[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2011
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND 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
JOSE E. SERRANO, New York
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.
David Reich, Nicole Kunko, Stephen Steigleder, Donna Shahbaz,
John Bartrum, Lisa Molyneux, and Mike Friedberg,
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 2011
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2011
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND 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
JOSE E. SERRANO, New York
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.
David Reich, Nicole Kunko, Stephen Steigleder, Donna Shahbaz,
John Bartrum, Lisa Molyneux, and Mike Friedberg,
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
58-144 WASHINGTON : 2010
COMMITTEE ON APPROPRIATIONS
DAVID R. OBEY, Wisconsin, Chairman
NORMAN D. DICKS, Washington JERRY LEWIS, California
ALAN B. MOLLOHAN, West Virginia C. W. BILL YOUNG, Florida
MARCY KAPTUR, Ohio HAROLD ROGERS, Kentucky
PETER J. VISCLOSKY, Indiana FRANK R. WOLF, Virginia
NITA M. LOWEY, New York JACK KINGSTON, Georgia
JOSE E. SERRANO, New York RODNEY P. FRELINGHUYSEN, New
ROSA L. DeLAURO, Connecticut Jersey
JAMES P. MORAN, Virginia TODD TIAHRT, Kansas
JOHN W. OLVER, Massachusetts ZACH WAMP, Tennessee
ED PASTOR, Arizona TOM LATHAM, Iowa
DAVID E. PRICE, North Carolina ROBERT B. ADERHOLT, Alabama
CHET EDWARDS, Texas JO ANN EMERSON, Missouri
PATRICK J. KENNEDY, Rhode Island KAY GRANGER, Texas
MAURICE D. HINCHEY, New York MICHAEL K. SIMPSON, Idaho
LUCILLE ROYBAL-ALLARD, California JOHN ABNEY CULBERSON, Texas
SAM FARR, California MARK STEVEN KIRK, Illinois
JESSE L. JACKSON, Jr., Illinois ANDER CRENSHAW, Florida
CAROLYN C. KILPATRICK, Michigan DENNIS R. REHBERG, Montana
ALLEN BOYD, Florida JOHN R. CARTER, Texas
CHAKA FATTAH, Pennsylvania RODNEY ALEXANDER, Louisiana
STEVEN R. ROTHMAN, New Jersey KEN CALVERT, California
SANFORD D. BISHOP, Jr., Georgia JO BONNER, Alabama
MARION BERRY, Arkansas STEVEN C. LaTOURETTE, Ohio
BARBARA LEE, California TOM COLE, Oklahoma
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
PATRICK J. MURPHY, Pennsylvania
Beverly Pheto, Clerk and Staff Director
(ii)
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2011
Wednesday, May 12, 2010.
----------
TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS
----------
Chairman's Opening Statement
Mr. Obey. Well, good morning, everybody. Let me apologize
for being late and to make just a couple comments about what we
are going to be doing here today.
I appreciate the fact that everyone who testifies today is
going to be here in earnest support of programs that they think
are vital. I spent a good deal of time last night looking over
the statements of all of the witnesses for this morning and
this afternoon, and I have to say that I agree with virtually
all of them.
But there is a problem. If you total up the cost of all of
the items that are being requested in these statements, we wind
up with requests that we increase the President's budget by
almost $14 billion and I think that, on the merits, is needed
when it comes to health care research or when it comes to
education. But when it comes to worker protection, I am a big
spender and I make no apology for it.
But we do have a problem because we have, even though the
President asked for a budget freeze, we have the Republican
leadership asking that we cut deeper than that; we have blue
dog Democrats who are also asking that we cut deeper than that.
In fact, if you take a look at the budget levels that we
are going to be forced to operate under, we will not be able to
increase this bill by $14 billion as a lot of you are going to
be asking today; we are going to have to cut this bill by about
$3.5 billion. And that means $3.5 billion below Obama's budget.
And the reason for that, frankly, is that the Country, and many
members in the Congress, are apparently fixated only on one
deficit, the Federal budget deficit. And I agree that is an
important problem that must come down over time, once the
economy starts to recover.
But we have other deficits, as the testimony here today
will certainly demonstrate. We have opportunity deficits, we
have health care deficits, we have education deficits, we have
science deficits; and those will not be responded to to any
great degree unless there is a significant mind-set in the
Country and a significant mind-set in the Congress.
That is one of the reasons why I am leaving Congress,
because I am tired of producing bills that are inadequate to
meet the needs of the Country, and yet the Congress and past
presidents have not been at all bothered to increase the size
of those deficits by providing very large tax cuts by
financing, in my view, a misbegotten war.
So I know some people will say, well, yeah, but you can fit
my program in, you just have to cut some other fellow's
program. And it is because of that response that I have had
hanging on my wall for the last eight years this sign. As you
can see, it is elegant and beautiful. What it says is: What do
you want me to do for somebody besides yourself that is more
important than whatever it is you want me to do for you?
Because that is the spirit that we have to move forward in if
we are going to deal with budgets in a rational way.
So I do not by any means want to discourage any of you from
testifying today. What you will ask for is certainly needed; I
recognize that. But I hope that you recognize that we need one
hell of a lot of help to convince the public that we do the
Country no favors when we short-sheet crucial long-term
investments in health care, education, worker protection,
environmental protection, and the like.
We came out of the wilderness as a backward Country, and in
the 19th century, because this Country made the right
investments, by the beginning of the 20th century we became a
worldwide powerhouse; and we did that by making the right kind
of investments in the right things.
So I apologize ahead of time to all of you for the
limitations of the budget that we will be able to produce this
year because of the factors that I have just described. And if
you want to change that so that we do not have to, in the
future, or so that people in the future, who are sitting in
this chair, do not have to cut bills that they do not want to
cut, then you have to go back home to your neighbors and make
them understand that we are not going to be a great Country if
we recognize the cost of everything and the value of nothing.
So thank you for listening while I spout off.
Mr. Tiahrt is not here.
Denny, would you like to say anything in response before we
begin?
Ranking Member's Opening Statement
Mr. Rehberg. Well, let me just begin by saying, Mr.
Chairman, thank you for your service on the Subcommittee. I do
not get to be Acting Ranking very often, so I do not want to
miss the opportunity to just say a few words to you, and that
is I have appreciated everything you have done, both for this
Subcommittee and the full Committee.
I was sitting here reminiscing a bit while you were
speaking. The last CODEL I took was with Mr. Murtha, Mr.
Hobson, Mr. Walsh, and yourself, and I am the last man
standing. That makes me a little nervous.
But it has been an educational experience, and serving on
all the subcommittees that I do and have, this is the most
meaningful exercise that any of the Subcommittees does, by
bringing in a number of people to, in a rapid fashion, tell us
their needs and give us a little glimpse of their organization
and their desires of building a more secure future for the
people that they represent.
So I appreciate the process and I appreciate your
leadership. We are going to miss you a lot. If you would be so
kind, I would adopt Archie the Cockroach: ``And if I have
anything to say about it, we will get rid of the pencils; I do
not think we need anything with an eraser on it.'' But thanks
for your kind service and an opportunity to thank you publicly,
and why do we not begin?
Mr. Obey. Thank you. Thank you very much.
All right, first we have Brigadier General Billy Cooper,
representing the National Job Corps Association.
And let me say that we are going to have to strictly
enforce the four minute time limit, or the people at the back
end of the schedule will not get a chance to testify. I am also
concerned we are going to be interrupted by roll calls on the
House Floor. The Congress would work just fine if we did not
have to interrupt our work to go vote. [Laughter.]
Mr. Obey. Proceed.
----------
Wednesday, May 12, 2010.
JOB CORPS
WITNESS
BRIGADIER GENERAL (RET.) BILLY COOPER, CENTER DIRECTOR, EARLE C.
CLEMENTS JOB CORPS CENTER, NATIONAL JOB CORPS ASSOCIATION,
DEPARTMENT OF LABOR
General Cooper. Mr. Chairman, members of the Subcommittee,
thank you for this opportunity to talk about a passion of mine
and thousands of other professionals around the Country, which
is Job Corps. I am Billy Cooper. As you indicated, I am a
retired Brigadier General from the United States Army, and
currently I am the Center Director for the second largest Job
Corps Center in the Country, in Morganfield, Kentucky, the
Earle C. Clements Center.
Before I get started, I would like to thank you for
championing Job Corps throughout your illustrious service. As
you know, in the very near future, we are going to open the new
center in Wisconsin, and I look forward to meeting you there
when we have an opportunity to open that one.
My journey to Job Corps was not typical. While I do hold a
Master's Degree in Education, I did not start out as an
educator; I am a Vietnam draftee who ascended to the rank of
Brigadier General and had an opportunity to live the American
dream by virtue of service in our armed forces. And my goal is
to try to figure out how to help young men and women today to
understand that the American dream is still possible; they can
live it, but it is going to take some hard work, some
education, some job training, and an opportunity that will only
exist for them in America.
I first learned about Job Corps when I was serving as the
Deputy Commanding General of the U.S. Army Recruiting Command
at Fort Knox. There, I was introduced to the dozens of unique
and holistic services that Job Corps has to offer to
disadvantaged youth, and I became a believer in the program. I
was responsible for starting a partnership between Job Corps
and the Army which enhances the opportunity for young men and
women who attend Job Corps to enlist in our armed forces today,
and that agreement is still intact.
Nine years ago, I could have gone into a very comfortable
retirement, but I chose to serve my Country again through Job
Corps. Like so many and you, we saw that the youth in America
today might have had an opportunity to miss out on the American
dream, and that is why Job Corps exists.
I left the military, became a Center Director, and Job
Corps, unlike many programs I encountered in the military, does
in fact teach young men and women to be all that they can be
through the comprehensive services that Job Corps provides.
Job Corps is the only viable option for thousands of
disadvantaged youth. They enroll voluntarily. It is difficult
for a young man or woman to learn when they are hungry, when
they are homeless, when they live in poverty and really cannot
see a way out. The promising news is that, with a modest
investment in fiscal year 2011, Mr. Chairman, Job Corps can
cost-effectively use its existing facilities to serve
additional needy youth.
Secondly, Job Corps offers comprehensive services, which
include health care, dental care, education through college,
job training, counseling; and we have Job Corps Centers in
almost 50 States today. We have 123 and the Wisconsin Center
will be number 124.
On average, I welcome 40 new students to my Center every
Tuesday. As I said, they are volunteers, and instead of
dropping out of society in general, they come to Job Corps to
get a second chance. We provide healthy meals, nutrition
counseling, counseling, education, and job training again. And
for members of the Subcommittee, I simply want to say it is the
only program that provides these comprehensive services.
Do not just take my word for it. Before I run out of time,
I would like to introduce one of my students----
Mr. Obey. [Remarks made off microphone.]
General Cooper. Well, instead of having Mr. Brooks testify,
I will tell you he dropped out of high school. He was from
Oakland originally; he is from Florida now. He had an
opportunity to hit the mean streets, but did in fact choose to
help his family by coming to Job Corps, where he has earned his
skill certification in electricity, will complete his high
school diploma within the next couple of months. Instead of
being a liability to society, he will in fact be an asset.
Serves as a role model. He is probably going to go on to
college when he leaves Job Corps; we believe we can get him a
music scholarship at Kentucky State University. He is a great
alto saxophonist and a super young man, and I regret that you
did not have an opportunity to hear his entire story.
Mr. Obey. I do too, especially if he is a musician. I like
bluegrass and play it myself. [Laughter.]
But we are going to have to move on.
And let me say, do not take the lack of comments or
questions from people on the panel as disinterest. We get
plenty of time to talk to each other, but if we do not shut up
today, we will never get through all of the witnesses that we
have.
Thank you much.
General Cooper. Thank you, sir, for your service and my
opportunity to testify before the Committee.
[Written statement by Billy Cooper follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. You too. Thank you much.
Next, Joseph Sharpe from the American Legion.
----------
Wednesday, May 12, 2010.
VETS PROGRAMS
WITNESS
JOSEPH C. SHARPE, JR., DIRECTOR, NATIONAL ECONOMIC COMMISSION, AMERICAN
LEGION, DEPARTMENT OF LABOR
Mr. Sharpe. Mr. Chairman and members of the Subcommittee,
the American Legion thanks you for this opportunity to present
its views on fiscal year 2011 funding issues under your
jurisdiction. The Department of Labor's Veterans' Employment
and Training Service administers the following programs:
Disabled Veterans' Outreach Program, the Local Veterans'
Employment Representatives State grant programs; Transition
Assistance Programs; Veterans' Preference and Uniformed
Services Employment and Reemployment Rights Act, USERRA;
Homeless Veterans' Reintegration Program; Veterans Workforce
Investment Program; and the National Veterans' Training
Institute. VETS plays a vital role in promoting the economic
security of America's veterans by assisting them in finding
meaningful employment.
The American Legion believes staffing levels for DVOPs and
LVERs should match the needs of the veteran's community in each
State and should not be based solely on the fiscal needs of the
State government. Such services will continue to be crucial as
today's active duty service members, especially those returning
from Iraq and Afghanistan, transition into the civilian
workforce. Adequate funding will allow the programs to increase
staffing to provide comprehensive case management job
assistance to disabled and other eligible veterans.
The American Legion recommends $267 million to the
Department of Labor's VETS State Administration Grants for
fiscal year 2011. And please note that the amount recommended
for State grants include funds for the Transition Assistance
Program.
The American Legion also recommends $50 million for the
Homeless Veterans Reintegration Program in fiscal year 2011.
The program has successfully integrated homeless veterans into
meaningful employment at a high percentage. In addition, the
HVRP is the only nationwide program focused on assisting
homeless veterans to reintegrate into the workforce.
The American Legion also recommends $6 million for the
National Veterans' Employment and Training Service Institute in
fiscal year 2011 so that VETS staff can receive comprehensive
training that will ultimately turn into higher levels of
proficiency for them and more employment opportunity for
veterans and their families.
The American Legion recommends $20 million for the Veterans
Workforce Investment Program, VWIP, in fiscal year 2011. The
increase in funding for VWIP would ensure continued efforts in
life-long learning and skills development programs that are
designed to serve the most at-risk veterans, those with
service-connected disabilities and those who recently
separated.
The American Legion recommends $61 million for the Program
Management that encompasses Uniformed Services Employment and
Reemployment Rights Acts, USERRA, and Veterans' Employment
Opportunity Act, VEOA, in fiscal year 2011, to ensure service
members who are deployed return to their jobs and Federal
agencies are properly adhering to veterans' preference rights.
Finally, the American Legion is requesting a total of $404
million for the Department of Labor's Votes Program.
In conclusion, thank you for the opportunity to submit the
American Legion's recommendations on funding for the VETS
program in the Department of Labor.
[Written statement by Joseph C. Sharpe, Jr., follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you for your testimony and for staying
within the time limit. I appreciate it.
Next, Robert Pleasure, from the Building and Construction
Trades Department. How are you?
----------
Wednesday, May 12, 2010.
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
WITNESS
ROBERT PLEASURE, SPECIAL ASSISTANT TO THE PRESIDENT, BUILDING AND
CONSTRUCTION TRADES DEPARTMENT, AFL-CIO
Mr. Pleasure. Good morning, Mr. Chairman, members of the
Committee. As the Chairman just indicated, my name is Robert
Pleasure. I am Assistant to the President of the Building and
Construction Trades Department at AFL-CIO.The purpose of our
testimony today is to request your support for increased
funding for the National Institute for Occupational Safety and
Health, NIOSH, and its Construction Research Program.
Despite some improvements in workplace safety and health as
a result of research and efforts of the Occupational Safety and
Health Administration, still, nearly 15 American workers die
each day from workplace injuries, and another 134 die from
work-related diseases.
Four out of those 15 that die on the job are employed in
the construction industry. Indeed, the construction industry
has the unfortunate distinction of being the single most
hazardous industry from the perspective of the number of
fatalities in the United States, accounting for some 1,200
construction workers killed on the job each year.
While construction workers make up only 8 percent of the
U.S. workforce, they account for more than 22 percent of all
work-related deaths. In fact, due to exposures to an array of
toxic and hazardous substances, construction workers have
unacceptably high levels of occupational disease, including
cancer, silicosis, asbestosis, and other heart, lung, and
neurological diseases.
I have to say that I also have had the dubious distinction
of having worked on construction safety and health for a number
of years as Director, in the past, of CPWR, the National
Construction Center that has been supported over the years by
NIOSH. But that program has been at $5 million for many, many
years, from the early 1990s until the present, and I do not
discount the important hazards that other workers are exposed
to, having spent time, in my work life, with the Federal Mine
Safety and Health Review Commission.
I know that there are many other industries that face these
challenges, but construction not only faces these very high
rates of injury and illness, but we know now, as we move from
research to practice, how to abate these hazards; and the
research we are now focused on and leading a vanguard effort by
NIOSH is this R2P, research to practice, program.
So I speak as any person that might represent the mine
workers, for example, or offshore workers, many of whom are
part of the construction industry, with a sense of urgency.
This is not just a question of research, but it is a movement
from surveillance to intervention, from research to practice.
Except for a special $80 million for the World Trade Center
Health Program and some $7 million for nanotechnology research,
the President's fiscal year 2011 NIOSH budget request remains
at last year's level; and, as I said, the Construction Research
Center has remained at the same level going back to the mid-
1990s.
While we support both the WTC program and the
nanotechnology program, we believe that a major increase in the
NORA budget, the National Occupational Research Agenda budget,
for NIOSH is essential.
With respect to that funding, we recommend a $25 million
increase over the President's $124 million NORA request, which
was a static request. And we ask particularly for support for
the work that is done in the construction industry.
I thank you very much for this opportunity to appear before
you. We brought our data up to 2008 BLS data in what I
submitted today, the 35 copies, and I ask your permission to
include those changes in the record.
Mr. Obey. Sure. All right.
Mr. Pleasure. Thank you very much.
[Written statement by Robert J. Pleasure follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you much.
Next, James Kohlmoos from Knowledge Alliance.
----------
Wednesday, May 12, 2010.
K-12 ED
WITNESS
JAMES W. KOHLMOOS, PRESIDENT, KNOWLEDGE ALLIANCE, DEPARTMENT OF ENERGY
Mr. Kohlmoos. My name is Jim Kohlmoos, this is Augustus
Mays, and we are both from Knowledge Alliance, which is a
coalition of 35 education organizations dedicated to promoting
the expanded use of research-based knowledge in policy and
practice. We greatly appreciate this opportunity to testify.
And to you, Mr. Chairman, thank you so much for your
skilled and dedicated leadership on so many critical issues of
equity and excellence in education over so many years. We will
greatly miss you, but your legacy will endure for a very, very
long time. So thank you, sir.
Mr. Obey. Thank you.
Mr. Kohlmoos. We wish to offer three critical ideas as you
grapple with this appropriations bill.
Number one, the Nation is still at risk. If you were to
read the Nations At Risk Report this afternoon, you would think
that it was written just yesterday, not in 1983. The critical
issues that we face today were pervasive more than 25, 30 years
ago: the trend towards mediocrity, glaring achievement gaps,
diminishing global competitiveness.
Even though education reform has been a top priority for
the last 30 years, why have we made so little progress? A lack
of political will? A fractured education system? The
curriculum? Human capital? We think it is all of the above and
more. And the more in this case is that we do not have in place
an education and R&D infrastructure that can deliver the kind
of research-based solutions in ways similar to other sectors
like medicine, agriculture, energy, and defense. Education is
not yet an evidence-based, knowledge-driven field.
Second, education funding in R&D ranks near the bottom.
While there are a number of structural flaws in the education's
R&D infrastructure, the root cause is the woefully meager
Federal investment. Consider this: $78; $0.38. The difference
between what you can buy with $78 versus $0.38 is obviously
very significant. In similar proportions, it is the difference
between the Federal investment in defense R&D, at $78 billion,
and the Federal investment in education R&D, at just $170
million. For a $500 billion industry like K-12 education to
invest less than one-one hundredth of a percent in R&D is a
recipe for perpetual failure.
Third, invest more in what is currently working. Despite
the low investment in education R&D, there is reason for
optimism in the pockets of excellence in the knowledge sector
in education that can invigorate the R&D enterprise.
