[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.
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    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.
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                                         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.
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                                         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.
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                                         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.
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                                         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.
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    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.
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                                         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.
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                                         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.
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                                         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.
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                                         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.
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                                         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:]

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                                         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:]

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                                         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:]

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                                         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:]

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                                         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.
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    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.
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    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.
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    [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:]

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    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.

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                           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

                                  



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