[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:]
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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:]
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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:]
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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.
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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.
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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.
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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.
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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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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
W I T N E S S E S
----------
Page
Acquaviva, K.D................................................... 713
Adams, B.R....................................................... 941
Aldrighetti, Rino................................................ 923
Alexander, Hon. Rodney........................................... 361
Alexander, Jay................................................... 993
Amundson, Sara................................................... 744
Anderson, David.................................................. 855
Assmann, Dr. S.M................................................. 565
Ayers, Jennifer.................................................. 519
Bailey, Don...................................................... 837
Bardeguez, Arlene................................................ 736
Barton, Hope..................................................... 165
Beall, R.J....................................................... 663
Beavo, J.A., Jr.................................................. 562
Bednash, Geraldine............................................... 977
Beer, Kimberly................................................... 434
Bell, Dr. F.W.................................................... 471
Blank, Helen..................................................... 50
Block, T.M....................................................... 730
Bockerstette, J.A................................................ 826
Bonta, Paul...................................................... 499
Bordallo, Hon. Madeleine......................................... 361
Breidenstine, Adrienne........................................... 841
Butler, Susan.................................................... 128
Carew, T.J....................................................... 946
Cheng, Dr. T.L................................................... 270
Clanon, Kathleen................................................. 938
Clark, Donald.................................................... 808
Cohen, Hon. Steve................................................ 380
Connors, S.H..................................................... 616
Coyle, J.T....................................................... 480
Coyle, Kevin..................................................... 888
Davis, T.S....................................................... 631
Dent, Hon. C.W................................................... 381
Desrosiers, Ronald............................................... 855
Donaldson, Tom................................................... 717
Donoff, R.B...................................................... 708
Eberle, Dr. Francis.............................................. 875
Eckstein, E.C.................................................... 519
Elias, C.J....................................................... 911
Epperly, T.D..................................................... 425
Ewen, Danielle................................................... 19
Farr, Hon. Sam................................................... 361
Farrell, G.M..................................................... 646
Farrell, Lindsay................................................. 300
Felknor, S.A..................................................... 603
Finkelman, L.G................................................... 867
Fleshman, Julie.................................................. 906
Gamel-McCormick, Michael......................................... 69
Gardner, Timothy................................................. 509
Gibbons, Jim..................................................... 722
Gipp, David...................................................... 60
Girard, David.................................................... 760
Gonzalez, R.I.................................................... 533
Gorden, Susie.................................................... 612
Green, W.R....................................................... 466
Haigwood, Nancy.................................................. 855
Harris, Dr. J.P.................................................. 490
Harrison, Patricia............................................... 391
Hauck, Heather................................................... 319
Heft, Marc....................................................... 444
Helms, W.D....................................................... 634
Hendrix, Mary J.C................................................ 80
Herrin, D.M...................................................... 977
Hill, J.O........................................................ 559
Hille, Amy....................................................... 551
Horikoshi, Neil................................................203, 577
Hurwitz, Dr. T. Alan............................................. 883
Hyde, Anna....................................................... 485
Hyde, Dallas..................................................... 855
Ingenhousz, Flora................................................ 782
Jernigan, Donna.................................................. 599
Johns, Harry..................................................... 420
Johnson, Ronald.................................................. 407
Kagan, Jill...................................................... 870
Kanjorski, Hon. P.E.............................................. 383
Kay, Peter....................................................... 504
Kemnitz, Joseph.................................................. 855
Kerger, Paula.................................................... 594
Kever, J.F....................................................... 396
Kim, Paula....................................................... 853
Kirwin, Dr. P.D.................................................. 218
Klein, Hon. Ron.................................................. 386