Specifically, I am referring to three existing programs that
lay a strong foundation from which to grow in the future: the
Comprehensive Assistance Center Programs for providing
technical assistance to States; the Regional Education
Laboratories that serve as an essential bridge between the
research community and State and local agencies; and National
R&D Centers for conducting research on issues of enduring
national significance.
As outlined in my written comments, we urge substantial
increases in these three vital programs. And when combined with
the resources for school improvement and innovation in the ARRA
funds, these three programs can create a powerful launchpad
from which to erect a world-class R&D system for education.
Mr. Chairman, members of the Committee, the time has
arrived to unleash America's ingenuity, to solve our most
pressing education problems, to deliver break-the-mold
solutions to our schools, and to guide a new knowledge and
innovation revolution in teaching and learning. You can begin
doing that by taking on our recommendations for increased
investment in Federal R&D.
Thank you so much.
[Written statement by James W. Kohlmoos follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much. Appreciate your time.
Next, Chris Francis, Afterschool Alliance.
----------
Wednesday, May 12, 2010.
AFTERSCHOOL PROGRAMS
WITNESSES
CHRIS FRANCIS, CEO, YMCA OF THE NORTHWOODS, RHINELANDER, WISCONSIN,
AFTERSCHOOL ALLIANCE, DEPARTMENT OF EDUCATION
JODI GRANT, EXECUTIVE DIRECTOR, AFTERSCHOOL ALLIANCE, DEPARTMENT OF
ENERGY
Ms. Grant. Good morning, Chairman Obey, members of the
Subcommittee. It is an honor to be here today. I am Jodi Grant,
Executive Director of the Afterschool Alliance. Afterschool
programs are critical to America's next generation; keeping
kids safe, inspiring them to learn, and providing a lifeline
for working parents.
Thank you for your strong support of afterschool programs.
This afternoon, more than 1.2 million children will be in
afterschool programs supported by the 21st Century Community
Learning Centers Fund. They are the lucky ones. They have
access to a variety of exciting activities: CSI labs, robotics,
theater, dance, art, music, and sports. Afterschool teachers
make sure learning is fun and complements what the students are
working on during the day.
Children in 21st Century Centers have access to a snack or
supper, homework help, tutoring, and caring adult mentors. More
than 15 million children remain unsupervised after the school
bell rings. It is vital that this year's budget provide the
additional resources that afterschool programs so desperately
need.
I am delighted to introduce Chris Francis. Chris is the CEO
of the YMCA of the Northwoods in Rhinelander, Wisconsin. Like
many----
Mr. Obey. Let me interrupt to say the staff listed it as
Whinelander. It is Rhinelander. [Laughter.]
Ms. Grant. Like many YMCAs around the Nation, Chris
operates an afterschool program serving the needs of youth and
families in the community.
Afterschool programs have been hit hard by this recession.
Private funding sources have dried up and fees have gotten
harder for families to pay. Federal funding has been essential
in making afterschool available to many of the children that
Chris serves and hundreds of thousands of them all across the
Country.
The Administration's budget proposal for fiscal year 2011
carves out dollars from afterschool funding for other purposes,
leaving some of our working parents and students behind. In
addition, the blueprint for ESEA proposes to expand the
priorities of the 21st Century Program in a way that would
leave many more children without access to quality afterschool
programs.
On behalf of the more than 26,000 afterschool programs that
the Afterschool Alliance works with, we urge the Committee to
appropriate additional funds for 21st Century this year and to
make certain that it remains a dedicated funding stream for
afterschool and summer programs in the years to come.
Chris.
Mr. Francis. Good morning, Chairman Obey and Subcommittee
members. I am Chris Francis and I am the CEO of the YMCA in
Rhinelander, Wisconsin.
Let me start by thanking my member of Congress, Chairman
Obey, for his decades of public service. He has served the
people of Wisconsin honorably and we are grateful for all he
has done for our region.
The YMCA provides the community and the school district of
Rhinelander's sole afterschool chance program. We are almost
entirely reliant on the district's 21st Century dollars. There
are two multi-year grants at work, one for children grades 6
through 8 and one through grades 4 through 5. The district also
applied for 21st Century dollars for K through 3, but was
unfortunately not awarded a grant.
The first point I want to promote is that we work very hard
to make sure our program is coordinated with what is going on
in the regular school day. We have regular school day teachers
who serve as tutors, and they have specific knowledge of what
is being taught when and what extra help children might need.
At one of our centers, our site coordinator is also the
school's guidance counselor, and she is vigilant about making
sure we know which students need help with a given issue.
Over the course of the last year, students in our program
have dramatically improved their grades. The average GPA of
regular attendees has increased steadily from 2.5 in the first
quarter to 3.2 the first quarter this year.
One of our afterschool students, whose name I will protect,
came to us as a seventh grade student last year. He eventually
had a run-in with law enforcement after school. That is the
point at which a lot of kids can and do slip right through the
cracks, labeled as troublemakers or low achievers. But the
school district and the YMCA worked very hard with him to get
his grades up and get him back on track, and this year he is on
the honor roll and continues with our program because he enjoys
it.
I know the Committee is interested in the opportunity that
afterschool programs offer for delivery of health care services
and health literacy instruction, and I could tell you that
afterschool provides an ideal platform.
Now turning to a second to proposals going forward, I have
some concerns. First, being a relatively small district, we do
not have a professional grant writer on staff, so I am
concerned about what it would mean if grants were nationalized.
Mr. Chairman, afterschool programs are in short supply.
More than 300,000 kids are left unattended after school.
Children in our State and in our Country deserve and need more
afterschool programs.
[Written Statement by Chris Francis follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much. Just one comment. You talk
about kids who run into trouble with the law. When I was in the
seventh grade, I skipped two days out of five regularly. I
would get off the school bus----
[Laughter.]
I would get off the school bus, I would walk three miles
home, grab my dog, go out and sit in the woods. If I had not
had the intervention by a couple of teachers in what was the
equivalent of an afterschool program, I might be in an
institution, but it would not be the United States Congress.
[Laughter.]
Mr. Francis. Thank you, Mr. Chairman. We hear those stories
a lot.
Mr. Obey. Next, Sharon Washington, National Writing
Project.
----------
Wednesday, May 12, 2010.
NATIONAL WRITING PROJECT
WITNESSES
SHARON J. WASHINGTON, EXECUTIVE DIRECTOR, NATIONAL WRITING PROJECT,
DEPARTMENT OF ENERGY
MARY TEDROW, ENGLISH TEACHER, JOHN HENLEY HIGH SCHOOL, WINCHESTER,
VIRGINIA, DIRECTOR, SHENANDOAH VALLEY SUMMER INSTITUTE
Ms. Washington. Good morning, Chairman Obey and other
members of the Subcommittee. My name is Sharon Washington,
Executive Director of the National Writing Project. I
appreciate the opportunity to present this testimony requesting
continued support. The National Writing Project is the only
nationwide network of professional development centers
dedicated to improving the teaching of writing. Since 1991, the
National Writing Project has been an authorized program within
the Elementary and Secondary Education Act. With consistent
Federal funding, NWP has built a national infrastructure of
more than 200 sites located in universities across the Country.
NWP sites serve teachers at all grade levels and across
disciplines; and teachers, schools, and districts across all 50
States, the District of Columbia, Puerto Rico, and the U.S.
Virgin Islands.
As you know, the Administration's fiscal year 2011 budget
proposal recommends a competitive grants program for States
called Effective Teaching and Learning: Literacy. NWP is not
eligible to compete for funds in this consolidated program and
would receive no direct funding. As a result, this effective
national infrastructure that Congress has invested in since
1991 would be lost.
NWP professional development addresses two essential
elements in educational improvement: the importance of quality
teaching and the vital skill of writing. And today this means
writing in all its forms--blog posts, tweets, persuasive
essays, scientific and business writing, as well as digital
stories, to name just a few.
In fact, writing in its many forms is the signature means
of communication in the 21st century. In a 2009 national public
opinion poll, three-quarters of those surveyed believe good
writing skills are more important today than they were 20 years
ago. And those of us who have children, grandchildren, nieces
and nephews, do not need to be convinced on that score.
Since 1974, the National Writing Project has expanded its
capacity to work with teachers from one local site to more than
200 today. NWP is truly a national, innovative, effective
program with a significant portfolio of research and evaluation
studies that show impact on student writing and performance.
Here are three key facts:
One hundred thousand teachers are served each year. Over
the last decade, at least one million teachers have
participated in our programs.
Two, National Writing Project's direct Federal support
leverages a 1:1 match with university, local, State, and
private dollars to improve classroom instruction in writing
that reaches millions of students annually.
Three, NWP develops new innovative programs to support the
work of local sites. For example, NWP has been awarded a three-
year grant from the MacArthur Foundation to help support
professional development programs using new digital tools for
the teaching of writing.
We know how important it is for the next new generation of
students to be able to communicate effectively and how
important that will be to their futures. I would like to
introduce to you Mary Tedrow, an English teacher at John Henley
High School in Winchester, Virginia, the Director of the
Shenandoah Valley Summer Institute.
Mary.
Ms. Tedrow. Thank you.
My initial contact with the NWP came in 1982, when I was a
relatively new teacher and attended a professional development
program featuring presentations by classroom teachers trained
through the Northern Virginia Writing Project located at George
Mason University. In an era when teachers worked in isolation,
this was the first time teachers shared their best lessons and
their student work with me.
This contact resulted in immediate changes to my practice,
such as adding daily writing and student sharing, all unheard
of in traditional classrooms.
In 1998, I was accepted into the five-week invitational
summer institute. Since then, I have been able to extend the
investment in my leadership to other teachers. Over 50 teachers
in grades kindergarten through university have received
training in the Shenandoah Valley since 2005 and returned to
their respective districts to lead their peers in professional
development, while continuing to learn new skills from the NWP
network.
I have been exposed to more than 21 years of professional
development programs, and the Writing Project stands alone in
its transformative nature.
I thank you on behalf of Writing Project teachers from
across the Country and the students that we teach each year.
[Written statement by Sharon J. Washington follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you both very much.
Next, Sheriff Dean Roland, from Fight Crime: Invest in
Kids.
----------
Wednesday, May 12, 2010.
CHILD CARE AND DEVELOPMENT BLOCK GRANT PROGRAM, HEAD START PROGRAM, AND
21ST CENTURY COMMUNITY LEARNING CENTERS PROGRAM
WITNESS
DEAN ROLAND, SHERIFF, BURNETT COUNTY, WISCONSIN, FIGHT CRIME: INVEST IN
KIDS
Mr. Roland. Thank you for the opportunity to testify before
you today. My name is Dean Roland, and I am the Sheriff of
Burnett County, Wisconsin. I am also a member of Fight Crime:
Invest in Kids, a national organization of more than 5,000 law
enforcement leaders who have come together to take a hard-nosed
look at the research about what really works to keep kids from
becoming criminals. Fight Crime: Invest in Kids takes no
Federal, State, or local money, and does not run any of the
programs we advocate for. I know from my experience and from
research that access to high-quality early care and education
for at-risk kids cannot only help close the achievement gap,
but prevent crime and make our communities safer as well.
For example, a study found that at-risk kids left out of
Chicago's Child Parent Centers Early Education Program, similar
to Head Start, were 70 percent more likely to be arrested for a
violent crime by age 18. Another study found that at-risk kids
left out of the high-quality Perry Preschool Program were five
times more likely to be chronic offenders, with five or more
arrested by age 27. By age 40, those who did not attend the
Perry Preschool Program were more than twice as likely to
become career offenders, with more than 10 arrests and twice as
likely to be arrested for violent crimes.
Head Start is the Nation's premier school readiness program
for children in poverty. Head Start incorporates most of the
key features of high-quality, early education programs proven
to cut crime, such as appropriate class size and teacher-
student ratios, comprehensive and age-appropriate early
learning standards, related services, including health
referrals, and parent involvement and coaching.
Research shows Head Start works for kids. For example, one
national study found that Head Start increases high school
graduation rates by 7 percent for children in the program
compared to their siblings not in the program, but in other
care, and decreased crime by 8.5 percent.
Early Head Start provides comprehensive child development
and family strengthening services for infants and toddlers from
birth to age 3. Research shows that Early Head Start is
effective. A study of over 3,000 families participating in 17
Early Head Start programs nationwide found that three-year-olds
who had participated in Early Head Start had higher levels of
cognitive and language development, better attention to play,
and lower levels of aggressive behavior.
This finding on aggressive behavior relates directly to
crime. Research shows that 60 percent of children with high
levels of disruptive, aggressive behaviors in early childhood
will manifest high levels of antisocial and delinquent behavior
later in life.
High-quality early care and education for at-risk kids not
only reduces crimes, but saves the public money as well. For
example, a cost-benefit analysis of the high scope Perry
Preschool Program showed that it saved $16 for every $1 spent.
And having been in this profession 35 years and 20 years as a
professionist, I can tell you you cannot build enough jails. We
need to focus on the education. Prevention works.
Unfortunately, despite these proven benefits, these
programs remain chronically underfunded. Nationally, Head Start
is only able to serve about half of the eligible kids. Early
Head Start serves less than 5 percent of eligible infants and
toddlers.
The Child Care and Development Block Grant is only able to
help one in seven eligible low-income kids get high quality
child care. In the current economic climate, more kids need
these services, but are unable to access them, and States are
cutting back their early care and education investments due to
their budget shortfalls.
To ensure at-risk kids get the high quality, early care and
education they need, I strongly urge you to increase funding
for investments that have been proven to reduce later crime and
violence by helping kids get the right start in life.
As you develop the fiscal year 2011 appropriations package
for the Department of Labor, Health, and Human Services, I urge
you to fund President Obama's proposed increase of nearly $1
billion over fiscal year 2010 levels for Head Start and Early
Head Start, and to increase funding for the Child Care and
Development Block Grant by $1 billion over fiscal year 2010
levels. As a law enforcement officer who has watched too many
kids grow up and become criminals, I know these investments
will make our community safer.
Thank you again for this opportunity.
[Written statement by Dean Roland follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much, and I appreciate the work
you have done through the years.
Mr. Roland. Thank you very much.
Mr. Obey. Thanks for coming.
Mr. Roland. Same to you.
Mr. Obey. Next, Ford W. Bell, American Association of
Museums.
----------
Wednesday, May 12, 2010.
AMERICAN ASSOCIATION OF MUSEUMS
WITNESS
FORD W. BELL, PRESIDENT, AMERICAN ASSOCIATION OF MUSEUMS, INSTITUTE OF
MUSEUM AND LIBRARY SERVICES
Mr. Bell. Thank you, Chairman Obey and Ranking Member
Tiahrt--who is not here--and other members of the Subcommittee.
I appreciate the opportunity to testify today. I am here on
behalf of the American Association of Museums to request your
support for an increased investment in our Nation's museums.
The American Association of Museums is proud to represent the
full spectrum of our Nation's museums, from aquariums,
botanical gardens, and historic sites, to planetariums,
presidential libraries, science and technology centers, zoos,
aquariums, and everything in between, along with professional
staff and volunteers who work for and with museums.
The Institute of Museum and Library Services is the primary
Federal agency that supports the Nation's 17,500-plus museums,
and its Office of Museum Services awards grants to all types of
museums to help museums care for their collections and to
create innovative programs and exhibits.
We urge your support for $50,000,000, a $15,000,000
increase for the Office of Museum Services at the Institute of
Museum and Library Services.
Museums are essential to our communities, schools, and
economy for many reasons. Each dollar that supports museums is
an important economic investment. In 2008 alone, museums
contributed approximately $20 billion to the American economy.
Museums also serve as economic engines, bolstering local
infrastructure and encouraging tourism. There are 850 million
museum visits in the United States every year.
Museums create jobs. An estimated 500,000 people currently
work for museums, but the more than $20 billion pumped into the
American economy by museums creates millions more jobs.
Museums are also key partners in education. Museums spend
more than $2.2 billion annually on educational programming for
K through 12 children and design educational programs in
coordination with State and local curriculum standards in
almost every subject. They also provide professional
development for teachers in all subjects.
Through the use of digitization and traveling exhibitions,
museums are able to bring their collections to underserved
regions across the Country. Unfortunately, like so many other
nonprofits, museums are struggling in this economy. They have
been forced to cut back hours, programming, community services,
and, therefore, jobs. Some have had to close their doors for
good.
It is for these reasons that increased funding for the
Office of Museum Services, which has been essentially flat-
funded for many years, is so critical. For example, Congressman
Obey, in your district, IMLS grants support Lac Courte Oreilles
Band of Lake Superior Chippewa Indians Malagasy Cultural
Resources Center, allowing the Center to partner with the local
schools to develop regional history curriculum.
Congressman Rehberg, in your district, with IMLS support,
the great Museum of the Rockies will host Dinosaurs Under the
Big Sky through its new Mesozoic Media Center. This multi-
partner project will bring science to entirely new audiences
with live webcasts and other educational programming.
It is important to note that zoos and aquariums are
critical members of our museum family. They are leaders in
environmental education; they are saving endangered species;
and they too are economic engines creating thousands of jobs
and spurring local tourism dollars. I raise the issue today
because a year ago zoos and aquariums were excluded from
competing for stimulus funds and are currently excluded from
some proposed jobs bills.
Museums are significant job creators, and zoos and
aquariums, in particular, create green jobs. They are science
education jobs, keep us competitive globally, and they are
investments in community infrastructure that we cannot afford
to ignore. I urge the Subcommittee to consider the vital role
that zoos and aquariums play as any further stimulus bills or
jobs bills or other appropriations bills are considered.
Thank you for the opportunity.
[Written statement by Ford W. Bell follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you. Let me just make one point. Zoos were
not excluded because there is anything wrong with zoos; they
were excluded because it was necessary to find the votes to
pass the stimulus bill. There are some people in this
institution and out who have a habit of demagoging when they
can find anything they can get a handle on, and they certainly
have done so in the past with respect to those institutions,
which is why, for the greater good, we regretfully had to
recognize that the power of their outlandish rhetoric
outweighed our ability to counter it, to be frank about it.
Mr. Bell. I understand, Congressman. Thank you, Mr.
Chairman.
Mr. Obey. Thank you.
Next, Vivian Schiller, National Public Radio.
----------
Wednesday, May 12, 2010.
NATIONAL PUBLIC RADIO
WITNESS
VIVIAN SCHILLER, PRESIDENT AND CEO, NATIONAL PUBLIC RADIO, CORPORATION
FOR PUBLIC BROADCASTING
Ms. Schiller. Thank you, Mr. Chairman and members of this
Subcommittee. I appreciate your giving me the opportunity to
express support for funding for public broadcasting. As the
President and CEO of NPR, I am testifying today on behalf of
more than 850 public radio station partners, producers, and
programming allies, including American Public Media, Public
Radio International, and Public Radio Exchange.
The public radio system, all in public broadcasting, and
the tens of millions of Americans who listen and watch every
week are grateful for your decades of support. We are also
grateful for the additional $25 million in funding provided by
Congress last year to help stations offset the devastating
financial impact of the Country's economic crisis.
The concept of public funds for public broadcasting is a
cornerstone of the relative financial stability of our system.
In the few minutes I have with you today, let me cover two
closely related topics: the dramatic changes that have engulfed
media, and particularly the world of journalism and news that
are the strengths of public radio; and the state of public
radio and steps we have taken.
Last month, the Project for Excellence in Journalism from
Pew released its annual State of the News Media Report. Every
year it is a very hotly anticipated document and, at 700 pages,
it is pretty closely analyzed for clues and nuances about the
future of the business. Well, usually it is tea leaf reading,
but not this year. This year, the report came like a blow to
the head with a two-by-four.
Here are a few phrases I pulled verbatim from the State of
the Media Report: enormous losses; grim revenue numbers;
continued declines in audience; continued declines in revenue;
continued declines in staff; and this line, the losses suffered
in traditional news gathering in the last year were so severe
that, by any accounting, they overwhelmed the innovations in
the world of news and journalism.
Here are these findings translated into numbers.
Newspapers, including online, saw ad revenue fall 26 percent
during the past year, bringing total losses over the last three
years to 41 percent. Nearly one in every five journalists
working for newspapers in 2001 is no longer doing so. Almost
6,000 full-time newsroom jobs were cut, or about 11 percent in
2008. Sixteen hundred jobs lost in local television the last
two years. Over the past five years, newspaper audiences have
declined by 29 percent. And on and on.
