO BONNER, Alabama SANFORD D. BISHOP, Jr., Georgia STEVEN C. LaTOURETTE, Ohio MARION BERRY, Arkansas TOM COLE, Oklahoma BARBARA LEE, California ADAM SCHIFF, California MICHAEL HONDA, California BETTY McCOLLUM, Minnesota STEVE ISRAEL, New York TIM RYAN, Ohio C.A. ``DUTCH'' RUPPERSBERGER, Maryland BEN CHANDLER, Kentucky DEBBIE WASSERMAN SCHULTZ, Florida CIRO RODRIGUEZ, Texas LINCOLN DAVIS, Tennessee JOHN T. SALAZAR, Colorado Beverly Pheto, Clerk and Staff Director (ii) DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 2010 ---------- TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS ---------- Wednesday, March 18, 2009. Mr. Obey. Well, good morning, everyone. Thank you all for coming. I am pleased to open the Subcommittee's first hearing for the new fiscal year. Let me first start by welcoming our new Ranking Member, Todd Tiahrt. He and I have long experienced changing tires with each other in the middle of nowhere, and I am looking forward to our relationship on this Subcommittee. I also want to welcome the other new members of the Subcommittee: Congressman Jim Moran; we have a returning member, Congressman from Montana, Mr. Rehberg; we also are being joined by Congressman Rodney Alexander; Congressman Jo Bonner; and Congressman Tom Cole from--I cannot say it is my home State, but it is my birth State--Oklahoma. We are happy to have all of them on the Subcommittee. We are starting off the hearings for this Subcommittee at a time when the Country is in a deep recession, and that impacts people all throughout the Country. I am sure we will see evidence of that by people's testimonies here today. We are somewhat handicapped because any time you have a new President, that sort of discombobulates the budget schedule. With a new President, they want time to prepare their own budget, so we are not yet in receipt of the President's budget, which I understand will be coming down some time this year. [Laughter.] I hope it comes down sooner than that. And, when it does, we will deal with it in as much depth as time permits so that we can try to stay on schedule this year. We also hope that the Budget Committee will move its product ahead in a timely fashion so that we can meet our own schedule. I am going to ask every witness to please adhere to the four minute limit. We are not trying to be rude, but if you do not adhere to the four minute limit, there are other people who will not get a chance to testify, because we are going to be interrupted from time to time by things called roll calls. This would be a great job if we did not have to interrupt our work to go vote once in a while, but, unfortunately, we have to, so I would ask for your cooperation. I appreciate your being here today. With that, I would turn to Congressman Tiahrt for whatever comments he would like to make. Mr. Tiahrt. Thank you, Mr. Chairman. It is a pleasure to join you on this Committee. I am looking forward to the interesting work that you have been carrying on. I know that this Committee has been a passion of yours, so I know that you will reflect that and the witnesses that we get to hear from. I am pleased to be joined by my members here. I think the way you explained this birth in Oklahoma and end up in Wisconsin was I was born in Oklahoma by the grace of God, I am a Wisconsinian. Mr. Obey. I think that is how that worked, Todd. [Laughter.] Mr. Tiahrt. I know we have a full schedule today. I am looking forward to working with the members and listening to the testimony. Thank you, Mr. Chairman. Mr. Obey. I should explain. I have explained to people many times. My father was the only man in America who moved to Oklahoma during the Depression to get a job. [Laughter.] I also want to just bring to the attention of our new members, as well as the audience, the pictures on the wall there. What we have tried to do in this Committee is to remind people that this Subcommittee has a distinguished heritage, and the heritage is best exemplified by the members on the wall, starting with John Fogerty up on the left, who chaired this Subcommittee for many years. He was a bricklayer by profession before he fell into a life of sin and got elected to Congress. His ranking member for many years was Mel Laird, who was my predecessor in the Congressional district that I now hold. If you take a look at the men pictured there, you will see a history of bipartisanship and a history of doing some really remarkable things for the Country. This Subcommittee, in the past, oversaw the spectacular growth of the National Institutes of Health; the birth of the Department of Health, Education, and Welfare; the splitting up of that agency; the creation of the Department of Education; and very major changes in budget trends in the Country through the years. I would hope that we can continue that tradition. With that, our first witness will be introduced by the gentleman from Illinois, Mr. Jackson. Mr. Jackson. Thank you, Mr. Chairman. Let me also congratulate you and thank you for the pictures that you have hung in the Subcommittee hearing room. It gives me something to aspire to. I can see that I am still probably 30 or 40 years away having my picture hung. [Laughter.] Mr. Obey. Members are generally hung before their pictures are. [Laughter.] Mr. Jackson. Thank you, Mr. Chairman. Let us hope that is not the case. It is my pleasure to welcome Mr. J.B. Pritzker to our Subcommittee. Mr. Pritzker is a partner of and founded New World Ventures in 1996 and is also a managing partner of the Pritzker Group. Mr. Pritzker also heads the J.B. and M.K. Pritzker Family Foundation, a Chicago-based philanthropy. The Foundation is a private family foundation deeply committed to the pursuit of social justice and to shaping innovative and effective strategies for solving society's most challenging problems. As Mr. Pritzker will describe, The Children's Initiative, a project of the J.B. and M.K. Pritzker Family Foundation, seeks to enhance the early learning capabilities of infants and toddlers, with a special focus on at-risk children. Inspired by the early childhood development work of the late Chicago entrepreneur and philanthropist Irving Harris, and motivated by the relief and the belief that all children are born with great potential, The Children's Initiative supports policies, programs, research, and advocacy to allow at-risk children to achieve better economic, educational, and social outcomes. Mr. Chairman, a number of us back in Chicago have worked with J.B. for a number of years. We have, at various moments in his philanthropic career, encouraged him to consider entering this body. He would make a fine United States Representative and certainly, if he ever desired, a fine member of the other body. Ladies and gentlemen, Mr. Chairman, Mr. J.B. Pritzker. Mr. Obey. I could not understand why anyone would ever want to be a member of the other body, but that is beside the point. [Laughter.] Mr. Pritzker, you are recognized for four minutes. ---------- Wednesday, March 18, 2009. THE CHILDREN'S INITIATIVE WITNESS J.B. PRITZKER Mr. Pritzker. Thank you, Mr. Chairman. Fortunately, I do not live in the 2nd Congressional District, so my chances are improved somewhat if I ever decide to do that. Thank you, Chairman Obey, for inviting me to be here today. It is a great honor to sit here in front of you as a champion of children and the disadvantaged. You have done so much and I am personally very grateful. Congressman Jackson, thank you for the kind introduction. Our long personal relationship goes back probably even before you may remember, to when I worked for Senator Terry Sanford and you were on the campaign trail or working with your dad, and the two of them met early morning in a hotel room in North Carolina to talk about the future of the Democratic Party. So I got to be witness to maybe your political birth. Thank you also to the entire Committee for your advocacy on behalf of disadvantaged children, for all the wonderful successes that you have already accomplished this year and for all that you do and will do for our Nation's children. In my day job, I worry non-stop about making good investments about building businesses and growing capital, and behind you on the wall, Chairman Obey, I understand you had painted on the wall the quote from Hubert Humphrey that begins ``The moral test of government is how it treats those who are at the dawn of life, the children.'' I might add, for everybody else, that it is also the mark of a fiscally responsible Government to invest in early childhood. In my philanthropic work, I have similar goals, that is, to make good investments. I face far less worry, of course, in that, and enjoy much more certainty. By supporting early childhood education, I know I am making an investment in fostering human capital that is guaranteed to pay dividends. We all know that everyone is born with potential, but we often do not have the facts to say how much society should invest in maximizing potential from an early age or whether financial risk makes sense. Well, finally, the work of economists like Nobel Laureate Jim Heckman, at the University of Chicago, developmental psychologists, sociologists, statisticians, and neuroscientists provides the answer with decades of research, solid data, and multi-disciplinary analysis. Investing in early childhood development for disadvantaged children and their families provides a real return on investment, around 10 percent--it has been calculated by not liberal, but even conservative economists--through increased personal achievement and social productivity. It improves the health, economic and social outcomes not just for individuals, but for society at large. In these complicated and tumultuous times, we face a litany of problems we would like to fix and goals we would like to achieve: fostering economic competitiveness; achieving better educational outcomes; increasing the opportunity for health; reducing crime; building a capable, productive, and competitive workforce. Anyone looking for upstream solutions for the biggest problems facing America should understand that the great gains to be had by investing in early and equal development of human potential exists in investing in early childhood. If I leave you with nothing else today, I hope you will take away the following: Your efforts in early childhood development are an investment yielding real dollar returns. Early childhood development is not just an education issue, it is also a health issue that affects the health of our economy. A vast body of research shows that early childhood development from the ages of zero to five greatly affects cognitive development, social and emotional health, and the ability to learn as a child and later function at a high level as an adult. Effective early childhood development has the potential to reduce teen pregnancy, crime, and other social burdens, while increasing human productivity that drives economic security for all. It will produce a smarter, stronger, healthier, and more prosperous Nation, helping America stay the top competitor in the global economy. In the long run, it will cost us less than it is costing us now to remediate the consequences we suffer by not providing effective early childhood development investment. Mr. Obey. Could I ask you to wind up, because your time has expired? Mr. Pritzker. Yes, sir. We know our investments need to begin at birth and have a particular focus on infants and toddlers, who currently have the greatest needs and receive the fewest services. Implementing effective early childhood education programs can be done because it is being done, with measurable results. I invest in Educare of Chicago. It is one solution to this. It is the gold standard of high quality early education, providing full day, full year care and education for disadvantaged children from birth to five with high quality and highly qualified teachers. Thanks to the investments made in American Recovery and Reinvestment Act, you have provided a down payment to help serve more children and improve the quality of the education they are receiving. But there is much more to be done. For millions more children in poverty who do not have access to early learning opportunities, closing that disadvantage gap would prove to be of great advantage to all Americans. Please continue to support Head Start, Early Head Start, the Child Care and Development Block Grant, and the President's Early Learning Challenge Grants. We do not have to reinvent the wheel when it comes to effective early childhood development programs; we simply need to get the wheel rolling across America to benefit all. Thank you very much. Mr. Obey. Thank you very much. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Next, Mr. Ryan. Mr. Ryan. Thank you, Mr. Chairman. I would like to take this opportunity to introduce Linda Lantieri, who is going to testify. She is on behalf of the Collaborative for Academic Social and Emotional Learning. This is a collaborative that actually exists in Congressman Jackson's district at the University of Illinois at Chicago. Let me just quickly say I think this is a transformational education program for our country, and this is based on a lot of the research and work that was done from the book Emotional Intelligence by Dan Goldman, and this is something, Mr. Chairman, that I am taking up now as a personal mission in my life to support you. With that, Ms. Lantieri. ---------- Wednesday, March 18, 2009. COLLABORATIVE FOR ACADEMIC, SOCIAL AND EMOTIONAL LEARNING WITNESS LINDA LANTIERI Ms. Lantieri. Thank you, Congressman Ryan. I appreciate the opportunity to speak to you today from the perspective and experience of someone who has been in the field of education for four decades, as a classroom teacher and administrator in East Harlem, and as education faculty at Hunter College, New York City. More recently, I have been deeply involved in the healing and recovery efforts in 12 schools in Lower Manhattan in which 8,000 children and 200 teachers fled for their lives on the fourth day of school, September 11th, 2001. Today, I am representing the Chicago-based Collaborative for Academic, Social, and Emotional Learning. CASEL is the world's leading organization advancing research, school practice, and public policy to establish social and emotional learning as an essential part of education, pre-K through 12. The field of social and emotional learning is informed by scholarly research that demonstrates that the systemic teaching of emotional and social skills as part of a student's regular school day adds to the lessons needed for life: improving self- awareness and confidence, managing disturbing emotions and impulses, increasing empathy and cooperation. These skills also provide students with the essential tools they actually need to be effective learners as well. A recent review of 31 studies on social and emotional learning showed that improvements in students' academic scores were an average of 11 percentile points over students who did not receive social and emotional learning. For example, one of the studies in the review that by the time they were 18, students who received social and emotional learning in grades 1 through 6 had significantly higher grade point averages, showed lower school misbehavior and delinquency, and showed lower heavy alcohol use from students who were in the control group. The academic and life success returns on the investment in SEL are substantial. These are also the same very skills that our Nation's business and government leaders have defined as essential for effectiveness in the modern workplace. I am happy to say that Illinois and New York have already passed legislation and released guidelines to move this agenda forward. However, too few students have access to this critical programming, and the schools that do need training and technical assistance so their SEL efforts are maximized. Because SEL requires serious commitment at the Federal, State, school district, and community levels, CASEL is advising in the development of authorizing legislation to support SEL programming in the field. The proposed legislation would establish both a National Training and Technical Assistance Center and a State and local grant program to promote SEL nationwide. We look forward to sharing with you more about this as this proposed legislation progresses. There is, however, much we can do right now to further this agenda by using existing Federal funding. I ask you to support report language to the Labor, HHS, Education Appropriations bill that will encourage States and local agencies to use Federal funds for SEL programming, particularly as part of Title I school improvement, Title II teacher quality enhancement, and effective use, of course, of Title IV, Safe and Drug Free Schools funding. Unfortunately, many of our young people today would describe school as a place that prepares them for a life of tests, instead of preparing them for the tests of life. I hope you agree with me that we can do better, and I thank you for the opportunity to speak to you today. Mr. Obey. Thank you very much, and thank you for staying within the time. Ms. Lantieri. You are very welcome. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. CENTER FOR LAW AND SOCIAL POLICY WITNESS DANIELLE EWEN Mr. Obey. Next, Center for Law and Social Policy, Danielle Ewen. Ms. Ewen. Chairman Obey, members of the Subcommittee, thank you for the opportunity to testify today about the importance of continuing to grow Federal investments in Head Start and Early Head Start in order to support our most vulnerable: infants, toddlers, preschoolers, and their families. Your support for these birth to five programs, most recently demonstrated by the funding increases they received in the economic recovery package, has long been critical to their success. I am testifying today on behalf of the Center for Law and Social Policy, or CLASP. CLASP is a national nonprofit that works to improve the lives of low-income people. CLASP's mission is to improve the economic security, education and workforce prospects and family stability of low-income parents, children, and youth, and to secure equal justice for all. AS you know, Head Start and Early Head Start are the only federally-funded programs providing comprehensive early education and support services for poor children and their families. Both Head Start and Early Head Start have proven their effectiveness in national studies that show gains in cognitive development and physical and mental health. More importantly, both programs have proven their effectiveness by improving the lives of children and families. Head Start and Early Head Start serve a diverse array of children and families living in poverty. Seventy-seven percent of participants across all Head Start funded programs are in families earning below the Federal poverty level. Another 15 percent qualify because they receive public assistance. Thirty- one percent of participants in the programs come from homes where English is not the primary language. A greater proportion of African-American and Latino children participate in Head Start than do white or Asian children. One-third of all parents with children in Head Start have less than a high school diploma or GED. But Head Start and Early Head Start families are working hard to become self- sufficient. Seventy percent of all Head Start families include at least one working parent, and 13 percent of families include a parent in school or job training. Yet, despite their best efforts, most of these families still live in poverty and lack access to basic supports. We know that children living in poverty face many risk factors to healthy development, risks that often go undetected until the children enter school. The majority of participating families receive health and social service referrals through Head Start. Eighty-four percent of families in Early Head Start and 73 percent in Head Start accessed at least one service in 2008. Importantly, half of all children in Head Start with disabilities were diagnosed during the program year. Without the intervention of the program, it is likely that these issues would have gone undetected until children entered kindergarten or even first grade. To expand their reach, Head Start providers are partnering with State pre-kindergarten, child care, and other early childhood programs to provide high quality full day and year experiences. In Hamilton County schools in Chattanooga, Tennessee, the school district uses Title I funds in conjunction with Head Start funds to expand the availability of high quality classrooms. In Birmingham, Alabama, the Head Start agency has partnered with family child care providers to provide Head Start services in family child care homes. Providers are trained in the model and receive the full range of professional supports. Providers also meet all of the performance standards for every child and are monitored on a regular basis. Yet, even as they leverage as much support as possible, Head Start and Early Head Start programs are unable to serve the majority of eligible children and families. Head Start is serving only about half of eligible preschoolers and Early Head Start is serving less than three percent of babies and toddlers. Infants and toddlers are more likely to live in poverty, and economists predict that this recession will be longer and more severe than any the United States has faced in recent decades, suggesting that many more families will need the comprehensive supports that Head Start and Early Head Start provide. CLASP looks forward to working with the Committee to continue to reverse the losses in recent years and ensure that early childhood programs, including Head Start, Early Head Start, and the Federal Child Care Assistance Program, stay firmly on the growth path set out in the recent economic recovery package and the 2010 budget proposal from the Administration. These investments are vital components of economic recovery because they support the important early years of a child's development, and that is critical to our Nation's future success. Thank you. Mr. Obey. Thank you very much. Appreciate your time. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. NATIONAL ASSOCIATION OF CHARTER SCHOOL AUTHORIZERS WITNESS GREG RICHMOND Mr. Obey. Next, Mr. Greg Richmond, National Association of Charter School Authorizers. I do not know if we should let any authorizers in the room. [Laughter.] Mr. Richmond. Good morning, Chairman Obey, Ranking Member Tiahrt, members of the Subcommittee. My name is Greg Richmond and I am the President and Chief Executive Officer of the National Association of Charter School Authorizers, or NACSA. Thank you for the opportunity to testify before your Subcommittee on actions that the Federal Government can take to improve quality within the charter school sector. NACSA is a trusted resource and innovative leader for charter school quality. We are a professional membership organization, but our members are not charter schools; our members are the agencies or the authorizers that oversee public schools on behalf of the public. We have many members and perform work in many of the cities and States that you represent on this Committee. We know that a number of cities and States across the Country have many quality charter schools. Recent studies in Boston, New York, Chicago, New Orleans, and Oakland are showing that charter schools can raise test scores, graduate more students, and send more students to college. But we also know that there is nothing easy or automatic about charter school quality, and that there are some places where there are too many weak charter schools. We support President Obama's call, stated last fall and again last week, for increasing the number of charter schools and for raising our standards for charter school quality. Since 1995, the U.S. Department of Education has spent more than $1,700,000,000 on its Federal Charter School Program, or CSP. While these funds have promoted the growth of the charter school sector, they have done less to promote consistent quality within that sector. Currently, the CSP requires charter schools to meet very few requirements, such as admitting students via random lottery and following basic civil rights laws. Absent are critical standards and practices that would strengthen charter school operations and outcomes. Congress should take several small, but important, steps to put academic and financial quality controls in place within this important Federal program. These quality controls can be achieved through four steps: contracts, student performance requirements, audits, and proper monitoring. First, contracts. The charters held by charter schools are multi-year, multi-million dollar arrangements under which schools provide education services in exchange for receiving public funds. Yet, by our estimate, between 10 and 20 percent of charter schools across the Nation do not operate under a basic legal contract. This is unacceptable and the CSP should require all charter schools to operate under the terms of a legal contract. Second, student performance requirements. Accountability is at the core of the charter school philosophy. Yet, too many low performing charter schools remain open because charter school accountability requirements in their State are vague and not centered on student performance. We need to close these low performing charter schools because they are not serving students well and because they are undermining those charter schools that are excelling. The Charter Schools Program should require that charter schools meet the same objective measurable student performance standards that apply to all other public schools in a State. Third, audits. Some of the most troublesome problems in the charter school sector have occurred due to a lack of adequate financial controls at a small number of schools. Most States, but not all States, require charter schools to conduct annual independent, financial audits. The Federal Charter School Program should require all charter schools to do so. Finally, monitoring. We know that passing new strong laws that incentivize quality is only the first step. Laws are of little value if no one is monitoring or enforcing them. The role of the authorizer is to provide that oversight on behalf of the public. To this end, Congress should require that a small portion of Federal Charter School Program funds be used to improve the quality of authorizing. Since the program's inception, State education agencies have been allowed to use five percent of funds for their own general administration. In the future, a portion of these funds should be used to improve the practices of authorizers and thereby improve the quality of monitoring. Taken together, these small but important steps--contracts, student performance requirements, audits, and monitoring--will go a long way toward achieving the shared goal of President Obama and U.S. Secretary of Education Arne Duncan to promote, support, and strengthen the charter school sector. I appreciate this opportunity to testify on the need for quality controls among charter schools and authorizers. By establishing these quality controls, we will take a strong step forward in our efforts to provide all of our students with the greatest educational opportunities possible. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. Just a quick question. Do you happen to know how many charter schools we would find in a small town or rural area as opposed to how many we would find in your major metropolitan areas? Mr. Richmond. More charter schools are in major metropolitan areas, but it does vary by State to State. Wisconsin has a pretty significant population of charter schools outside of major metropolitan areas relative to other States. Colorado also has more charter schools outside of major metropolitan areas. But in some States it is the opposite; they are concentrated in big cities. And that is a function of State laws and the role of school districts in supporting those schools. Mr. Obey. Thank you. Mr. Tiahrt. Mr. Tiahrt. Thank you, Mr. Chairman. Mr. Richmond, you mentioned Chicago in your testimony. Are you familiar with Secretary Duncan? Mr. Richmond. Yes, I know him well. I used to work with Arne at the Chicago Public Schools. Mr. Tiahrt. And there are charter schools in Chicago. You mentioned in here that part of the plan was that if they were not working, you would close the charter schools. How would you measure that and how did you determine success or closure? Mr. Richmond. We put forward some very straightforward measurements: not only test scores, but also attendance, graduation rates, and then we did look at finances to make sure the finances were being properly managed, and we audited those every year. But we defined very clear measurable outcomes. In each school we had a contract; with each school, we signed it, they signed it, and said these are the performance expectations. If you achieve these you will be renewed, you will stay open; if you do not achieve them, you are at risk of being closed. During my time there, we closed two schools. Mr. Tiahrt. Out of how many? Mr. Richmond. Out of about 30. Mr. Tiahrt. Interesting. Thank you, Mr. Richmond. Mr. Jackson. Mr. Chairman? Mr. Obey. Thank you. Mr. Jackson. Very quickly. The President said, in his most recent address to Congress, that we cannot be a Nation--if I remember correctly--that is satisfied with just graduating students from high school, and that someone who is dropping out of school is not just dropping out on themselves, they are also dropping out on every citizen and on the society. Has your association ever thought about adding the college acceptance rates as a criteria to the effectiveness of the charter school? Not that you are just graduating students from high school, but that they are being accepted to college; that they are attending college; and that they have a low matriculation out of the institution as one of the criteria? Mr. Richmond. We are actually working on that as we speak in a joint project with ourselves, the National Alliance for Public Charter Schools, and a center at Stanford University, where we are putting forward, with Federal support, a broader set of school quality measures that include test scores, but then also include tracking how many students go on to college. This was a very important lesson that we learned in Chicago that came out of the charter sector. There was a school on the west side in North Lawndale, in the late 1990s, that was doing a fantastic job preparing kids to go to college, actually helping them apply and make sure they got in. Nothing like that had been happening in the regular city high schools. Arne Duncan saw that happening at the charter school on the West Side, he hired that gentleman from the charter school to come into the central office of the school district and put that in place for all high schools in the city. It is tremendously important that all kids have the opportunity to go on to college. Mr. Obey. Thank you. Ms. Lee. Question. Mr. Obey. Go ahead. Ms. Lee. Good morning. Mr. Richmond. Good morning. Ms. Lee. Thank you, Mr. Chairman. Let me just ask a quick question about the distinction between public charter schools and private charter schools. I have been one who has been very skeptical of charter schools, and I am trying to hear a compelling case to make my mind up whether I support or do not support charter schools, because I have seen evidence both ways. Mr. Richmond. Right. Except in Arizona, where they do have something that is called private charter schools--and I honestly do not even know what they are--everywhere else in the country, all charter schools are public schools and, to me, the thing that makes them public is the fact that they are publicly funded, they are publicly monitored--they are accountable for finances and test scores--and they are open to all students, they serve students on behalf of the public. Those are the things, to me, that make them public schools, because they have the funding, the monitoring, and the service to all students. They cannot discriminate, they cannot administer tests. They have to be open to all. Mr. Obey. Mr. Cole. Mr. Cole. Thank you, Mr. Chairman. It is my understanding, Mr. Richmond, that, in the wake of Hurricane Katrina, your organization did a lot to get charter schools up and operational in New Orleans. Obviously, you have got a pretty concentrated experience there, and experiment. I am just curious what your observations are, what role they played, how successful they have been. Mr. Richmond. I think that the work has been very successful. It certainly is not something we have done alone, but I traveled to Louisiana shortly after Hurricane Katrina, first met with State Superintendent Cecil Picard. I now work closely with State Superintendent Paul Pastorek. Every charter school that has opened in New Orleans since the hurricane, our association has evaluated on behalf of the State of Louisiana and made those recommendations. But it is not just us. The real strength of this is that New Orleans public education before the hurricane was really almost a lifeless system. There was no hope in the city that anyone could fix what was happening in the traditional school district. Afterwards, by opening up so many charter schools has really created a lot of opportunity. There is a much greater level of engagement: community engagement in schools, parent engagement in schools, teacher engagement. Much greater optimism. And the real importance of that, when all is said and done, the charter schools that have opened in New Orleans since the hurricane are performing 50 percent higher on the State's academic performance system than the schools that the State opened at the same time. Same kids; same neighborhoods; anyone can go to either school. The charter schools are performing 50 percent higher than the traditional schools opened by the State. Mr. Obey. Thank you. Mr. Richmond. Thank you. Mr. Obey. Let me simply observe that I hope people understand that just because members on the Committee do not ask questions of most witnesses, that is not because of a lack of interest; we are trying to stifle ourselves so that as many people have an opportunity to talk here today as possible. Something about Mr. Richmond's testimony or else the subject matter itself triggered an unusually long round of questions. So you ought to try to figure out what that was, because you certainly had everybody's interest. Mr. Richmond. I am a native of Wisconsin, Mr. Chairman, so that has to be what it was. Mr. Obey. Aha. Well, I hope it is Northern Wisconsin. ---------- Wednesday, March 18, 2009. NATIONAL ASSOCIATION OF STATE DIRECTORS OF SPECIAL EDUCATION WITNESS MARY WATSON Mr. Obey. Okay, next, Helen Blank, National Women's Law Center. Oh, I am sorry, I got ahead of myself. First it is National Association of State Directors of Special Education, Mary Watson. Sorry about that. Ms. Watson. Good morning, Mr. Chairman and members of the Committee. My name is Mary Watson, Director of Exceptional Children Division for the Department of Public Instruction for the State of North Carolina. I am speaking to you today as President of the Board of Directors for the National Association of State Directors of Special Education. NASDSE is the national not-for-profit association that represents State directors of special education. I thank you sincerely on behalf of NASDSE for the opportunity to appear before you this morning to talk about funding for special education programs under the Individuals with Disabilities Education Act, known as IDEA. Mr. Chairman and members of the Committee, I first want to thank you sincerely for including support for special education in the American Recovery and Reinvestment Act. In North Carolina, this came at a critical time, when services for students with disabilities were about to be suspended or teachers laid off. While these funds are going to help States in the short term, for the next two years, we remain concerned about the long-term funding for IDEA. Even with the national budget crisis, no child with a disability can be turned away from our public schools. My testimony will briefly address four parts of IDEA and funding for each of these parts. The first is the Part B program, which serves children ages 3 through 21. When IDEA was reauthorized in 2004, the authorizers spoke about putting IDEA on a glide path to full funding. We ask you to appropriate funding for Part B for the fiscal year 2010 that will bring it closer to the full funding. Section 619, a program that serves children ages 3 to 5. President Obama and Secretary Duncan have made pre-K programs one of their educational priorities. Section 619 was level- funded in fiscal year 2009, which represents a funding cut due to the across-the-board spending cuts in fiscal year 2008 appropriations. We urge you to provide a 10 percent funding increase for the Section 619 program. The Part C program serves infants and toddlers from birth to age two. We have compelling evidence that indicates if services are received early on, they can help mitigate the services required at a later date, thus reducing costs of special education when children enter school. It is important that these children be identified and services be provided as soon as possible. While this Committee has increased funding slightly for Part C in fiscal year 2009, we request the Committee again consider increasing fund for the Part C program in recognition of the importance of identifying and meeting the needs of this young and vulnerable population. The Part D program, the fourth part, provides valuable support to State education agencies and through State education agencies to the local education agencies. NASDSE would like to thank this Committee for increasing funding for several of the Part D programs in the fiscal year 2009 Omnibus bill. I would especially like to mention two of the programs of critical importance. The Regional Resource Centers that are funded through the technical assistance and dissemination line item in Part D is the first. These centers, over the years, have provided invaluable, hands-on support to States. The State Personnel Development Grants, known as the SPDGs. From my own personal experience, I thank you for restoring the SPDGs in the fiscal year 2009 Omnibus bill that President Obama has just signed into law. This program is critical to supporting the personnel programs and special education which caused increased outcomes for students with disabilities. In North Carolina, because of the professional development that was made possible through this funding, students with disabilities have more than double the progress made by their non-disabled peers in reading. For students with disabilities who were taught math by teachers who were trained using the SPDG funding, these students increased 27 percentage points, while regular education students only increased 3 percentage points. With respect to discipline of schools implementing positive behavior supports, office discipline referrals have decreased, increasing instructional time, thus increasing achievement scores. Across the States, the SPDG funding is used in various ways. In sum, this funding remains critically important to States and to students. NASDSE requests that you return this program to its original funding level by adding just $2,000,000 and provide a 10 percent increase for the other Part D programs. Mr. Chairman, this concludes my testimony. I would be happy to answer any questions. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. NATIONAL WOMEN'S LAW CENTER WITNESS HELEN BLANK Mr. Obey. Now, we will hear from Helen Blank, National Women's Law Center. Ms. Blank. I am from Michigan. Not close enough, I guess. Chairman Obey, members of the Subcommittee, thank you for the opportunity to testify. The National Women's Law Center works to increase low income women's access to Head Start, Early Head Start, and child care because they are all key to ensuring a family's economic security and their children's futures. We welcome your strong support for these programs. Head Start was founded on one very common sense principle: children do not come in pieces. Helping children to exceed involves addressing the full array of factors that affect their development, most notably, the role that their parents play in their lives. With its comprehensive approach to early childhood, Head Start and Early Head Start are fundamental building blocks of a high-quality early education system. Data is clear that low- income children such as those targeted by Head Start often start out at a disadvantage. Head Start is dedicated to these children who need the most intensive help. It offers them high- quality early education, as well as other supports. This comprehensive approach is not replicated in most other early education programs. In Head Start, social workers help stressed families work through the challenges of unstable jobs, abusive relationships, and inadequate housing, as well as the depression and sense of hopelessness that comes from living on the edge. Health workers make sure children are screened and treated, and help parents navigate the community's health system, bringing children in rural areas to dentists that are miles away. Staff help parents become partners in their children's education. Programs collaborate with job training programs and local colleges to aid parents in gaining skills and returning to school. Fathers are helped to strengthen the connection they need with their children and their families. What does this mean? A four-year-old boy came to an organ program quiet and withdrawn. The annual screening process identified him as hearing impaired and, after a referral to a local pediatrician and audiologist, he was found to be profoundly deaf. Through the efforts of Head Start staff, the child received intensive sign language education. Staff worked with the family, who only spoke Spanish, to access high-quality medical services. They also assisted the family in obtaining Cochlear implants for their son. Head Start is also comprehensive in its approach to early learning, addressing language, math, literacy, science, as well as physical health, approaches to learning, social and emotional development, and creative arts. Head Start is dynamic; it is constantly improving and updating its standards. The last reauthorization, which received strong bipartisan support, continued to strengthen the program with stronger standards in literacy and math, stronger requirements for teachers, tougher accountability requirements for boards of directors, increased program reviews, a requirement for more programs to compete to renew their grants, increased requirements for collaboration with local school districts, and, very importantly, an increased focus on infants and toddlers. Unfortunately, until the much welcomed increase for Head Start in the ARRA and the Omnibus bill, Head Start funding had been virtually flat since 2002. Instead of focusing on the goals of the reauthorization, programs had to make due with less: cutting the number of hours and days, reducing staff, cutting training, not replacing equipment or buying new books, reducing or eliminating transportation for children to the core program and to medical and dental appointment, threatening the poorest children's access to Head Start. Programs have had less access to child care funds, making it more difficult to support full day services. The lack of child care funding is a significant challenge for Head Start parents and for countless others. That is why we are also grateful for the increase in CCDBG included in the ARRA and the Omnibus bill. The funding included in the economic recovery legislation demonstrated a recognition that Head Start helps our economy today and in the future. We look forward to working with this Committee to ensure that Head Start, Early Head Start, and child care continue on the growth path the Administration has set out, because it underscores the importance of investing in the critical early years of a child's development. It is essential, in fiscal year 2010, to enable these programs to continue to meet the needs of the low-income young children and families they serve, as well as reach the growing numbers of unserved children ages zero to five. Thank you very much for all your support. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. UNITED TRIBES TECHNICAL COLLEGE WITNESS DAVID GIPP Mr. Obey. Next we will hear from Dr. David Gipp, United Tribes Technical College. Mr. Gipp. Thank you, Mr. Chairman. It is an honor to be here. I might say this is only the third time in the 35 years I have been in Indian education and education that I have been able to appear before this Committee, so it is a great honor to be here. Mr. Obey. Well, you have been lucky to avoid us so far. [Laughter.] Mr. Gipp. Thank you for having here, on behalf of our tribal communities. I am President of United Tribes Technical College, which has been around for about 40 years. We celebrate our fortieth anniversary this coming year here and we appreciate the opportunity. I am going to get straight to the point and note our request, Mr. Chairman, and that is that we are requesting that the authorized programs under the Carl Perkins law, Section 117, that the amounts of $8,500,000 or $727,000 above the fiscal year 2009 enacted level be provided for principally two schools, United Tribes Technical College and Navaho Technical College, which benefit by this. Together, we serve close to 2,500 students and about 500 children on our campuses. United Tribes is located in Bismarck, North Dakota, and we serve, as I mentioned, between 20 to 60 different tribes from throughout the region and throughout the Nation, along with 400 to 500 children on our campus, and we offer a comprehensive model that includes both early childhood centers, as well as a K through 8 elementary school that works principally with our adult population in 17 different areas of career and technical education. This is part of the benefit from the Carl Perkins law. The second request that I will speak to is also providing for added funding under Title III and Title III-A of the Higher Education Act for the tribal colleges and universities, of which there are 37 throughout the United States, serving approximately 30,000 students throughout the United States of America. So we ask that those not only be reauthorized, but that the funds be provided for adequacy so that these institutions can continue in the development phases of their post-secondary programs, as well as needed construction facilities. All of these schools, with the exception of one or two, do not receive State appropriated dollars and they do not have the benefit of local tax bases, as is the case with United Tribes. I mentioned, in the case of United Tribes, that we are a comprehensive model, and I mentioned some of the array of services that we provided. I will also highlight that we have about an 80 percent retention rate, a 94 percent job placement rate in the fields for which students graduate and go on, in many cases, to four-year institutions. We have a very good return on our investment and we have achieved our highest level of accreditation through the North Central Association for Tenures. In 2011 we are up for our comprehensive, and we look forward to expanding our programs. I should mention the need for providing these funds, and that is that about 51 percent of our population throughout Indian Country or where there are tribal populations is now under the age of 25, and, in many cases, 51 percent or more of that population is under the age of 18. We have a growing population. So the challenge is to meet the needs of this population in terms of education and training, so that is the role for us as we see it. We will grow, in the case of United Tribes, from about an average of 1,100 students to about 5,000 students in the course of the next five years. That is how we look at it in terms of what is happening throughout our various communities. We offer courses that range from the licensed practical nursing, to criminal justice, to auto mechanics and the standard trades, to online education and five degrees that we provide therein. So those are just some of the things that I mentioned, Mr. Chairman, and we would greatly appreciate the continuation of support of these institutions, given the fact that the previous Administration tried to zero us out this past year and Congress saw the wisdom of continuing the support of these very valuable institutions. Thank you. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. ASSOCIATION OF UNIVERSITY CENTERS ON DISABILITIES WITNESS MICHAEL GAMEL-McCORMICK, PH.D. Mr. Obey. Next, Dr. Michael Gamel-McCormick, Association of University Centers on Disabilities. Mr. Gamel-McCormick. Good morning, Chairman Obey, Ranking Member Tiahrt, and members of the Subcommittee. Thank you for the opportunity to testify today regarding fiscal year 2010 appropriations. My name is Michael Gamel-McCormick. I am the President of the Association of University Centers on Disabilities and the Interim Dean of the College of Human Services, Education and Public Policy at the University of Delaware. I want to talk to you about two of our programs today, the University Centers for Excellence in Developmental Disabilities, what we sometimes call UCEDDs, and our Leadership Education in Neurodevelopmental and Related Disabilities, or LEND, Programs. The mission of the UCEDDs is to advance policy and practices for and with people with developmental and other disabilities. As a network of 67 interdisciplinary centers across the United States and its territories, we work to ensure that individuals with all types of disabilities are full members of their communities. Our LEND programs help to ensure that the more than 3.8 million children with disabilities in the United States can find appropriate medical care from highly qualified professionals who have been trained on the most up-to-date interdisciplinary practices. The general education and training of health care professionals and other elements of the health care system have not necessarily kept pace with the needs of these children. LEND programs are designed to address this shortage of highly qualified health care professionals for the needs of those children today and into the future. The LEND program in Representative Obey's State is at the University of Wisconsin-Madison, and the Waisman Center is leading the way in looking at new treatments for Parkinson's, spinal muscular atrophy, Rett Syndrome, Fragile X, and Down Syndrome, training professionals on how to use science-based interventions in order to improve the quality of life of thousands of children and young adults. Our university centers work to develop and evaluate promising practices that improve the lives of children and adults with disabilities and their families, conducting research in such areas as causes and prevention of disabilities and chronic conditions, and then translating that research into practice. I will give you an example from my own university center. We have a child care facility called The Early Learning Center. It serves 240 children living in poverty, living in foster care settings, or with disabilities. The ELC is a site where over 500 university students observe best practices, participate in practical experiences, and conduct research. In one of the most exciting examples of combined research, training, and service, we are in the middle of conducting a robot-assisted mobility study with infants and toddlers. Preliminary results indicate that providing these children with disabilities with mobile devices at 18 years of age or younger actually increases their social, their language, and their cognitive abilities. The good thing is that people have already recognized this and we have been able to attract partners to help create these mobility devices and then get them into children's and families' hands and feet already. I now want to shift gears for just a little bit and talk about some of the challenges our Nation faces and how our network can help. I will address four things: Autism Spectrum Disorder, returning veterans with disabilities, racial and ethnic health and mental health disparities, and the increasing aging population. Regarding health disparities, children and adults of color with developmental disabilities experience poorer health and have more difficulty finding and paying for health care as compared to other populations. Our network proposes to partner with minority-serving institutions of higher education to better engage research, education, and service efforts for African-Americans, Hispanic-Americans, Native Americans, Pacific Islanders, and Asian-Americans. In partnership with our existing university centers, minority-serving institutions of higher education would be well positioned to train future leaders, conduct necessary research, and disseminate pertinent information widely into communities. We also want to extend our efforts from the university centers and the LENDs to reach out to returning veterans, to address the aging population, and especially to address the increasing number of individuals who are being diagnosed with Autism Spectrum Disorder. Mr. Chairman, there are many challenges that we see and are ready to accept through our network. AUCD urges the Congress to provide sufficient funds that continue to take advantage of our highly effective and productive national network, and to continue the research, education, and service to address these critical emerging needs. Our written testimony outlines funding recommendations. Thank you, and I would be glad to take any questions that the Committee has. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. THE AD HOC GROUP FOR MEDICAL RESEARCH WITNESS MARY J.C. HENDRIX, PH.D. Mr. Obey. Next, The Ad Hoc Group for Medical Research, Dr. Mary J.C. Hendrix. Ms. Hendrix. Good morning, Mr. Chairman and members of the Subcommittee. My name is Mary Hendrix, and I serve as the President and Scientific Director of the Children's Memorial Research Center at Northwestern University's Feinberg School of Medicine. I am testifying on behalf of The Ad Hoc Group for Medical Research, a coalition of more than 300 patient and voluntary health groups, medical and scientific societies, academic and research organizations, and industry. As an active cancer researcher who runs an institute that employs more than 500 staff, I thank and commend Congress for including the extraordinary investment in medical research through the National Institutes of Health in the American Recovery and Reinvestment Act, as well as the $938,000,000 in NIH funding in the Omnibus Appropriations Act for fiscal year 2009. In particular, I am deeply grateful to the Chairman and this Subcommittee for your longstanding leadership in support of the NIH. These are difficult times for our Nation, for everyone around the globe, and investing in science is a key step to a better future and is a strategic approach. The funding increases in the Recovery Act and the fiscal year 2009 Omnibus will provide an immediate infusion of funds into the Nation's highly competitive medical research enterprise so that we can pursue new diagnostics, prevention strategies and treatments, and also so we can provide state-of- the-art scientific facilities and support our scientists and their support personnel. As a result of this Subcommittee's prior investment in NIH, we have made critical advances in many different areas in research, including Parkinson's Disease, including infectious diseases and cancer. And I would say that all of these advances are leading us to an area of more effective, personalized medical treatment. However, the discovery process often takes a long, lengthy, and unpredictable path; and the infrastructure that we are creating needs to be maintained so large fluctuations in funding will be disruptive to training, to careers, to long- term planning and projects, and ultimately to progress. The research engine needs a sustained investment in science to maximize our investment globally. We must ensure that, after the stimulus money is spent, that we do not have to dismantle all of our progress and newly built capacity. In 2011 and beyond, we need to be able to continue to advance the new directions chartered with the Recovery Act support. So, Mr. Chairman, as you noted in your recent press release, the fiscal year 2009 Omnibus and the Recovery Act provided $38,500,000,000 for NIH to provide over 16,000 new research grants for lifesaving research into many diseases. So keeping up with the rising cost of medical research in the 2010 appropriations will help NIH begin to prepare for the post- stimulus era. In 2011 and beyond, we need to make sure that the total funding available to NIH does not decline and that we can resume a steady, sustainable growth consistent with the President's vision for investment in basic research. Consistent with the President's proposal, we respectfully urge this Subcommittee to increase funding for NIH in fiscal year 2010 by at least 7 percent. As we appreciate the ravages of disease are many and the opportunities for progress across all fields of medical science are profound, investing broadly in biomedical research is key to ensuring the future of America's medical enterprise and the health of our citizens. We thank you again for your leadership and for the Subcommittee's leadership in improving the health and quality of life for all Americans and for the opportunity to speak to you today. Thank you. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Mr. Tiahrt. Mr. Tiahrt. Thank you, Mr. Chairman. You mentioned personalized treatment. Is that as a result of the genome project, that you can tailor treatment for an individual? Ms. Hendrix. Yes, sir. I am glad you asked about that. So, based on the sequencing of the human genome, which took over two decades and finished in 2003, we are now able to look at the genes responsible for many different diseases; and as these are being discovered almost on a daily basis, we now can apply them to predict diseases at the earliest possible time and then to think about prevention strategies. So that is where we are going. Mr. Tiahrt. It is not just applicable to cancer, it is to other diseases as well? Ms. Hendrix. To diseases across the board, sir. Yes. Thank you. Mr. Tiahrt. Thank you. Mr. Jackson. Mr. Chairman, if I might pick up on what Representative Tiahrt said. Mr. Obey. Yes. Mr. Jackson. And, I gather, design specific medications that can be personalized to the individual based upon the genome sequence in that individual, leading to a designer drug? Ms. Hendrix. That is exactly correct, and then predicting which patients will be more receptive to receiving these particular drugs based on their genetic background. Mr. Jackson. Thank you, Mr. Chairman. Ms. Hendrix. Thank you. Thank you, sir. ---------- Wednesday, March 18, 2009. CROHN'S AND COLITIS FOUNDATION OF AMERICA WITNESS GARY SINDERBRAND Mr. Obey. I understand Mr. Jackson would like to introduce our next witness. Mr. Jackson. Thank you, Mr. Chairman. I appreciate the opportunity to introduce Gary Sinderbrand to the Subcommittee. Gary is the Chairman of the Board of Trustees for the Crohn's and Colitis Foundation of America. CCFA is the Nation's oldest and largest nonprofit organization dedicated to finding a cure for these devastating disorders. Gary will share with us his daughter's courageous story of living with Crohn's Disease. Unfortunately, I know all too well the challenges these patients face, having watched my chief of staff endure a similar struggle. Mr. Chairman, I want to personally thank you and the Subcommittee and the staff for all of the work that you have given to this important cause over the years. I look forward to continued progress in this Congress. Gary, thank you for being with us today. We look forward to your testimony. Mr. Sinderbrand. Congressman Jackson, first, let me extend my heartfelt thanks on behalf of the 1.4 million Americans suffering from these diseases for all of your ongoing support. We truly appreciate it. Let me say at the outset how appreciative we are for the leadership this Subcommittee has provided in advancing funding for the National Institutes of Health. Hope for a better future for our patients lies in biomedical research, and we are grateful for the recent investments that you have made in this critical area. Crohn's Disease and ulcerative colitis are devastating inflammatory disorders of the digestive tract that cause severe abdominal pain, fever, and intestinal bleeding. Complications include arthritis, osteoporosis, anemia, liver disease, and colorectal cancer. We do not know their cause and there is no medical cure. They represent the major cause of morbidity from digestive diseases and forever alter the lives of the people they afflict, particularly children. I know because I am the father of a child living with Crohn's Disease. Seven years ago, during my daughter, Alexandra's sophomore year in college, she was taken to the ER for what was initially thought to be acute appendicitis. After a series of tests, my wife and I received a call from the attending GI who stated coldly, your daughter has Crohn's Disease. There is no cure and she will be on medication the rest of her life. The news froze us in our tracks. How could our vibrant, beautiful little girl be stricken with a disease that was incurable and has ruined the lives of countless thousands of people? Over the next several months, Alexandra fluctuated between good days and bad. Bad days would bring on debilitating flares which would rack her body with pain and fever as her system sought equilibrium. Our hearts were filled with sorrow as we realized how we were so incapable of protecting our child. Her doctor was trying increasingly aggressive therapies to bring the flares under control. Each treatment came with its own set of side effects and risks. Every time Alexandra would call from school, my heart would jump before I picked up the call, in fear of hearing that my child was once again in pain from the flares. Ironically, the worst call came from one of her friends to report that Alexandra was back in the ER being evaluated by a GI surgeon to determine if an emergency procedure was needed to clear an intestinal blockage that was caused by the disease. Several hours later, a brilliant surgeon at the University of Chicago removed over a foot of diseased tissue from her intestine. The surgery saved her life but did not cure her. We continue to live every day knowing the disease could flare at any time with devastating consequences. Fortunately, the scientific community is making tremendous strides in the fight against IBD. We have terrific partners at the NIH and CDC, and I will now turn my attention to CCFA's fiscal year 2010 recommendations for these agencies. Throughout its 40-year history, CCFA has forged successful research partnerships with the NIH. CCFA provides crucial seed funding to researchers, helping investigators gather preliminary findings, which in turn enables them to pursue IBD research projects through the NIH. For fiscal year 2010, CCFA joins with other patient and medical organizations in recommending a 7 percent increase in funding for the NIH. Mr. Chairman, as I mentioned earlier, CCFA estimates that 1.4 million people in the United States suffer from IBD, but there could be many more. We do not have an exact number due to these diseases' complexity and the difficulty in identifying them. We are extremely grateful for your leadership in providing funding over the past five years for an epidemiology program on IBD at the Centers for Disease Control and Prevention. The program is yielding invaluable information about the prevalence of IBD and increasing our knowledge of the demographic characteristics of the patient population. Finally, Mr. Chairman, the unique challenges faced by children and adolescents battling IBD are of particular concern to CCFA. In recent years, we have seen an increased prevalence of IBD among children, particularly those diagnosed at a very early age. To combat this alarming trend, CCFA, in partnership with the pediatric gastroenterology community, has instituted an aggressive pediatric research campaign empowering investigators with HIPAA-compliant information on young patients from across the Nation that will jump start our efforts to expand basic and clinical research on our pediatric population. We encourage the Subcommittee to support our efforts to establish a pediatric IBD patient registry within the CDC in fiscal year 2010. Mr. Chairman, once again, thank you for the opportunity to testify. I would be happy to answer any questions. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. AMERICAN COLLEGE OF CARDIOLOGY WITNESS JACK LEWIN, M.D. Mr. Obey. Next, we will hear from Dr. Jack Lewin, American College of Cardiology. Dr. Lewin. Good morning, Chairman Obey and Ranking Member Tiahrt and members of the Committee. I am a physician and the Chief Executive of the American College of Cardiology. It is a real privilege to be here with you today. Thank you. I would like to just take some excerpts from my testimony, which has a lot of details I hope that you will appreciate. The American College of Cardiology represents veritably all the practicing cardiologists in this country. We also represent many thousands of international cardiologists. We represent advance practice nurses and pharmacists and others who practice cardiovascular medicine in teams with us. We are concerned about the fact that the burden of cardiovascular disease in this country is rapidly growing. We estimate about $475,000,000,000 of health services, medications, lost productivity due to cardiovascular disease will occur in 2009. It is still, by far and away, the number one cause of morbidity and mortality, the number one killer in this country. In Medicare, $420,000,000,000 we spent in Medicare last year, 43 percent of it will be cardiovascular cost. That is over $180,000,000,000. Twenty-four hundred people die each day from heart disease, one every 30 seconds or so. About 1.5 million people will have a heart attack, one will die about every minute in this country. We can do a lot to improve that. Now, despite all that, since 2000, there has been a 29 percent reduction of morbidity and mortality in this country in heart disease because of new imaging modalities, new treatment modalities in terms of angioplasties and stents, improvements in surgical outcomes and prevention. And that is great, but disparities exist in cardiovascular disease. Gender and ethnic disparities are just inexcusable. More women die than men of heart attacks in this country today, and most people do not seem to understand that. We can do far better. We are spending far more than we need to for what we need in this future to build prevention and other health care services. So this ought to be a new era in which some of the colleges' most proud traditions could be better implemented with your help. We have, for 25 years, translated science into guidelines, performance measures, and, lately, appropriate use criteria for technology to make sure the best evidence gets to the patients at the point of care. The Rand Corporation estimates that about 50 percent of the time people in this country are getting that evidence. We have got to improve upon that, not only with electronic health records and clinical decision support systems to make sure that does get better, but by tracking how we are doing. The college runs something called the National Cardiovascular Data Registries. CMS actually requires some of the use of some of our registries in Medicare programs. We run these in 2,400 major hospitals where cardiovascular services are provided and we measure outcome across these, over hundreds of measures in these hospitals. In the last year, for example, we demonstrated that while the science says if you are having a heart attack in the emergency room, you need to get that heart attack treated and the blockage opened within 90 minutes to prevent permanent damage to your heart, as we measured across the country, and people thought we were doing this in about an hour, hospitals were shocked to learn that the average was well over two hours. In just one year we have gotten almost all of American hospitals down to under 90 minutes just by giving them the data. So these registries are critically important and we need your help to expand the use of these registries through Federal agencies and others to systematically improve quality, address misuse and overuse of technologies, and go out and try to find those people who need services that are not getting them today. That is our professional accountability. So we are asking that NIH get a 7 percent increase, to $3,200,000,000, to help NIH and NIHLBI with some of the research needs to deal with some of the gaps in knowledge that still exist to help us improve the evidence-based care at the point of care. We would like to see AHRQ, Agency for Health Research and Quality, get an increase of $32,000,000 to $405,000,000 to help us with the registry activities and to help us with comparative effectiveness research that would, again, advance these causes. We would like to see CDC get some more money, another $20,000,000 to $74,000,000, for heart disease and stroke prevention activities; and the Health Resources and Services Administration also needs more resources for emergency defibrillation and for rural and community health activities. The research needs are critically important. The comparative effectiveness research is critically important to us. So, in conclusion, Mr. Chair and members of the Committee, we believe this increased investment in NIH and NIHLBI, AHRQ, CDC, and HRSA will pay off with huge dividends for our society, huge return on investment there. The social and economic costs are great, but the opportunities are great. We have made great progress in cardiovascular disease, but the epidemic is increasing as America grays and as the diabetes and obesity problems multiply. So thank you very much for listening to the testimony and receiving the details of it. We look forward to working with you. It has been an honor to be with you today. Mr. Obey. Thank you. I would just point out that, in the stimulus package, we did provide $300,000,000 to AHRQ and $400,000,000 to NIH for the kind of research you are talking about. Dr. Lewin. And we are so grateful for that. Thank you, sir. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. PARKINSON'S ACTION NETWORK WITNESS MARY McGUIRE RICHARDS Mr. Obey. Next, Mary McGuire Richards, Parkinson's Action Network. Ms. Richards. Thank you. Thank you, Chairman Obey, thank you, Ranking Member Tiahrt for inviting me to testify on behalf of the Parkinson's Action Network regarding the National Institutes of Health. I am the Deputy Chief Executive Officer at the Parkinson's Action Network. We are also known by our acronym PAN. PAN represents the entire Parkinson's community, including more than 1 million Americans living with Parkinson's Disease, their families, and all of the major national Parkinson's organizations across the Country. You may have indeed met with some of your Parkinson's constituent advocates yesterday, when more than 300 people living with Parkinson's Disease were here on Capitol Hill to communicate with their elected representatives about the issues that are facing them back at home. Parkinson's Disease is a chronic, debilitating, neurological disorder that results from premature death of dopamine-producing neurons in the brain. Parkinson's patients experience devastating physical and mental symptoms, including tremors, debilitating slow movements, postural instability, profound sleep disturbances, and a variety of cognitive impairments. Parkinson's is the second most common neurodegenerative disease in the United States and it is currently without a known cure. Parkinson's state-of-the-art treatment is currently based on a 40-year-old therapy. This therapy only provides some relief for some of the motor symptoms of the disease. There is nothing that slows or stops progression of disease. All of our current treatments are simply symptomatic relief and not disease modifying. As such, people living with Parkinson's Disease are desperately awaiting innovative disease modifying therapies that will relieve their pain and ultimately halt the unrelenting march of the disease. Before I begin discussing 2010 funding issues, I would like to thank members of this Committee for their support for the National Institutes of Health, including the $10,000,000,000 in the stimulus bill for the NIH. PAN not only applauds your commitment to biomedical research funding, but we will continue working with the NIH to ensure strategic investment of this one-time infusion of money to the NIH. PAN continues to support the research advocacy communities' NIH request; however, we are also invested not only in how much money is spent at the NIH, but how those dollars are best spent. To truly deal with the public health needs facing this Nation, disease modifying therapies, those that slow or stop progression of disease, are needed for untreated and under- treated diseases such as Parkinson's Disease. To accomplish this, NIH must launch a large, coordinated effort to overcome the scientific valley of death. Simply put, the valley of death is the gap between basic discoveries and potential therapies to treat disease. It is also known as translational research. This science is new, it is challenging, it is costly, but it is essential if our aim is ultimately to develop those therapies that will meet an increasingly burdensome public health need. NIH funds world-class basic science, but translational research is new science that requires new thinking. A consequence of tremendous discovery, such as the human genome project, has been additional science sophistication, but also somewhat less hopefully, it is a further separation from the researcher and that researcher's science to the people who might benefit from such science. A new model is required that will fill that gap. NIH must rethink how we support the unique needs of translational science. The same systems that have supported basic science so well are not aiding in the application of that knowledge. Different expertise, leadership, and training are necessary to tackle complicated translation issues that are preventing or slowing research from moving into potential therapies. NIH must develop a unique infrastructure, as well as systems to support translational science. Infrastructure must include things such as intellectual property and FDA expertise, which are essential to this part of the research endeavor. Many existing efforts at the Institute must be bolstered or remodeled, and new systems called for under NIH reform must simply be funded. Unfortunately, a lack of dedicated resources at NIH has resulted in slowed implementation of NIH reform, which the Parkinson's community strongly supported. NIH reform aimed to enhance NIH's transparency, accountability, portfolio management, and strategic planning efforts, all of which will hasten basic discoveries and their translation into better therapies and treatments for all Americans facing diseases and disorders. Without the commitment of resources to implement these reform activities, the struggle between any new efforts, such as the ones we would think are necessary in translational science, and the need to continue funding new ideas and research is increasingly difficult. Let me be clear that PAN continues to support basic research discoveries coming out of NIH. Robust research at the beginning of the pipeline is essential for continuing to grow our knowledge of biomedical and disease processes, as well as to provide a feeding ground for new and novel ideas in science. Of course, should novel ideas show promise, additional funding must be directed at translating these discoveries into the treatments to alleviate the suffering of people living with diseases. As a patient advocacy organization, PAN is ultimately concerned with improving the health of people living with Parkinson's Disease. However, this is not a disease-specific problem, nor does it require a disease-specific approach to a solution. I do appreciate the Committee's time. We do advocate for the Committee to continue asking NIH to maintain the dedicated funding resources and systems necessary to support patient- oriented research and finding a cure for all Americans. I am happy to take any questions. We really do appreciate your time and your consideration. Mr. Obey. Thank you. Ms. Richards. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. AMERICAN LUNG ASSOCIATION WITNESS ALBERT A. RIZZO, M.D. Mr. Obey. Next, Dr. Albert Rizzo, American Lung Association. Dr. Rizzo. Thank you, Chairman Obey and Committee members. I am a board certified practicing physician in pulmonary sleep medicine and critical care, and currently the Chief of Pulmonary and Critical Care Medicine Section at the Christiana Care Health Systems in Newark, Delaware. I am also a long-time volunteer of the American Lung Association and currently serve as Speaker of the Nationwide Assembly, which is the body of that volunteer organization that oversees the mission work. I am pleased to present the American Lung Association's recommendations today. The public health and research programs funded by this Committee will prevent lung disease and improve and extend the lives of millions of Americans who suffer from lung disease. First and foremost, we want to thank you, Mr. Chairman and Committee members, for the investments in health you made in H.R. 1, the American Recovery and Reinvestment Act. We particularly appreciate the investments in research and funding for prevention and wellness programs. These investments will have net a near-term and long-term dividend for the health of American people, as well as people worldwide. Many lung diseases are chronic diseases and, as such, are huge drivers of cost and human suffering. We urge the Committee to focus resources on reducing the burden of such chronic diseases. While our focus is on lung disease, we know that America must maintain a renewed commitment to medical research in general, and strongly support increasing the investment in research across the entire NIH. A growing, sustained, predictable, and reliable investment in the National Institutes of Health provides hope for millions afflicted with lung disease. A new and sustained investment in prevention and wellness will lead to a healthier, more productive population and reduce health care costs. Investments in proven interventions, like smoking cessation and the Healthy Committees Program at the Centers for Disease Control and Prevention, reduce the burden of disease. Progress in these areas was made in fiscal year 2009 and in the stimulus bill. But as you well know, Mr. Chairman, to see the outcomes that we all seek, these investments must be sustained over time. The toll of lung disease is enormous. It is responsible for one in every six deaths, and more than 33 million Americans suffer from a chronic lung disease. Chronic obstructive pulmonary disease, or COPD, which is more commonly known as emphysema or chronic bronchitis, is the fourth leading cause of death and the only leading cause of death in this Country that continues to increase. The cost in human toll of COPD is staggering. I see patients every day who suffer from this disease. Mary G. was a patient of mine who developed COPD and sent the last six months of her life on a ventilator or breathing machine. Mary's daughter, Beth, who I now treat for asthma, lived with and loved a very significantly impaired mother who could not participate in the day-to-day activities that a mother should participate in because she was so short of breath. Despite the enormity of this problem, COPD receives far too little attention at CDC or in health departments across the Nation. The American Lung Association strongly supports the establishment of a national COPD program within CDC's National Center for Chronic Disease Prevention and Health Promotion, with a funding level of at least $1,000,000 for fiscal year 2010 to create a comprehensive national action plan for combating this disease. This plan will address the public health role in prevention, treatment, and management of this disease. So, in concluding, besides COPD, the American Lung Association's recommendations are that NIH needs to have significant and sustained increasing and funding research for lung cancer to improve the terribly low lung cancer survivorship; adequate funding for the CDC's Office on Smoking and Health that can help prevent so much of the disease I see in my office every day; asthma research and asthma programs for the nearly 23 million afflicted individuals with that chronic lung disease; tuberculosis, especially multi-drug resistant TB, needs research because of the significant threat it poses to public health; and influenza, since the Nation must continue to invest and be prepared for a significant pandemic, as well as providing yearly annual vaccination. Many patients with these diseases are literally fighting for air every day, sometimes from breath to breath, so, Chairman and members of the Committee, I thank you for your time, and please consider the Nation's urgent lung health needs in 2010 appropriation bill. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. OVARIAN CANCER NATIONAL ALLIANCE WITNESS SUSAN BUTLER Mr. Obey. I regret to inform the Committee that I am told that we are going to have two votes sometime between 11:30 and 11:45, which will mess up the lives of the last three people on this list unless we can keep tightly to the time. So, next, can we call Susan Butler? Mr. Moran, I think you wanted to introduce her? Mr. Moran. Yes. Thanks, Mr. Chairman. Susan, back in 1995, was diagnosed with ovarian cancer. At that time, the prospects were very harsh and the treatment options few. She was fortunate enough to enroll in an NIH clinical trial and it saved her life. Since then, she has devoted her life to the 22,000 additional women every year that are diagnosed with ovarian cancer, giving them hope and comfort. I could go on and on--I will not--about the other things she does. She is a CEO; she has had award-winning websites; she has gotten the NIH Director's Award for her commitment to enhance patient care and service at NIH's Clinical Center. But she is a great witness and thank you for having her, Mr. Chairman. Mr. Obey. Thank you. Please proceed. Ms. Butler. Mr. Chairman, Mr. Ranking Member, distinguished members of Congress, and especially Congressman Moran for your steadfast support of cancer and cancer research all of these years, I am Susan Lowell Butler, the Executive Director of the DC Cancer Consortium, and I am a proud cofounder of the Ovarian Cancer National Alliance, the national advocacy organization for ovarian cancer. As Congressman Moran has said, I am a 13- year survivor of simultaneous breast and ovarian cancer, and I am here today to ask you to fund programs in the Labor, HHS and Appropriations bill that will help combat this cancer. In considering this request, please think of the sobering statistics of this cancer. About 22,000 women are diagnosed with ovarian cancer each year, and about 15,000 die from the disease. It is the fifth leading cause of cancer deaths among women, a statistic that has been unfortunately true for many years. Fewer than 20 percent of women with ovarian cancer are diagnosed with early stages of the disease, where survival is the greatest, and only 45 percent of women diagnosed will live more than five years. More than 70 percent of women who get the disease will have at least one recurrence; and when recurrence happens, within months after individual treatment, as is the case for many women, the cancer then responds to fewer and often less effective treatment options. I am happy to say that, so far, despite the classic late diagnosis and the presence of another cancer, I have beaten the odds, and I am pleased to be here more than 13 years after diagnosis and one year after a recurrence. I wish I had more company. There are three major programs that address ovarian cancer in this bill that will help me have more company. First is Johanna's Law: The Gynecologic Cancer Education and Awareness Act. Many of you have been vocal champions for this bill and I thank you for your work. The program has been funded for the past two years, allowing the Centers for Disease Control to begin a national awareness campaign about the signs and symptoms of gynecologic cancer. The law is named for Johanna Silver Gordon, who, like many women, had symptoms of ovarian cancer that she missed, as did her health care providers. Without a reliable early detection screen, our best hope now is for early detection is awareness among women and their health care providers of the signs and symptoms of the ovarian cancer. On behalf of the thousands of women that experience these symptoms, we ask that you appropriate $10,000,000 for this program for fiscal year 2010. But symptom awareness is just the beginning. We need better treatments for women who have the cancer, as well as a real understanding of how it works in the body. We do not know enough about who is at risk, how this disease develops, how to detect it early, and how to keep it in remission. Other than that, we are in good shape. Without sufficient basic and translational research, we will never have that knowledge. The National Cancer Institute funds SPORE programs, Specialized Programs of Research Excellence, which are cross- institutional research programs and an important research collaboration. One of these SPOREs is run by the Gynecologic Oncology Group, which runs many much needed clinical trials on ovarian cancer. In fiscal year 2008, NCI funded more than 500 research grants on ovarian cancer across a wide array of important issues. Please keep this critical research going and increase the appropriations for NCI to $6,000,000,000 for fiscal year 2010. Finally, CDC runs the Ovarian Cancer Control Initiative, a research program that includes risk perception and screening for women at high risk, clinical practices in the follow up of ovarian masses, and in the relationship between symptoms and time to diagnosis. This research is of critical importance, and on behalf of the women and families who are touched by or at risk of being touched by ovarian cancer, we request you increase its funds to $10,000,000. Despite these grim statistics, the research you have funded over the years has brought progress and years of life for women with ovarian cancer. On behalf of all of us, thank you for what you have done and we hope very much for your continued support in the future. I will take any questions you may have. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. AMERICAN SOCIETY OF CLINICAL ONCOLOGY WITNESS RICHARD L. SCHILSKY, M.D. Mr. Obey. Next, American Society of Clinical Oncology, Dr. Richard Schilsky. I am going to ask people to please hold it to four minutes so that we do get to hear everybody before the bells mess us up. Go ahead. Dr. Schilsky. Good morning, Chairman Obey, Ranking Member Tiahrt, members of the Subcommittee. Thank you for the opportunity to testify today. My name is Richard Schilsky. I am a medical oncologist at the University of Chicago and President of the American Society of Clinical Oncology. On behalf of ASCO's 27,000 members who treat people with cancer and conduct oncology research, I want to thank you first for your longstanding commitment to cancer research and highlight the critical importance of sustaining a robust and vibrant national clinical trial system through NIH and NCI. My testimony today will focus on the following points: We thank Congress and the President for the recent stimulus funding for NIH that will help cancer patients and provide significant boost to our local economies. We urge the Subcommittee to support the President's fiscal year 2010 budget proposal for NIH and a sustained multi-year commitment to increasing funding for cancer research. This Federal funding for cancer research is critical for a number of reasons, including to advance the best interest of U.S. patients, to support our next generation of cancer researchers, and to answer important questions about cancer diagnosis and treatment. ASCO applauds President Obama's call to cure cancer, and we strongly support the President's request of over $6,000,000,000 for cancer research within NIH and, importantly, his pledge to provide a multi-year plan to double Federal funding for cancer research. We believe that most of this funding should support work carried out through the extensive NCI network. This Country is poised to deliver on the challenge to cure cancer. Cancer deaths are decreasing and the survival rates for many cancers are increasing. These successes are largely the result of our publicly funded research system. However, the underlying research infrastructure is at a critical break point, endangered by a lack of predictable funding and the failure to keep pace with the growing costs of conducting research. We commend Congress for the additional $10,400,000,000 for NIH included in the stimulus bill. However, this funding has some limitations: it cannot fund multi-year research or stave off the impact of the 15 percent decline in purchasing power that NIH has lost since 2003. Only sustained funding into NIH and NCI's baseline can ensure the long-term viability of the U.S. research system. Sustained funding will also bolster our researcher workforce, our next generation of investigators, one of the most important resources to preserve our position as the world leader in medical innovation. These young people are questioning whether to pursue careers as clinician investigators. Most importantly, lack of adequate funding threatens the important trials being performed through NCI that provide access to innovative therapies for Americans in virtually every community where cancer care exists. Federally funded research answers questions that are fundamentally different from the studies that typically are supported by private companies. Federally funded research answers important questions regarding cancer diagnostics and treatments that improve patient care. As one example that reflects the movement toward personalized medicine, we now know that 40 percent of colon cancer patients have tumor with a particular gene mutation that makes certain drug treatments ineffective. By testing each patient with a colon tumor, we can customize their treatment regimens and care plans. Such research, while resource-intensive, promotes better outcomes for patients, avoids unnecessary treatments, and results in savings for our health care system. Thank you for the opportunity to present ASCO's views to the Subcommittee today. We look forward to continuing our longstanding collaborative work with you to provide improved clinical outcomes for all Americans who are faced with cancer. Thank you. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. ASSOCIATION FOR CLINICAL RESEARCH TRAINING WITNESS HARRY P. SELKER, M.D. Mr. Obey. Next, Dr. Harry Selker, Association for Clinical Research Training. Dr. Selker. Thank you for inviting me here today. My name is Dr. Harry Selker. I am past President and current Chair of the Advocacy and Public Policy Committee for the Association for Clinical Research Training, ACRT. ACRT is committed to improving the Nation's health by increasing the amount and quality of clinical research through the expansion and improvement of clinical research training. We also serve as a host organization for the National Alliance for Societies for Clinical Research Resources that coalesces in support of these goals. I want to start by thanking the Subcommittee for its strong commitment to improving health through the recently passed fiscal year 2006 Omnibus Appropriations package and the economic stimulus legislation. Both bills provided meaningful funding increases for our Nation's health sciences agencies, specifically National Institutes of Health and Agency for Healthcare Research and Quality. These will translate into improved treatments and health for our citizens. I want to address three issues that are critical to optimally leveraging the Country's investment in research and health care. To not address these is to not take advantage of the world's greatest biomedical research and medical care capabilities just when we need to. First, I want to talk about the importance of fully funding the NIH Clinical and Translational Science Awards, the CTSAs. In 2005, NIH announced an ambitious plan to create CTSAs at 60 universities, with the goal of transforming our Nation's biomedical research enterprise and become more effectively translational into improved health care. This is a major undertaking for NIH, but with the understanding that it will repay that investment many times over. Funding started for the first 12 CTSAs in 2006 with great promise; however, with increasingly constrained resources at NIH, NIH's National Center for Research Resources that administers the CTSAs and the Office of the Director curtailed CTSA funding. Thus, for the CTSAs started in 2007 and in 2008, upon funding, there were deep cuts, sometimes exceeding 50 percent of their budgets, as they had constructed them based on the RFA. Now, with improvements at NIH funding brought by the stimulus package and the fiscal year 2009 appropriations, NIH and NCRR could potentially restore full funding for the current 38 CTSAs going forward, but it is concerned about doing so because of the long-term commitment that would be needed for full funding of their goal of 60 fully-funded CTSAs. This deserves the attention and support of this Subcommittee. Second, I would like to bring to your attention the importance of restoring and growing K-Awards and T-32 awards for research, training, and career development. Last year, the Subcommittee showed strong leadership and urged NCRR to continue K-30 Clinical Research Curriculum Awards to support core needs in research training and career development at those institutions that do not have CTSAs. I am pleased to inform you that NCRR has complied with this request and recently issued the K-30 re-competition announcement. However, these K-30 awards support the curriculum to train the needed new generation of clinical and translational researchers, but they do not have funds for stipends or the tuition for the young physician investigators to actually take the courses. Thus, to leverage this growing capacity for training, there is a need to grow at NIH and AHRQ--not cut back, as they have done recently--K series research career development awards and T-32 training awards so that young researchers can participate in these K-30 and CTSA training programs. Third, and lastly, I want to emphasize the importance of continuing your support for Comparative Effectiveness Research, CER. The American Recovery and Reinvestment Act of 2009 contained $1,100,000,000 for CER activities, as was mentioned, at NIH and AHRQ. AHRQ has been the Federal focus for CER, especially since the Medicare Modernization Act, and NIH has been supporting CER for some time. We are pleased that Congress recognizes the importance of this work and that CER's proper home is in the health sciences agencies, where peer review process and infrastructure are in place to ensure the highest quality science, rather than at a new, untested funding entity. Thank you for this opportunity to share my views with you. Mr. Obey. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. GENETIC ALLIANCE WITNESS SHARON F. TERRY Mr. Obey. I am going to ask the remaining three witnesses to try to hold their testimony to about three minutes, because, otherwise, the last person on the list is going to have to wait about 45 minutes to be heard because of these votes. Next, Sharon Terry, Genetic Alliance. Ms. Terry. Chairman Obey, Ranking Member, and the Subcommittee, thank you very much for the opportunity to testify before you today on behalf of all Americans who seek therapies and treatments for genetic diseases. I did not choose this work as my career; this vocation was bestowed on me more than 14 years ago when my own children were diagnosed with pseudoxanthoma elasticum. In my capacity as President and CEO of Genetic Alliance, I serve the 10,000 health-related organizations in our network. I have four requests and one statement, all in the context of the organic linkages we as a society are experiencing in global finance, social networking, and so on. Number one, we ask that you focus a substantial amount of funding on health information technology that balances privacy with access; two, that HHS develop a strategic, long-term plan that involves innovative translational tools to enhance the clinical adoption of discovery research. We envision two projects under this: the first, a large cohort study enrolling millions of Americans; and, the second, increased and substantial funding for the newly established NIH Rare and Neglected Diseases Initiative. Through the NIH road map libraries, we have been able to identify disease probes, and it is time to bring them through to drug development. Three, a mandatory registry for genetic and genomic tests should be developed, and oversight of the clinical laboratory quality systems by the CLIA program should be strengthened. Four, the Health Resources and Services Administration should receive funding commensurate with its sister agencies so the focus can shift from basic research to treatment and services. And, finally, we must take our advocacy, research and services and policy to the next level and establish a collaborative approach. Until now, earmarking has been reflective of our collective understanding of this system and how to approach it. We now recognize that earmarking represents fragmentation and segmented communication. It is time to work together to bring us a systemic response. The collaboration that we seek on the Federal level must also take place in the nonprofit community. Many disease advocacy organizations move forward in an isolated manner to address their specific issues and needs, and historically, though progress has been made, these lessons are not shared with the community at large. This impedes the advances we need. Biology is systems based and, since sequencing the human genome, we know there are gene families, pathways, and other more effective ways to understand diseases. There are many examples of treatments and cures for diseases coming from an unexpected direction. Congressional earmarks for specific diseases have contributed to a siloed effect and have stifled progress for the greater good. It is possible they also stymie progress on that very disease. It is time to move away from earmarking as a solution. Every effort must be made to disseminate success and to learn from failures. We acknowledge that the budget and appropriation process must include prioritization and differentiation. We can go much further together. Let us step into the future as collaborators who build shared infrastructure that accelerate our work beyond anything what anyone can do alone. We look forward to partnering with you and the Federal agencies to create this network model. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. MEDICAL LIBRARY ASSOCIATION WITNESS HOPE BARTON Mr. Obey. Next, Medical Library Association, Hope Barton. Ms. Barton. Thank you very much for the opportunity to be here today. I am going to go in fast forward mode and maybe speak in some phrases and bullet points. My name is Hope Barton. I am a medical librarian from the University of Iowa, and I would like to thank the Subcommittee very much for the opportunity to speak today. I am here on behalf of the Medical Library Association and the Association of Academic Health Sciences Libraries, and we work very hard to support the critical role of the National Library of Medicine within the NIH. We are very pleased that in the 2009 funding package NLM received an $8,000,000 increase. This is the first meaningful increase we have received in a number of years, and we hope this is a very positive indication of momentum going forward and that there will be increased adequate increases as well every year. For 2010, we feel that a 7 percent increase would be adequate to keep momentum going, as we have gained a little bit of financing here, and we feel it is important for the databases and the programs that NLM serves. Our mandates have grown over the years and, as an example of this, the last session of Congress passed FDA amendment legislation that required NLM to play an increased role in the clinicaltrials.gov database. Unfortunately, no monies came with that mandate, so the NLM budget was stretched even further. NLM also plays a very important role in disaster preparedness and management, and got very important health information, environmental information to the Katrina area shortly after that hurricane. Very importantly, we would like to thank the Subcommittee for its leadership in the NIH public access policy. We feel this policy is very important for expediting medical research and also for getting health information out to the citizens of the Country. After all, it is taxpayers' dollars that helped to support the research and the new information that has generated, and we certainly hope that this Subcommittee will continue to support and defend this policy. Thank you again for the opportunity to speak today. Mr. Obey. Thank you. Appreciate it. Thanks for your cooperation on time. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Wednesday, March 18, 2009. FEDERATION OF BEHAVIORAL, PSYCHOLOGICAL, AND COGNITIVE SCIENCES WITNESS JAMES McCLELLAND Mr. Obey. And, last, Dr. James McClelland, Federation of Behavioral, Psychological, and Cognitive Sciences. Mr. McClelland. Thanks very much. Today, I will argue that it is essential for Congress to increase support for mind research at NIH because it will have a real impact on human health and human potential. Mr. Obey. Especially on the Congress itself. [Laughter.] Mr. McClelland. You know, scientific questions can be examined at many levels, and, in the case of the human sciences, these levels range from genes and molecules to organ systems, including the brain, to behavior, to social and cultural context. At the nexus of all these levels is the mind, our thoughts, perceptions, and emotions, the things we identify as ourselves. Mental process is influence and our influence by processes occurring at all other levels. This is why the sciences of mind, brain, and behavior are so relevant to human well-being and human productivity. It may seem natural to think of heart disease, physical injury, and illnesses ranging from cancer to the common cold as physical conditions disconnected from the mind and brain. But, in fact, research shows that people who have social relationships with many others are healthier and live longer than those with fewer relationships. What are the mechanisms, the biological and mental processes that lead from social support to better health and longer life? One study focused on married couples. Both members of the couple were admitted to the hospital and received a small skin wound. This occurred on two occasions. On one occasion, they had a discussion about how they support each other; on the other occasion they were induced to have a bit of an argument about a subject they usually disagree on. After the supportive discussion, their wounds actually healed faster. The work provides a striking demonstration of links across levels of analysis. There is a sound basis for thinking that social support works through the mind to affect more critical illnesses as well, including cancer and heart disease. Building on this base, NIH funding can now support research on the mental processes triggered by social support and on the effects of these processes on the biological response to illness and injury. If I have one more minute, I just want to make the point that research on the mind can have a huge impact on our children's success in school; not just figuring out how better to teach math or science, but figuring out how to help children think about their own abilities. A common theory is that it helps people to tell them that they are inherently capable, they have an innate intelligence. But recent research suggests that this is actually counterproductive. If you tell people that their brains are flexible, that they can make them grow, they are like a muscle and they can be strengthened with practice, it actually has a much better effect on their responses to challenge and their attitudes towards school and their ultimate educational achievements. This is new research, it is evidence-based, goes against intuition, and it is a very important demonstration that research at the level of the mind can really have an impact on outcomes. In my written testimony, I note many other issues that research on mind, brain, and behavior can address. These further points support the conclusion that sustained funding for research at NIH, including research on mind, brain, and behavior, will lead to significant discoveries and improved health for the American people. We urge the Subcommittee to support this important work. We recommend an increase for NIH of 7 percent over the fiscal year 2009 appropriations. We also urge comparable support for research on mind, brain, and behavior in other agencies under the Subcommittee's jurisdiction. Thank you very much. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. We have five minutes to make that vote, so we stand adjourned. ---------- Afternoon Session ---------- Wednesday, March 18, 2009. TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS Mr. Obey. Well, good afternoon, everybody. Let me thank all of you for coming. Let me thank the witnesses who will appear before us here today, and let me explain a couple of matters of procedure. I am going to have to insist that people limit their testimony to four minutes. If we don't, there are people who are never going to get heard because we have other things to do after this hearing is over today, and we can't ignore those responsibilities either. We also have a practical problem. There will be a number of votes that occur on the House Floor sometime around 3:00, and that will eat substantially into the time of the witnesses available. So I am going to ask all of the witnesses to hold their testimony to four minutes sharp. When that red light goes on, I am going to have to ask you to conclude your statement. As I said this morning, we have finished action on the recovery package, and we finished action on the Omnibus Appropriation Bill. Now we want to turn to the new budget for fiscal year 2010. The problem we have is that every time we have a new President, it takes a while for the Executive Branch to send down their budget request, and we do not yet have a budget request from the White House. I don't say that by way of criticism. It is normal, given the turnover of administrations, but it does create an inconvenience for this Committee and makes it much more difficult for us to do our work on the schedule we set. So we are trying to get as much work under our belts as possible, including public witnesses, and a number of other hearings, so that when we do get the budget we can move swiftly to analyze it, mark it up, and move on with the process. At this point, let me call on our new Ranking Member, Mr. Tiahrt, for any comments he has before we listen to the witnesses today. Mr. Tiahrt. Thank you, Mr. Chairman. Thank you for keeping us on track. We have covered a lot of territory today, and we appreciate the cooperation from the witnesses, and we are anxious to hear your testimony. Thank you, Mr. Chairman. Mr. Obey. One other thing, as I said, this morning. Please understand if you don't get questions from the panel, which is normal during this testimony, as it is not because of a lack of interest. We are simply trying to save as much time as possible for the witnesses. We have all heard each other's dulcet tones often. We will try to limit our enthusiasm, or, as Archie Bunker said to Edith once, we will try to stifle ourselves. [Laughter.] With that, let me ask Ms. Roybal-Allard to begin the process. Ms. Roybal-Allard. First, Mr. Chairman, let me thank you for having these very important public testimony hearings. And I just want to apologize in advance to the witnesses for having to leave early because I also have another hearing going on at the same time as this one, so I will to leave. Mr. Chairman, I have the privilege of introducing Mikayla Minnig, who will be testifying about the importance of funding arthritis research. Mikayla is a fifth grader who lives in the City of Downey in my Congressional district. Like many active 10-year-olds, Mikayla divides her time between school, Girl Scouts and cheerleading. But what makes Mikayla remarkable is that she has done all of this while battling juvenile rheumatoid arthritis that was diagnosed at the age of three. Mikayla is a courageous young lady who has chosen not to let this frequently debilitating disease control or limit her life. She has also chosen to be an active advocate for the Arthritis Foundation. Besides coming to Washington, D.C. to encourage Congress to increase funding for arthritis research, she has also raised money for that research herself by participating in the Orange County Foundation Arthritis Walk. Mikayla, I want to thank you for your courage and for taking the time to come to Washington to share your story before this Committee. You truly are an inspiration to all of us. Mr. Obey. We are glad to have you here. I hope you are getting better grades in the fifth grade than I did when I was in fifth grade. [Laughter.] Go ahead. ---------- -- -------- Wednesday, March 18, 2009. ARTHRITIS FOUNDATION WITNESS MIKAYLA MINNIG Ms. Minnig. Good afternoon. My name is Mikayla Minnig, and I live in Downey, California. I am here today on behalf of the nearly 300,000 kids like myself who have juvenile arthritis. I am 10 years old and in the fifth grade. I was diagnosed with pauciarticular juvenile rheumatoid arthritis when I was just three years old. Pauciarticular means it affects four or fewer joints and usually large joints. For me, it affects my left knee and ankle. I also am at high risk for eye inflammation and must have them checked often so I don't become blind, which could happen. It all began when I felt a lot of pain and swelling in my neck. I couldn't walk or run like the other kids, and I couldn't turn my head. For many months, I went to a lot of different doctors to figure out what was wrong with me. Some of these doctors told my parents I must have bad growing pains or must be faking the pain and tears. Finally, we were sent to a pediatric rheumatologist, a doctor who treats kids like me with juvenile arthritis. Dr. Starr said I had arthritis. My parents were surprised. They didn't know, like most people, that kids got arthritis too. In fact, most people don't know that juvenile arthritis is one of the leading causes of disability in common childhood diseases in the United States. People are surprised when I tell them I have arthritis because I don't look very different from other kids. But unlike other kids, I take a cancer drug every week plus daily medication to help control my arthritis, and it helps me try and lead a normal kid life. I have met other kids through the Arthritis Foundation who are not as lucky as me. The drugs don't work for them, and they end up in wheelchairs or have to have joints replaced. In fact, juvenile arthritis is the leading cause of disability in kids. I also am lucky to be able to see a doctor who understands and can treat my disease. Kids in nine States don't have a single specialist to see them. I am here today to ask Congress to focus more attention on kids like me with arthritis. Research is the key to a cure. Research has led to newer drugs that help kids stay out of wheelchairs, but these drugs can have really bad side effects. We need a cure. Right now, the government spends $9,800,000 at the National Institutes of Health for juvenile arthritis research. That sounds like a lot of money to me, but when you think of the nearly 300,000 kids, that works out to be just about $32 per child. There is a group of pediatric rheumatologists who are working together to study and treat children with arthritis, but they need your help. With more funding and attention from Congress, more research studies can move forward to help find a cure. The Arthritis Foundation supports at least a doubling of juvenile arthritis research over the next few years. Also, the NIH should spend more money training future doctors. Thousand of kids around the country are diagnosed too late to prevent damage. Please help change this. I hope one day when I tell people I got arthritis at age three and they say, but kids don't get arthritis, I can tell them, you are right, not any more because research has found a cure. Thank you for the opportunity to speak to you today. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. [Applause.] Thank you very much for sharing your story with us. Next is Dr. Schraufnagel, TB Coalition. We are sorry about the order that we put you in. You get extra points for that. [Laughter.] ---------- Wednesday, March 18, 2009. TB COALITION WITNESS DR. DEAN SCHRAUFNAGEL, M.D. Dr. Schraufnagel. That is a tough person to follow. I am Dean Schraufnagel. I am a professor of medicine in the Department of Pulmonary and Critical Care Medicine at the University of Illinois in Chicago. And, for Congressman Obey, I grew up in Mason, Wisconsin, a town of only about 65 people these days. Mr. Obey. They vote right. [Laughter.] Dr. Schraufnagel. I also serve as Vice President of the American Thoracic Society, and I am here to speak on behalf of the TB Coalition which is a network of public health research professional and advocacy organizations working to support policies to eliminate tuberculosis in the United States and around the world. There are three points I want to make: First, tuberculosis is a problem in the United States. Second, we will never defeat tuberculosis until we develop new diagnostic tools, anti- tuberculosis drugs and an effective vaccine. Third, Congress passed an historic law reauthorizing the Nation's domestic TB program. Appropriate funding of this law will put the U.S. back on the right path toward tuberculosis elimination. As you know, TB is an airborne infection caused by a bacterium. It is spread by cough, so that we are all vulnerable. It is the second leading global cause of death for infectious disease, claiming about 1.7 million lives per year. It is estimated that nine to fourteen million Americans have latent tuberculosis. According to a February, 2008, World Health Organization report, resistant TB accounts for about 5 percent of all new TB cases in the world. Although drugs, diagnostics and vaccines for TB exist, these technologies are antiquated. The most commonly used TB diagnostic in the world, sputem microscopy, is more than 100 years old and lacks the sensitivity in many HIV/TB cases and in children. Current diagnostic tests to detect drug resistance take at least one month to complete and in that time the TB can spread to others. The TB vaccine, BCG, provides some protection to children but has little effect in preventing adult pulmonary tuberculosis. There is an urgent need for new anti-TB treatments and particularly for a shorter drug regimen. There is also a critical need for drugs that can safely be taken concurrently with the anti-retroviral drugs used for HIV. The good news is that these drugs are in development and hold promise for shortening TB from six to nine months to two to four months. In the United States, TB cases continue to decline, although the progress has slowed in the last few years. Foreign-born and ethnic minorities bear a disproportionate burden of the domestic TB rate. U.S.-born blacks make up almost half, 45 percent, of all TB cases among U.S.-born. Border States and States with high immigration such as California, Texas and New York are among the highest burdened TB States. Drug resistance poses a particular challenge to domestic TB control due to the high costs and intensive treatment required. The costs for treating drug-resistant tuberculosis may range from $100,000 to $300,000 per case, which can be a significant strain on the State public health budget. In-patient costs have been estimated by the California XDR for extremely drug resistant TB to be up to $600,000 per patient. The U.S. Public Health Service has the expertise to eliminate TB, but many State programs are seriously under- resourced. In recognition of the need to strengthen domestic TB control, Congress passed the Comprehensive Tuberculosis Elimination Act of 2008. This historic legislation was based on the recommendations of the Institute of Medicine to revitalize the CDC and NIH programs. We recommend that you give the full level of $210,000,000 in fiscal year 2010 for CDC's Division of Tuberculosis Elimination as authorized by the Comprehensive TB Act. In conclusion, Mr. Chairman, the U.S. stands on the brink of being able to eliminate tuberculosis. What is needed is U.S. leadership to reduce the global pandemic as called for by the Lantos-Hyde Leadership Against AIDS, TB and Malaria Act and the appropriate allocations of resources for domestic TB control and research that are called for in this Act. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. We appreciate your testimony. Next, Mr. Neil Horikoshi, Aplastic Anemia and MDS International Foundation. ---------- Wednesday, March 18, 2009. APLASTIC ANEMIA AND MDS INTERNATIONAL FOUNDATION WITNESS NEIL HORIKOSHI Mr. Horikoshi. Good afternoon and thank you very much for the opportunity, Chairman Obey and Ranking Member Tiahrt. Most of the people in this room today have probably never heard of bone marrow failure disease, let alone the words, aplastic anemia, myelodysplastic syndromes, as well as PNH. But this strikes home very close to Congress as these diseases have hit members of your family, including Congressman Joe Moakley and Congressman Bob Matsui. So, for me, I am affiliated with this organization, the Aplastic Anemia and MDS International Foundation as Chair in part because I am an aplastic anemia patient myself, and I came within 48 hours of death. In my darkest hours, I looked exactly like this. If you think about your colleagues and what happened just before Christmas of 2004, Congressman Bob Matsui was in his office. On January 1, 2005, he passed away. He looked like me. He looked exactly like me. He went to the office. So what happened? What happens is it happens inside of one's body. Bone marrow fails. You fail to produce blood. And I am going to explain what that means for the various diseases. In my case, it was all about taking the last physical, getting a blood exam and finding out I didn't have any blood in me. That is coming very close. So, hence, I dedicate myself to supporting this organization and what bone marrow failure means to other Americans. Aplastic anemia is the condition where one's body is not able to produce any blood. MDS, which is what Bob Matsui and Joe Moakley had, are the conditions where they were able to produce some blood, but the blood was defective. And PNH is the condition where you are able to produce blood, but your immune system ends up destroying that blood. These are all very, very rare diseases often called orphan diseases, in a nutshell. So, hence, there hasn't been much focus on the topic overall. Roughly, 20,000 to 30,000 Americans get these types of diseases each year. One of the things that I will ask for, and I know it is not within the jurisdiction of this Subcommittee, but I would ask all members sitting before me today to look at H.R. 1230, the Bone Marrow Failure Disease and Treatment Act of 2009 which increases the surveillance efforts at CDC and also creates a Bone Marrow Failure Registry. This legislation was introduced by Congresswoman Doris Matsui after she lost her husband, and I am sure your colleague and friend, Bob Matsui. I would also ask this Subcommittee to seriously consider the appropriate appropriations once this bill is passed. And I also urge this Subcommittee to continue to focus on its ongoing research to NIH because but for the work that individuals such as Dr. Neal Young, who did the necessary work some years ago to find at least treatment for aplastic anemia, I really wouldn't be here in front of you today. Twenty-five years ago when our organization was founded, the death rate of anyone with aplastic anemia was 100 percent. One hundred percent. Fifteen years ago, had I received this disease, it was still about 50 percent. I am one of the lucky few that made it through in the 50 percent. So ongoing funding to NIH is extremely important to us. Lastly, I ask that the full Appropriations Committee continue to be very cognizant of the work that is going on for the Bone Marrow Failure Disease Research Program that DOD has embarked upon and to fund this program to the increased funding of $7,500,000 from $5,000,000 today. Thank you very much. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. We appreciate your sharing your story with us, and we wish you well. Next, Ms. Linda Rosenberg, National Council for Community Behavioral Healthcare. ---------- Wednesday, March 18, 2009. NATIONAL COUNCIL FOR COMMUNITY BEHAVIORAL HEALTHCARE WITNESS LINDA ROSENBERG, MSW Ms. Rosenberg. Thank you. Good afternoon, Chairman Obey and members of the Subcommittee. My name is Linda Rosenberg, and I am the President and CEO of the National Council for Community Behavioral Healthcare. The National Council represents 1,600 community mental health centers and safety net agencies. Collectively, they serve over six million low-income children and adults with mental health and addiction disorders. Mr. Chairman, the public mental health system confronts twin crises. First and foremost, the mortality rates among persons with serious mental illnesses are shocking. According to a 2006 SAMHSA survey, persons with conditions like schizophrenia and bipolar disorder die, on average, 25 years sooner than other Americans. Most people with serious mental illnesses will not live to see their fiftieth birthday. This constitutes the highest death rate among any population by any agency of the U.S. Public Health Service that receives funding from this Subcommittee. These horrific mortality rates are primarily caused by co-occurring medical illnesses: asthma, diabetes, cancer, heart disease and pulmonary conditions. That is why, Chairman Obey, we owe you a great debt. In the appropriations legislation passed last week, you fought for the inclusion of $7,000,000 to co-locate primary care capacity in community mental health organizations. This integrated care model will enable us to do little things like take a patient's blood pressure and big things like make sure a person who has schizophrenia and heart disease gets to see a cardiologist. We always appreciate your willingness to both listen and to take action. A parallel crisis we confront is the economic downturn. The State of Illinois is preparing to close 5 community mental health centers in Chicago, cutting psychiatric capacity in that city by 40 percent. In Iowa, the counties are running out of mental health dollars, and the State just announced a 6.5 percent mental health cut across the board. And I should note that these consumers do not just disappear. Their outcomes are bad. They wind up in State mental hospitals. They wind up in nursing homes. They wind up in jails, and they wind up on the streets. At the same time that these cuts are being enacted, community mental health centers are reporting a surge of newly unemployed people seeking services. A survey we took indicates a 20 percent increase in psychiatric intakes. In Colorado, members are serving a record number of people, 90,000 men, women and children. In New York, providers report a 30 percent increase in demand for psychiatric treatment. We cannot also ignore the ravages of addiction. Addiction affects one in ten Americans and one in four children. State and local governments fund half of the substance abuse treatment in this country, and the current economic downturn is resulting in addiction service reductions across the country. While the Recovery Act was helpful to us, particularly the Medicaid policy changes, we are turning to this Committee for additional Federal support, and, specifically, we have three priorities. First, a $35,000,000 increase for the Integrated Mental Health Primary Care Program. As you well know, these funds help us to save lives. Furthermore, the funding increment we are asking for is consistent with the second year of funding for the Children's Mental Health Services Program, another vital program that you started. Second, a $100,000,000 increase for the SAMHSA Community Mental Health Services Block Grant. I should note that the block grant has not had an increase in a decade and has lost 50 percent of its purchasing power. The additional funds would flow directly to community mental health providers and States hit with budget deficits and high unemployment. Third, a $150,000,000 increase to the Substance Abuse Prevention and Treatment Block Grant. This increase will go a long way to ensuring that our Nation's addiction treatment system can respond to increasing demand. We know that you are confronted with difficult choices in the 2010 appropriations cycle, but, Mr. Chairman and members, we can assure you these new dollars would be wisely spent, helping those in need and providing central primary care services to persons with serious mental illness. We thank you for the opportunity to testify. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. Just two comments, I guess. With respect to your comments about State budgets squeezing mental health services, what I find frustrating is that whenever we have tough times, well, especially when we have tough times, we usually see a squeeze on those services. People seem to think that both of those aren't real problems, and, as you know, they are. Secondly, I am pleased that we were able to provide the $7 million last year. What we are trying to do is to see that the patients are handled in an integrated manner, and I think that is fully consistent with what the Administration is talking about with respect to creating incentives in their health reform legislation that will see to it that the treatment of patients, while they are being treated, is on an integrated basis and, that there is still an after-the-event coordination as well. Ms. Rosenberg. We thank you so very much, all of you. Mr. Obey. Next, Dr. Paul Kirwin, American Association for Geriatric Psychiatry. ---------- Wednesday, March 18, 2009. AMERICAN ASSOCIATION FOR GERIATRIC PSYCHIATRY WITNESS DR. PAUL D. KIRWIN, M.D. Dr. Kirwin. Thank you, Mr. Chairman and members of the Subcommittee, and thank you for the privilege of being here to be able to talk about the mental health needs of the elderly. I am a practicing geriatric psychiatrist and on the Board of Directors of the American Association for Geriatric Psychiatry. I also serve as the program director for a geriatric psychiatry fellowship at Yale University School of Medicine. As medical school faculty, I often ask my own students if they have a grandparent that is still alive, so that our teaching points can be relevant and real and personal. As I look at the members of this Committee and the staff behind you, I wonder how many of you have an aging grandparent or parent that might need assistance one day. Mr. Obey. I am an aging grandparent. [Laughter.] Dr. Kirwin. You don't look it. I saw patients in my clinic yesterday, one man, a decorated Korean War veteran, frozen with Parkinson's disease, now in social isolation in a nursing home, struggling with depression. I also saw another gentleman with a new onset diagnosis of prostate cancer, who also was struggling with depression. And, an 80-year-old woman who was searching to remember the names of her own children and memories that kept her life cohesive and intact, now ravished with progressive dementia. These could be our loved ones, and maybe you have people in your family with similar ailments--a favorite raucous uncle who used to take you skiing with your cousins, a grandmother who brought you to her home for Sunday dinner, a mother who laughed and cried with joy as you stepped off a graduation podium. These people are with us now in our lives. This is not an abstract concept. As you know, the Baby Boom generation is nearing retirement. Shortly, there will be approximately 40 million people in the United States over the age of 65. Many estimates predict that at least 20 percent of those people will suffer with some form of mental illness in the sunset of their lives. The economic, emotional and family costs of dealing with late life mental illness are staggering, as you know. Efforts to prevent and treat these disorders are critical to our Nation's health. The AAGP believes that three key issues need to be addressed. First, workforce issues. As a training director, I know how dire it is to recruit people into our field to treat people with late life mental illness. Last spring, the Institute of Medicine released a study of the Nation's health care workforce to meet the needs of an aging population which called for immediate investments in preparing our health care system to care for older Americans and their families. While providing vital information on many issues regarding the health care of older adults, the 2008 report didn't delve deeply into the mental health care needs. The AAGP believes that a complementary study must be undertaken to consider vital areas of concern. We have the support of the IOM for an additional study and have been advised by IOM staff that the study would cost about $1,000,000. Second, the lack of funding for mental health research focused on older adults. Funding for increases in the NIH and NIMH budget are critical and to have those funds focused on not just the broader mental health needs but those specifically of older Americans. And, lastly, the need for adequate funding for mental health outreach and treatment programs for the elderly under the Center for Mental Health Services. I appreciate the Committee's patience and having us present before you. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. We appreciate your testimony. The next party on the list I am told is not here, and so we will move to Christine Lubinski, Infectious Diseases Society of America. ---------- Wednesday, March 18, 2009. INFECTIOUS DISEASES SOCIETY OF AMERICA WITNESS CHRISTINE LUBINSKI Ms. Lubinski. Good afternoon. IDSA is pleased to testify about the urgent need to increase funding for HHS programs that address two deadly global pandemics: HIV/AIDS and tuberculosis. IDSA and its sister organization, the HIV Medicine Association, represent more than 8,000 infectious disease and HIV physicians and scientists. In 2008, IDSA and HIVMA launched the ID Center on Global Health Policy and Advocacy to address global HIV, TB and HIV/TB co-infection. U.S. leadership has been a catalyzing force in saving millions of lives from HIV, but only about one-third of persons in developing countries who are clinically eligible for treatment are receiving it, and prevention strategies to reduce the more than 7,000 new HIV infections that occur daily are urgently needed. CDC's Global AIDS Program helps poor countries prevent HIV infection, improve treatment care and support for people living with HIV and build health care capacity. An fiscal year 2010 funding level for CDC GAP of $225,000,000 is essential to fulfill its mission as the lead agency on global HIV prevention and public health systems strengthening. TB is the second leading global infectious disease killer, claiming more than 1.7 million lives every year. Highly drug-resistant forms of TB have emerged. Drug- resistant TB is a direct result of human failure--failure to adequately treat TB and develop the tools necessary to address this ancient and deadly scourge. The increase in multi-drug resistant TB and the emergence of extremely drug-resistant TB raise concerns about the potential for an untreatable XDR TB epidemic. The global spread of drug-resistant TB presents a persistent public health threat to the U.S. TB is an airborne infection. Drug-resistant TB anywhere in the world translates into drug-resistant TB everywhere. Last year, Congress passed the Comprehensive TB Elimination Act of 2008 to enhance our capacity to address drug-resistant TB and escalate development of new tools, drugs, diagnostics and vaccines. Promises made in this law can't be fulfilled without funding. The $210,000,000 funding level authorized in the law should be appropriated for the CDC Division of TB Elimination. IDSA is extremely pleased that the stimulus bill contained an infusion of desperately needed dollars for NIH. This long overdue increase must be maintained and enhanced in this year's bill. The success of HIV research is a testament to the value of research investment. A comprehensive research portfolio was responsible for the rapid and dramatic gains in HIV knowledge that led to an 80 percent reduction in AIDS mortality in the U.S. and in developing countries. Continued investment is essential to develop more effective prevention strategies and better treatment to aid prevention. NIH funding for TB totaled $160,000,000 in fiscal year 2008, a modest level for an infectious disease that kills millions through a pathogen that is showing increased resistance to available drugs. We must have resources for trials on new TB drugs, to test diagnostics, to evaluate vaccine candidates. Research activities focused on HIV/TB co-infection must continue. TB is the leading cause of death among persons with AIDS, and it is more difficult to treat in people with HIV. Living with HIV and dying from TB has become an all too familiar mantra. A doubling of funding for TB research is a reasonable response to the world disease burden and the scientific opportunities. Finally, we support funding for the Global Fund to Fight AIDS, TB and Malaria. It provides a quarter of all international financing for AIDS globally, two-thirds for tuberculosis and three-quarters for malaria. The Global Fund has helped save 3.5 million lives in 140 countries. Thank you very much. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. We appreciate your testimony. Next, Helen Keller International, Robert Thomas, Jr. ---------- Wednesday, March 18, 2009. HELEN KELLER INTERNATIONAL WITNESS ROBERT M. THOMAS, JR. Mr. Obey. Who is that strange fellow with you? Mr. Thomas. I think it is someone you know, actually. Mr. Obey. Okay. Mr. Thomas. Thank you very much for this opportunity for Helen Keller International and me to testify on behalf of HKI's ChildSight Program. My name is Bob Thomas. I am a volunteer trustee of HKI. HKI was co-founded in 1915 by the deaf and blind crusader, Helen Keller, as a lead nonprofit organization dedicated to preventing the causes and consequences of blindness, poor vision and malnutrition. I am requesting that you recommend continued funding of ChildSight through the U.S. Department of Education in fiscal year 2010. ChildSight's mission is to improve the vision and academic potential of school children living in urban and rural poverty. Uncorrected refractive error, what most of us know more commonly as nearsightedness, farsightedness and astigmatism, two of which I have, significantly affects a child's academic performance and overall development. ChildSight's data, collected over 15 years, confirm that up to 1 in every 4 children between the ages of 10 and 15 fail standard vision screenings. There is a simple, very cost- effective solution: prescription eyeglasses. However, millions of children in the U.S. suffer from uncorrected vision due to social, economic, transportation barriers as well as inadequate treatment under existing school health programs. ChildSight tackles this challenge by going directly into schools with populations of children from poor families. The hallmark of the ChildSight program is the provision of prescription eyeglasses at the school. I recently visited one of our sites in New York City. This was a middle school on the edge of Chinatown. The population there was mainly Oriental, children of Oriental extraction from various parts of the Far East, and African American children. It was done in the school library, which was a very warm and well-used place I might note, and I am afraid it was the first time I had been in a public school for a long time. We had volunteers there who conducted initial screenings which basically consist of reading the eye chart with the big E at the top that we are all familiar with. Anyone that showed any possible problems was then referred to one of the two optometrists that we had there that day. They were both extremely good with these children, very engaged with them, and you could see that the children easily talked to them about what their problems were. They examined their eyes and wrote a prescription. The child was then sent to a table where we had 30 or 40 different frames for these glasses available, and this is a key part for the children because if we can't find them something that either is acceptable or even cool they won't wear them. And they pick out the frame. One week later, after we have sent off the prescriptions to a manufacturer, we come back and the frames, and the glasses are distributed to the kids and adjusted as necessary. I brought a couple of pictures of the results here. One might say some of our satisfied customers. With support from this Committee, the Department of Education and private donations, ChildSight has now screened over 1.2 million children in 7 States and has delivered free eyeglasses to 139,000 students since the program's inception in 1994. Teachers report that a majority of the students who have their vision corrected with ChildSight glasses exhibit increased class participation and improved grades. I ask the Committee to recognize our concern that much more needs to be done. Children who need eyeglasses must have them while they are in school, so they can make full use of their educational opportunities. I ask the Committee to recommend at least $1,800,000 in fiscal year 2010 to support ChildSight in its current locations and to expand our sites so that, as we say, we can bring education into focus. Thank you, Mr. Chairman. The attention and consideration of the Committee are greatly appreciated. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. We appreciate your testimony. Next, National Association of State Alcohol and Drug Abuse Directors, Flo Stein. ---------- Wednesday, March 18, 2009. NATIONAL ASSOCIATION OF STATE ALCOHOL AND DRUG ABUSE DIRECTORS, INC. WITNESS FLO STEIN Ms. Stein. Chairman Obey, Ranking Member Tiahrt, members of the Committee, I am Flo Stein. I am the President of the National Association of State Alcohol and Drug Abuse Directors. We call it NASADAD. The members of NASADAD manage the publicly- funded addiction services in all of the States and territories. I serve as the Director of Substance Abuse in the State of North Carolina, and I want to thank you very much for offering us this opportunity to provide testimony. We are very grateful for this Committee's leadership in providing funding for the States' addiction and treatment and prevention systems. I have submitted a more detailed report that you can look at. It shows some of the issues going on in particular States and some of the outcomes those States are having. For today, I am going to focus on three important points regarding our top priority, and that is an increase in the Substance Abuse and Prevention Block Grant of $150,000,000. That program currently receives $1,780,000,000. It is a very large block grant, but I think it is important to remember that it is the foundation of the Nation's treatment system. The block grant represents half of all the dollars available in my State, for instance. In the State of Wisconsin, it represents about 48 percent of all the dollars spent. The other primary source of financing for the public addiction, prevention, treatment and recovery system is State appropriations. So it is sort of like very limited streams of funding that come to the addiction treatment system. A second point that I think is really important that I think we might finally be successful is that we are getting outstanding results. We have partnered with the Substance Abuse and Mental Health Services Administration on the National Outcome Measures. The States are showing very much improved outcomes for people gaining recovery. For example, in 2008, all the States together, 63 percent of the people who received treatment were abstinent from illicit drugs, having come in being drug users and leaving treatment and recovery, and 7 percent abstinent from alcohol use. The third point is one that you are hearing about quite a bit, and that is that the system, because it is so dependent on this important block grant, is very much under stress right now. We have increasing numbers of people needing services as the economy declines. Unfortunately, more and more people cope with the stress of their situation by sometimes using alcohol and other drugs. And, as you have heard, alcohol and drug abuse contribute to all the leading causes of death: the chronic illnesses, heart disease, stroke and cancer. So it is an important investment. That is the backdrop to the request that we are asking for $150,000,000 increase in the block grant. The block grant has been stable for a number of years. We are very grateful to this Committee for the additional $19,900,000 this past year. It is going to make a big difference. But because the block grant had been level funded for a number of years since 2004, we are not quite back to the original purchasing power that we had. So I think it is an important investment in the future of our Country. Again, thank you for your leadership, and we stand ready to answer any questions or provide additional information. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. Ms. Lee. Mr. Chairman, may I just ask one quick question, please? Mr. Obey. Sure. Ms. Lee. Thank you very much. Let me ask you, and I know this would entail a longer discussion, but I want to ask you about the treatment approaches and funding now for prescription drug use as it relates to recovery versus the illicit drug use. How is that working at this point? Ms. Stein. I can specifically for my State, but we have also had a number of discussions with the States that are members of NASADAD. This is our fastest growing problem both for children and adults but more alarmingly for children. What we are doing is just refocusing our dollars. We have the same number of dollars, and we are trying to develop new intervention techniques and especially working with families because the source of a lot of prescription drugs is actually people's homes. So we want parents to be more aware and be watching their children. We would be glad to send you some further ideas about what can be done. Mr. Obey. Thank you. Thank you very much. Let me tell the Committee that I am told that between 3:00 and 3:30 we will have the next series of votes. That means that we will be gone for 30 to 40 minutes. So, if we get lucky and that vote comes closer to 3:30 than 3:00, we might be able to finish all of our witnesses before we have to leave them in the lurch. Let me next call upon the Association of Maternal and Child Health Programs, Phyllis Sloyer. ---------- Wednesday, March 18, 2009. ASSOCIATION OF MATERNAL AND CHILD HEALTH PROGRAMS WITNESS PHYLLIS SLOYER, PH.D., R.N. Ms. Sloyer. Good afternoon, Mr. Chairman and Subcommittee Members. I am grateful for the opportunity to testify on behalf of the Association of Maternal and Child Health Programs, its members and the millions of women and children that we serve through the Title V Maternal and Child Health Services Block Grant every year. I am Dr. Phyllis Sloyer. I am the current President of AMCHP, and I am also a division director in the State of Florida. I am here today to respectfully ask the Subcommittee to support full funding for the Maternal and Child Health Services Block Grant at its authorized level of $850,000,000, and I want to begin with Adam's story. Adam is a 15-year-old from Milwaukee, Wisconsin, a cute guy. I am going to paraphrase in his words the benefits that he has received from this Title V block grant. He says: Hi. My name is Adam, and I live in Milwaukee, Wisconsin. I have a very rare genetic disorder that affects my ability to see, to learn and to move, and Title V services have been very important to me. His mother says: It is great to see that more services are becoming available through the funding, especially the five regional centers in the State of Wisconsin. These centers are dedicated to meeting family needs through information referral, follow-up services, parent-to-parent support and the building of a tremendous network of providers who help children with special health care needs. He wants you to know that families with kids who have special needs really do benefit from these services, and he wants us to help him so that other kids can get the services as well. He says, thanks. Now we know that two of these centers are actually in Chairman Obey's district. One is at the Chippewa County Courthouse, and the other one is at the Marathon County Health Department, and they are not unusual. We have used Title V funds throughout the Nation to develop similar centers and similar networks to help children like Adam. But I would like to point out a few high points about Title V and Title V of the Social Security Act. It was created during the Great Depression. It is a unique Federal-State partnership that is dedicated solely to improving the health of all mothers and children including children with special health care needs. I can't begin to tell you the millions of people that have received early prenatal care, child health screening, preventative services, support services because of this block grant. I also can't begin to tell you the kinds of systems of services that we have developed because of these funds. While we have made great strides in preventing long-term problems, the data are indicating now that we need to bolster our actions. Every 18 minutes, a baby dies before his or her first birthday. Basically, a dozen of them will die before the end of my testimony. Globally, we are 29th in infant mortality. We are failing to adequately screen all young children for developmental issues. I think you all know about the obesity problems and the health disparity problems. And only 50 percent of children with special health care needs actually receive comprehensive care through a medical home. Third, we have a proven track record of measuring what we do, and that data are fairly transparent, but it is beginning to tell us that we have a demand for services that is going beyond our capacity. Our States are facing significant economic challenges. Frankly, every day, I have a ten-fold increase in the number of people that are coming to us for services, whether they are prenatal care, whether they are preventative services, whether they are screening services. Our block grant is at its lowest funding level of $662,000,000 since 1993. We need the additional resources not for us but for the women and children who come to us. I urge you to consider full funding at $850,000,000. And I close with the story of Ashley in my State, whose mother had to make a decision between getting the eyeglasses her daughter needed to stay in school or the drugs that her daughter needed to be in a regular classroom. Through the efforts of Title V and coordinating with other agencies, she is in a regular classroom, and she is grateful that she is as a teenager. For all the Adams and Ashleys and the millions served by this remarkable block grant, thank you for the opportunity to share our story and thank you for your leadership. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. Now, Health Professions and Nursing Education Coalition, Dr. Tina Cheng. ---------- Wednesday, March 18, 2009. HEALTH PROFESSIONS AND NURSING EDUCATION COALITION WITNESS DR. TINA L. CHENG, M.D. Dr. Cheng. Good afternoon. My name is Tina Cheng, and I am Chief of the Division of General Pediatrics and Adolescent Medicine and Professor of Pediatrics and Public Health at Johns Hopkins University up the road, and it is a pleasure to speak to you today on behalf of the Health Professions and Nursing Education Coalition or HPNEC in support of $550,000,000 in fiscal year 2010 for the health professions education programs authorized under Title VII and VIII of the Public Health Service Act and administered through HRSA. HPNEC is an informal alliance of more than 60 national organizations representing schools, programs, health professionals and students dedicating to ensuring the health care workforce is trained to meet the needs of our diverse population. As you know, the Title VII and VIII health professions and nursing programs are essential components of the Nation's health care safety net, bringing health care services to our under-served communities. These programs support the training and education of health care providers to enhance the supply, diversity and distribution of the health care workforce, picking up where traditional market forces leave off. In particular, the programs emphasize primary care and training in interdisciplinary settings to meet the needs of special and under-served populations. We are thankful to the Subcommittee for the $200,000,000 provided for the health professions programs in the American Recovery and Reinvestment Act. We also greatly appreciated the recently enacted fiscal year 2009 Omnibus Appropriations Bill provides increases for most Title VII and VIII programs. The Nation is indebted to you, Mr. Chairman, as well as members of the Subcommittee for your forward-thinking vision. We cannot achieve universal access to health care and quality care unless we ensure that a well-prepared health care workforce is in place to provide that care. Today, however, we remain a long way from realizing that vision. According to HRSA, an additional 30,000 health practitioners are needed to alleviate existing health professional shortages. Combined with faculty shortages across health professions disciplines, racial and ethnic disparities in health care and a growing chronically ill and aging population, these needs strain an already fragile health care system. In my own experience at Johns Hopkins, in collaboration with the University of Maryland Family Medicine Program, Title VII dollars have allowed us to train clinician educators and researchers who are the primary care faculty across the Country. We have a commitment and a strong track record of training under-represented minorities and, in the last two decades, have trained almost 100 pediatric and family medicine trainees, 61 percent of them, under-represented minorities, most all serving under-served populations today and most doing research on health disparities. As noted while I was on HRSA's Advisory Committee on Training in Primary Care Medicine and Dentistry, the education and training of our health care providers is an integral part in preparing our Country to meet the health needs of the future as well as current and growing health needs, many that you have heard about already today: mental health, global health issues, et cetera. Because of the time required to train health professionals, we must make appropriate investments today. HPNEC's $550,000,000 recommendation for Title VII and Title VIII health professions programs will help sustain the health care workforce expansion supported by funding in the recovery package. Further, this appropriation will restore funding to critical programs that still have not recovered from the substantial funding lost in the drastic fiscal year 2006 cuts. We are grateful to President Obama for his support of the health professions program throughout his tenure in the Senate. We also appreciate the pledge in his fiscal year 2010 budget to invest in strengthening the health professions workforce. We look forward to working with the Subcommittee to help achieve this goal and to reinvest in the health professions program. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. Next, American Dental Education Association, Dr. James Swift. ---------- Wednesday, March 18, 2009. AMERICAN DENTAL EDUCATION ASSOCIATION WITNESS DR. JAMES Q. SWIFT Dr. Swift. Good afternoon, Mr. Chairman and members of the Subcommittee. I am Dr. Jim Swift, I am the Director of the Division of Oral and Maxillofacial Surgery at the University of Minnesota, and I am here today as the Immediate Past President of the American Dental Education Association which is also called ADEA. Thank you for your unwavering support of the SCHIP legislation which recognized that oral health care was an important component of children's overall health care, and I also appreciate your earlier comment about the mental and dental component, of the importance of dental care to systemic health. We request a build-upon funding of the American Economic Recovery and Reinvestment Act and your Committee's 2010 fiscal year appropriations. We applaud, Chairman Obey, your decision to provide $500,000,000 to address health care professional shortages and $200,000,000 to the Title VII health professional programs and $300,000,000 through the Recovery Act. Additionally, President Obama's budget blueprint for 2010 builds upon the down payment made in the economic stimulus package by investing $300,000,000 to increase the number of physicians, nurses and dentists practicing in under-served areas of this Country. This afternoon, I would like to discuss our budget recommendations under three areas: dental education, dental research and access to oral health care. Specifically, I would like to urge Congress to provide $16,000,000 for dental Title VII health profession programs and $117,000,000 for Title VII diversity and student aid programs. The dental health professional programs support general practice residency training programs as well as pediatric dental training programs to provide access to care and the training that is necessary to provide our dentists to be trained in a way to be able to access this patient population. The diversity and student aid support will allow us to get under-represented minorities into our profession to provide care that is needed in those communities. Secondly, we urge Congress to provide $33,000,000,000 for the National Institutes of Health, specifically of which $441,000,000 would be allocated to the National Institute of Dental and Craniofacial Research. I think many of you are aware of the oral systemic connection of the association of periodontal disease with cardiac disease and the utilization of salivary markers to determine disease in disease-risk population. All these entities were studied by the NIDCR, and funding would be appropriate. Thirdly, we recommend $19,000,000 for the dental program Part F of the Ryan White HIV/AIDS Treatment and Modernization Act. This dental reimbursement program is a cost-effective mechanism to allow care to those individuals that need it through our dental education institutes as well as through community-based partnerships that allow the type of treatment to be rendered, to train our students to be able to render it and have an appreciation for the care that is needed and the special type of care that these patients have to have. We also recommend $10,000,000 for the Dental Health Improvement Act. This newly reauthorized program supports the development of innovative dental workforce programs specifically to States' specific dental workforce needs. Grants are being used to support a variety of initiatives including but not limited to loan repayment programs, to recruit culturally and linguistically competent dentists to work in under-served areas and with under-served populations. We also request $17,000,000 for the oral health programs at the Centers for Disease Control and Prevention which allows technical assistance to provide preventive programs with fluoridation of water as well as sealant programs to prevent disease. Lastly, we recommend $235,000,000 for the National Health Service Corps which allows loan repayment programs for dentists to be able to work in environments. They have significant debt when they are finished with their dental training. If they have an opportunity to repay their dental educational debts by loans, then they are more likely to go into areas where the access to care is important. In conclusion, I want to thank the Committee for considering our budget request for dental education and research in fiscal year 2010. Any comprehensive reform of the U.S. health care system should provide universal coverage and access to high quality care of which dental is a component. Thank you very much for the opportunity to present. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. I appreciate it. Let me tell the Committee that we obviously have an effective sabotage operation going on, on the House Floor. [Laughter.] We have eight votes coming up, including a Motion to Recommit with ten minutes debate. So, when we break up, I don't have the foggiest idea when we are going to get back here. We will try to make it as quickly as we can. Let's see how many people we can get through before, so we inconvenience as few people as possible after the vote. Next, Academic Family Medicine Advocacy Alliance, Dr. Jerry Kruse. ---------- Wednesday, March 18, 2009. ACADEMIC FAMILY MEDICINE ADVOCACY ALLIANCE WITNESS DR. JERRY KRUSE, M.D., M.S.P.H. Dr. Kruse. Mr. Chairman, members of the Committee, I am Jerry Kruse, professor and Chair of Family and Community Medicine at the SIU School of Medicine in Springfield, Illinois, and I am here on behalf of the academic family medicine organizations that are listed in the written statement. I thank you for the opportunity to testify in support of funding for Title VII primary care medicine and dentistry and in support of funding for primary care research at AHRQ and the NIH. The U.S. health care system is out of balance, over-reliant on specialty care, very expensive and trails the wealthy nations of the world in health care outcomes. We know that health systems with strong foundations in primary care have the best health care outcomes, the best quality indicators, significantly lower costs, more equitable care, and they eliminate disparities in health care outcomes. Abundant evidence like this over the past 30 years proves that primary care is the essential foundation of the best health care system. So, for the best health care system, we need to train more family physicians. We are very concerned about the production pipeline of family physicians in the United States. For the past 3 years, only 15 percent of U.S. medical school graduates chose careers in primary care, one-third of what we need to have the best system. What can be done? Two key steps come under the purview of this Committee: Primary care training and primary care research. So we ask your help to increase funding for key programs that work: primary care training under Title VII and primary care research at AHRQ And NIH. So, how will increased funding in these areas help our health care system? I will give an example. Since 2003, the funding for community health centers, CHCs, has doubled by $2,000,000,000. The Recovery Bill has added $1,500,000,000 to this, and this is laudable. However, over the same period of time, the funding for programs that train physicians most likely to practice in these places, the Title VII programs, has been cut by 55 percent. So here is an analogy. Do you think that new sports stadiums would be built if there were not a pipeline of players and coaches to attract the fans to fill the seats? No, of course, they wouldn't. Mr. Obey. Unless you are a Cubs fan. [Laughter.] Dr. Kruse. I am a Cardinals fan. Likewise, funding for CHCs must be accompanied by corresponding significant increases funding to train and to attract family physicians and the health care professionals that are needed. Are these programs effective? Yes. Important organizations like the Institute of Medicine, CRS, the GAO, the Medicare Payment Advisory Commission and others all testify to the fact that these programs are effective and undervalued. In addition, these programs are stimulants to local economies. We appreciate that this Committee proposed to double the current Title VII primary care funding in the Recovery Bill, but today we don't know how much of the $200,000,000 available will be distributed to primary care medicine and dentistry. We ask that Congress rebuild its investment in primary care medicine and add to the investment made in the Recovery Bill by providing an annual appropriation of $215,000,000 for primary care medicine and dentistry health professions training grants. With respect to primary care research, we are pleased with the Recovery Bill's infusion of funding for comparative effectiveness research at AHRQ, but more core funding is needed at AHRQ to fulfill its mission. We support the request of the Friends for AHRQ for base funding of $405,000,000 annually. The Institute of Medicine believes AHRQ is critical to retooling the American health care system and goes further, recommending $1,000,000,000 annually. For NIH, we are encouraged by the NIH road map and the emphasis on translational research. We support an increase in NIH funding directed toward primary care research and population-based translational research. This research is key to building the type of practice that attracts and supports family physicians and improves health outcomes. In conclusion, as the U.S. moves toward major health care reform, we urge the Committee to support programs that emphasize an increased supply of family physicians and emphasize primary care research. These programs will work together for the health of all Americans. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. Now let me call on Congresswoman Lowey. Mrs. Lowey. Well, thank you. And I am sorry I couldn't be here, but, thank you, Chairman Obey, for giving me the privilege of introducing Lindsay Farrell who works fast, talks fast, is doing a great job in one of my community health centers, and I am very proud of her. Lindsay, your work has been an absolutely critical part of the strategy to keep our community healthy, and we all thank you so much for appearing before us today. Thank you, Chairman Obey. ---------- Wednesday, March 18, 2009. NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS WITNESS LINDSAY FARRELL Ms. Farrell. Thank you, Congresswoman Lowey, Chairman Obey, Ranking Member Tiahrt, members of the Subcommittee. I am the President and CEO of Open Door Family Medical Center located in the suburbs north of New York City in Westchester County. We operate 8 health centers and serve 32,000 patients. While Westchester is one of the wealthiest counties in the Country, the income disparity between the rich and the poor is huge. More than 55 percent of our patients have no health insurance whatsoever. The rest of our patients are covered by essential programs like Medicaid, SCHIP and Medicare. A small number are covered by commercial insurance, only 3 percent, provided through their employers. And so, on behalf of Open Door as well as the 18 million patients served by community health centers nationwide, I want to thank you for your unyielding support and for your dedication to our mission of providing affordable, accessible primary health care to all Americans. In this time of enormous challenges for our health care system and our economy, your faith in us and your support through the Recovery Act will allow us to rise and meet the challenges and continue to excel. Over more than 40 years, the Health Centers Program has grown to become a critical component of our Nation's primary care infrastructure. My health center serves as the family doctor and dentist to people who would otherwise have to seek care in hospital emergency rooms. Because we are open six days a week and evenings or we are on call 24 hours a day, we prevent countless non-urgent emergency room visits. Open Door is also dedicated to comprehensive primary and preventive care. For example, we provide our State's prenatal care assistance program. Our obstetricians and midwives delivered nearly 600 babies last year. At Open Door, doctors, dentists, nutritionists and social workers all work as a health care team under one roof. We are a health care home that provides an array of health screenings, works to prevent disease and treat illnesses, but, importantly, we also strive to engage patients so that they will do what they need to in order to be healthy. We know this is the best way to use health care dollars effectively. We sincerely appreciate the funding increases for the Health Centers Program that the Subcommittee has approved over the last several years. This expansion has brought access to care to millions who were previously medically disenfranchised. Despite this record expansion, hundreds of communities have submitted high-quality applications over the past few years for a new health center that could not be funded. An investment of $2,600,000,000 for the Health Centers Program in fiscal 2010, the level authorized in the recently enacted Health Care Safety Net Act, could expand care to millions of new patients. Carving out $66,000,000 of that increase for base grant adjustments for existing centers would ensure that we keep pace with rising health care costs and increasing numbers of under- served patients. This funding will also keep the Health Centers Program on a path toward reaching our goal of servicing 30 million patients by 2015. I know that the members of the Subcommittee are well aware that the Health Centers Program is an unprecedented health care success story. However, the reason I am most proud to be here representing health centers nationwide is my own center and the way we are transforming health care at the grassroots. Health centers sit at the intersection of private practice and public health. We are unique in our vantage point and have much to contribute to the debate over health care reform. As Mrs. Lowey heard at her meeting on Monday, I know you forced to make difficult decisions in these tough times. However, health centers provide a documented value to the government and to all who benefit from our services. Please continue your outstanding support of our efforts once again this year. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. And next--I am going to try to get at least one more in before we have to run to the Floor--National Black Nurses Association, Dr. Debra Toney. ---------- Wednesday, March 18, 2009. NATIONAL BLACK NURSES ASSOCIATION, INC. WITNESS DR. DEBRA A. TONEY, PH.D., R.N. Ms. Toney. Good afternoon, Mr. Chairman and members of the Subcommittee. The National Black Nurses Association requests $215,000,000 for Title VIII, the Nursing Workforce Development Program. For 11 years, our Nation has faced a critical nursing shortage which is expected to last through the next decade. This shortage threatens the safety and well being of the patients whom we are charged to care for in our health care systems. The nursing shortage only exacerbates health disparities among people of color, especially women and children. A study by Dr. Peter Buerhaus and others estimates that a half million new nurses will be needed by 2025. The U.S. Bureau of Statistics estimates that over 140,000 nursing positions remain vacant in hospitals, nursing homes, health departments, community health centers, schools and other work places. Using the State of California as an example, it is estimated that the State would have a nursing shortage of 12,000 by 2014. Many factors contribute to the nursing shortage including: an aging nursing workforce with the average age of a nurse being 47 years old, 66 percent of the nurse faculty is expected to retire in the next 5 to 15 years, an aging population demanding access to high quality, culturally competent health and nursing care, a population that has preventable chronic diseases that overwhelm the nursing workforce and health care systems, leading to high health care costs. An investment in Title VIII will support the education and training of registered nurses at all levels including advanced practice nurses, nurse faculty and nurse scientists. The use of advanced practice nurses is critical to the elimination of health disparities, managing chronic disease and promote adoption of culturally relevant self-care management practices. We must provide funding to ensure an adequate pipeline of advanced practice nurses if we are going to improve access to healthcare. Funding for the Nurse Education Loan Repayment Program is essential as it allows for new nursing graduates to enter health facilities deemed to have critical shortages such as departments of public health, community health centers and disproportionate share hospitals. Funding for the education of nurses of diverse backgrounds is vital to improving the delivery of culturally competent nursing care to close the health disparities gaps. Studies have shown that people are more comfortable receiving care from providers of similar ethnic and cultural background. In the academic year 2005-2006, the National League for Nursing found that 88,000 applicants were turned away because of the lack of capacity such as lack of faculty, lack of technology, low salaries, classroom space, laboratories and limited clinical education sites. Hospitals and other facilities that are already understaffed cannot handle the patient workload and facilitate the training of nursing students. It has been found in California State Schools of Nursing that there are more qualified students than there are slots. Moreover, California associate degree nursing schools use a lottery system to admit applicants because there are more applicants than there are openings. In a report by the National Black Nurses Foundation it was found that because of the nursing shortage, patient safety issues become more frequent, there are longer waits for clinical appointments and admissions into hospitals, staffing for acute care beds are declining, more medical errors occur, and failure to rescue events go up. Without interventions by nurses, the health disparities gap will only increase. NBNA is requesting $175,000,000 for the National Institute of Nursing Research. Nurse scientists conduct clinical and behavioral research that may be translated into nursing practice. These effective interventions improve quality of life, offer approaches for self management, symptom management and care giving. Moreover, there is a need for more nurses to be trained to design, implement and lead clinical trials. I appreciate your time today. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you very much. Next, National Alliance of State and Territorial AIDS Directors, Heather Hauck. ---------- Wednesday, March 18, 2009. NATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS WITNESS HEATHER HAUCK Ms. Hauck. Good afternoon, Mr. Chairman and members of the Subcommittee. My name is Heather Hauck. I am the Director of the Maryland Department of Health and Mental Hygiene's AIDS Administration. I am also the incoming Chair of the National Alliance of State and Territorial AIDS Directors, NASTAD. We represent AIDS directors and adult viral hepatitis coordinators in all States and territories in the United States. Thank you for inviting us to address you today. State AIDS directors appreciate the opportunity to highlight the needs of State HIV, STD and viral hepatitis public health programs and thank the Subcommittee for its longstanding support of these programs. State and local health department HIV programs work to eliminate health disparities based on race, ethnicity, gender, sexual identity and class. HIV prevention and care efforts must be aligned to meet the needs of those who bear the greatest HIV burden in our United States. As you are aware and as has been eluded to, States across the Country are facing significant budget deficits. NASTAD has surveyed the State HIV programs and found that over half of the 36 States responding have received cuts in their State funding and staff for their programs. The anticipated cuts in State fiscal year 2010 HIV programs funding totals over $87,000,000. People living with HIV need access to trained HIV clinicians, life-saving and life-sustaining therapies and a full range of support services to live healthy lives and to ensure adherence to complicated treatment regimens. All State Ryan White Part B Base and AIDS Drug Assistance Programs or ADAPs have reported to NASTAD that we are all seeing a significant and in some cases a doubling of new clients seeking HIV care and support services. This is certainly due to a number of factors including an increase in HIV testing efforts and also increasing unemployment. The continuing increase in clients and cuts to State contribution to AIDS Drug Assistance Programs certainly puts the fiscal future of ADAPs on very uncertain ground. We respectfully request a minimum increase of $362,000,000 for State Ryan White Part B Grants which includes an increase of at least $113,000,000 for the Part B Base and at least $269,000,000 for ADAPs. NASTAD also supports a $200,000,000 increase for a total of $610,000,000 for the Minority AIDS Initiative which assists us in addressing health disparities further. Turning from care to prevention, our Nation's efforts to prevent HIV must be ramped up. Every 9.5 minutes, someone in the United States is infected with HIV. Investing in prevention is cost effective. CDC estimates that every year there are over 56,000 new HIV infections which result in approximately $9,500,000,000 in treatment costs. Unfortunately, over the past 5 years, CDC funding to State and local health department prevention cooperative agreements has decreased by $21,000,000. Additionally, core HIV surveillance funding has also eroded over the last decade. While the importance of this data has become paramount for targeting prevention efforts and directing Ryan White resources, CDC has identified the need for a funding increase of $878,000,000 for a total funding of $1,600,000,000 for HIV prevention. NASTAD would respectfully request at least an initial increase of $249,000,000 in State and local health department HIV prevention and cooperative surveillance agreements. In addition to testing efforts and additional HIV prevention resources, State HIV programs need resources and flexibility to utilize a range of public health strategies to reduce transmission. We urge the Subcommittee not to include language banning the use of Federal funds for syringe exchange programs in the fiscal year 2010 Labor, HHS Appropriation Bill. We also urge you to eliminate funds for the three separate Federal abstinence only until marriage programs and, instead, create a dedicated Federal funding stream of at least $50,000,000 to fund medically accurate, comprehensive sex education programs. We certainly also, as representatives for adult hepatitis, would urge the Committee to increase funding for the Division for Viral Hepatitis at CDC, and, lastly, we would encourage you to increase funding for sexually transmitted disease prevention, treatment and surveillance activities with the State and local health departments. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. We have a dilemma. We have three people left on the sheet, and with the number of votes that are occurring it could be as much as an hour before we get back here. So I am going to ask you what you want to do. We can either give each of you the opportunity to summarize your statement in about a minute, so that everybody gets a chance to say something, or we can ask that you simply hold it until we get back in about an hour. What is your choice? Mr. Wright. I will take a minute. Mr. Obey. All right. Grab the mic. You are David Wright? Mr. Wright. David Wright, yes, sir. Mr. Obey. Do we have Charmaine Ruddock and Robert Pestronk in the room? Ms. Ruddock. Yes. Mr. Obey. What are your choices? Mr. Pestronk. I will do it in a minute. Mr. Obey. Okay. Ms. Ruddock. I will as well. Mr. Obey. All right. Let's try to do it in one minute. ---------- Wednesday, March 18, 2009. ALLIANCE FOR BIOSECURITY WITNESS DAVID P. WRIGHT Mr. Wright. Thank you very much, Mr. Chairman and members of the Subcommittee. I am here today on behalf of the Alliance for Biosecurity. The Alliance is a consortium that includes the Center for Biosecurity from the University of Pittsburgh and about 13 biopharmaceutical companies. The Alliance is here today to request that the Subcommittee provide $1,700,000,000 in their fiscal year 2010 appropriation for BARDA specifically to support advanced development of medical countermeasures against bioterrorism. This is a large amount of money. However, bioterrorism is real. In the recent report by the bipartisan Commission on the Prevention of Weapons of Mass Destruction, it was predicted that in 2013 a weapon of mass destruction is most likely to be used during that time and will be a biological agent. We need to support biodefense and in a way that is consistent with the way we support our troops. This is very much needed, and I look forward for an opportunity to talk to you about this in the future. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. All right. Thank you, and I apologize for cutting you short. Next, Charmaine Ruddock. ---------- Wednesday, March 18, 2009. NATIONAL REACH COALITION WITNESS CHARMAINE RUDDOCK Ms. Ruddock. Good afternoon, Chairman Obey, Ranking Member Tiahrt and other members of this distinguished Committee. I am Charmaine Ruddock, Project Director for the Bronx Health REACH New York program funded by the CDC. My testimony today is on behalf of the National REACH Coalition, which represents more than 40 communities and coalitions in 21 States, working to improve the health of African Americans, Asian Pacific Islander, Native American and Latino populations and communities. Expanding funding for REACH programs provides a sound science-based approach that improves the health of these communities while also rebuilding infrastructure, creating jobs and stimulating the local economy. In 2007, more than 200 communities applied for funding in the last CDC REACH program application cycle, but only 40 were funded. Of the 160 who applied that were unfunded, 42 alone were from States and districts from members on this Committee. REACH communities have spent the last decade leveraging CDC funding with public-private partnerships to effectively address health disparities. Using innovative science-based approaches, we have demonstrated that health disparities, once considered expected, are not unsolvable. Thank you. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. I'm sorry. But thank you. And Robert Pestronk. ---------- Wednesday, March 18, 2009. NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS WITNESS ROBERT PESTRONK Mr. Pestronk. Thank you, Mr. Chairman. I really have four points to make. First, that local health departments have a unique and distinctive role and a set of responsibilities in the larger health system and within every community. They are the grassroots entity, source of data for State and Federal departments of health as well. Second, that local health departments depend upon Federal funding. About 20 percent overall, without Medicare and Medicaid, of the funding for local health departments comes from Federal sources. Yet that funding continues to be inadequate and shrinking, both in real terms and in absolute terms. Third, that the Nation's recession is further diminishing the capacity of your health departments in three areas: to measure population-wide illness and death, to organize efforts to prevent disease and prolong quality of life and to serve the public through programs in each of your communities. Seven thousand local health department jobs were lost in 2008, and we expect at least that many or more in 2009 to be lost. Our recommendations are in the written material, and I thank you very much for your time this afternoon. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. All right. Thank you, and I apologize again for the screwy schedule we keep around here. The Committee is adjourned. Tuesday, May 12, 2009. MEMBER REQUESTS WITNESSES HON. SAM FARR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA HON. MADELEINE BORDALLO, A DELEGATE IN CONGRESS FROM GUAM HON. PETE OLSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS HON. RODNEY ALEXANDER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF LOUISIANA Mr. Obey. This afternoon the subcommittee convenes its Member Day hearing for the fiscal year 2010 budget cycle. I want to welcome Members who will be testifying on behalf of their requests. This hearing is part of the package of additional earmark process reform that I announced earlier this year with Speaker Pelosi that expands on the transparency and accountability measures adopted since January of 2007. Congressionally-directed funding is part of Congress's power of the purse. At the same time, we have to protect the integrity of the process and ensure the proper use of taxpayers' money. I think that is what this committee has consistently tried to do. But there is another reason also for this hearing, frankly. I know that some Members have expressed their unhappiness in the past because we have not been able to fund some of their significant priorities. Because of that, and because we have got a finite amount of resources that can be devoted to these projects, I wanted to give any Member who had a special interest in the projects that they are promoting. I wanted to give them an opportunity to appear before the committee to make their case, and I appreciate the fact that you have come here today. So why don't we simply start with Mr. Farr? Why don't you give us whatever information you care to impart on your project? Mr. Farr. Thank you very much, Mr. Chairman. This is the first time I have appeared on behalf of one of my asks, and I appreciate you giving me this opportunity. This one is really very, very important. It is a million and a half dollars for a program called the Silver Star Program. It is in Monterey County. And just to put you in perspective, Monterey County is in the central part of California. It is the Salinas Valley, which a good chance that the food you eat for lunch and dinner tonight will come from the Salinas Valley. It is the biggest agricultural area in the United States. It is row crops, and all of those crops have to be taken out by trucks. So you have about 5,000 trucks coming in and out of Salinas every single day. It is also the home, Monterey County, of the largest State prison in California. And what has happened over the years, because of this, low- income ag workers, culture of poverty, it has really become a center of the State for a huge international gang war that is being fed by the cartels between the Nortenos from the north and the Surtenos from the south. And we are just geographically located right in that midspot. And what has happened is the small town, the City of Salinas, about 150,000, largest town in my district, but certainly small in the big perspective, is having the responsibility of breaking the back of international cartels with just local law enforcement resources. And they can't do it alone. So I have gotten very involved in this because I used to serve in local government. The fact is, if you want to stop this, and I was looking at Dwight D. Eisenhower's quote right here, there should be an unremitting effort to improve those health, education and social security programs which have proven their value; to bring all of those assets, that are at, some at the county level, some at the city level, some at the State level and some at the national level, to try to develop a really comprehensive package to try to stop organized crime. And how are we doing that? We are taking kids out of the breeding grounds for these gangs, which are their neighborhoods, early in the morning and taking them to this Silver Star Program, which deals with education; truancy abatement; health care and addiction services; family counseling; career counseling; job training; psychiatric care; mental health and related care. It is a one-stop program that is really successful. And what we are trying to do is, there is a surge going on because we are finding now second- and all third-generation; imagine in your district if you had had a killing a week in a small town. That is what has happened. We have had 15 killings this year. It is shocking the community. It is hurting the economic development of the community, on top of what is, this is the city that ranked 12th in the Nation in drop of home prices, and one of the top cities in foreclosures. We are designated as one of the High Intensity Gang Area, the HIGA jurisdiction. There were 77 robberies in Salinas; 40 of them committed by firearms. So we think we have got some ability to really tackle this thing in a comprehensive way. And that is why I am putting all my effort into this earmark, to try to make sure that we can pull together all the resources, and particularly those of the Federal Government. I might just conclude by telling you that I have done one thing that I think is going to be really effective. We have the Naval Postgraduate School in Monterey County; it is in Monterey, not in Salinas. That school has, inside the school, a center for Homeland Security, where you have both the military folks and the civilian folks looking at, what are the root causes of violence around the world? They are the ones that are coming up with plans of, how do we bring peace to Afghanistan and Iraq through a combination of military and civilian activities? I have sort of said to the school, if you are so smart, why don't you go over and look at a town in there and look at the assets of what this is. This is like a town in a foreign country with probably more assets than most foreign countries. But if you can figure out how we can curtail the root causes of violence that are culturally driven and poverty driven and so on, and deal with the issues that people deal with, illegal guns, drugs and so on, maybe we can, if we can be effective in our own hometown, maybe we can be more effective overseas, particularly in Afghanistan. So hopefully this is going to be the year where we bring all of that together, where the leather meets the road. And I would appreciate your consideration of this earmark. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. I appreciate that. Any comments? Mr. Tiahrt. I think that this is, human nature is human nature. I think you made a good point about if we are successful in our own communities, we can transfer this to elsewhere. One of the things that we have noticed in Wichita, and it probably is true with human nature, is that many gangs have a strong personality that stirs everybody up. And when they take that strong personality out of that setting, many of the kids just go back to their regular lives, and they quit stealing. They are not as involved in drugs. It is sort of what gives them an opportunity to get away from that strong personality. And it would be nice if your research would confirm that that is an effective way of dealing with gangs. Mr. Farr. We have already done that, and I would be glad to share that with you. One of the difficulties you have is, because there is so much peer pressure on gangs, I mean, I am told that there is about 100 different social gangs, little kids. These houses are so crowded, kids play in the street. They are starting at young ages. You get this buddy on the street, a little bit older kid, who becomes your protector for that little block. And that is sort of the social gangs that you belong to. And then, maybe, as you get older and into your teenage years, and the problem with the Nortenos and Surtenos is one of your sort of life passages is you have got to kill somebody. And what you find, the kids who are taken out are saying, we don't want to go back in. We love this program. We love the diversion. We love being on probation. Don't put us back in the high school. So we are going to have to figure out ways to continue that alternative success rather than, you know, just take them out and throw them back in. Then you are going to get recidivism. Thank you. Mr. Obey. Thanks for your time, Sam. Next, our colleague, Madeleine Bordallo. How is Guam doing these days? Ms. Bordallo. It is doing very well, and it still afloat, in spite of the large build-up that we expect. Good afternoon, Chairman Obey and Ranking Member Tiahrt. My testimony today emphasizes four of the priority projects that I have requested and also includes a request for legislative language. These were outlined in my letter to the subcommittee submitted last month, but given the time constraints, my testimony today will focus on the priorities most in need of Congressionally-directed funding. The first priority, Mr. Chairman and Ranking Member, is a project that I request for an appropriation of $725,000 to renovate and expand a nursing education and training laboratory at the University of Guam. The University of Guam provides the only nursing education program on the island and in the region, and there is no shortage of interest in the nursing program. But due to the overwhelming number of applicants this past academic year, the nursing program had to turn away individuals who were interested in pursuing a degree in nursing. By renovating the laboratory, the university expects to expand the number of graduates and also provide them with an environment that will help them to continue developing their skills. Skill enhancement, in turn, enables its nursing graduates to provide a more current and more sophisticated level of the care for the people of Guam. And this was a request from a former Member of Congress who is now the president of the University, the Honorable Robert Underwood, who I am sure you know, Mr. Obey. The second priority project that I request is for $300,000 for a collaborative project entitled the Guam Seamless Education Path Program, between the public school system of Guam, the Guam Community College and the University of Guam. This important pilot program, if funded, will assist students enrolled in Guam's public elementary and secondary schools in identifying and pursuing a college or professional trade education. This project is timely, given the current statistics presented by the superintendent of the public schools, which indicate that only 65 percent of public school students completed high school last year, and only a third of these students are expected to pursue higher education. Overall, only one in five Guam public high school freshmen enrolled in a college or university. So as a collaborative program between the three main educational institutions on Guam, the Guam Seamless Education Path Program is essential to enhancing the overall educational outcomes for all the students on Guam. Now, the third priority project that I request for, Mr. Chairman and Mr. Ranking member, is for $300,000 to support training programs in the construction and the electrical trades at the Guam Community College. This funding would be used to expand the current program through recruitment of students and the purchasing of educational materials. There is a great need for the Guam Community College to expand its existing programs because of the demand for workers with these specific skill sets on Guam. Guam is increasingly significant as a result of the greater Federal investment in construction programs on Guam. Based on current measures, there is a shortage of trained workers to build the facilities as a result of the oncoming military buildup. With the booming construction activity, including the execution of $747 million in military construction projects on Guam that is included in the President's budget request for Fiscal Year 2010, the funding I am requesting would expand existing job training programs offered in the construction and electrical fields in order for residents of Guam to be trained for and to compete for these jobs. And my fourth priority project is for $200,000 to the Chamorro Studies and Special Projects Division of the Guam public school system to implement innovative language instructional programs promoting and preserving our Chamorro language and our culture. This would be the second phase of the project, as this has been congressionally funded in the past, in 2007. Chamorro, our language, is traditionally an oral language, and there is a lack of books, magazines, audio-visual and other media resources in Guam's indigenous language, causing a decline in Chamorro fluency and literacy among younger generations. So funding will help continue the efforts to revive and maintain the indigenous language and the culture of Guam by providing additional resources to develop and implement innovative curriculum and unit lessons for Chamorro language instruction. Such curriculum may involve the production of Chamorro language audio and video programs and the development of new Chamorro language and grammar books and activities. And finally, a language request. I respectfully request that the bill include a section with language authorizing the outlying areas to consolidate funds received as a result of its enactment, as well as any remaining funds received under prior year appropriation acts for the Department of Education pursuant to Title V of the Elementary and Secondary Education Act. Now, similar bill language was enacted into law as Section 306 of the Department of Education Appropriations Act of 2009. The loss of consolidation authority under Title V resulted two budget cycles ago from a realignment of national budget priorities under the budget submitted to Congress by the President. So the Department of Education continues to work with the local educational agencies in the outlying areas to determine the best means for consolidation, flexibility of Federal funds received under the Elementary and Secondary Education Act. Until such time as an alternative solution is identified and agreed to, it is important that the outlying areas and the Department of Education be granted the legal authority to an option of consolidating grants in a manner similar to past practices. So I want to thank you, Mr. Chairman and Members, for your consideration of all the requests I have submitted to the committee, and for your attention to the health, educational and work force needs of Guam. And I appreciate the assistance that the subcommittee has provided in the past, and hope that you will include Congressionally-directed funding for the projects I have outlined today. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. Let me simply say with respect to your point on nursing, the Department of Labor statistics show that even though we have a huge wave of unemployment in this country, one of the few areas of job growth in the economy is in the area of health care professions, especially nursing. Ms. Bordallo. And social workers. Mr. Obey. Well, I have to be for social workers because my wife is a social worker. But with respect to nursing, if we are serious about health care reform, we are going to have to expand the capacity of the health care system through developing a lot more primary care physicians and other health professions, including nursing. So I appreciate your being here today. Any other comments? Okay. Next, Congressman Olson. Mr. Olson. Chairman Obey, Ranking Member Tiahrt, Congressman Rehberg, thank you for the opportunity to speak with you today in support of a very worthwhile project that needs funding in the Fiscal Year 2010 Labor/HHS Appropriations bill. And this is the only request I have before the committee and humbly feel that the benefits of this program justify the use of Federal taxpayer dollars. Within the Department of Labor, Employment and Training Administration, Training and Employment Services Account, I am requesting $350,000 for San Jacinto College for a project designed to help displaced workers in the Houston area obtain training to re-enter the work force in high-demand positions. The college is going to match this level of funding with $350,000 of their own. This project would train new workers and retrain and upscale existing workers to become welders, pipe fitters and nondestructive testing personnel for the U.S. petrochemical industry. This initiative is not important only to the economy of the 22nd District of Texas but to our Nation as well. The mission of San Jacinto College is to deliver accessible, affordable high-quality secondary education programs designed to meet the needs of the citizens of southeast Texas and America. The college's primary focus is helping students achieve their personal and professional goals, create seamless transitions among educational levels, and to prepare students to enter the job market or transfer to 4-year institutions. Through its programs and services and partnerships with industry, the college supports the economic growth of the community, the region and the Nation as well. Current labor and skills shortages in key occupational clusters are inhibiting economic development. The Houston metropolitan area is fortunate in that workers can be trained in cross-cluster skills in order to be employed in either the aerospace or petrochemical industries. By combining training and education with specific career pathways that lead to advanced skills, entry-level workers can then move through a predetermined pipeline to higher-skilled and higher-paying jobs. Among the industry employment positions to be advanced by the Workforce Development Training Project are nondestructive testing technicians, pipe fitter's helper, welder's helper, combination welder, stick pipe welder and structural welder. That is all I know about welding. As workers are trained for new jobs, their existing positions become available, opening up vertical movement and higher wages for others. The project will also enable the college instructors to move from a board-drafting lab to a computer-aided drafting lab and will involve training in basic math skills. Many displaced workers need only basic math skills to qualify for workforce training programs so they may re-enter the work force with more marketable skills. The Workforce Development Training Program enjoys the support and involvement of San Jacinto College's public and private-sector partners, a list of whom I would like to include for the record. This is the proverbial win-win situation in my mind. It helps provide jobs to those who need them, while supplying a skilled work force to an industry that is short of workers and can help fuel our Nation's economic recovery. The program is slated to help 600 students upon its creation to start filling the thousands of available positions in the region. I come before this committee humbly and with the utmost respect for the allocation of taxpayer funds, and firmly believe that this project is a wise investment for our Nation to further educate a needed work force and to help strengthen our national economy. And thank you for the opportunity to testify before you today. I am happy to answer any questions. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. I would simply observe, given your comments on welding, I have never seen a community college in my district that feels that it is producing enough welders. There is a constant demand for them. Mr. Olson. Yes, sir. Certainly with our petrochemical industry there in the greater Houston area, they need more than they can get. The pipeline can't get full enough. Thank you. Mr. Obey. Okay. Thank you very much. Appreciate your time. Our colleague, Mr. Alexander. Mr. Alexander. Thank you, Mr. Chairman and Mr. Tiahrt and the Ranking Member on the Louisiana Purchase Delegation. I am here today, my number one programmatic request was for Even Start. And the President has zeroed that out, perhaps because it looked like a duplicate program. But Congress must continue to support family literacy programs as an important delivery model in the provision of adult education and early childhood services. There is a direct correlation with the education of the parent, the poverty status of the home, and the likelihood of the child's success in school. We must focus on the interconnectedness of the program, which will lead us to real long-lasting solutions, educating the entire family. Adult education does just what it emphasizes. It educates the adult, and early childhood likewise educates the young child. But to make a difference, we must educate the family. By addressing the needs of parents and children simultaneously, we are outperforming stand-alone programs. Even Start participants are 13 percent poorer than Head Start families, and over 75 percent of our participants have not gone beyond the 9th grade. Despite these obstacles, families exceed state benchmarks in adult education proficiency, preschool vocabulary, and preschool alphabet knowledge. As a result, more adults are obtaining their GEDS and vocational credits, making them more employable. And our children are entering school ready to learn and equal to their peers of higher socioeconomic background. No other program is evaluated as deeply as family literacy as to the impacts of the family, because no other program does what is being done, delivering services from birth to through adulthood. Losing Even Start will impact services to families that I have described. Thank you, Mr. Chairman. [The information follows:] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] Mr. Obey. Thank you. As you know, our old colleague, Bill Goodling, cared strongly about Even Start. He worked for it when he was ranking member and chairman of the Educational Labor Committee in the House, and he is still putting in a pitch for it whenever he can. I am sure he would be happy with your testimony today. Any others? Well, that represents all of the witnesses we have before us today. I thank you for showing up, and we will see you on the floor Thursday. [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] W I T N E S S E S ---------- Page Acquaviva, K.D................................................... 713 Adams, B.R....................................................... 941 Aldrighetti, Rino................................................ 923 Alexander, Hon. Rodney........................................... 361 Alexander, Jay................................................... 993 Amundson, Sara................................................... 744 Anderson, David.................................................. 855 Assmann, Dr. S.M................................................. 565 Ayers, Jennifer.................................................. 519 Bailey, Don...................................................... 837 Bardeguez, Arlene................................................ 736 Barton, Hope..................................................... 165 Beall, R.J....................................................... 663 Beavo, J.A., Jr.................................................. 562 Bednash, Geraldine............................................... 977 Beer, Kimberly................................................... 434 Bell, Dr. F.W.................................................... 471 Blank, Helen..................................................... 50 Block, T.M....................................................... 730 Bockerstette, J.A................................................ 826 Bonta, Paul...................................................... 499 Bordallo, Hon. Madeleine......................................... 361 Breidenstine, Adrienne........................................... 841 Butler, Susan.................................................... 128 Carew, T.J....................................................... 946 Cheng, Dr. T.L................................................... 270 Clanon, Kathleen................................................. 938 Clark, Donald.................................................... 808 Cohen, Hon. Steve................................................ 380 Connors, S.H..................................................... 616 Coyle, J.T....................................................... 480 Coyle, Kevin..................................................... 888 Davis, T.S....................................................... 631 Dent, Hon. C.W................................................... 381 Desrosiers, Ronald............................................... 855 Donaldson, Tom................................................... 717 Donoff, R.B...................................................... 708 Eberle, Dr. Francis.............................................. 875 Eckstein, E.C.................................................... 519 Elias, C.J....................................................... 911 Epperly, T.D..................................................... 425 Ewen, Danielle................................................... 19 Farr, Hon. Sam................................................... 361 Farrell, G.M..................................................... 646 Farrell, Lindsay................................................. 300 Felknor, S.A..................................................... 603 Finkelman, L.G................................................... 867 Fleshman, Julie.................................................. 906 Gamel-McCormick, Michael......................................... 69 Gardner, Timothy................................................. 509 Gibbons, Jim..................................................... 722 Gipp, David...................................................... 60 Girard, David.................................................... 760 Gonzalez, R.I.................................................... 533 Gorden, Susie.................................................... 612 Green, W.R....................................................... 466 Haigwood, Nancy.................................................. 855 Harris, Dr. J.P.................................................. 490 Harrison, Patricia............................................... 391 Hauck, Heather................................................... 319 Heft, Marc....................................................... 444 Helms, W.D....................................................... 634 Hendrix, Mary J.C................................................ 80 Herrin, D.M...................................................... 977 Hill, J.O........................................................ 559 Hille, Amy....................................................... 551 Horikoshi, Neil................................................203, 577 Hurwitz, Dr. T. Alan............................................. 883 Hyde, Anna....................................................... 485 Hyde, Dallas..................................................... 855 Ingenhousz, Flora................................................ 782 Jernigan, Donna.................................................. 599 Johns, Harry..................................................... 420 Johnson, Ronald.................................................. 407 Kagan, Jill...................................................... 870 Kanjorski, Hon. P.E.............................................. 383 Kay, Peter....................................................... 504 Kemnitz, Joseph.................................................. 855 Kerger, Paula.................................................... 594 Kever, J.F....................................................... 396 Kim, Paula....................................................... 853 Kirwin, Dr. P.D.................................................. 218 Klein, Hon. Ron.................................................. 386 Kobor, Patricia.................................................. 541 Kruse, Dr. Jerry................................................. 291 Kutler, Stephanie................................................ 970 Lackner, Andrew.................................................. 855 Lacy, James...................................................... 933 Lang, William.................................................... 461 Lantieri, Linda.................................................. 11 Levering, Carolyn................................................ 848 Levi, Jeffrey.................................................... 981 Lewin, Jack...................................................... 97 Lewis, Rosalie................................................... 674 Lewis, Van....................................................... 668 Liss, Cathy...................................................... 573 Lomax, M.L....................................................... 986 Lopeman, Dave.................................................... 966 Lubinski, Christine.............................................. 229 Malone, Beverly.................................................. 977 Marchase, R.B.................................................... 687 Margolis, Todd................................................... 584 McClelland, James................................................ 173 McGovern, Patrick................................................ 726 McKnight, Evelyn................................................. 740 Meltzer, David................................................... 529 Minnig, Mikayla.................................................. 185 Modell, Fred..................................................... 763 Modell, Vicki.................................................... 763 Mori, Floyd...................................................... 823 Nolan, Martha.................................................... 956 Norton, N.J...................................................... 756 Olson, Hon. Pete................................................. 361 Osthus, Rebecca.................................................. 538 Parry, Hugh...................................................... 918 Patton, R.M...................................................... 977 Peel, Ann........................................................ 914 Peluso, Karen.................................................... 897 Perez, D.P....................................................... 678 Perry, Daniel.................................................... 417 Perry, Nancy..................................................... 748 Pestronk, Robert................................................. 350 Pierson, Carol................................................... 832 Pollick, A.S..................................................... 579 Pressley, P.L.................................................... 654 Price, S.T....................................................... 961 Pritzker, J.B.................................................... 3 Raines, Fay...................................................... 977 Ream, K.A.................................................569, 844, 977 Richards, M.M.................................................... 108 Richmond, Greg................................................... 29 Rieger, Paula.................................................... 901 Rizzo, A.A....................................................... 118 Robinette, Travis................................................ 968 Robinson, S.P.................................................... 449 Roman, Frankie................................................... 878 Roman, Nan....................................................... 789 Rosenberg, Linda................................................. 209 Rowles, Jackie................................................... 475 Ruddock, Charmaine............................................... 340 Ryan, D.G........................................................ 893 Sangalli, Ramona................................................. 767 Schiller, Vivian................................................. 863 Schilsky, R.L.................................................... 133 Schmid, Carl..................................................... 412 Schraufnagel, Dr. Dean........................................... 195 Schwartz, Colin.................................................. 735 Schwartz, M.S.................................................... 396 Scott, R.A....................................................... 776 Selker, H.P...................................................... 144 Shannon, S.C..................................................... 458 Sharpe, A.L...................................................... 639 Shoemaker, Janet................................................. 553 Sidman, Larry.................................................... 594 Sinderbrand, Gary................................................ 88 Skogsbergh, J.H.................................................. 404 Sloyer, Phyllis.................................................. 261 Smith, Tiffany................................................... 799 Soler, Esta...................................................... 683 Sonntag, Chief David............................................. 691 Speakman, V.M., Jr............................................... 396 Stacey, Dr. Gary................................................. 565 Stein, Flo....................................................... 252 Stewart, B.D..................................................... 589 Stierle, L.J..................................................... 977 Swift, Dr. J.Q................................................... 282 Tagliareni, M.E.................................................. 977 Terry, S.F....................................................... 154 Thomas, R.M., Jr................................................. 239 Thompson P.A..................................................... 977 Tolbert, J.A..................................................... 794 Toney, Dr. D.A................................................... 311 VandeBerg, John.................................................. 855 Veazey, Reverend C.W............................................. 928 Wade, Kerri...................................................... 608 Watkins, Dr. J.M................................................. 658 Watson, Mary..................................................... 38 Watts, M.L....................................................... 559 Wein, Olivia..................................................... 818 Weinberger, Dr. S.G.............................................. 778 Weiss, Dr. M.L................................................... 771 White, Dale...................................................... 858 Wigode, Emil..................................................... 703 Witherspoon, N.O................................................. 626 Wolkoff, Allan................................................... 524 Wright, D.P...................................................... 329 Wright, Janel.................................................... 504 Young, M.T....................................................... 972 Zola, Stuart..................................................... 855 I N D E X ---------- Page 3M Company....................................................... 401 Academic Family Medicine Advocacy Alliance....................... 291 Advocate Health Care............................................. 404 AIDS Action...................................................... 407 AIDS Institute................................................... 412 Alliance for Aging Research...................................... 417 Alliance for Biosecurity......................................... 329 Alzheimer's Association.......................................... 420 American Academy of Family Physicians............................ 425 American Academy of Ophthalmology................................ 429 American Academy of Physician Assistants......................... 434 American Association for Cancer Research......................... 439 American Association for Dental Research......................... 444 American Association for Geriatric Psychiatry.................... 218 American Association of Colleges for Teacher Education........... 449 American Association of Colleges of Nursing...................... 453 American Association of Colleges of Osteopathic Medicine......... 458 American Association of Colleges of Pharmacy..................... 461 American Association of Immunologists............................ 466 American Association of Museums.................................. 471 American Association of Nurse Anesthetists....................... 475 American Brain Coalition......................................... 480 American College of Cardiology................................... 97 American College of Obstetricians and Gynecologists.............. 485 American College of Physicians................................... 490 American College of Preventive Medicine.......................... 494 American Dental Education Association............................ 282 American Diabetes Association.................................... 504 American Heart Association....................................... 509 American Indian Higher Education Consortium...................... 514 American Institute for Medical and Biological Engineering........ 519 American Liver Foundation........................................ 524 American Lung Association........................................ 118 American National Red Cross...................................... 529 American Nurses Association...................................... 533 American Physiological Society................................... 538 American Psychological Association............................... 541 American Public Health Association............................... 546 American Public Power Association................................ 551 American Society for Microbiology................................ 553 American Society for Nutrition................................... 559 American Society for Pharmacology and Experimental Therapeutics.. 562 American Society of Clinical Oncology............................ 133 American Society of Plant Biologists............................. 565 Americans for Nursing Shortage Relief............................ 569 Animal Welfare Institute......................................... 573 Aplastic Anemia and MDS International Foundation................. 203 Arthritis Foundation............................................. 185 Asian and Pacific Islander American Scholarship Fund............. 577 Association for Clinical Research Training....................... 144 Association for Psychological Science............................ 579 Association for Research in Vision and Ophthalmology............. 584 Association of American Cancer Institutes........................ 589 Association of Maternal and Child Health Programs................ 261 Association of Public Television Stations........................ 594 Association of Rehabilitation Nurses............................. 599 Association of University Centers on Disabilities................ 69 Association of University Programs in Occupational Health and Safety......................................................... 603 Association of Women's Health, Obstetric and Neonatal Nurses..... 608 Big Brothers Big Sisters of America.............................. 612 Brain Injury Association of America.............................. 616 Center for Disease Control and Prevention Coalition.............. 619 Center for Law and Social Policy................................. 19 Children's Environmental Health Network.......................... 626 Close Up Foundation.............................................. 631 Coalition for Health Services Research........................... 634 Coalition for the Advancement of Health Through Behavioral and Social Science Research........................................ 639 Coalition of Northeastern Governors.............................. 644 Collaborative for Academic Social Learning....................... 11 Commissioned Officers Association of the U.S. Public Health Service........................................................ 646 Consortium of Social Science Associations........................ 654 Corporation for Public Broadcasting.............................. 391 Council on Social Work Education................................. 658 Crohn's and Colitis Foundation of America........................ 88 Cystic Fibrosis Foundation....................................... 663 Doctors Opposing Circumcision.................................... 668 Dystonia Medical Research Foundation............................. 674 Facioscapulohumeral Society, Inc................................. 678 Family Violence Prevention Fund.................................. 683 Federation of American Societies for Experimental Biology........ 687 Federation of Behavioral, Psychological, and Cognitive Sciences.. 173 Fight Crime: Invest in Kids...................................... 691 First Five Years Fund............................................ 3 Friends of the Health Resources Services Administration.......... 696 Friends of the National Institute of Child Health and Human Development.................................................... 703 Friends of the National Institute of Dental and Craniofacial Research....................................................... 708 Friends of the National Institute on Aging....................... 713 Friends of the National Institute on Alcohol Abuse and Alcoholism 717 Genetic Alliance................................................. 154 Goodwill Industries International................................ 722 Harlem United Community AIDS Center, Inc......................... 726 Health Professions and Nursing Education Coalition............... 270 Hellen Keller International...................................... 239 Hepatitis B Foundation........................................... 730 Hepatitis C Appropriations Partnership........................... 735 HIV Medicine Association......................................... 736 HONOReform....................................................... 740 Humane Society Legislative Fund.................................. 744 Humane Society of the United States.............................. 748 Infectious Diseases Society of America........................... 229 International Foundation for Functional Gastrointestinal Disorders...................................................... 756 International Myeloma Foundation................................. 760 Jeffrey Modell Foundation........................................ 763 Lions World Services for the Blind............................... 767 March of Dimes Foundation........................................ 771 Medical Library Association...................................... 165 Mended Hearts, Inc............................................... 776 Mentor Consulting Group.......................................... 778 Montgomery County Stroke Association............................. 782 National Alliance for Eye and Vision Research.................... 784 National Alliance of State and Territorial AIDS Directors........ 319 National Alliance to End Homelessness............................ 789 National Association for State Community Service Programs........ 794 National Association of Anorexia Nervosa and Associated Disorders 799 National Association of Charter School Authorizers............... 29 National Association of Community Health Centers................. 300 National Association of County and City Health Officials......... 350 National Association of State Alcohol and Drug Abuse Directors, Inc............................................................ 252 National Association of State Directors of Special Education, Inc............................................................ 38 National Association of State Mental Health Program Directors.... 803 National Black Nurses Association, Inc........................... 311 National Coalition of STD Directors.............................. 808 National Congress of American Indians............................ 813 National Consumer Law Center..................................... 818 National Council For Community Behavioral Healthcare............. 209 National Council on Asian Pacific Americans...................... 823 National Down Syndrome Society................................... 826 National Energy Assistance Directors Association................. 828 National Federation of Community Broadcasters.................... 832 National Fragile X Foundation.................................... 837 National Health Care for the Homeless Council.................... 841 National League for Nursing...................................... 844 National Marfan Foundation....................................... 848 National Melanoma Alliance....................................... 853 National Primate Research Centers................................ 856 National Psoriasis Foundation.................................... 858 National Public Radio............................................ 863 National REACH Coalition......................................... 340 National Recreation and Park Association......................... 867 National Respite Coalition....................................... 870 National Science Teachers Association............................ 875 National Sleep Foundation........................................ 878 National Technical Institute for the Deaf........................ 883 National Wildlife Federation..................................... 888 National Women's Law Center...................................... 50 Nephcure Foundation.............................................. 893 Neurofibromatosis, Inc........................................... 897 Oncology Nursing Society......................................... 901 Ovarian Cancer National Alliance................................. 128 Pancreatic Cancer Action Network................................. 906 Parkinson's Action Network....................................... 108 PATH............................................................. 911 Prevent Blindness America........................................ 918 Public Broadcasting Service...................................... 391 Pulmonary Hypertension Association............................... 923 Railroad Retirement Board........................................ 396 Religious Coalition for Reproductive Choice...................... 928 Rotary International............................................. 933 Ryan White Medical Providers Coalition........................... 938 Scleroderma Foundation........................................... 941 Society for Neuroscience......................................... 946 Society for Public Health Education.............................. 951 Society for Women's Health Research.............................. 956 Spina Bifida Association......................................... 961 Squaxin Island Tribe............................................. 966 Sun Life Family Health Center.................................... 968 TB Coalition..................................................... 195 The Ad Hoc Group for Medical Research............................ 80 The Endocrine Society............................................ 970 The Society for Healthcare Epidemiology of America............... 972 Tri-Council for Nursing.......................................... 977 Trust for America's Health....................................... 981 United Nations Foundation........................................ 529 United Negro College Fund........................................ 986 United Tribes Technical College.................................. 60 We Can Take It................................................... 993