Kobor, Patricia.................................................. 541
Kruse, Dr. Jerry................................................. 291
Kutler, Stephanie................................................ 970
Lackner, Andrew.................................................. 855
Lacy, James...................................................... 933
Lang, William.................................................... 461
Lantieri, Linda.................................................. 11
Levering, Carolyn................................................ 848
Levi, Jeffrey.................................................... 981
Lewin, Jack...................................................... 97
Lewis, Rosalie................................................... 674
Lewis, Van....................................................... 668
Liss, Cathy...................................................... 573
Lomax, M.L....................................................... 986
Lopeman, Dave.................................................... 966
Lubinski, Christine.............................................. 229
Malone, Beverly.................................................. 977
Marchase, R.B.................................................... 687
Margolis, Todd................................................... 584
McClelland, James................................................ 173
McGovern, Patrick................................................ 726
McKnight, Evelyn................................................. 740
Meltzer, David................................................... 529
Minnig, Mikayla.................................................. 185
Modell, Fred..................................................... 763
Modell, Vicki.................................................... 763
Mori, Floyd...................................................... 823
Nolan, Martha.................................................... 956
Norton, N.J...................................................... 756
Olson, Hon. Pete................................................. 361
Osthus, Rebecca.................................................. 538
Parry, Hugh...................................................... 918
Patton, R.M...................................................... 977
Peel, Ann........................................................ 914
Peluso, Karen.................................................... 897
Perez, D.P....................................................... 678
Perry, Daniel.................................................... 417
Perry, Nancy..................................................... 748
Pestronk, Robert................................................. 350
Pierson, Carol................................................... 832
Pollick, A.S..................................................... 579
Pressley, P.L.................................................... 654
Price, S.T....................................................... 961
Pritzker, J.B.................................................... 3
Raines, Fay...................................................... 977
Ream, K.A.................................................569, 844, 977
Richards, M.M.................................................... 108
Richmond, Greg................................................... 29
Rieger, Paula.................................................... 901
Rizzo, A.A....................................................... 118
Robinette, Travis................................................ 968
Robinson, S.P.................................................... 449
Roman, Frankie................................................... 878
Roman, Nan....................................................... 789
Rosenberg, Linda................................................. 209
Rowles, Jackie................................................... 475
Ruddock, Charmaine............................................... 340
Ryan, D.G........................................................ 893
Sangalli, Ramona................................................. 767
Schiller, Vivian................................................. 863
Schilsky, R.L.................................................... 133
Schmid, Carl..................................................... 412
Schraufnagel, Dr. Dean........................................... 195
Schwartz, Colin.................................................. 735
Schwartz, M.S.................................................... 396
Scott, R.A....................................................... 776
Selker, H.P...................................................... 144
Shannon, S.C..................................................... 458
Sharpe, A.L...................................................... 639
Shoemaker, Janet................................................. 553
Sidman, Larry.................................................... 594
Sinderbrand, Gary................................................ 88
Skogsbergh, J.H.................................................. 404
Sloyer, Phyllis.................................................. 261
Smith, Tiffany................................................... 799
Soler, Esta...................................................... 683
Sonntag, Chief David............................................. 691
Speakman, V.M., Jr............................................... 396
Stacey, Dr. Gary................................................. 565
Stein, Flo....................................................... 252
Stewart, B.D..................................................... 589
Stierle, L.J..................................................... 977
Swift, Dr. J.Q................................................... 282
Tagliareni, M.E.................................................. 977
Terry, S.F....................................................... 154
Thomas, R.M., Jr................................................. 239
Thompson P.A..................................................... 977
Tolbert, J.A..................................................... 794
Toney, Dr. D.A................................................... 311
VandeBerg, John.................................................. 855
Veazey, Reverend C.W............................................. 928
Wade, Kerri...................................................... 608
Watkins, Dr. J.M................................................. 658
Watson, Mary..................................................... 38
Watts, M.L....................................................... 559
Wein, Olivia..................................................... 818