This is coverage of the very issues that you referenced as
so needing of support, a lot of things that are being talked
about today. This is coverage about health care, about
education, about worker protection, about children in need and
children at risk.
I add one more statistic that really begins to tell the
story or, rather, leaves the story untold: overseas, all three
television networks had, by the end of 2008, eliminated the
posting of a full-time reporter in Iraq. The Pew report begins
with two words: What now?
First, you should know that we are NPR still have our Iraq
bureau and a full-time bureau in Kabul, Islamabad, and 14 other
international locations, plus 21 domestic bureaus. Yes, we were
hit by the recession and suffered losses, mostly in
underwriting revenue, but we have not hit in audience. We have
just reached an all-time high: 34 million listeners every week
to NPR member stations at six hours per week. Our audience
continues to grow.
So here is the what now for us. We are moving forward
through innovation and partnership in three areas: more
original reporting, foreign investigative breaking news, and
particularly local reporting; reaching more diverse audiences
to reflect changes in each race and ethnicity as the
demographics of the Country change; and fully embracing new
platforms and technologies--streaming, podcasting, use of the
iPhone, iPad, BlackBerry; wherever our audience needs us.
And unlike others in media seeking to turn a profit or
charge fees for access to the news, we will always be free to
our audience, the American people. NPR believes public radio
and all of public broadcasting have an integral and primary
role to present the future information needs of American
communities, and we thank you for our support today. Thank you.
[Written statement by Vivian Schiller follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Next, Yasmina Vinci, from the National Head Start
Association.
---------- --
--------
Wednesday, May 12, 2010.
HEAD START
WITNESS
YASMINA VINCI, EXECUTIVE DIRECTOR, NATIONAL HEAD START ASSOCIATION
Ms. Vinci. Chairman Obey and distinguished members of the
Committee, thank you very much for the opportunity to testify.
Chairman Obey, given your recent announcement of your
pending retirement, I would like to take a very quick moment
and thank you for all you have done as Chairman of the
Committee, and I think early care in education is stronger as a
result of your efforts. Thank you.
I am testifying today on behalf of the National Head Start
Association, which represents more than one million children,
200,000 staff, and 2600 programs in the United States.
Created in 1965, Head Start is the evidence of the
Country's longest commitment to early education and care. Head
Start programs across the Country prepare young high-risk
children and their families to succeed in school and in life.
These investments in Head Starts have paid dividends to the
children, to their families, and to the communities. Reliable
research studies demonstrate that fewer Head Start children
repeat grades; fewer need costly special education; more
graduate from high school.
Because of Head Start's health services, 33 to 50 percent
fewer children die of preventable diseases in their early
school years. And as you heard from Sheriff Roland, Head Start
benefits society at large by reducing crime and its cost to
crime victims.
More than 27 million children have benefitted from Head
Start. But prior to the American Recovery and Reinvestment Act,
Head Start was only able to serve about 40 percent of eligible
children and Early Head Start served only 2 to 3 percent.
Thanks to Congress, through the Recovery Act funding, Head
Start and Early Head Start have been able to serve 14,000 more
three- and four-year-olds, and 50,000 more infants and toddlers
across the Country.
However, the increased numbers of children and families now
assisted by Head Start still falls short of the need. According
to the U.S. Bureau of Census, another 1.1 million children
under the age of six slipped into poverty between 2001 and
2008, and those children are now on Head Start programs'
waiting lists.
For instance, in Sedgwick County, Kansas, there were over
2,000 applications for only 237 spaces. In five Minnesota
communities, 1,866 families are on waiting lists. And in just
one program in California, Berkeley-Albany YMCA, 240 families
are waiting anxiously every day for a space to open.
For all of these reasons and more, NHSA strongly supports
the President's budget for fiscal year 2011. Specifically, the
President's budget provides an additional $989 million for Head
Start and Early Head Start to continue to serve the 64,000
additional children and families funded by the Recovery Act.
The President's proposal would allow Head Start programs to
preserve the recent gains. After years of flat funding that did
not keep up with the rate of inflation, we are moving towards
paying Head Start staff wages consistent with their skills.
Through the Recovery Act, an additional 24,000 jobs were
created for the new Head Start staff. Thousands more jobs were
created in building new Head Start classrooms and playgrounds,
and many more children and families are being served.
Accordingly, it would be devastating to every community
across the Country if Head Start suddenly had to cut back and
reduce the size of the program. Tens of thousands of early
childhood professionals would have to be laid off; at-risk
families would be dropped from the program with nowhere else to
turn; buildings would sit empty; and the gains that have been
made would be lost. This Country cannot afford for that to
happen.
For all these reasons and more, National Head Start
Association hereby requests that this Committee support the
President's fiscal year 2011 budget proposal for Head Start and
for the other early childhood programs as well.
Thank you very much.
[Written statement by Yasmina Vinci, follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Next, is it Tunde Eboda? National Association for State
Community Services Programs.
----------
Wednesday, May 12, 2010.
COMMUNITY SERVICES BLOCK GRANT PROGRAM
WITNESS
TUNDE EBODA, PH.D., CSBG STATE ADMINISTRATOR, DISTRICT OF COLUMBIA,
NATIONAL ASSOCIATION FOR STATE COMMUNITY PROGRAMS
Mr. Eboda. Yes, Mr. Chairman. Thank you very much. Chairman
Obey, Acting Ranking Member Rehberg, good morning. Members of
the Committee, we want to thank you for the opportunity this
morning to provide testimony on behalf of the National
Association for State Community Services Programs.
We want to thank Congress for the support of the Community
Services Block Grant and we look forward to the many
opportunities in the future to demonstrate the successes and
build upon the successes that we have accomplished in promoting
economic stability and mobility for Americans everywhere.
We especially want to thank Chairman Obey for the ardent
work that he has done over the week and for being the champion
of vulnerable populations. We very much appreciate your service
and thank you for it.
Mr. Obey. Thank you.
Mr. Eboda. I planned today to talk about CSBG outcomes, and
we do have a lot of them, but first I want to talk about jobs.
We are the recipient of economic recovery funds, and we are
happy to report that this year, so far, we have created and
retained or retained a minimum of 8,000 jobs, and have helped
approximately 22 percent of Americans in poverty to stay
employed and retain economic stability.
The Federal recovery spending data ranks the Community
Services Block Grant number 12 out of approximately 200
programs that were reviewed for jobs created and retained.
Because of the Recovery Act funds, we have been able to
accomplish this many successes.
We stand the risk of losing the Recovery Act funds at the
end of 2010. We will be asking and request that a minimum of
$300 million be added to the CSBG funds, which would be
approximately 33 percent of what we will be losing as a result
of the Recovery Act funds expiring at the end of fiscal year
2010.
What are some of the functions of the state in the
Community Services Block Grant Program? We provide, of course,
the assurance through the Federal Government and to all
stakeholders that we hold community action agencies accountable
for the use of Community Services Block Grant funds; we provide
the partnerships that is critical to making Community Services
Block Grant funds work.
Many other Federal programs are already located within the
State. The Temporary Assistance for Needy Families, the Low
Income Home Energy Assistance Program, Early Head Start
programs, all combine to make CSBG work through partnerships.
We provide the monetary and evaluation that is necessary to
assure our stakeholders that we are good stewards of Federal
funds.
Additionally, we have the responsibility for providing
reports to Congress on an annual basis that demonstrate the
successes and how we have overcome challenges that exist within
the network.
We are asking also that language in the CSBG statute be
retained so that we have the flexibility to recapture funds and
redistribute those funds within the CSBG network if agencies do
not expend up to 20 percent of their grant going into the next
fiscal year.
We have many examples of successes within the CSBG program.
We have provided details for the record in the testimony that
we have submitted before the Committee today.
We are happy to be here to report on the successes and we
have many, many more, and we encourage members to please review
the testimony, and we are happy to answer any questions that
you may have. Thank you.
[Written statement by Tunde Eboda follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you again.
Mr. Eboda. Thank you very much.
Mr. Obey. Next, Steven Berg, National Alliance to End
Homelessness.
----------
Wednesday, May 12, 2010.
HOMELESSNESS
WITNESS
STEVEN R. BERG, VICE PRESIDENT FOR PROGRAMS AND POLICY, NATIONAL
ALLIANCE TO END HOMELESSNESS
Mr. Berg. Good morning, Mr. Chairman and members of the
Subcommittee. The last time we had full national data was early
in 2008, and at that point there were two-thirds of a million
people homeless in the United States. Now, that is too many
people. But that is also significantly fewer people than were
homeless even a few years beforehand. We started to make
progress on this issue thanks to what communities around the
Country are doing to adopt new practices and better approaches.
Homelessness is a problem with a solution, and an important
part of that solution is in the jurisdiction of this
Subcommittee. My written testimony identifies 11 different
items that we believe are key and relevant to continuing to
make progress. I want to spend a couple minutes just focusing
on three of those that involve some new things.
First of all, SAMHSA has a series of direct grants to
nonprofits around the Country to provide services in supportive
housing. Supportive housing is deeply subsidized housing, where
the rents are subsidized, combined with intensive support
services in health treatment that has proven to really work to
get people who have been on the streets for many years, who
have severe problems of mental health, substance abuse, other
kinds of physical problems, to get them off the street,
permanently housed, and end their homelessness. That is a model
that has directly contributed to thousands of people who used
to live on the streets now being housed.
This year there is something in the President's budget that
people on this Committee and around the Country have been
demanding for many years, which is for an initiative to get HHS
and HUD to work more closely together to provide permanent
supportive housing. So most of the funding for that is coming
from HUD, but there is $15.8 million in the President's budget
to provide supportive services specifically matched up with
HUD-funded rental vouchers to provide permanent supportive
housing both for homeless people with disabilities and also for
homeless families with children. This is a new initiative we
think is going to go a long way toward getting those two
agencies to work together and to get the people who get their
money on the ground to work together. So that is an important
item.
Community Health Teams is a grant program that was in the
health care reform bill that is ready to go as soon as money is
appropriated for it. This would fund primary care providers to
coordinate with other providers at the State and local level to
provide services to people in medical homes, which is a term of
art, but which applies to permanent supportive housing. So it
is another way into this permanent supportive housing problem.
We believe an initial allocation of $20 million for that
program, to get that program started and off the ground would
be money well spent.
Finally, the third piece has to do with youth homelessness.
There are many unaccompanied youth who are homeless in our
cities and our rural areas. We do not know as much about that
part of the problem, but we do estimate that there is probably
50,000 who are long-term living on the streets, without
anyplace to live, without any support from family.
We are working very hard to up the visibility of this issue
this year and to really look for better solutions, and we think
the Runaway and Homeless Youth Act programs at the
Administration for Children and Families are going to be a key
part of those solutions.
I would like to close just by saying we have made great
progress on this issue over the last few years. The
Appropriations Committee has been at the center of that
progress by investing in things that work, so on behalf of
myself, on behalf of literally hundreds of thousands of people
who are going to bed tonight in a modest apartment, who would
be sleeping in the back seats of their cars, I want to thank
you for the work you have done over the years as a leader on
this issue and assure you that we will continue to work on it
while you are gone.
[Written statement by Steve Berg follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you much.
Mr. Berg. Thank you.
Mr. Obey. Next, Kevin Martone, National Association of
State Mental Health Program Directors.
----------
Wednesday, May 12, 2010.
MENTAL HEALTH BLOCK GRANT
WITNESS
KEVIN MARTONE, COMMISSIONER, NEW JERSEY DEPARTMENT OF HUMAN SERVICES,
DIVISION OF MENTAL HEALTH SERVICES, NATIONAL ASSOCIATION OF STATE
MENTAL HEALTH PROGRAM DIRECTORS
Mr. Martone. Mr. Chairman, members of the Subcommittee, I
want to thank you for the opportunity to appear before you
today. My full-time job, I am New Jersey's Mental Health
Commissioner. Today, I am here to reflect the views of the
National Association of State Mental Health Program Directors,
NASMHPD, which represent the public mental health authorities
in the 50 States, as well as the District of Columbia and the
territories.Permit me to briefly summarize the situation we
confront. The larger State fiscal crisis is having a severe
impact on public mental health systems across the United States
and is certainly being felt in New Jersey. According to
February 2010 data collected by NASMHPD's Research Institute,
between fiscal year 2009 and fiscal year 2011, States have been
forced to cut mental health agency budgets by a combined total
of $1.82 billion. That estimate reflects reporting from 45
States.
Mr. Chairman, to put this in historical context, that
number probably represents the largest total funding reduction
to public center mental health services in nearly 50 years. The
effect of these shortfalls on America's mental health safety
net, as well as the consumers it serves, can only be described
as devastating. Some States have been forced to make cuts
equaling 20 percent of their total mental health spending. In
the worst hit States, reductions approaching 40 percent are
being contemplated or have already been implemented.
As an illustration, in Ohio, the combined State mental
health cut over the last three fiscal years total over $191
million. The total percentage reduction equals 36 percent
across the board.
To date, the programs hardest hit are indigent care
initiatives providing mental health services to low-income
people and uninsured adults, many of whom recently lost health
insurance coverage in this recession. Let me take a moment to
give you some specific examples of what these cuts mean in our
communities.
In Illinois, Governor Quinn is being forced to contemplate
a $90 million funding cut to Illinois' Division of Mental
Health Community Services. Once Medicaid reimbursements
reductions are included, the proposed State cut would result in
a 40 percent reduction in community-based mental health
services statewide. It is estimated that more than 70,000 low-
income persons, including over 4200 children, will lose access
to mental health care.
In Kansas, 9 of the State's 27 community mental health
centers are in the red and may close. Most serve rural health
professional shortage areas. Furthermore, it is astonishing to
note that Kansas is actively contemplating a complete freeze on
all new admissions to the State's public psychiatric hospitals
for up to a full year.
In New Jersey, consistent with the United States Supreme
Court's Olmstead decision, and with Governor Christie's
support, we are reducing the number of State psychiatric
hospitals and serving more people with severe mental illnesses
in the community, closer to family and friends. In fiscal year
2011, our Division will close Hagedorn Psychiatric Hospital,
producing a projected savings of $9 million.
Yet, at the same time, the budget crisis has forced us to
reduce community contracts and my division was required to make
targeted cuts to partial care, case management, and jail
diversion programs. This situation greatly contemplates our
ability to close Hagedorn. Moreover, in all candor, what keeps
me up at night is that fiscal year 2012 does not look much
better than 2011.
Let me end my testimony by making two larger points. First,
State mental health agencies nationwide are caught in a policy
vice. We are losing State and county revenues, while at the
same time the recession is producing a huge spike in the number
of people coming to us for mental health care. Twenty States
are reporting increased demand for both outpatient services, as
well as acute care hospital services. In Rhode Island, for
instance, community mental health service centers served nearly
22,000 people with mental illnesses last year, one of the
highest totals in its State history.
Second, although Federal Medicaid FMAP increases approved
in ARRA have helped temporarily avert even deeper cuts, they
have not shielded the public mental health system from the
worst funding reductions in nearly five decades. In addition,
the new health care reform law will not begin providing health
insurance to many indigent persons for several years, and many
of the intensive rehabilitative services these individuals
require will not be covered by the new insurance exchanges or
Medicaid.
In March 2010, Representatives Tonko and Napolitano, along
with 35 other members of Congress, wrote to this Subcommittee
requesting a $100 million increase for SAMHSA's Community
Mental Health Services Block Grant, resulting in a total
funding level of $520 million. Both NASMHPD and the New Jersey
Division of Mental Health Services strongly support this
request.
Yes, I acknowledge that the Tonko and Napolitano request is
without precedent, but the scale of the fiscal crisis we
confront is also unprecedented. The hard fact is that Mental
Health Block Grant is the only program available to help public
mental health authorities recover State and county service
dollars lost during the current fiscal crisis.
I welcome any questions you may have.
[Written statement by Kevin Martone follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. [Remarks made off microphone.]
Next, Michael J. Fitzpatrick, National Alliance on Mental
Illness.
----------
Wednesday, May 12, 2010.
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
WITNESS
MICHAEL J. FITZPATRICK, EXECUTIVE DIRECTOR, NATIONAL ALLIANCE ON MENTAL
ILLNESS
Mr. Fitzpatrick. Chairman Obey and members of the
Subcommittee, I am Mike Fitzpatrick. I am the Executive
Director of the National Alliance on Mental Illness. I am
pleased today to offer NAMI's views on the Subcommittee's
upcoming fiscal year 2011 bill. NAMI is the Nation's largest
grassroots advocacy organization representing persons with
serious mental illness and their families.
I first want to thank the Subcommittee for a long
bipartisan history of supporting funding for research and
services for people with serious mental illness. As you know,
the cost of mental illness to our Nation is enormous.
I want to summarize NAMI's statement to you by making three
major points.
The investments in research at the National Institute of
Mental Health are critical for our Nation. NAMI joins the ad
hoc group on medical research recommending $36 billion in
overall funding for the National Institutes of Health,
representing a 12 percent increase.
NAMI also recommends a corresponding 12 percent increase of
$1.7 billion for the National Institute of Mental Health. This
increase will enable NIMH to continue supporting two critical
initiatives that were started using stimulus monies.
The first is RAISE, Recovery After an Initial Schizophrenia
Episode. This is the first ever large-scale trial supporting
early and aggressive treatment, integrating a variety of
different therapies to reduce symptoms and prevent the gradual
deterioration or functioning that is characteristic of
schizophrenia.
The second project is STARRS, which is the Study to Assess
Risk and Resilience in Service Members, a joint Army and
National Institute of Mental Health study of suicide and mental
health among military personnel.
Additionally, this 12 percent increase will allow the
National Institute of Mental Health to continue supporting
other important research initiatives to find better treatments
and ultimately a cure for disabling illnesses.
Our second point is this Subcommittee must address, as you
just heard from the Commissioner of New Jersey and from
NASMHPD, the current crisis in funding of the public mental
health system.
Mr. Chairman, as our Nation continues to struggle with this
current economic downturn and States continue to struggle with
diminished revenue, we see a crisis in America's mental health
system that we have not seen in our tenure at NAMI over the
past 31 years. The system is literally collapsing in front of
us. We echo and have the same numbers that NASMHPD has, the
cuts of nearly $1.8 billion since 2009. We see cuts in States
totaling as much as 20 percent and more. Looking at the budget
numbers in State budgets for the next two or three years, we
see this picture not changing through 2011, 2012.
This has led to the elimination of State hospital beds, the
closure of important, essential mental health services, and
really has left the burden in communities falling on jails,
homeless shelters, and emergency rooms as really the backbone
of the mental health systems. This is tragic and really
unacceptable.
To help fill these gaps left by these ill-conceived cuts,
NAMI strongly recommends a $100 million increase to the Mental
Health Block Grant for fiscal year 2011. Funding for the Block
Grant has been frozen at its current level of $420 million
since fiscal year 2000. An increase is long overdue. While this
will not make up for the cuts to services on the State side,
this is an important step that Congress must take to assist our
most vulnerable citizens.
NAMI also supports targeted increases in the President's
budget for the Center for Mental Health Services, including the
PATH program, the Children's Mental Health program, Suicide
Prevention Programs under the Garrett Lee Smith Memorial Act,
and homeless programs at SAMHSA.
And third, and finally, for fiscal year 2011, the
Subcommittee should continue the progress it has made in recent
history in addressing the Social Security claims and appeals
backlog. Mr. Chairman, people with mental illness and other
severe disabilities have been bearing the brunt of the backlog
crisis for disability claims at Social Security. Behind the
numbers are individuals whose lives have unraveled because of
this backlog.
We applaud the work the Subcommittee has done in recent
history to boost funding to the Social Security Administration.
We would ask you just to please continue this progress by
supporting the President's funding recommendations regarding
the Social Security Administration.
Thank you for the opportunity to speak to you today.
[Written statement by Michael J. Fitzpatrick follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. [Remarks made off microphone.]
Next, Julio Abreu, Coalition for Health Funding.
----------
Wednesday, May 12, 2010.
NATIONAL INSTITUTES OF HEALTH, CENTERS FOR DISEASE CONTROL, HEALTH
RESOURCES AND SERVICES ADMINISTRATION, SUBSTANCE ABUSE AND MENTAL
HEALTH SERVICES ADMINISTRATION, AGENCY FOR HEALTHCARE RESEARCH AND
QUALITY, FEDERAL DRUG ADMINISTRATION, AND INDIAN HEALTH
WITNESS
JULIO ABREU, SENIOR DIRECTOR, GOVERNMENT AFFAIRS, MENTAL HEALTH
AMERICA, ALEXANDRIA, VIRGINIA, COALITION FOR HEALTH FUNDING
Mr. Abreu. I have been called worse, Chairman.
Mr. Obey. [Comments made off microphone.] [Laughter.]
Mr. Abreu. Good morning, Mr. Chairman and members of the
Subcommittee. My name is Julio. I am President of the Coalition
for Health Funding and Senior Director of Government Affairs at
Mental Health America. I am pleased to offer this testimony on
behalf of the Coalition regarding funding for agencies and
programs of the U.S. Public Health Service, including NIH, CDC,
HRSA, SAMHSA, and AHRQ.
Since 1970, the Coalition has advocated for sufficient and
sustained discretionary funding for the public health continuum
to meet the mounting and evolving health challenges confronting
the American people. We acknowledge and applaud the
longstanding support of public health programs from the
Subcommittee, particularly that of the Chairman. And I want to
echo our deep gratitude for your tremendous leadership.
Our diverse membership, representing the interest of over
50 million patients, providers, researchers, and public health
professionals, supports the belief that the public health
agencies and programs are essential for improving health and
health care through greater access, higher quality, lower
costs, improved safety, faster cures, and ultimately healthier
people.
The Coalition's pressing and immediate goals are to: one,
build the capacity for our public health system; two, address
America's mounting health needs under the weight of an ongoing
recession and aging population, a health workforce shortage,
and rising rates of chronic disease; and, three to support the
implementation of the Patient Protection and Affordable Care
Act, a new health care reform legislation, PPACA.
Given the current fiscal challenges, the Coalition
appreciates the funding increases proposed in the President's
fiscal year 2011 budget for public health programs. We are also
grateful to you and your colleagues for the mandatory funding
stream for public health, now provided through health reform,
to augment discretionary funding for the existing public health
infrastructure.
We hope Congress will seize the opportunity to increase
momentum for health system transformation by further investing
in the public health continuum, building on previous
discretionary investments in the public health service, and
making permanent capacity created by ARRA.
We also hope Congress will resist the urge to look to the
Mandatory Public Health and Prevention Fund provided in PPACA
as a means to supplant current discretionary public health
funding, as this mandatory investment was intended to make
whole the existing public health infrastructure and support
innovative cross-cutting programs to transform the ways in
which public health services are delivered.
These transformational investments will help lead the
Nation toward a more community-oriented accountable approach to
public health, which will in turn decrease our Nation's health
care costs and make America healthier.
The public health infrastructure has experienced
significant erosion over the past several years, despite its
important role in keeping Americans healthy, productive, and
secure. Federal spending for public health has been flat for
nearly five years, and our States around the Country have cut
more than $392 million for public health programs in just the
past year. These shortfalls have left communities struggling.
Federal discretionary investment in public health service
represents only a fraction of our Nation's total health care
spending, just 2 percent in 2008 based on expenditure data from
CMS, even though the public health continuum has the potential
to slow sustainable growth in mandatory costs. Our Nation's
lost opportunity to save lives and money through investments in
the public health continuum is possibly best represented by the
Medicare program. A study published in Health Affairs finds
that the causes of Medicare spending growth have changed
dramatically in two decades, where Medicare's skyrocketing
costs are now mostly attributable to the treatment of
preventable chronic conditions such as diabetes, conditions
that could have been prevented with a more serious investment
in public health.
We listened to you, Mr. Chairman. We have been working with
our other public health organizations and have 300 of them
signed up with five former surgeon generals urging Congress to
invest in public health.
Let me close by saying that while I am not a musician, I
bet I can get the public health community to join and perhaps
create a band to go around the Country to make a compelling
case for the need to invest in public health. Thank you for
this opportunity, Mr. Chairman.
[Written statement by Julio Abreu follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. [Remarks made off microphone.]
Next, James Sykes, AIDS Institute.
----------
Wednesday, May 12, 2010.
CENTERS FOR DISEASE CONTROL, HEALTH RESOURCES AND SERVICES
ADMINISTRATION, AND NATIONAL INSTITUTES OF HEALTH
WITNESS
JAMES SYKES, DIRECTOR OF GLOBAL PROGRAMS, POLICY AND ADVOCACY, AIDS
INSTITUTE
Mr. Sykes. Good morning, Mr. Chairman and Subcommittee
members. The AIDS Institute is pleased to be here today to
comment in support of funding domestic HIV/AIDS and hepatitis
programs. We thank you for your support of these programs over
the years and trust that you will do your best to adequately
fund them in the future in order to provide for and protect the
health of many Americans.
HIV/AIDS remains one of the world's worst health pandemics
in history. To date, nearly 600,000 people have died of AIDS in
the U.S. Over 1.1 million people in the U.S. are living with
HIV/AIDS, and there is a new infection every nine and a half
minutes. Persons of minority races and ethnicities are
disproportionately affected, as well as the poor. About 70
percent of those infected rely on publicly funded health care.
Despite the growing need, domestic HIV/AIDS programs have
experienced only very minor increases in recent years. We hope
you will support President Obama's desire to increase funding
for these important public health programs. Federal funding is
particularly critical at this time, since State and local
government budgets are being severely cut during this economic
downturn, while demand for services are escalating due to the
fact that people are living longer, people are losing their
health insurance, and HIV testing programs are identifying more
people who have HIV.
Of immediate importance is our request of $126 million in
emergency funding this year for the AIDS Drug Assistance
Program. ADAPs provide lifesaving HIV drug treatment to over
150,000 people, the majority of whom are people of color and
very poor. Currently, ADAPs are experiencing unprecedented
growth. The monthly growth rate of nearly 1300 clients is an
increase of 80 percent from fiscal year 2008.
Due to the economic crisis, State contributions to the
programs have dropped from $329 million to $214 million in just
one year. Meanwhile, the Federal share of the ADAP program has
dropped to only 49 percent, compared to 69 percent in 2000.
Due to the lack of funding, States have instituted waiting
lists and have reduced the number of drugs on their
formularies, reduced eligibility, and capped enrollment. There
are currently 1,056 persons in 10 States on ADAP waiting lists
as of today. In order to address the ADAP funding crisis, which
will grow much worse in fiscal year 2011, we are requesting an
increase of $370 million. To address the immediate situation,
the AIDS Institute requests $126 million of those funds in
fiscal year 2010 as part of an emergency supplemental.
We are very pleased that just last week 66 members of the
House sent a letter to President Obama in support of this
emergency funding for ADAP.
For fiscal year 2011, the President requested an increase
of only $39.5 million, or just 1.7 percent for the entire Ryan
White Program, which includes ADAP; and no increase for Parts A
and D of the program.
The AIDS Institute urges the Subcommittee to consider the
growing needs of all parts of the Program and provide the
necessary resources it requires to meet the needs of people
living with HIV/AIDS in the U.S.
Nearly two years ago, the CDC increased its estimate of new
infections per year by 40 percent. In order to reverse that
trend, the CDC is going to need additional resources so that it
can scale up HIV prevention. But currently we only allocate
about 3 percent of our total HIV/AIDS spending on domestic
prevention.
Unfortunately, the requested $31 million increase by the
President is far from what is needed to reduce the number of
new HIV infections. We would, however, like to commend the
President for focusing much of this increase on gay men, who
represent a majority of HIV cases in the U.S. and is the only
group in which HIV incidence is increasing.
Investing in prevention today will save money tomorrow.
Every case of HIV that is prevented saves, on average, $355,000
of lifetime treatment costs. That translates into nearly $20
billion in annual future medical costs for the 56,300 new
infections that occur every year.
As detailed in our written statement, the AIDS Institute
supports additional funding for AIDS research at NIH, the
Minority AIDS Initiative, the CDC's Viral Hepatitis Division.
We also appreciate the Committee's support for funding of
syringe exchange and comprehensive sex education programs, two
proven HIV prevention programs.
Again, the AIDS Institute appreciates the opportunity to
appear before you today, and thank you for your continued
support. Thank you, sir.
[Written statement by James Sykes follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. [Remarks made off microphone.] [continuing]. Have
written the Committee asking for increased funding. I am sure
most of them are consistent, but there are more than a few
members in Congress who will sign every blessed letter that
comes along asking for more money, and then they will vote
against the bill that contains the money when it comes to the
Floor and kick the hell out of us for saying it contains too
much money.
Mr. Sykes. I understand.
Mr. Obey. So if you can help us to avoid giving hypocrisy a
bad name, it would be appreciated. [Laughter.]
Mr. Sykes. Give me the names of those members, sir, and we
would gladly call on them.
Mr. Obey. Next, Dr. Heidi Chumley, Health Professions and
Nursing Education Coalition.
----------
Wednesday, May 12, 2010.
TITLE VII AND VIII
WITNESS
DR. HEIDI CHUMLEY, SENIOR ASSOCIATE DEAN OF MEDICAL EDUCATION,
UNIVERSITY OF KANSAS MEDICAL CENTER, HEALTH PROFESSIONS AND NURSING
EDUCATION COALITION
Dr. Chumley. Good morning. My name is Dr. Heidi Chumley,
and I am a family physician and the Senior Associate Dean for
Medical Education at the University of Kansas School of
Medicine.
Like most academic family physicians, I have a firsthand
appreciation for HRSA's health profession programs, as they
have supported my work throughout the various stages of my
career. So it is a pleasure to testify today on behalf of the
Health Professions and Nursing Education Coalition, or HPNEC,
an alliance of more than 60 national organizations representing
schools, programs, health professionals, and students dedicated
to ensuring the health care workforce is trained to meet the
needs of the diverse population.
I am here to speak with you about the Title VII health
professions and Title VIII nursing programs, which enhance the
supply of the diversity and the distribution of health care
workforce by supporting the education of health professionals.
In particular, these programs emphasize primary care and
training in interdisciplinary settings. With the recent
enactment of health reform legislation, the Nation will need a
robust, diverse health care workforce to meet the increased
demands for care.
HPNEC recommends $600 million to sustain and strengthen the
existing Title VII and Title VIII programs in fiscal year 2011.
As you know, PPACA updated and restructured the existing health
professions programs to improve their efficiency,
effectiveness, and accountability. The legislation also
authorized several new programs and initiatives designed to
help mitigate health workforce challenges.
Many HPNEC members are enthusiastic about the opportunities
afforded through these newly authorized workforce programs. As
a coalition, HPNEC encourages an investment in these new
programs that supplements, but does not replace, support for
the existing Title VII and Title VIII programs.
We are grateful to the Chairman and this Subcommittee for
the increases provided for many of the health professions
programs in recent years, and for the Subcommittee's
longstanding support.
These investments are crucial to addressing existing and
looming provider shortages throughout the Country. According to
HRSA, over 30,000 health practitioners are needed today to
allay existing shortages. Further, within the next 10 to 20
years, the Nation faces shortages of 200,000 physicians,
including at least 46,000 primary care professionals, a million
nurses, 38,000 pharmacists, 250,000 public health
professionals, and 40,000 geriatricians and geriatric social
workers, as well as shortages among dental, allied health,
mental health, and other providers.
These shortages, combined with faculty shortages, racial
and ethnic disparities, and shortages of health professionals
in rural and other underserved areas will take time to reverse.
We must make appropriate investments in the education and
training of health professionals today to truly extend health
care access to all segments of the population.
At KMC, where I am from, Title VII and Title VIII grants
work to alleviate these strains on the system. Primary care
loans incentivize financially needy students to choose primary
care; nursing loans help students pursue a diploma, associate,
baccalaureate, or graduate degree in nursing; and scholarships
help disadvantaged students pursue a health professions degree.
In the last five years along, KU has given out over 400
Title VII and Title VIII funded scholarships and loans to help
students pursue a career in the health professions.
Faculty and staff have also benefitted from grants, helping
boost faculty development in primary care, as well as
supporting the Central Plains Geriatric Education Center
Consortium. Additionally, thanks to ARRA, our Minority Centers
of Excellence Program and our Health Careers Opportunity
Program can still operate today, providing mentorship and
guidance to aspiring health professions from diverse
backgrounds. With this support, over 5,000 students have been
able to participate in KU's health professions pipeline
programs.
In closing, HPNEC's $600 million recommendation for the
existing health professions programs will not only help sustain
the expansion of the health workforce supported in recent
years, but will also help to ensure the programs are able to
fulfill their mission of improving the supply distribution and
diversity of health professionals nationwide.
Thank you.
[Written statement by Heidi Chumley follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you. Appreciate it.
Lori J. Heim, American Academy of Family Physicians.
----------
Wednesday, May 12, 2010.
HEALTH RESOURCES AND SERVICES ADMINISTRATION
WITNESS
LORI J. HEIM, MD, PRESIDENT, AMERICAN ACADEMY OF FAMILY PHYSICIANS
Dr. Heim. Good morning, Chairman Obey and members of the
Subcommittee. I am Dr. Lori Heim, family physician from Vass,
North Carolina. As the President of the American Academy of
Family Physicians, representing 94,700 family doctors,
residents, and medical students, I congratulate the Congress on
the enactment of the Patient Protection and Affordable Care
Act.
In order for a successful implementation of that health
care reform, I urge you, despite what you said, Chairman, to
increase the Federal investment in primary care workforce.
Despite the consensus that good primary care is essential for
genuine health care reform, 65 million Americans--that is about
one in five--live in primary care shortage areas.
Not only do we have shortages in primary care physicians in
practice, but the medical education pipeline is now only
producing 22.6 primary care physicians, down from 33 percent a
decade ago. As a result, we have fewer primary care physicians
being trained to care for the newly insured.
Health reforms include a number of provisions to increase
the workforce, including the vital Primary Care Medicine Grants
authorized through Title VII. We believe a minimum of $600
million for all of Title VII programs is needed. We also urge
the Committee to provide $170 million for Title VII Section 747
primary care training and enhancement programs.
Physician shortages are particularly hard on rural
Americans, as they face more barriers to care than their urban
or suburban areas. Family physicians provide the majority of
the care for America's underserved and rural populations, so we
were very pleased with the new Rural Physician Training Grants
authorized by health reform. We request that you fully fund the
Title VII Rural Physician Training Grants.
The AAFP supported the authorization of the innovative
Teaching Health Centers Program to train primary care residents
in non-hospital settings, which is where the care is delivered.
However, if this program is going to be effective, there must
be grants for planning. We recommend the Committee appropriate
the full authorized amounts for the Teaching Health Centers
Developmental Grants of $50 million for fiscal year 2011.
Another significant barrier to the production of primary
care physicians is the huge student debt that they have. The
National Health Service Corps has long provided debt relief to
primary care physicians and has helped to reduce the health
disparities. We urge that the Corps receive $414.1 million in
fiscal year 2011.
The AAFP commends Congress for authorizing the Primary Care
Extension Program within the Agency for Health Care Research
and Quality, as small primary care practices need the kind of
support that was offered by the Federal Cooperation Extension
Services to implement innovative and best practices. This new
program will assist primary care providers to transform their
practices using effective evidence-based therapies and
techniques in their practices. The AAFP recommends the
Committee provide $731 million for AHRQ to provide the funding
requested in the President's budget, as well as the important
new Primary Care Extension Program authorized by the health
reform law at $120 million.
Thank you very much for the opportunity, sir.
[Written statement by Lori Heim follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you. Again, let me simply say that I agree
with everything you said. The problem is there is no way I can
get there because, in negotiations over the budget resolution
right now, for instance, one of the offers on the table, in
order to get people who are reluctant to vote for it to
actually do so, one of the offers was to reduce domestic
appropriations by $110 billion over the next five years. That
is not deep enough for some of our brethren.
So I would love to provide the dollars you are talking
about. We do not have the votes for it because we have to live
under budget ceilings and, as I said earlier, there are a whole
lot of people who are very comfortable at reducing the deficit
by cutting this portion of the budget, but not in cutting the
portions of the budget that have been treated much more
gingerly the last ten years.
But thank you for coming.
Dr. Heim. Thank you. And we will help take that message
forward because, otherwise, without the workforce, we will not
be able to take care of the people.
Mr. Obey. You are absolutely right.
Next, Wayne Riley, Association of Minority Health
Professions Schools.
----------
Wednesday, May 12, 2010.
HEALTH RESOURCES AND SERVICES ADMINISTRATION--TITLE VII
WITNESS
WAYNE J. RILEY, MD, MPH, CHAIRMAN, BOARD OF DIRECTORS, ASSOCIATION OF
MINORITY HEALTH PROFESSIONS SCHOOLS, INC.
Dr. Riley. Good morning, Mr. Chairman, members of the
Subcommittee. It is my pleasure to be here today. My name is
Wayne Riley, President and Chief Executive Officer of Meharry
Medical College, Nashville, Tennessee. I am here today in my
role as Chair of the Association of Minority Health Professions
Schools. AMHPS, as it is called, represents 12 of the Nation's
superb HBCU academic health science centers. We train graduates
in dentistry, pharmacy, medicine, and veterinary medicine. Mr.
Chairman, these institutions are indeed national treasures.
We applaud the passage of health care reform, as some of my
colleagues have already mentioned, but we do want to alert the
Committee that, with the passage of health care reform, there
are looming shortages of health professionals to take care of
Americans. We are particularly concerned about the shortage
among minority groups. For example, although African-Americans
represent 13 percent of the Nation's population, only 3 percent
of health care professionals are African-American. The similar
statistics are evident in Latino and Native American and Asian
Pacific Islanders as well.
Now, sometimes I get the question: Why are you guys always
up here asking for help? Well, it is simple. Minority-serving
institutions do not have the big endowments; we do not have big
fat donors that give us millions of dollars to do our work. But
we are private institutions with a very public mission, and we
take that mission very seriously. So much so that our
institutions are among the leaders in producing primary care
physicians.
Next week, I will graduate a class of Meharry physicians,
of which over 50 percent are going into primary care fields,
the kinds of doctors our Nation needs.
So the programs that this Subcommittee has jurisdiction
over are very important to us. The first being Title VII Health
Profession Training. As you know, there were some cuts between
2006 and here, cuts anywhere from 45 to 90 percent in COE and
HCOP. Those cuts have partially been restored, and we
appreciate your leadership, Mr. Obey, on restoring some of
this. However, we do request a consideration of the
Subcommittee and the Committee and the Congress to restore the
program to about the $300 million level, which would add an
incremental increase of $33 million to $35 million
respectively, in Title VII.
The other program particularly germane to our mission is
the National Center for Research Resources. That is the
Extramural Facilities Program which helps to beef up our
laboratories and clinical facilities on our campuses. We are
recommending $50 million for extramural facilities construction
and we remind the Subcommittee that the first 25 percent of
such appropriations are earmarked or set aside, rather, for
institutions of emerging excellence like the 12 I represent.
Also want to highlight the work of the Research Careers and
Minority Institutions Program, again, that allows us to focus
our work there.
One of the great byproducts of health care reform, Mr.
Chairman, is the fact that we now have a new institute, the
National Institute of Minority Health and Health Disparities,
which was elevated through the landmark legislation. This is
outstanding news, but we urge the Committee to fund it at an
institute level of approximately $500 million given the fact
that it has been given significantly enhanced authority and
power over Minority and Health Disparities work.
Mr. Chairman, we also ask consideration to increase the
HBGI program, which trains doctoral students at our
institutions.
We appreciate the work of this Committee. Mr. Chairman, we
salute you for your distinguished service to Congress and our
Nation in the 7th Congressional District of Wisconsin. You have
been a champion of these programs and we salute you. Thank you,
Mr. Chairman.
[Written statement by Wayne J. Riley follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you much.
Next, Debbie Hatmaker, American Nurses Association.
----------
Wednesday, May 12, 2010.
HEALTH RESOURCES AND SERVICES ADMINISTRATION NURSING PROGRAMS
WITNESS
DEBBIE HATMAKER, PHD, RN-BC, SANE-A, FIRST VICE PRESIDENT, BOARD OF
DIRECTORS, AMERICAN NURSES ASSOCIATION
Ms. Hatmaker. Good morning, Mr. Chairman, distinguished
members of the Subcommittee and congressional staff. I am
Debbie Dawson Hatmaker. I am here as First Vice President of
the American Nurses Association, the largest nursing
organization in the Country that represents the interest of the
Nation's 3.1 million registered nurses. I have been an RN for
31 years, practicing in a variety of settings, and it is an
honor to be with you today to talk about funding for the Title
VIII programs.