Weinberger, Dr. S.G.............................................. 778
Weiss, Dr. M.L................................................... 771
White, Dale...................................................... 858
Wigode, Emil..................................................... 703
Witherspoon, N.O................................................. 626
Wolkoff, Allan................................................... 524
Wright, D.P...................................................... 329
Wright, Janel.................................................... 504
Young, M.T....................................................... 972
Zola, Stuart..................................................... 855
I N D E X
----------
Page
3M Company....................................................... 401
Academic Family Medicine Advocacy Alliance....................... 291
Advocate Health Care............................................. 404
AIDS Action...................................................... 407
AIDS Institute................................................... 412
Alliance for Aging Research...................................... 417
Alliance for Biosecurity......................................... 329
Alzheimer's Association.......................................... 420
American Academy of Family Physicians............................ 425
American Academy of Ophthalmology................................ 429
American Academy of Physician Assistants......................... 434
American Association for Cancer Research......................... 439
American Association for Dental Research......................... 444
American Association for Geriatric Psychiatry.................... 218
American Association of Colleges for Teacher Education........... 449
American Association of Colleges of Nursing...................... 453
American Association of Colleges of Osteopathic Medicine......... 458
American Association of Colleges of Pharmacy..................... 461
American Association of Immunologists............................ 466
American Association of Museums.................................. 471
American Association of Nurse Anesthetists....................... 475
American Brain Coalition......................................... 480
American College of Cardiology................................... 97
American College of Obstetricians and Gynecologists.............. 485
American College of Physicians................................... 490
American College of Preventive Medicine.......................... 494
American Dental Education Association............................ 282
American Diabetes Association.................................... 504
American Heart Association....................................... 509
American Indian Higher Education Consortium...................... 514
American Institute for Medical and Biological Engineering........ 519
American Liver Foundation........................................ 524
American Lung Association........................................ 118
American National Red Cross...................................... 529
American Nurses Association...................................... 533
American Physiological Society................................... 538
American Psychological Association............................... 541
American Public Health Association............................... 546
American Public Power Association................................ 551
American Society for Microbiology................................ 553
American Society for Nutrition................................... 559
American Society for Pharmacology and Experimental Therapeutics.. 562
American Society of Clinical Oncology............................ 133
American Society of Plant Biologists............................. 565
Americans for Nursing Shortage Relief............................ 569
Animal Welfare Institute......................................... 573
Aplastic Anemia and MDS International Foundation................. 203
Arthritis Foundation............................................. 185
Asian and Pacific Islander American Scholarship Fund............. 577
Association for Clinical Research Training....................... 144
Association for Psychological Science............................ 579
Association for Research in Vision and Ophthalmology............. 584
Association of American Cancer Institutes........................ 589
Association of Maternal and Child Health Programs................ 261
Association of Public Television Stations........................ 594
Association of Rehabilitation Nurses............................. 599
Association of University Centers on Disabilities................ 69
Association of University Programs in Occupational Health and
Safety......................................................... 603
Association of Women's Health, Obstetric and Neonatal Nurses..... 608
Big Brothers Big Sisters of America.............................. 612
Brain Injury Association of America.............................. 616
Center for Disease Control and Prevention Coalition.............. 619
Center for Law and Social Policy................................. 19
Children's Environmental Health Network.......................... 626
Close Up Foundation.............................................. 631
Coalition for Health Services Research........................... 634
Coalition for the Advancement of Health Through Behavioral and
Social Science Research........................................ 639
Coalition of Northeastern Governors.............................. 644
Collaborative for Academic Social Learning....................... 11
Commissioned Officers Association of the U.S. Public Health
Service........................................................ 646
Consortium of Social Science Associations........................ 654
Corporation for Public Broadcasting.............................. 391
Council on Social Work Education................................. 658
Crohn's and Colitis Foundation of America........................ 88
Cystic Fibrosis Foundation....................................... 663
Doctors Opposing Circumcision.................................... 668
Dystonia Medical Research Foundation............................. 674
Facioscapulohumeral Society, Inc................................. 678
Family Violence Prevention Fund.................................. 683
Federation of American Societies for Experimental Biology........ 687
Federation of Behavioral, Psychological, and Cognitive Sciences.. 173
Fight Crime: Invest in Kids...................................... 691
First Five Years Fund............................................ 3
Friends of the Health Resources Services Administration.......... 696