ANA appreciates the continued support of the Subcommittee,
but we remain concerned that Title VIII funding levels have
been insufficient to address the growing nursing shortage. In
preparation for the implementation of health reform initiatives
which ANA strongly supported, we believe there will be even
greater demand for nurses, deeming funding even more essential.
ANA asks you to meet today's shortage with a relatively modest
investment of $267.3 million in Title VIII programs.
Registered nurses are fundamental to the critical shift
that will occur in health services delivery. Title VIII
programs recruit new nurses into the profession, promote career
advancement, and improve patient care delivery. These programs
also direct RNs into areas with the greatest need, including
public health, community health centers, and disproportionate
share hospitals.
Today, the nursing shortage continues to impact patient
care. HRSA released projections that the Nation's nursing
shortage would grow more than one million nurses by the year
2020, and that all 50 States would experience a shortage of
nurses to varying degrees by the year 2015. The U.S. must
graduate approximately 90 percent more nurses to meet this
demand.
This growing shortage is already having a real impact on
the ability to provide quality care. A study in the Journal
Medical Care provides new evidence of the economic value of
appropriate RN staffing. The findings demonstrate that as
nursing staffing levels increase, patient risk of complications
and hospitalization stays decrease, resulting in medical cost
savings, improved national productivity, and lives saved. The
study suggests that adding 133,000 RNs to the acute care
hospital workforce would save 5,900 lives per year. These are
not just numbers; these are real avoidable deaths.
In order to meet our Nation's health care needs, an
integrated national health care workforce must be put into
action. The ability of advanced practice registered nurses to
provide high quality, cost-effective care has been widely
recognized. Title VIII funds more than 60 percent of U.S. nurse
practitioner education programs and assists 83 percent of nurse
midwifery programs. Over 45 percent of the nurse anesthesia
graduates supported by this program go on to practice in
medically underserved communities.
A study published in the Journal of Rural Health showed
that 80 percent of the nurse practitioners who attended a
program supported by Title VIII chose to work in a medically
underserved or health profession shortage area after
graduation.
As an administrator of a clinical nursing program, I
experience the difficulty in finding clinical sites for nursing
students. One way to combat this problem is to support nurse
managed health clinics. With more than 250 clinics reporting
over 2.5 million annual client encounters, these clinics also
serve as sites for nursing education. Led by advanced practice
nurses, the nurse managed care model is especially effective in
disease prevention, early detection, and management of chronic
conditions.
ANA thanks you for the opportunity, Mr. Chairman, to
testify and appreciates your commitment to nursing. We urge you
to fund the fiscal year 2011 Title VIII nursing programs at
$267.3 million. Thank you so much.
[Written statement by Debbie Hatmaker follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Next, Cheryl Phillips, American Geriatrics Society.
----------
Wednesday, May 12, 2010.
AMERICAN GERIATRICS SOCIETY
WITNESS
CHERYL PHILLIPS, MD, AGSF, PRESIDENT, AMERICAN GERIATRICS SOCIETY
Dr. Phillips. Again, thank you, Chairman Obey and members
of this special Subcommittee. This is a remarkable opportunity
and I wish to take advantage to talk about funding for fiscal
year 2011 to improve care for America's older adults.
My name is Cheryl Phillips, and I am a fellowship-trained
geriatrician, a rare breed these days and becoming rarer. I am
also President of the American Geriatrics Society, the Nation's
largest professional organization which represents the
interdisciplinary health care professionals serving America's
older adults, particularly those with complex chronic needs,
medical conditions, frailty, and the risk for functional
decline.
The 2008 Institute on Medicine Report that I know you are
all familiar with, Retooling for an Aging America, noted the
severe shortage of geriatric health professionals and called
for initiatives to increase recruitment into geriatrics and
ensure all health care professionals are adequately trained to
serve America's older adults.
If we are going to fulfill our promises of health care
reform that have been articulated in the Act, we need
sufficient and sustained Federal investment to educate and
train geriatric health professionals across all disciplines,
which includes physicians, nurses, social workers, mental
health professionals, pharmacists, therapists, all of which
make up this geriatric team--it is indeed a team sport--which
has demonstrated both the improvement in quality and cost-
reduction and cost-effectiveness for this very vulnerable and
fragile group of individuals that we serve.
The Patient Protection and Affordable Care Act authorizes
geriatric health professions programs under Titles VII and
VIII, as we have been talking about with the previous speakers.
Specifically, AGS requests funding for the fiscal year 2011 in
the following areas: $49.7 million for Title VII Geriatrics
Health Professions Programs.
There are three key Federal initiatives under this Title
VII appropriations area. One is called the Geriatric Academic
and Career Awards, also known as GACAs; second are the
Geriatric Education Centers, one of which is in Marquette
University in Milwaukee that has served over 50,000 individuals
in the 15 years of its operation in reducing thousands and
thousands of dollars of medical costs for the population
served; and then also the Geriatric Health Faculty Fellowships.
All of these are required and essential to create the next
generation of health care professionals in order to serve the
increasing numbers of seniors. These programs have been
underfunded and, in fact, as has been mentioned earlier, there
was no funding in 2006.
We are also asking for a relatively small $3.34 million--
although in these days every penny counts, I know. But this is
specific funding for direct care workforce training. This is
the silent army of workers that is often unrecognized in
training programs. These are those individuals who do the
direct care, the bedside care, often unlicensed, but need
training for recruitment, for skills enhancement, and for
sustenance to maintain this growing body of need for our elder
Americans.
We are asking for $15.7 million for Title VIII, as was just
previously mentioned, specifically for the geriatric nursing
workforce. We recognize that the nursing personnel must receive
adequate education and training to serve all of our frail
Americans; and specifically 200 traineeships for advanced
practice nurses.
Lastly, briefly mentioning the National Institute on Aging.
It is the NIA funding that is essential to make advances today
that lead to higher quality and cost-efficient care for
tomorrow. We request that funding be restored to 2003 fiscal
year funding levels, taking in account medical inflation.
In closing, geriatrics is at a critical juncture. Our
Nation is facing an unprecedented increase in the number of
older patients with complex health needs. We acknowledge the
work that you have done. We appreciate your past commitment,
your continued commitment, and on behalf of the American
Geriatrics Society, we thank you for your continued support for
the health and quality of life for older Americans.
Thank you very much.
[Written statement by Cheryl Phillips follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Next, Peggy Troy, National Association of Children's
Hospitals.
----------
Wednesday, May 12, 2010.
NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS
WITNESS
PEGGY TROY, RN, MSN, PRESIDENT AND CEO, CHILDREN'S HOSPITAL AND HEALTH
SYSTEM, WISCONSIN, NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS
Ms. Troy. Chairman Obey and members of the Subcommittee,
thank you for the opportunity to testify today in support of
Children's Hospitals Graduate Medical Education, CHGME. I am
Peggy Troy, President and Chief Executive Officer of Children's
Hospital and Health System of Wisconsin. I am here today on
behalf of the National Association of Children's Hospitals and
the 60 independent children's teaching hospitals that qualify
for CHGME funding.
Congress established the CHGME program in 1999 to address a
disparity in Federal graduate medical education support that
existed between adult teaching hospitals and independent
children's hospitals. Because our hospitals treat kids, and not
the elderly, they are largely excluded from the predominant
payer of graduate medical education, Medicare.
Prior to CHGME, children's teaching hospitals received less
than .5 percent of the Federal GME support that adult teaching
hospitals received. Thanks to the Subcommittee's leadership and
the broad bipartisan congressional support, the CHGME program
currently provides about 80 percent of the GME that Medicare
provides to trained adult physicians.
CHGME funding is critical to the future of pediatric
medicine and access to care. This funding has allowed
children's hospitals to address a large gap that exists between
a child's need for pediatric subspecialty care and the supply
of pediatricians who are trained for their unique needs.
CHGME has shown remarkable success in erasing the decline
of the number of pediatric residencies that existed prior to
its enactment. It has enabled children's hospitals to sustain
and expand our residency programs at a time of national
specialist workforce shortages in pediatrics. In fact,
freestanding children's hospitals that receive this funding
have accounted for 65 percent of the growth in pediatric
specialty programs.
To give you an idea of the impact, since 1999, prior to the
enactment of the CHGME, Children's Hospital of Wisconsin had 65
pediatric residents rotating through our program. This past
year we trained 113 pediatric medical and dental residents.
You may be interested to know that the leading cause of
absenteeism for children from schools today is dental pain. So
it is important we also consider the dentists in this.
Because we now have dedicated CHGME funding for our
training programs, we can target other resources to better
serve all children in our regions. These funds provide vital
primary care training for our pediatric residents at the
Downtown Health Center in Milwaukee. The Center serves as a
medical home for 5400 low-income vulnerable children every
year. Because of this experience, half of our graduating
residents go into primary care and about a quarter of them
serve in urban and rural underserved areas.
CHGME funding is critical. It ensures that the safety net
children's hospitals, like us, can continue to care for all
children, irrespective of their parents' ability to pay. Nearly
50 percent of all of our services at Children's in Milwaukee is
supported by Medicaid. Similar figures exist for the
freestanding children's hospitals across our Nation.
In 2006, Congress reauthorized the CHGME program with
overwhelming bipartisan support, providing $330 million in
authorized funding. Last year, the House approved an
appropriation of $320 million for the program, $10 million
above the 2009 funding level.
The final funding level for CHGME in 2010 was $317.5
million, and President Obama maintained this funding level in
his fiscal year 2011 budget request. We deeply appreciate the
support of this program and what it has received by the members
of this Subcommittee, and, Chairman Obey, we personally really
appreciate all the support that you have given for the health
care and education needs of the citizens across the Country.
We are grateful for the leadership of you and Ranking
Member Tiahrt for supporting this program.
CHGME is a targeted, fiscally responsible, slow growth
program that operates under extensive data reporting
requirements. CHGME is important to the Nation's children's
hospitals and is absolutely critical to children's health and
the future of pediatric medicine. Our training program
represents less than 1 percent of all hospitals, but trains 35
percent of all pediatricians, 50 percent of all pediatric
specialists, and a great majority of the researchers.
As our workforce prepares for the increased volume as a
result of health care reform, this is going to play a very,
very important role. We thank you and the members of this
Committee for your support.
You have heard today from many of the children's programs,
the safety net programs. Health and education are inextricably
linked. We appreciate your support for this and we would hope
that you would guarantee the success of the future of the CHGME
program by appropriating the fully authorized level of $330
million in fiscal year 2011.
Thank you very much for your support.
[Written statement by Peggy Troy follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you. The Committee will recess until 2:00.
----------
Afternoon Session
----------
Wednesday, May 12, 2010.
TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS
Mr. Obey. Good afternoon, everybody. The Committee will
resume its sitting.
Mr. Rehberg, did you have anything you wanted to say?
Mr. Rehberg. No, let's get on.
Mr. Obey. Okay. I am for that.
Our first witness this afternoon will be Eric Rose from the
Alliance for Biosecurity. And as I said this morning, I am
going to have to be very strict with the four-minute rule
because otherwise people at the end will not get to testify,
because we have another meeting a 4:00 p.m. and somebody is
going to call a roll call on the House Floor, too, you can bet.
So please proceed.
----------
Wednesday, May 12, 2010.
CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL INSTITUTES OF
HEALTH
WITNESS
ERIC A. ROSE, M.D., CO-CHAIR, ALLIANCE FOR BIOSECURITY
Dr. Rose. Mr. Chairman and Members of the Subcommittee, I
am Eric Rose, the CEO of Siga Technologies and Co-Chair of the
Alliance for Biosecurity. It is a pleasure to be with you today
to provide you with my impression of how the United States
Government and specifically BARDA is handling a critical
national security mission.
We at Siga develop novel biodefense countermeasures to
treat and prevent serious infectious diseases. While many have
criticized the perceived slow pace of development of critically
needed novel defense countermeasures, our experience has been
that the substantial Federal investment in biodefense is
beginning to bear fruit less than seven years after BioShield
enactment and less than four years after the creation of BARDA.
We at Siga have pursued the development of a treatment that
has been sought for hundreds of years, namely an oral drug to
cure smallpox. The United States has stockpiled enough smallpox
vaccine for the entire Nation, but the vaccine cannot treat the
potentially large number of symptomatic disease victims in the
event of a surprise attack whose expected mortality rate would
be 30 percent.
We are now producing commercial scale validation batches of
our drug candidate which we hope will soon be added to the
Strategic National Stockpile.
The Alliance for Biosecurity is a collaboration among
pharmaceutical and biotechnology companies that is working in
the public interest to improve prevention and treatment of
biological threats. The H1N1 pandemic has given us all a better
sense of how quickly biological threats can spread. Fortunately
in that case, the consequences of mortality and morbidity were
minimal.
Most large pharmaceutical companies have chosen not to
develop biological countermeasures, while small biotechnology
companies have become heavily engaged. These financially
fragile enterprises must survive the so-called valley of death,
the significant product development hurdles between basic
research and procurement, in order to bring safe and effective
medical countermeasures to the government for purchase.
Congress appropriated $5,600,000,000 in 2003 to Project
BioShield to fund potential countermeasure procurements, while
three years later it created BARDA with a separate advance
development budget to ensure a pipeline of novel, safe,
effective and procurable countermeasures.
Our experience with BARDA leadership has been
overwhelmingly positive. I have interacted with Dr. Lurie and
Dr. Robinson and many others about the state of play for
emerging biotech companies like ours and how their decisions
affect the marketplace. They have been responsive and
interested and are gaining traction in the organization to
deliver on its critical mission.
We note that the December, 2008 report of the
Congressionally established Commission on the Prevention of
Weapons of Mass Destruction, Proliferation and Terrorism found
that ``it is more likely than not that a weapon of mass
destruction will be used in a terrorist attack somewhere in the
world by the end of 2013,'' most likely a bio-weapon.
With respect to appropriations, we encourage that even in
this challenging budget environment, the need to sustain and
even strengthen BARDA's advanced development funding is
understood well.
However, the transfer of BioShield resources to shore up
this funding is counterproductive to the Nation's overall
biodefense effort. This is because diversion of funds for
acquisitions from BioShield clearly disincentivizes private
investment in this sector at a time when increased private
sector effort and funding is clearly critical.
We at the Alliance urge the Committee not to transfer
additional dollars out of the BioShield reserve fund, and
instead to maintain the fund balances as guarantees that future
procurements will have sufficient resources available.
Let me stop there and invite your questions.
[Written statement by Eric A. Rose, M.D. follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Let me say that I think you will find me asking
virtually no questions because if we take any time at all,
people are not going to get done.
I thank you for coming.
Dr. Rose. Sure. Thank you.
Mr. Obey. Let me suggest that since we have a vote on that
Members go vote and let's just keep the Committee running and
that way I will go vote after you hurry back so we can avoid
stiffing somebody. Okay?
Mr. Moran. I think it is a series of votes, though. There
are four votes, that is the problem.
Mr. Obey. Oh, wonderful. Well, all right. In that case, we
will go until we are dangerously near missing the vote.
[Laughter.]
Next, Ronald Tankersley, American Dental Association.
----------
Wednesday, May 12, 2010.
NATIONAL INSTITUTES OF HEALTH
WITNESS
RONALD L. TANKERSLEY, DDS, PRESIDENT, AMERICAN DENTAL ASSOCIATION
Dr. Tankersley. Good afternoon. I am Ron Tankersley, a
practicing oral surgeon and President of the American Dental
Association. On behalf of the ADA's 157,000 member dentists,
thank you, Mr. Chairman and Members of the Subcommittee for the
opportunity to comment on the 2011 appropriations for Federal
dental programs.
The ADA last testified before the Committee in 2006. Since
that time, many oral health programs have made great advances,
but much remains to be done to help reduce oral disease and
increase access to dental care for those with untreated
disease.
Since 2005, the National Institute of Dental and
Craniofacial Research has established research networks to
answer the questions that private dentists face every day in
their practices. These networks allow for the rapid translation
of scientific advances to clinical practice.
The NIDCR is also leading the investigation into salivary
diagnostics. This research indicates that there is a strong
possibility that saliva can one day be used to screen for
breast, prostate, oral and pancreatic cancer, as well as detect
cardiovascular disease, drug usage and exposure to diseases
like anthrax. As a diagnostic tool, this could dramatically
reduce cost and invasive procedures.
However, the most common of the oral diseases, dental
caries or tooth decay, remains the most prolific communicable
disease in the world. Even though it is preventable, it is
still a major problem. Childhood caries are epidemic among the
under-served populations, especially Native Americans. The ADA
urges the Committee to fund NIDCR at $463,000,000 to continue
its critical research.
The Committee's past support has allowed general dentists
and pediatric dental residency programs to remain stable and
strong. The new healthcare reform law adds funding for public
health dental residencies. This could not have happened at a
more opportune time because there are still three States with
fewer than 10 pediatric dentists and there are only 180
certified public health dentists in America.
The ADA recommends that training in pediatric and public
health dentistry programs be funded at the authorized amount of
$30,000,000.
The ADA has said for many years that the Nation cannot
drill and fill its way out of the epidemic of untreated dental
disease.
Mr. Obey. I thought you were getting into another subject
there. [Laughter.]
Dr. Tankersley. We think it is catchy.
But there are viable solutions for preventing disease
through community water fluoridation, early applications of
dental sealants and varnishes, and establishing dental homes
for children, and last but not least, oral health literacy
programs. These proven cost-effective measures can dramatically
reduce oral disease.
The new healthcare law includes several provisions for
prevention and research programs in the CDC's Division of Oral
Health. The ADA recommends $33,000,000 to fully fund the
Division's State Infrastructure Grant Program, and also help
communities establish or rebuild their community fluoridation
systems for their water supplies.
Mr. Chairman, I would be remiss if I did not note the
personal interest that you have taken to improve oral health in
your State and in this Country. We appreciate your recognition
of how funding for small clinics, local dental sealant
projects, where Federal dental programs can improve oral health
outcomes in the dental workforce.
You have been a wonderful champion for oral health in this
Country and we will greatly miss you, and thank you for the
opportunity to testify.
[Written statement by Ronald L. Tankersley, D.D.S.
follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much. I appreciate your coming.
Next, Daniel Church, Hepatitis Appropriations Partnership.
----------
Wednesday, May 12, 2010.
CENTERS FOR DISEASE CONTROL AND PREVENTION
WITNESS
DANIEL CHURCH, ADULT VIRAL HEPATITIS PREVENTION COORDINATOR,
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
Mr. Church. Good afternoon, Chairman Obey and Members of
the Subcommittee. I am Dan Church, the Adult Viral Hepatitis
Prevention Coordinator for the Massachusetts Department of
Public Health. I am here representing the Hepatitis
Appropriations Partnership and the National Alliance of State
and Territorial AIDS Directors.
Thank you for allowing me to address you today. I am here
to speak to you about viral hepatitis. Viral hepatitis is a
group of contagious liver diseases that can lead to life-long
infection. There are over 5 million Americans chronically
infected. It is the leading cause of liver disease, liver
cancer and liver transplantation. It is also the most common
cause of death in persons infected with HIV.
Unfortunately, two thirds of those infected do not know it
because symptoms often don't occur until irreversible and
potentially fatal liver damage has occurred. Chronic hepatitis
B and C infections cost the United States approximately
$16,000,000,000 each year. Experts estimate that baby boomers
account for two out of every three cases of chronic hepatitis
C. If we do nothing to increase screening, the cost of these
diseases will skyrocket and the American taxpayer will foot the
bill as this cohort ages into Medicare in the next decade.
In Massachusetts, it is estimated that over 100,000 people
are living with hepatitis C virus alone, most of whom are not
aware of their infection. Since 2002, we have had 8,000 to
10,000 newly diagnosed cases of hepatitis C and 2,000 cases of
hepatitis B reported to the Department of Public Health each
year.
Since 2005, there has been an alarming increase in the
numbers of people under the age of 25 being reported with
chronic hepatitis C infection, indicating a new epidemic of
disease largely due to heroin use among youth.
Despite this remarkably high disease burden both in
Massachusetts and nationally, the only dedicated Federal
funding for viral hepatitis is $19,000,000 to CDC's Division of
Viral Hepatitis. State health departments receive a total of
$5,000,000 that averages to $90,000 per jurisdiction. This
provides for only one staff person and no money for core
prevention services such as hepatitis education, testing,
vaccination for hepatitis A and B, surveillance and referral
into medical management and care. I am that staff person in the
Massachusetts Department of Public Health.
It is important to note that because of such minimal
funding, CDC cannot implement a comprehensive prevention
approach such as we have for other infectious diseases.
Additionally, there is no funding for a national surveillance
system so that we can understand the impact of these diseases
and plan our prevention programs accordingly. We must rely on
estimates from a national household survey from 2002 that did
not include two highly impacted populations: homeless and
incarcerated people.
The President's fiscal year 2011 budget proposes an almost
$2,000,000 increase for a total of $21,000,000. While we laud
this increase in a time of decreasing resources, it is
insufficient to address the chronic diseases of this magnitude.
We are asking for an increase of $30,700,000 for total of
$50,000,000 for the Division of Viral Hepatitis. We are not
asking for creation of a separate infrastructure, but rather to
integrate into existing infectious disease programs such as
HIV, STDs, and tuberculosis. Unfortunately, funding to support
this integration is largely not available.
If we had the resources to test those at risk, the good
news is that there are effective treatments to manage, and in
the case of hepatitis C, to clear the virus. There are also new
therapies for both hepatitis B and C in the pipeline. The
Institute of Medicine recently issued a report, Hepatitis and
Liver Cancer: A National Strategy for Prevention and Control of
Hepatitis B and C.
I was a member of the panel that authored the report. The
report attributes the lack of knowledge and awareness among the
American public and healthcare providers, and large health
disparities, to the lack of dedicated resources and high
mortality rates. Without concerted efforts to respond,
Americans will continue to be infected and fail to be
identified, diminishing their quality of life and life
expectancy. I urge you to invest in the prevention of these
diseases so that we may one day control these burgeoning
epidemics.
Thank you again for allowing me to speak with you today.
[Written statement by Daniel Church follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Let's keep going. Janel Wright, American Diabetes
Association.
----------
Wednesday, May 12, 2010.
CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL INSTITUTES OF
HEALTH, NATIONAL INSTITUTE OF DIABETES, DIGESTIVE AND KIDNEY DISEASE
WITNESS
JANEL WRIGHT, NATIONAL ADVOCACY COMMITTEE CHAIR, AMERICAN DIABETES
ASSOCIATION
Ms. Wright. Mr. Chairman, distinguished Members of the
Subcommittee, thank you for the opportunity to testify today.
As someone who has lived with diabetes for nearly 35 years,
I am proud to represent the American Diabetes Association,
nearly 24 million Americans with diabetes, and 57 million with
pre-diabetes.
The Centers for Disease Control and Prevention have
identified diabetes as a disabling, deadly epidemic on the
rise. Between 1980 and 2007, its prevalence increased by 300
percent. Its total cost is over $218,000,000,000 a year. During
the four minutes I will be speaking to you, 12 Americans will
be diagnosed with diabetes. Today, 55 Americans will go blind,
120 will enter end-stage kidney disease programs, and 230 will
undergo an amputation because of diabetes.
If we do not take action to stop diabetes, one out of three
of our children will face a future with diabetes. And for
children in minority communities, it is close to one in two.
Despite these numbers, there is hope. Thank you for
consistently funding vital HHS programs, including the National
Institute of Diabetes, Digestive and Kidney Disease at the NIH
and the CDC's Division of Diabetes Translation to help reduce
the overwhelming burden of diabetes.
Because of this investment, our knowledge of the disease
has been expanded and the critical work towards ending this
epidemic can continue. As you consider fiscal year 2011
appropriations, we urge you to make diabetes a priority by
increasing funding for these essential research and prevention
programs proportionate to the magnitude of diabetes in our
Country. And by doing so, changing the future and destiny of
diabetes in America.
NIDDK continues to make major discoveries, including the
ability to predict type 1 diabetes and new drug therapies for
type 2. Because of advances in treatment, my hemoglobin A1c,
which provides a snapshot of how well my disease is managed,
went from 12.9 to 5.9. Each point I lower my A1c translates to
a 40 percent better chance to avoid the devastating
complications of diabetes.
There is still so much work to do. Scientists stand ready,
willing and able to take diabetes research to the next level.
The $2,200,000,000 we are requesting for 2011 will allow the
NIDDK to act on promising research opportunities and ultimately
move us closer to the cure.
Stopping diabetes also means transforming new discoveries
into new ways to prevent the disease. CDC's DDT works to
eliminate the preventable burden of diabetes. DDT has a proven
record of success through community-based prevention programs,
national diabetes surveillance, and translational research. But
DDT is woefully under-funded.
The Association is requesting $86,000,000 in 2011 funding
for the DDT so these vital programs can reach more Americans at
risk for the disease and its complications. DDT works to speed
effective interventions to local communities. For example,
NIDDK's Diabetes Prevention Program found modest weight loss
prevented type 2 diabetes by 58 percent in patients at high
risk. DDT moved this program into community settings and
improved upon the trial, achieving the same astounding results
for less than $300 a year.
Congress recognized the importance of this program by
authorizing the National Diabetes Prevention Program in the
recently passed health reform law which, when funded, will
expand this successful program. We acknowledge the
Subcommittee's leadership in the implementation of the newly
created Prevention in Public Health Fund, and respectfully
request your support of $80,000,000 in 2011 for implementation
of the NDPP through the fund.
As you consider the 2011 appropriations for NIDDK and the
DDT, we ask you to consider diabetes as an epidemic, growing at
an astonishing rate, which will overwhelm our healthcare system
with tragic consequences. To change this future, we must
increase our commitment to research and prevention to reflect
the burden diabetes poses both for us and for our children.
Thank you.
[Written statement by Janel Wright follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much.
And I hate to do this, but I have to go vote and we will be
back as soon as the votes are over.
[Recess.]
Next, we have Scott Kneser from the American Heart
Association. He is from a place called Wausau, Wisconsin.
[Laughter.]
----------
Wednesday, May 12, 2010.
NATIONAL HEART, LUNG AND BLOOD INSTITUTE, NATIONAL INSTITUTE OF
NEUROLOGICAL DISORDERS AND STROKE
WITNESS
SCOTT KNESER, VOLUNTEER, AMERICAN HEART ASSOCIATION
Mr. Kneser. Mr. Chairman and Members of the Subcommittee, I
thank you for this opportunity to share my story and to
advocate for increased funding for heart disease and stroke
research, prevention and treatment.
As the Chairman has mentioned, my name is Scott Kneser. I
am from Wausau, Wisconsin. I am a proud constituent of the
Seventh Congressional District of Wisconsin, which is Chairman
Obey's District. I am an accountant for the hospital, but more
importantly, thanks to NIH-supported research, I am a heart
disease survivor. I am also a volunteer for the American Heart
Association, where I try to help other people like myself.
Chairman Obey, when you announced your retirement last
week, you expressed your hope that you had made a difference
during your 41 years in the House of Representatives. I am here
to tell you that you have made a difference through your
continued support of heart disease research and prevention
programs. I am living proof of how your investment in NIH can
lead to longer, more productive lives.
My battle with heart disease began in 1982 when I was
diagnosed with hypertrophic obstructive cardiomyopathy, a
genetic defect with a mitral valve prolapse and a heart murmur.
In layman's terms, the main pumping chamber of my heart was
enlarged and I had a valve that did not close properly. This
condition caused blood to leak from my mitral valve and
diminish my blood flow, creating a decrease in my activity
level. In 2005, I became more symptomatic and experienced
increased fatigue during normal activity like climbing stairs.
My doctors determined that I needed a type of surgery
called septal myectomy. During this procedure, my surgeon went
through my aortic valve and carved out the enlarged section of
muscle on my septum which separates my heart's chambers to
improve my blood flow.
Also at this time, I had an implanted cardio defibrillator
placed in my chest to regulate my irregular heartbeats that
were discovered during an EKG. This amazing device, a result of
your investment in the NIH, keeps me alive by regulating my
heartbeat. If I have more than five consecutive irregular
heartbeats, the ICD shocks my heart back into a normal rhythm.
I can even hold a magnet over my ICD, which uploads the data on
my heart. This data is then transferred to my cardiologist via
the telephone lines.
Not long ago, the only solution to my condition was a heart
transplant, but thanks to advances in medical research, I am
recovered from my surgery and today I enjoy a 30 percent
increase in my blood flow and my energy level has improved
substantially. I can still run up and down the basketball court
refereeing high school basketball games.
As a heart disease survivor, I have also benefitted from
other advances such as color flow Doppler echocardiograms,
which improve the non-invasive images of the heart and blood
flow. And the gold standard for diagnosing heart problems, a
heart catheterization, no longer requires an overnight hospital
stay.
Despite these advances, there is no cure for heart disease
and stroke. Heart disease remains our Nation's number one
killer and stroke is still the number three cause of death.
Thanks to NIH research, there are survivors like me. But to
bring us closer to a cure, it is critical for Congress to
increase funding for NIH heart research, now at only 4 percent
of the budget, and stroke research, still at just 1 percent of
the budget.
Also, Congress must increase funding for CDC's Heart
Disease and Stroke Prevention Programs. Although heart disease
and stroke can often be prevented, Americans need access to
prevention programs, but that is not happening.
CDC spends just 16 cents per person on heart disease and
stroke prevention. Moreover, more rural areas like my hometown
of Wausau need increased access to automated external
defibrillators to improve chances of sudden cardiac arrest
victims surviving this particularly deadly form of heart
disease.
Americans deserve better. Thank you for your time.
[Written statement by Scott Kneser follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much. I appreciate your coming.
Glad you are doing so well.
Mr. Kneser. Thank you.
Mr. Obey. I hope you have better luck with airplanes
getting back. I usually do. [Laughter.]
Next, Landon King, American Thoracic Society.
----------
Wednesday, May 12, 2010.
AMERICAN THORACIC SOCIETY
WITNESS
LANDON KING, M.D., DIRECTOR, PULMONARY AND CRITICAL CARE MEDICINE,
JOHNS HOPKINS SCHOOL OF MEDICINE
Dr. King. Good afternoon. My name is Landon King. I am
Director of Pulmonary and Critical Care Medicine at Johns
Hopkins. I am here today representing the American Thoracic
Society, whose 18,000 members are dedicated to preventing and
fighting respiratory disease around the globe through research,
education, patient care and advocacy.
I would like to particularly thank you, Mr. Chairman, for
your leadership role in providing the historic biomedical
research investment made through the American Recovery and
Reinvestment Act. This investment is accelerating lifesaving
research into respiratory diseases affecting millions of
people.
I would like to illustrate how NIH-funded research turns
medical advances that save people's lives by telling you about
one patient that I treated in the medical intensive care unit
in November. This 19 year old girl arrived in our ICU after
becoming progressively ill at home for the preceding week. She
developed worsening shortness of breath and required mechanical
ventilation to stay alive.
In the ICU, she was diagnosed with H1N1 influenza. She
required intravenous medication to support her blood pressure,
as well as intravenous antibiotics to fight infection. She was
on a ventilator in the ICU for several weeks and required
additional weeks of hospitalization once she left the ICU.
Her care was managed throughout by dedicated teams of
nurses, therapists and physicians. What ultimately improved
this young girl's chances of survival was a new mechanical
ventilation strategy that was less stressful on her lungs.
Several elements of her story are relevant to my testimony
today. First, this young girl had H1N1 influenza, emphasizing
the continued importance of a strong public health system.
Second, respiratory failure of the type she experienced, called
acute lung injury, can be caused by many things, including
infection, drowning and traumatic injury, for example in
traffic accidents. Threats from infectious disease or other
exposures frequently cause illness or death because of the
effect on the lungs.
Third, she's alive today as a result of the mechanical
ventilation strategy developed through a National Heart, Lung
and Blood Institute-funded clinical trial. In this study,
pulmonary and critical care investigators identified that
mechanical ventilation itself can damage the lung and through a
multi-center clinical trial published in The New England
Journal of Medicine demonstrated that survival was improved by
25 percent using a ventilator strategy distinct from
traditional approaches.
Finally, despite the advances in ventilator management that
saved this young girl's life and thousands of other patients
each year, many more people are not so fortunate. Of the nearly
200,000 people per year who develop acute lung injury,
approximately 75,000 people still die each year. By 2030, as a
result of the aging population, it is estimated that the number
of acute lung injury cases per year will increase to 335,000
and the number of deaths per year will increase to 147,000.
Despite groundbreaking research by NHLBI, NIGMS and other
institutes, we do not have specific therapies other than
mechanical ventilation to treat this type of respiratory
failure. More investigation is essential to generate new
approaches to therapy.
These examples are emblematic of respiratory disease in
general. Chronic obstructive pulmonary disease, such as
emphysema or chronic bronchitis, affects more than 12 million
Americans and is the fourth leading cause of death in the U.S.,
the only one of the top four that has actually increased.
More than 22 million children and adults have asthma, with
personal and public health costs of $20,500,000,000 billion per
year. It is estimated that more than 50 million Americans have
breathing disturbances associated with sleep disorders, shown
through NIH-funded investigation to increase strokes and death.
Beyond these, significant numbers of Americans have other
lung diseases that cause illness and deaths every day.
Mr. Chairman, thanks in no small measure to the generous
support of this Committee, the research and public health
community continues to make advances against lung diseases. We
urge this Committee to build on the biomedical research
investment made through the ARRA to speed the discovery of more
lifesaving treatments and cures.
Similarly, our Nation's public health and chronic and
infectious disease prevention programs must be equipped to
effectively translate NIH research into programs in chronic
disease prevention, infectious disease control, and
occupational safety and health research and training.
Thank you.
[Written statement by Landon King, M.D. follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much.
Next, Neil Bressler, American Academy of Ophthalmology.
----------
Wednesday, May 12, 2010.
NATIONAL INSTITUTES OF HEALTH, NATIONAL EYE INSTITUTE
WITNESS
DR. NEIL BRESSLER, WILMER EYE INSTITUTE, JOHNS HOPKINS UNIVERSITY
SCHOOL OF MEDICINE; AMERICAN ACADEMY OF OPHTHALMOLOGY
Dr. Bressler. Mr. Chairman, Subcommittee Members, thank you
for the opportunity to appear before you today in support of
appropriations for the National Institutes of Health and the
National Eye Institute.
My name is Neil Bressler and I am the James P. Gills
Professor of Ophthalmology at Johns Hopkins University. I
currently serve as Chief of the Wilmer Eye Institute's Retina
Division, but I also chair the FDA Ophthalmic Devices Panel and
chair the Data and Safety Monitoring Committee, which oversees
all intramural clinical trials by the National Eye Institute.
And I have been the recipient of many NIH grants to chair
large scale multi-center clinical trials, most recently, a
comparative effectiveness study conducted at more than 50
clinical centers by the Diabetic Retinopathy Clinical Research
Network.
This network confirmed just two weeks ago a treatment
breakthrough for saving the vision of tens of thousands of
people in the United States each year with a common diabetic
eye disease. And I am pleased to be here testifying on behalf
of the American Academy of Ophthalmology, the world's largest
organization of eye physicians and surgeons.
It is particularly appropriate, Mr. Chairman, to discuss
vision and preventing blindness today since May is Healthy
Vision Month, a designation to elevate vision as a health
priority for the Nation. We need our vision to work, to read,
to drive, to distinguish the faces in this room.
The Academy and the vision community commends Congress for
$10,400,000,000 in NIH funding in the ARRA, as well as fiscal
year 2009 and 2010 funding increases that enabled the NIH to
keep pace with biomedical inflation after six previous years of
flat funding that resulted in a 14 percent loss of purchasing
power.
The Academy supports a fiscal year 2011 NIH funding level
of $35,000,000,000, which would result in NEI funding at almost
$800,000,000. This funding level would increase the level of
grants available to researchers, maintain the momentum of the
research I am describing, and leverage the investment that
Congress has already made in the NIH and the NEI through ARRA
funding to allow us to continue to make breakthroughs which
reduce blindness throughout the world.
The recent treatment breakthroughs which are having a huge
impact on reducing vision impairment and blindness from these
common eye diseases suggests that this is not the time for a
less-than-inflationary increase that nets a loss in NEI's
purchasing power, which was previously eroded by 18 percent in
fiscal years 2003 through 2008.
The baseline funding in fiscal years 2009 and 2010 has also
enabled the NEI to fund key research networks that are studying
such issues as the genetic basis of glaucoma, the second
leading cause of blindness. And as I mentioned, the NIH just
issued a press release only two weeks ago announcing the
publication of this comparative effectiveness study which
confirmed that a new treatment for swelling of the retina from
diabetes, the main cause of central vision loss in people with
diabetes, which can affect as many as 30 percent of people who
have had diabetes for more than 20 years, and affects their
ability to read or drive, the study showed that these eye
injections of a new medication, combined with laser, nearly 50
percent of the people who received this treatment had
substantial vision improvement, and fewer than 5 percent lost
vision.
The unprecedented level of fiscal year 2009 to 2010 vision
research funding is moving our Nation that much closer to
preventing blindness and to restoration of vision. With an
overall NIH funding level of $35,000,000,000 and an NEI funding
level of almost $800,000,000, the vision community can
accelerate these efforts and reduce healthcare costs,
maintaining productivity, causing independence, and ensuring
quality of life.
In closing, I would just like to summarize and encourage
the Subcommittee to increase the funding level of the NIH to
$35,000,000,000 or at a minimum increase the NEI funding by at
least 3.2 percent in fiscal year 2011 in order to continue the
momentum of vision-saving research in the United States. Not
working today to stave off debilitating eye disease will have a
huge and grave economic and social repercussion for America's
future.
Thank you very much.
[Written statement by Neil Bressler, M.D. follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Next, Wanda Burns, American Cancer Society Cancer Action
Network.
----------
Wednesday, May 12, 2010.
NATIONAL INSTITUTES OF HEALTH, NATIONAL CANCER INSTITUTE
WITNESS
WANDA BURNS, RN, AMERICAN CANCER SOCIETY CANCER ACTION NETWORK
Ms. Burns. Chairman Obey and Members of the Subcommittee,
thank you for the opportunity to appear before you this
afternoon to testify in support of the National Institutes of
Health and National Cancer Institute. My name is Wanda Burns
and I am from Niles, Ohio, a town just outside of Youngstown.
I am here today on behalf of the American Cancer Society
Action Network, and my late sister-in-law Cindy. Cindy died
from ovarian cancer in 2008 and I appear here today to honor
her fight against cancer. I have been a registered nurse for 30
years, and in that time have seen first-hand the results of the
tremendous progress we have made thanks to research in
preventing, detecting and treating cancer, and better managing
symptoms and side effects to improve patient quality of life.
Part of my nursing career has been in the hospice study, so
I am also keenly aware that far too many people facing the
disease, our cancer-fighting tools for early detection,
treatment, and care remain limited. Ovarian cancer lacks a
screening test to aid in the early diagnosis and treatment that
is essential to survive. The majority of cases are diagnosed at
a distant stage when the cancer has spread and the five-year
survival rate in those cases drops to only 31 percent.
Cindy, sadly, was one of those cases. She discovered a
protrusion on her abdominal wall in early January, 2004 and was
diagnosed with cancer a few weeks later. By that time, Cindy's
cancer had metastasized to her colon and diaphragm. According
to statistics, Cindy's life expectancy was 19 months.
We were fortunate that Cindy's oncologist was able to help
her find and enroll her in a clinical trial sponsored by the
National Cancer Institute which took place at the Cleveland
Clinic. While conventional chemotherapy failed and offered
Cindy little help and hope, the clinical trial offered an
additional course of treatment and an additional 45 months of
life. Her participation in these clinical trials gave all of us
hope. More importantly, it gave us precious additional time
together as a family.
I am so pleased to tell you that Cindy beat the odds and
enjoyed nearly five rewarding years of life after her late
stage diagnosis, which included being there to see her only son
get married. This meant the world to Cindy and to the entire
family.
But research progress does not happen overnight, though we
would wish it could. Cindy enrolled in one particular clinical
trial at Cleveland Clinic in 2005, a trial that had actually
initiated in 2001 and just concluded earlier this year. This
trial, which took just under 10 years to complete, evaluated a
combined therapy regimen for treating ovarian cancer.