Friends of the National Institute of Child Health and Human
Development.................................................... 703
Friends of the National Institute of Dental and Craniofacial
Research....................................................... 708
Friends of the National Institute on Aging....................... 713
Friends of the National Institute on Alcohol Abuse and Alcoholism 717
Genetic Alliance................................................. 154
Goodwill Industries International................................ 722
Harlem United Community AIDS Center, Inc......................... 726
Health Professions and Nursing Education Coalition............... 270
Hellen Keller International...................................... 239
Hepatitis B Foundation........................................... 730
Hepatitis C Appropriations Partnership........................... 735
HIV Medicine Association......................................... 736
HONOReform....................................................... 740
Humane Society Legislative Fund.................................. 744
Humane Society of the United States.............................. 748
Infectious Diseases Society of America........................... 229
International Foundation for Functional Gastrointestinal
Disorders...................................................... 756
International Myeloma Foundation................................. 760
Jeffrey Modell Foundation........................................ 763
Lions World Services for the Blind............................... 767
March of Dimes Foundation........................................ 771
Medical Library Association...................................... 165
Mended Hearts, Inc............................................... 776
Mentor Consulting Group.......................................... 778
Montgomery County Stroke Association............................. 782
National Alliance for Eye and Vision Research.................... 784
National Alliance of State and Territorial AIDS Directors........ 319
National Alliance to End Homelessness............................ 789
National Association for State Community Service Programs........ 794
National Association of Anorexia Nervosa and Associated Disorders 799
National Association of Charter School Authorizers............... 29
National Association of Community Health Centers................. 300
National Association of County and City Health Officials......... 350
National Association of State Alcohol and Drug Abuse Directors,
Inc............................................................ 252
National Association of State Directors of Special Education,
Inc............................................................ 38
National Association of State Mental Health Program Directors.... 803
National Black Nurses Association, Inc........................... 311
National Coalition of STD Directors.............................. 808
National Congress of American Indians............................ 813
National Consumer Law Center..................................... 818
National Council For Community Behavioral Healthcare............. 209
National Council on Asian Pacific Americans...................... 823
National Down Syndrome Society................................... 826
National Energy Assistance Directors Association................. 828
National Federation of Community Broadcasters.................... 832
National Fragile X Foundation.................................... 837
National Health Care for the Homeless Council.................... 841
National League for Nursing...................................... 844
National Marfan Foundation....................................... 848
National Melanoma Alliance....................................... 853
National Primate Research Centers................................ 856
National Psoriasis Foundation.................................... 858
National Public Radio............................................ 863
National REACH Coalition......................................... 340
National Recreation and Park Association......................... 867
National Respite Coalition....................................... 870
National Science Teachers Association............................ 875
National Sleep Foundation........................................ 878
National Technical Institute for the Deaf........................ 883
National Wildlife Federation..................................... 888
National Women's Law Center...................................... 50
Nephcure Foundation.............................................. 893
Neurofibromatosis, Inc........................................... 897
Oncology Nursing Society......................................... 901
Ovarian Cancer National Alliance................................. 128
Pancreatic Cancer Action Network................................. 906
Parkinson's Action Network....................................... 108
PATH............................................................. 911
Prevent Blindness America........................................ 918
Public Broadcasting Service...................................... 391
Pulmonary Hypertension Association............................... 923
Railroad Retirement Board........................................ 396
Religious Coalition for Reproductive Choice...................... 928
Rotary International............................................. 933
Ryan White Medical Providers Coalition........................... 938
Scleroderma Foundation........................................... 941
Society for Neuroscience......................................... 946
Society for Public Health Education.............................. 951
Society for Women's Health Research.............................. 956
Spina Bifida Association......................................... 961
Squaxin Island Tribe............................................. 966
Sun Life Family Health Center.................................... 968
TB Coalition..................................................... 195
The Ad Hoc Group for Medical Research............................ 80
The Endocrine Society............................................ 970
The Society for Healthcare Epidemiology of America............... 972
Tri-Council for Nursing.......................................... 977
Trust for America's Health....................................... 981
United Nations Foundation........................................ 529
United Negro College Fund........................................ 986
United Tribes Technical College.................................. 60
We Can Take It................................................... 993