After being invited to testify, I checked in with Cindy's
gynecological oncologist and learned that the results from the
clinical trial are very promising. It is clinical trials such
as this that give healthcare providers, patients, family and
friends hope. Clinical trials are important to all of us, for
no one knows what our personal futures hold.
Cindy's story and the countless stories of other cancer
patients make clear that sustained funding for cancer research
is critical to maintain and build on the progress we are making
every day. The clinical trials that gave us treasured years
with Cindy and gave Cindy countless special moments like being
at her son's wedding, would not have happened absent support
from the National Institutes of Health National Cancer
Institute.
The NIH and NCI support life-saving research at the
Cleveland Clinic, 64 NCI Cancer Centers and multiple other
institutions in oncology practice settings across the country.
Knowing that funding for this research is secure gives us all
hope.
For this reason, I am requesting on behalf of the American
Cancer Action Network that the National Institutes of Health
receive a budget of $35,000,000,000 in fiscal year 2011,
including $5,800,000,000 for the National Cancer Institute.
Thank you, Mr. Chairman, for the opportunity to testify.
[Written statement by Wanda Burns, R.N. follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Mr. Ryan. Mr. Chairman, I would just like to say hello
because Wanda is not only from my District, she is from my home
town, and I want to thank her for coming up.
So thank you for your work.
Mr. Obey. She told me a lot about you. [Laughter.]
Mr. Ryan. Let's keep that off the record, will you, Mr.
Chairman? [Laughter.]
Ms. Burns. Thank you.
Mr. Obey. Thank you.
Next, I understand, Congressman Shimkus would like to
introduce someone.
Mr. Shimkus. Thank you, Mr. Chairman.
It is an honor to be here, especially as I have never been
in this hearing room and it is good to be here in your last
years of serving, and I appreciate your service.
Thank you, Ranking Leader Rehberg also for this time.
I am here to introduce Kristin. Kristin is the widow now,
wife of my former Legislative Director Ray Fitzgerald, who
passed away from gastric cancer. Kristin has testified before,
now I am Ranking on the Subcommittee on Health, to talk about
the funding aspects of the National Cancer Institute and the
issues related there.
She is a former Hill staffer, was on Education and Labor
with now our Leader Boehner's staff, so she is very capable and
understanding of the ways of how we work out here. She came out
here on the train.
Mr. Obey. I'm glad that somebody is. [Laughter.]
Mr. Shimkus. She came out on the train with Nora, Maggie
and Lucy.
About half the deaths from cancer come from a deadly cancer
disease, and only 17 percent of the funding goes there. And so
I think in part what we had in our hearing raised that issue
and talked about the proportion of where our money should go
and how it should be spent. She does a much better job than I
do. I am just pleased to have her still working on behalf of
healthcare for all Americans, and in a legacy of my former
employee and her husband, Ray Fitzgerald, who we miss dearly.
Thank you, Mr. Chairman.
Mr. Obey. Thank you. Glad to have you.
---------- --
--------
Wednesday, May 12, 2010.
NATIONAL INSTITUTES OF HEALTH, NATIONAL CANCER INSTITUTE
WITNESS
KRISTIN W. FITZGERALD
Ms. Fitzgerald. Thank you, Congressman Shimkus, for your
tireless commitment and support.
Mr. Chairman and Members of the Subcommittee, thank you for
the opportunity to testify at today's hearing on the need for
fiscal year 2011 funding to research gastric or stomach cancer
and other gastrointestinal or GI cancers in young people.
Chairman Obey, I was also sorry to hear of your retirement,
with your longstanding commitment to medical research.
I am here today not only on my own behalf, but that of my
husband, Ray Fitzgerald, who died last year of gastric or
stomach cancer. As you have heard, Ray was Legislative Director
for Congressman John Shimkus.
Until his diagnosis in May of 2008, Ray was a healthy 36
year old man. He had no risk factors for cancer. He had never
smoked, drank infrequently, and lived a healthy lifestyle. With
no family history of cancer, nothing would ever have put him at
a high risk of a cancer diagnosis.
Ray's cancer symptom was burping, which appeared for a
period of two months before his cancer was diagnosed. When he
was diagnosed, his cancer was an advanced stage four. His
gastric tumor had spread throughout the lining of his stomach
and progressed to his esophagus and liver.
We were told that there was no hope of a cure, but that
chemotherapy could reduce the cancer for a time. That time was
eight months. Let me be clear. The time between diagnosis and
Ray's death was only eight months. This is not an abnormal
scenario for gastric cancer. It is the second deadliest cancer
worldwide. It very often presents in stage four and is always
incurable at that point.
Ray, however, at 36, was 40 years younger than the average
gastric cancer patient, and thus the grim prognosis impacted
not just Ray, but myself and our three young daughters, Nora,
Maggie and Lucy.
Members of the Subcommittee, it is my belief that Ray's
diagnosis and prognosis is our worst cancer nightmare:
diagnosis of a deadly cancer with very few warning symptoms at
an advanced stage where cure is impossible. It is a death
sentence.
After Ray died, I spent time researching how this kind of
scenario can be prevented. As a former Congressional health
staffer, I assumed that gastric cancer research was ongoing.
However, far too little is being done to research gastric
cancer and other GI cancers that have a similar deadly
prognosis.
CBS News analyzed the disparity in research dollars in May
of 2009. For every cancer death, the most Federal research
dollars are spent on cancers of the cervix and breast. The very
least funded is gastric cancer, at about $1,100 a person.
GI cancers are some of the deadliest cancers in the United
States. Four out of the five lowest five-year cancer survival
rates for metastatic cancer are GI, including stomach cancer
with a survival rate of only 3.4 percent.
And GI cancers are rising, particularly in young people.
Last week, NCI released a study showing that a young person's
likelihood of being diagnosed with gastric cancer has increased
by almost 70 percent since 1977. Likewise, a recent NCI article
documented a 190 percent increase in a sub-type of cancers of
the stomach and esophagus in young white males like Ray.
And the situation for young people with GI cancers is
particularly grim. Because of their lack of symptoms, the
disease is usually in a late stage by the time a diagnosis is
established. And their very age works against them as the
strength and relative health of their bodies is passed on to
their cancers, making them even more aggressive than in older
patients. As a result, GI cancers in young people tend to be
fatal.
In my view, this is intolerable. Congress and NCI can and
should do more to ensure that researchers can have access to
the tools they need to prevent and diagnose these cancers
before it is too late. Research is essential in order to
understand the unique characteristics of the disease in younger
people and develop a screening test based on molecular markers
to allow for earlier detection.
In order to accomplish this research, NCI must develop a
coordinated national GI cancer tissue biorepository and a
research project to focus research in this area and make tumor
tissue available for research purposes.
A specific research project is critical in order to obtain
IRB approval to go beyond the standard of care in obtaining
tumor tissue and elicit the participation of our Nation's top
cancer centers.
Last year, the Labor, HHS, and Education Appropriations
Report included language asking the NCI to develop a research
project and biorepository to study these cancers in young
people, and language for fiscal year 2011 asking NCI to report
on its progress has been submitted by Congressman Jackson.
After my testimony to the Energy and Commerce Committee,
work with NCI has commenced to potentially include gastric
cancer in the Cancer Genome Atlas, but we need Congressional
support and NCI support to ensure that these cancers can be
cured.
[Written statement by Kristin W. Fitzgerald follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you very much. We are sorry for your loss.
Next, E. Clarke Ross, Friends of NCBDDD.
----------
Wednesday, May 12, 2010.
CENTERS FOR DISEASE CONTROL, NATIONAL CENTER FOR BIRTH DEFECTS AND
DEVELOPMENTAL DISABILITIES
WITNESS
E. CLARKE ROSS, CHAIR, FRIENDS OF THE NATIONAL CENTER FOR BIRTH DEFECTS
AND DEVELOPMENTAL DISABILITIES
Mr. Ross. Thank you, Mr. Chairman. I am representing the
Friends of the National Center on Birth Defects and
Developmental Disabilities at CDC. According to the National
Council on Disability, there are 54 million Americans with
disabilities, and NCBDDD is the disabilities center at CDC.
I have had the privilege of working for 40 years with five
different national disability organizations and I brought a
photo of you that I was at with the leadership of United
Cerebral Palsy of Wisconsin from the late 1970s or the early
1980s.
Mr. Obey. That guy is an imposter. [Laughter.]
Mr. Ross. People recognize you. People recognize you.
We are asking for a $20,000,000 increase in the
appropriation for NCBDDD. That is a 14-percent increase over
the $143,000,000 level of the current level and NCBDDD would do
five things with this $20,000,000. One is to enhance wellness
and prevention initiatives for people with disabilities. This
is a big priority of the First Lady, obesity. The new CDC
Administrator's big priority is anti-smoking, obesity,
infectious diseases.
I am the father of a 19-year-old son with high-functioning
autism and non-attentive ADHD, significant anxiety and learning
disabilities. He is 19. He is right out of high school. And
what does he do left to his own druthers? He sits in his
apartment and watches TV and does Game Boy kinds of things.
So this population is very socially isolated. And unless we
have aggressive NCBDDD programs that deal with things like
social isolation in this population, what are guys like my son
going to do? They are going to eat. Fortunately, he does not
drink or smoke or do drugs, but what he is going to do when he
is socially isolated by himself is use behaviors that are not
very positive and helpful.
So we would use some of this $20,000,000 to deal with
health and wellness programs like the First Lady and the CDC
Administrator desire.
We also need to do a lot in the health disparity area. The
disability population itself is highly under-served compared to
the population at large. Many of the witnesses are consumers
and family members. A high priority of NCBDDD is to educate
family members and consumers about all of these disabilities,
how to deal with the disabilities, how to plan your life around
the disabilities. That is a third area.
The fourth area is a big need. We have a good special
education law in this Country. We have 6.5 million kids in
special education. They come out of high school. We as a
society are not really dealing with the transition from high
school to employment or college, and we need a lot of planned
supportive activities to help young adults.
And this is very consistent with the whole employment
initiative. We need to help people get employed. We need to
support them in employment, and NCBDDD can do that with an
increase in appropriations.
And last, NCBDDD does do global health work like folic acid
distribution around the Country to prevent birth defects.
So $20,000,000, these are the five things the Friends would
like to see money used for.
[Written statement by E. Clarke Ross, D.P.A., follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. All right. Thanks again.
Next, Vicki Modell, Jeffrey Modell Foundation.
----------
Wednesday, May 12, 2010.
NATIONAL INSTITUTES OF HEALTH, OFFICE OF PUBLIC HEALTH GENOMICS
WITNESS
VICKI MODELL, CO-FOUNDER, JEFFREY MODELL FOUNDATION
Ms. Modell. Mr. Chairman and Members of the Committee,
thank you so much for this extraordinary opportunity to testify
today.
My husband and I created the Jeffrey Modell Foundation in
memory of our son Jeffrey, who died at the age of 15 after a
life-long battle with primary immunodeficiency. PI diseases
afflict more than 1 million Americans, but most of them go
undiagnosed.
Over the past 12 years that we are coming to Washington,
you have given us the opportunity to build a strong partnership
with Congress, CDC, NIH, as well as industry and private
donors. Now, I would like to tell you where we are, where we
are going with your continued support, and some changes that
are needed in the President's budget request that will allow us
to continue to help our patients and save lives.
This Committee provided the funding for physician education
and public awareness programs. Working with CDC, we started the
campaign five years ago and our public service ads have
generated more than $130,000,000 in donated media. It has
enabled us to generate additional funding from the private
sector, and we are very proud to report that every $1 of
Federal funds provided has been leveraged into more than $10
for our program.
I am delighted to report that this initiative is having
exactly the impact that we all had hoped for. Physicians at our
79 Jeffrey Modell Centers in the U.S. report a doubling every
year in the number of patients diagnosed and treated. And
severe infections, hospitalizations, school and workdays missed
were reduced by an average of 70 percent. This generates a
savings to the healthcare system of more than $80,000 per
patient per year.
Since the NIH reports that there are 500,000 Americans with
PI who are undiagnosed, the wasted cost to our healthcare
system is $40,000,000,000 annually. All of this has been
published in a peer-reviewed journal.
This program is successful, but here is the problem. The
President's budget for fiscal year 2011 reduces funding for the
Office of Public Health Genomics and eliminates the line items
created by this Committee to fund the education and awareness
programs. While CDC has indicated its support, the only
guarantee that it will go forward is if this Committee supports
that and acts.
For this reason, we are requesting that when you assemble
the Chairman's mark for the bill, you return this account to
the current status, as was found in the fiscal year 2010 bill.
The program is working and it has earned your continued
support.
An additional success story for this Committee and by this
Committee, I may say, is the newborn screening program that was
funded and piloted in Wisconsin and Massachusetts by CDC and
our Foundation. Today, every baby born in those two States is
being screened for this life-threatening condition, and
potentially cured. The cost of the screening is less than $5
per baby. Now, that is priceless.
That is why this past January the Secretary's Advisory
Committee voted unanimously to add SCID testing to the national
core panel.
I received a note from a mother in Edgar, Wisconsin, not
far from you, whose baby was screened, transplanted, and has
been completely cured. The impact of this Committee is
extremely well expressed in her note: ``We are so blessed to
have our beautiful baby Dawson. Every day I feel we are the
luckiest family in the world. I always think about the time we
testified in D.C. and we sat next to the parents from Oregon
who lost their baby Liam to SCID. That could have been us. This
September will be Dawson's two-year anniversary of his
transplant. We cannot imagine life without him.''
Well, tomorrow 11,000 babies will be born in this Country,
but only 300 to 400 of them will be born in States that
currently screen for SCID. They will be the lucky ones. They
will have a chance of life. If every State would screen for
SCID, we could actually wipe out this deadly disease. What a
great legacy for this Committee.
So Fred and I accept the reality that science and discovery
did not come in time to save Jeffrey, but we are dedicated and
committed to work with you so that all the Jeffreys in the
future will have a healthy life. This is our hope. It is our
dream. Let's go forward on this journey together starting
today.
Thank you and thank you for your service for so many years.
[Written statement by Vicki Modell follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Next, Madeleine Will, National Down Syndrome Society.
----------
Wednesday, May 12, 2010.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
WITNESS
MADELEINE WILL, VICE PRESIDENT, NATIONAL DOWN SYNDROME SOCIETY
Ms. Will. Good afternoon, Mr. Chairman and Members of the
Subcommittee. I am Madeleine Will, Vice President of Public
Policy for the National Down Syndrome Society. I want to thank
you for the opportunity to testify today and to thank you for
your leadership role that you and the Subcommittee have played
over the years in supporting and creating greater public
awareness of Down Syndrome.
There are more than 400,000 people living with Down
Syndrome in the U.S. and about 5,000 babies are born each year
or one in 733. Down Syndrome occurs in people of all races and
economic levels, and is the most frequently occurring
chromosomal condition.
Mr. Chairman, recognizing the challenges the Subcommittee
faces in prioritizing requests, the National Down Syndrome
Society respectfully recommends that you appropriate $5,000,000
in fiscal year 2011 to the Centers for Disease Control and
Prevention to implement the requirements of the Prenatally and
Postnatally Diagnosed Conditions Awareness Act which was
enacted in 2008.
This law will ensure that pregnant women who receive a
diagnosis of Down Syndrome and other genetic disorders
prenatally or postnatally receive up to date scientific
information about such things as life expectancy, functional
development, clinical course, prenatal and postnatal treatment
options, educational and psychosocial outcomes. This
information is to be provided through the development of
materials, the creation of hot lines, Web sites and
informational clearinghouses.
With $5,000,000, the Department of Health and Human
Services will be able to fund, to collect and distribute
information related to prenatally and postnatally diagnosed
conditions.
There are several points I would like to underscore in my
testimony. First, it is important to note that the
organizations supporting the legislation went to great lengths
to ensure bipartisan support for it, seeking out and achieving
the championships of Senator Brownback and former Senator
Kennedy.
We also went to considerable lengths to speak to both right
to life and pro-choice groups to convey that this legislation
should be characterized for what it is, a piece of legislation
about accurate evidence-based information that needs to be
delivered to pregnant women.
It is also important to underscore that the legislation was
not designed to focus only on women who receive information
about Down Syndrome. Rather, the legislation seeks to develop
and to have distributed information about many disabilities and
genetic disorders, to name a few: Trisomy 13 and 18, Williams
Syndrome, spina bifida.
More than 1,000 prenatal tests are available or in
development and a best practice bulletin has been issued by the
American College of Obstetricians and Gynecologists. It is
recommended that all pregnant women be offered prenatal
testing, all 4 million pregnant women annually.
This means that these women need to receive information
that is complex and challenging and changing with new data,
advances and findings that need to be conveyed, particularly
after Francis Collins' mapping of the human genome. Hank
Greely, the Director of Stanford University's Center for Law
and Biosciences, said recently, ``Information is powerful, but
misunderstood information can be powerfully bad.''
Another point I would like to emphasize is that we do know
how obstetricians feel about the issues of screening and the
delivery of a diagnosis of Down Syndrome and other chromosomal
disorders. In an article published by ACOG, 36 percent of
obstetricians feel well qualified to counsel patients who
screen positive for Down Syndrome; 51 percent thought the
training they received was adequate, but 40 percent thought it
was less than adequate; and only 29 percent of physicians
surveyed provided printed educational materials to a woman when
her fetus was diagnosed with Down Syndrome.
Lastly, we have information about how the diagnosis should
be delivered. A 29-member research team surveyed women who had
received a diagnosis to determine the best way of delivering
the news, and some of the most important findings were that all
women wanted to discuss all options available to them,
including continuing the pregnancy, adoption and termination.
They also wanted screening results explained as a risk
assessment and not as a positive or a negative result. They
wanted sensitive language used in the delivery of a diagnosis
and they wanted consistency in the messages conveyed by the
variety of professionals with whom they interact.
NDSS is working collaboratively with ACOG, the National
Society of Genetic Counselors, and the American College of
Medical Genetics since the passage of the law. We have
developed a consensus document which explored myths and
realities about prenatal testing. We have pledged to review
materials together, but frankly, we are stuck even if we had
materials developed, we would not be able to move forward to
publish and distribute this information to physicians and women
without a Federal partner and additional funding.
Mr. Obey. I will have to ask you to wrap it up.
Ms. Will. Yes, Mr. Chairman, thank you for your time and
attention. We are thrilled beyond measure that Congress enacted
this legislation and hope that the funding of this law will
lead to better information and better decision making.
Thank you.
[Written statement by Madeleine Will follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
I understand the situation. My nephew was a Down Syndrome
child.
Next, Michael Goldberg, Society for Neuroscience.
Oh, I am sorry. I mucked up. Okay.
Gail Smith, Dr. Anthony R. Horton, International Rett
Syndrome Foundation.
----------
Wednesday, May 12, 2010.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
WITNESS
GAIL SMITH, INTERNATIONAL RETT SYNDROME FOUNDATION
Ms. Smith. Mr. Chairman and Committee Members, thank you
for this opportunity to speak. I had a daughter with Rett
Syndrome, and this is my story.
My name is Gail Smith and I reside in Maryland. My husband
and I dreamed of raising a normal healthy family. Seems like
yesterday when our first child was born. She was a perfect
baby. She babbled and cooed her way through the first year, a
bouncing happy baby. She played patty-cake and waved bye-bye
and began to feed herself and walk.
Suddenly after one year old, Kristi became aloof and began
to lose skills rapidly. At two and a half, she literally
overnight lost her ability to walk independently. We were
terrified. We pursued countless doctors and many, many medical
tests, but still no answers. By five years of age, her mind was
trapped within a body that would not allow her to communicate
or physically respond.
We mourned the death of our normal child and began to
grapple with our changing life. We experienced fear, anger and
a deep sense of sadness. I used to lie in bed trembling and
praying that I could just learn to cope and that she wouldn't
die.
I searched fervently in medical journals and papers for any
remote likeness to the symptoms that Kristi exhibited. Then one
day a friend who had a daughter in some ways similar to mine
shared with me a paper on Rett Syndrome. That was the first
article on the condition ever published in English. I knew I
had found Kristi's diagnosis.
At 13 years of age, Kristi was one of the first girls in
the United States officially diagnosed with Rett Syndrome at
Johns Hopkins by Dr. Andreas Rett himself. Rett Syndrome is a
neurologic disorder that occurs almost exclusively in girls who
develop normally until between six and 18 months of age, when
the child begins a regression that severely challenges her
mentally and physically.
At that time, there was no known cause, treatment or cure.
Kristi spoke volumes with her eyes. She spread love with her
sweet smile. She and I became symbiotic, joined at the hip. The
last word she could speak was ``Mama,'' usually when she was in
stress. I became sensitive to her every need and I couldn't
help her frustration or take her place from her.
She endured so many operations for scoliosis, tendon
releases, and the placement of a feeding tube. As her lungs
deteriorated, she was hospitalized many times for aspiration
pneumonia. I have never experienced anything as painful as
watching her suffer.
On September 9, 2006, as I lay holding her in the intensive
care unit at Children's National Medical Center, she slipped
away. And part of me slipped away, too. She was 34 years old.
Despite the struggle, we have been so blessed to have her
in our life. She has taught me more about life and
relationships than any teacher I have ever had. I cry every day
since she has been gone. There is a hole in my heart.
However, I am somewhat comforted knowing that she is
smiling down knowing there is hope for other girls with Rett
Syndrome. It is my everlasting love for Kristi and the hope for
those children with Rett Syndrome, the hope that children with
Rett Syndrome can be reversed for those who have the disease,
and the families caring for them that brings me here today.
Research is the only way to help us find a cure for the
many thousands of girls who are today suffering as Kristi did
for 34 years. Through research, we have now found the cause of
Rett Syndrome. Through research, we now know it can be
reversed. Researchers tell us that we are at the point of
testing treatments to reverse the symptoms of this disease.
With your support, we can take the next steps on the path
and begin testing the therapies that will help these girls live
better lives. With your support, we could reverse this disease
once and for all.
I loved Kristi so much and it would mean so much to see
funding appropriated to help avenge the devastating impact of
this horrible disease.
Please help us. Thank you for your time and consideration.
Congressman Steny Hoyer has worked tirelessly with us on
funding for Rett Syndrome. Our families met at church. He and
Kristi have had a long and lasting relationship over the years.
He has worked with us and has been so helpful and I want to
thank him. I know he is not here.
Thank you for your time. God bless all.
[Written statements by Gail Smith and Dr. Antony R. Horton
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you. I know it is tough to bring that story
here.
Next, Michael Goldberg, Society for Neuroscience.
----------
Wednesday, May 12, 2010.
NATIONAL INSTITUTES OF HEALTH
WITNESS
MICHAEL E. GOLDBERG, M.D., PRESIDENT, SOCIETY FOR NEUROSCIENCE
Dr. Goldberg. Mr. Chairman and Members of the Committee, it
is an honor to testify today on the fiscal year 2011 budget.
On behalf of the 40,000 scientists and clinicians who are
members of the Society for Neuroscience, I thank the
Subcommittee for its past support of research at the NIH and in
particular I thank Chairman Obey for his unflagging support for
biomedical science.
I am Michael Goldberg, President of the Society for
Neuroscience, and the David Mahoney Professor of Brain and
Behavior at Columbia University in New York. Because I am both
a basic neuroscientist and an active clinical neurologist, I
know how basic research translates to new and better treatments
for human disease often in unexpected ways.
On behalf of the Society, I respectfully request a 2011 NIH
appropriation of $35,000,000,000. This level will sustain the
burst of scientific productivity funded by the American
Recovery and Reinvestment Act for which the scientific
community thanks this Congress and the Obama Administration,
and which was especially welcome after six years of below
inflationary increases for NIH.
ARRA funding was an unqualified success. Areas of research
that need to be sustained include the application of genetic
knowledge to clinical treatment, immunological treatments for
addiction, and the understanding of memory loss in Alzheimer's
and in normal aging.
While we applaud President Obama's strong commitment to
science, the Administration's fiscal year 2011 budget does not
fully take into account the tremendous scientific momentum from
ARRA. With continued funding at the ARRA-adjusted base of
$35,000,000,000, this research will form the foundation for new
medical applications. Without it, NIH will see the wasteful
termination of promising research programs just begun under
ARRA funding and the firing of thousands of technicians and
research fellows. Young investigators, the future of American
science, will be especially devastated. Ultimately, scientific
progress on diseases that cost society trillions will be
delayed or derailed.
In addition, strong NIH funding is vital to ensure that the
United States remains the world leader in biomedical research.
Today, that role is being threatened. For instance, China's
government is using financial resources to draw scientists
home. In my own lab, a post-doctoral fellow with a green card
received an offer from the Chinese government that could not be
matched in America, given the current funding climate, and he
went back to China.
SFN supports a robust international scientific community,
yet we understand that strong American leadership is vital both
to catalyze global research and to protect our Nation's future.
Finally, as an NIH-funded scientist, funded by the National
Eye Institute, I not only conduct research relevant to autism
and attention deficit disorder, I support a community of
workers. More than three-quarters of my funding goes to hire
fellows, machinists, computer scientists, biological
technicians and animal caretakers, as well as administrative
staff.
Nationwide, robust NIH funding generates hundreds of
thousands of high wage jobs in every American State. According
to a recent report, every $1 in NIH funding adds $2.11 to our
economy.
In closing, I stress that today, we live on the forefront
of an era of breathtaking potential to advance biological
knowledge and human health. And we are all fortunate to have
the NIH, the world's finest biomedical research enterprise and
a strong economic engine for America. As the Nation considers
difficult decisions in the face of economic strain,
prioritizing strong NIH funding remains a wise investment
precisely because it contributes to our health and our economic
strength.
As the Nation emerges from recession, ARRA's infusion in
infrastructure, labs, people and discoveries should be made
permanent to serve the American people, their health and our
economy.
On behalf of the Society for Neuroscience, I again thank
this Subcommittee, its Chair, and the Nation for America's
commitment to research. I urge you to sustain the momentum with
a fiscal year appropriation of $35,000,000,000.
Thank you, Mr. Chairman.
[Written statement by Michael E. Goldberg, M.D., follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Next, Cynthia Bearer, Children's Environmental Health
Network.
----------
Wednesday, May 12, 2010.
DEPARTMENT OF HEALTH AND HUMAN SERVICES, CLEAN GREEN AND HEALTHY SCHOOL
INITIATIVE
WITNESS
CYNTHIA BEARER, M.D., BOARD CHAIR, CHILDREN'S ENVIRONMENTAL HEALTH
NETWORK
Dr. Bearer. Good afternoon. Thank you for the opportunity
to testify before you today.
I am the Mary Gray Cobey Professor of Neonatology and
Division Chief of Neonatology at the University of Maryland.
However, I am not here today in that role, but in my role as
Board Chair for the Children's Environmental Health Network.
The Network is a nonprofit organization that has been
working for almost 20 years to promote a healthy environment
and to protect all children from environmental health hazards.
The world in which today's children live has changed
tremendously from that of previous generations. This includes a
phenomenal increase in the number of new substances to which
children are exposed. For example, my 13-year-old son Matt has
already been exposed to many more chemicals than I was at his
age. Most of these chemicals are untested in their effects on
developing organ systems such as the brain.
Children have unique vulnerabilities and susceptibilities
to toxic chemicals. As we have learned from lead, mercury and
alcohol, an exposure which may cause little or no harm to an
adult may cause permanent harm to a child. The Network
appreciates the wide range of needs that you must consider here
for funding. We urge you to give priority to those programs
that directly protect and promote children's environmental
health. In so doing, you improve not only our children's
health, but also their educational outcomes and their future.
My written testimony provides information on the funding
needs of a variety of agencies and collaborative programs that
are key in protecting children's environmental health, such as
the Children's Environmental Health Research Centers of
Excellence; the National Environmental Public Health Tracking
Program; and the National Children's Study.
The Network urges the Committee to provide full funding for
the Administration's Clean Green and Healthy School Initiative.
As you know, school children and their parents do not have an
OSHA. No agency is authorized to intervene to protect children
from environmental hazards in schools. We require our children
to spend hours in an environment where they and their parents
have no recourse if that environment is not healthy.
Unfortunately, studies have shown that many of our school
buildings are unhealthy. Similarly, although millions of
preschool children spend hours in day care, most State
licensing programs include few environmental health standards.
Thus, we urge the Committee to expand the Clean Green and
Healthy Schools Initiative to include child care.
I will close by mentioning an area that has been of great
concern to the Network, but which has received little attention
by policy-makers. I am referring to global climate change. Of
course, climate change has been a hot topic. However, the
health impacts of climate change, especially the health impact
on children, have received almost no attention. Yet children as
a vulnerable sub-population will be the first and worst hit by
climate change.
The World Health Organization estimates that more than
150,000 deaths per year due to climate changes are already
occurring in the world's low-income nations. Of these deaths,
almost 85 percent are young children. Thus, the Network urges
the Committee to provide $50,000,000 in fiscal year 2011 for
the Department of Health and Human Services to prepare for the
potential health effects of global climate change.
In conclusion, investments in programs that protect and
promote children's health will be repaid by healthier children
with brighter futures, an outcome we can all support. That is
why the Network asks you to give priority to these programs.
Thank you.
[Written statement by Cynthia Bearer, M.D., follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you. We appreciate your comments.
Next, Leonardo Trasande, Children's Environmental Health
Center.
----------
Wednesday, May 12, 2010.
NATIONAL CHILDREN'S STUDY
WITNESS
LEONARDO TRASANDE, M.D., CO-DIRECTOR, CHILDREN'S ENVIRONMENTAL HEALTH
CENTER, MT. SINAI MEDICAL CENTER
Dr. Trasande. Chairman Obey, Members of the Subcommittee,
thank you for the opportunity to update you on ongoing progress
at the National Children's Study, our Nation's opportunity to
address the preventable and environmental causes of the
epidemic of chronic conditions that affect children today.
I co-direct the Children's Environmental Health Center at
the Mt. Sinai School of Medicine, the Nation's first academic
policy center devoted to the protection of children against
environmental threats to health, and serve as the location
principal investigator for Queens, New York, one of seven
locations where the National Children's Study launched in early
2009.
The National Children's Study is a prospective study that
will follow 100,000 American children, a nationally
representative sample of all children born in the United
States, from conception to age 21, and was mandated by Congress
through the Children's Health Act of 2000. The study will
gather an unprecedented volume of high quality data on how
environmental factors acting either alone or in combination
with genetics affect the health of infants and children,
examining a wide range of environmental factors from air, water
and dust, to what children eat and how often they see a doctor.
The study will help develop prevention strategies and cures
for a wide range of childhood diseases. The National Children's
study will employ the latest tools in molecular epidemiology
and will incorporate state of the art analyses of gene-
environment interactions.
Congress has already laid a firm foundation for the
National Children's Study. Between 2000 and 2009, Congress
invested more than $580,000,000 to design the study and begin
building the nationwide network for its implementation. Seven
vanguard centers and a coordinating center were designed in
2005 to test the necessary research guidelines with plans to
expand the program to 41 States and 105 communities nationwide.
Findings in these study centers have suggested that further
refinements are necessary to ensure the most cost-effective
investment in implementing the study, and generating policy-
relevant findings for decades to come. The study has recently
been expanded to 30 additional locations where approaches to
recruitment can be more fully optimized.
A formative research program will generate new knowledge
that will inform redesign of key questionnaires and other data
collection approaches in response to important concerns that
were raised by the National Academy of Sciences regarding the
original vanguard protocol.
The tough job of designing and organizing is nearly
complete. Funding for the study this year will permit
researchers to begin achieving the results that will make
fundamental improvements in the health of America's children.
To abandon the study at this point would mean foregoing all of
that dedication, all of that incredible effort, and all of that
logistical preparation.
The National Children's Study will yield benefits that far
outweigh its cost. Six of the diseases that are the focus of
the study cost America over $642 billion each year. If the
study were to produce even a 1 percent reduction in the cost of
these diseases, it would receive $6,400,000,000 annually, 50
times the average yearly cost of the study itself.
The Framingham Heart Study upon which the National
Children's Study is modeled, is the prototype for longitudinal
medical studies and contributed powerfully to the 42 percent
reduction in mortality rates from cardiovascular disease that
were achieved in our Country over the past five decades.
Funding for the study will require a commitment of
$194,000,000. These funds will be used to begin enrolling
children in to the study. They will enable the NIH to continue
establishing the 105 study sites around the Country. We do not
need to wait 21 years for benefits to materialize from the
study. Valuable information will become available in a few
years time, as soon as the first babies in the study are born.
The National Children's Study will provide a blueprint for
the prevention of disease and for the enhancement of health of
America's children today and in the future. It will be our
legacy to the generations yet unborn.
Thank you for the opportunity to speak before you today.
[Written statement by Leonardo Trasande, M.D. follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Obey. Thank you.
Mr. Rehberg. May I ask how old you are? You look really
young.
Dr. Trasande. That is kind. I am 36. [Laughter.]
Mr. Ryan. Hey, Rehberg, quit picking on young people, okay?
We don't appreciate that. We have a caucus going over here.
[Laughter.]
Mr. Rehberg. Don't you wish you had that resume.
[Laughter.]
Mr. Obey. Next, David Meltzer, American Red Cross.
---------- --
--------
Wednesday, May 12, 2010.
CENTERS FOR DISEASE CONTROL AND PREVENTION, GLOBAL IMMUNIZATION
WITNESS
DAVID MELTZER, SENIOR VICE PRESIDENT FOR INTERNATIONAL SERVICES,
AMERICAN RED CROSS
Mr. Meltzer. Thank you, Chairman Obey and Members of the
Subcommittee. The American Red Cross appreciates the
opportunity to submit testimony in support of the measles
control activities of the U.S. Centers for Disease Control and
Prevention.
We recognize the leadership that Congress has shown in
funding CDC for these essential activities and we sincerely
hope that the Congress will continue to support the CDC during
this critical period in measles control.
In 2001, CDC, along with the American Red Cross, the United
Nations Foundation, the World Health Organization, and UNICEF
founded the Measles Initiative, a partnership committed to
reducing measles deaths globally.
The current UN goal is to reduce measles deaths by 90
percent by 2010 compared to 2000 estimates. Working towards
this goal, the Measles Initiative has achieved spectacular
results by supporting the vaccination of more than 700 million
children around the world. Largely due to the Measles
Initiative, global measles mortality dropped by 78 percent from
an estimated 733,000 deaths in the year 2000 to 164,000 deaths
in 2008. During this same period in Africa, measles deaths fell
by 92 percent, from 371,000 to just 28,000.
Working closely with host governments, the Measles
Initiative has been the main international supporter of mass
measles immunization campaigns since 2001. The Initiative
mobilized more than $720,000,000 and provided technical support
in more than 60 developing countries on vaccination campaigns,
surveillance, and improving routine immunization services.
From 2000 to 2008, an estimated 4.3 million deaths were
averted as a result of these accelerated measles control
activities at a donor cost of $184 per death averted. This
makes measles mortality reduction one of the most cost-
effective public health interventions.
Nearly all the measles vaccination campaigns have been able
to reach more than 90 percent of their target populations. By
the end of 2008, all WHO regions, with the exception of
Southeast Asia, achieved the 2010 goal two years ahead of
target. The extraordinary reduction in global measles deaths
contributed an estimated 25 percent of the progress to date
toward Millennium Development Goal Number 4, which is reducing
under age 5 child mortality.
However, at the height of global achievements in measles
control, a sharp decline in commitment threatens to erase the
gains of the last decade and permit a global measles
resurgence. The Measles Initiative presently faces a funding
shortfall of an estimated $47,000,000 for 2011. The American
Red Cross, which has to date contributed $141,000,000 to the
Initiative, currently faces financial challenges that reduce my
organization's foreseeable funding capacity.
Current funding gaps have led to delays in mass campaigns,
which have resulted in outbreaks and regrettably deaths.
Sufficient funding must be secured for measles control
activities in order to achieve the 2010 goal and to avoid a
measles resurgence.
Since fiscal year 2001, Congress has provided $43,600,000
annually in funding to CDC for global measles control
activities. These funds were used towards the purchase of 415
million doses of measles vaccine for use in large scale measles
vaccination campaigns in more than 60 countries in Africa and
Asia, and for the provision of technical support to the
Ministries of Health in those countries.
Your commitment has brought us unprecedented success in
reducing measles mortality around the world. The CDC support
made possible by the Congressional funding was essential to
achievement of the sharp reduction in measles deaths in just
eight years. In fiscal year 2010, Congress has appropriated
$51,900,000 to fund CDC for global measles control activities.
The American Red Cross thanks Congress for the increase in
financial support from past years. We respectfully request
level funding for fiscal year 2011 for CDC's measles control
activities to prevent a global resurgence of measles and a loss
of progress toward Millennium Development Goal Number 4.
Thank you for the opportunity to submit testimony.
[Written statement by David Meltzer follows:]
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Mr. Obey. Thank you.
Next, James Lacy, Rotary International.
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Wednesday, May 12, 2010.
CENTERS FOR DISEASE CONTROL
WITNESS
PAST PRESIDENT AND CHAIR JAMES LACY, POLIO ERADICATION ADVOCACY TASK
FORCE, ROTARY INTERNATIONAL
Mr. Lacy. Thank you very much, Chairman Obey and Members of
the Subcommittee. On behalf of 1.2 million Rotarians in more
than 170 countries around the world, we thank you for your
tremendous commitment to polio eradication globally.
Thanks to your leadership in appropriating funds, progress
toward a polio-free world continues on a positive course. Only
four countries have never stopped polio transmission:
Afghanistan, Pakistan, India and Nigeria.
The number of polio cases has fallen more than 99 percent
from an estimated 350,000 cases in 1988 to only 1,606 cases in
2009. This year to date, the number of polio cases globally is
84 compared to 383 at the same point in 2009. India went seven
weeks without reporting any case of the wild polio virus. This
is the first such lull in polio transmission since records have
been kept. Transmission of polio in India is now focused in
only 107 blocks in two states, a geographic area representing
only 2 percent of that country.
Due to increased ownership from national and state
governments and religious and traditional leaders in Nigeria,
the only polio endemic country in Africa, has reported only two
cases of polio for 2010. By this point in 2009, polio had
paralyzed 236 children. Twelve of the 20 reinfected countries
in 2009 and 2010 have not reported a case of polio in the last
six months.
In March and April, 2010, countries throughout West and
Central Africa took part in a preplanned synchronized
immunization campaign. Political interest in the campaigns were
extensive. Six heads of state and one First Lady launched the
campaigns. This included the critical new involvement of the
President of Chad, who declared war against polio.
In sum, the prospects for polio eradication are better than
ever in terms of the low level of polio incidence and the
commitment to polio eradication in the polio endemic and
outbreak countries.
Lack of funds to conduct necessary activities may now pose
the biggest threat. We have yet to identify sources of support
for approximately half the U.S. $2,600,000,000 needed between
now and the end of 2012 to achieve the goal of stopping all
outbreaks and interrupting transmission of the wild polio
virus.
Rotary is committed to doing whatever it takes to ensure we
seize the opportunity to conquer polio once and for all.
Rotarians have already contributed more than $900,000,000 in
this effort, plus thousands of man hours and are more than
halfway to our current fundraising goal of $200,000,000.
The leadership of the United States remains essential and
Rotary International urges you continued support toward the
shared goal of a polio-free world. For fiscal year 2011, we
respectfully request that you include $102,000,000 of level
funding for the targeted polio eradication efforts of the
Centers for Disease Control and Prevention.
The funds we are seeking will allow CDC to continue intense
supplementary immunization activities in Asia and improve the
quantity and quality of immunization campaigns in Africa to
ensure we meet the goal of interrupting transmission of wild
polio in these regions as quickly as possible.
These funds will also help maintain certification standard
disease surveillance, which is essential to protecting against
and responding to outbreaks. Failure to achieve success would
have significant humanitarian and economic consequences.
Within the next decade, hundreds of thousands of children
would again be paralyzed for life by this disease. Billions of
dollars would have to be spent on outbreak response activities,
rehabilitation, and treatment costs, and the associated loss to
economic productivity.
Success, on the other hand, will ensure that the
significant investment made by the United States, Rotary
International and many other countries and entities is
protected in perpetuity.
Thank you very much for your continued support, and we
thank you especially, Mr. Chairman, for your support through
the years, and thank you also for you also for the opportunity
to give this testimony.
Thank you.
[Written statement by James Lacy follows:]
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Mr. Obey. Thank you very much.
Thank you all for testifying. That is it for the day, just
in time.
The Committee stands adjourned.
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