[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]


                           MEMBER DAY HEARING

=======================================================================

                                HEARING

                               BEFORE THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             FIRST SESSION

                               __________

                              JULY 25, 2019

                               __________

                           Serial No. 116-57


      Printed for the use of the Committee on Energy and Commerce
      
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]      

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                        
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
45-261 PDF                 WASHINGTON : 2022                     
          
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                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
BOBBY L. RUSH, Illinois              GREG WALDEN, Oregon
ANNA G. ESHOO, California              Ranking Member
ELIOT L. ENGEL, New York             FRED UPTON, Michigan
DIANA DeGETTE, Colorado              JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California          CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida                BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland           PETE OLSON, Texas
JERRY McNERNEY, California           DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont                 ADAM KINZINGER, Illinois
BEN RAY LUJAN, New Mexico            H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York                 GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice     BILL JOHNSON, Ohio
    Chair                            BILLY LONG, Missouri
DAVID LOEBSACK, Iowa                 LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon                BILL FLORES, Texas
JOSEPH P. KENNEDY III,               SUSAN W. BROOKS, Indiana
    Massachusetts                    MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California            RICHARD HUDSON, North Carolina
RAUL RUIZ, California                TIM WALBERG, Michigan
SCOTT H. PETERS, California          EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan             JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas                GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
                            
                            C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     2
    Prepared statement...........................................     3
Hon. Greg Walden, a Representative in Congress from the State of 
  Oregon, opening statement......................................     4
Hon. Eliot L. Engel, a Representative in Congress from the State 
  of New York, prepared statement................................   175

                               Witnesses

Hon. Anthony Brindisi, a Representative in Congress from the 
  State of New York, opening statement...........................     4
    Prepared statement...........................................     6
Hon. Mark Takano, a Representative in Congress from the State of 
  California, opening statement..................................     7
    Prepared statement...........................................     9
Hon. Ed Case, a Representative in Congress from the State of 
  Hawaii, opening statement......................................    10
    Prepared statement...........................................    12
Hon. Bill Pascrell, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................    14
    Prepared statement...........................................    15
Hon. Sanford D. Bishop, Jr., a Representative in Congress from 
  the State of Georgia, opening statement........................    17
    Prepared statement...........................................    19
Hon. Bruce Westerman, a Representative in Congress from the State 
  of Arkansas, opening statement.................................    20
    Prepared statement...........................................    22
Hon. Ted W. Lieu, a Representative in Congress from the State of 
  California, opening statement..................................    24
    Prepared statement...........................................    25
Hon. Glenn Grothman, a Representative in Congress from the State 
  of Wisconsin, opening statement................................    26
    Prepared statement...........................................    27
Hon. Xochitl Torres Small, a Representative in Congress from the 
  State of New Mexico, opening statement.........................    28
    Prepared statement...........................................    30
Hon. Dean Phillips, a Representative in Congress from the State 
  of Minnesota, opening statement................................    32
    Prepared statement...........................................    33
Hon. Marcy Kaptur, a Representative in Congress from the State of 
  Ohio, opening statement........................................    35
    Prepared statement...........................................    37
Hon. Sean Casten, a Representative in Congress from the State of 
  Illinois, opening statement....................................    43
    Prepared statement...........................................    45
Hon. Mike Levin, a Representative in Congress from the State of 
  California, opening statement..................................    47
    Prepared statement...........................................    48
Hon. Elissa Slotkin, a Representative in Congress from the State 
  of Michigan, opening statement.................................    50
    Prepared statement...........................................    51
Hon. Scott Perry, a Representative in Congress from the 
  Commonwealth of Pennsylvania, opening statement................    52
    Prepared statement...........................................    54
Hon. Debra Haaland, a Representative in Congress from the State 
  of New Mexico, opening statement...............................    55
    Prepared statement...........................................    57
Hon. Donna E. Shalala, a Representative in Congress from the 
  State of Florida, opening statement............................    58
    Prepared statement...........................................    60
Hon. Grace Meng, a Representative in Congress from the State of 
  New York, opening statement....................................    62
    Prepared statement...........................................    63
Hon. Gregorio Sablan, a Representative in Congress from the 
  Territory of the Mariana Islands, opening statement............    65
    Prepared statement...........................................    67
Hon. Lucille Roybal-Allard, a Representative in Congress from the 
  State of California, and Hon. Jaime Herrera Beutler, a 
  Representative in Congress from the State of Washington, 
  opening statements.............................................    68
    Prepared statements..........................................    70
Hon. Grace F. Napolitano, a Representative in Congress from the 
  State of California, opening statement.........................    74
    Prepared statement...........................................    75
Hon. Lucy McBath, a Representative in Congress from the State of 
  Georgia, opening statement.....................................    76
    Prepared statement...........................................    77
Hon. Bonnie Watson Coleman, a Representative in Congress from the 
  State of New Jersey, opening statement.........................    78
    Prepared statement...........................................    79
Hon. Andy Levin, a Representative in Congress from the State of 
  Michigan, opening statement....................................    81
    Prepared statement...........................................    82
Hon. David Schweikert, a Representative in Congress from the 
  State of Arizona, opening statement............................    83
    Prepared statement...........................................    85
Hon. David Trone, a Representative in Congress from the State of 
  Maryland, opening statement....................................    86
    Prepared statement...........................................    88
Hon. James P. McGovern, a Representative in Congress from the 
  State of Texas, opening statement..............................    90
    Prepared statement...........................................    92
Hon. Dan Lipinski, a Representative in Congress from the State of 
  Illinois, opening statement....................................    93
    Prepared statement...........................................    94
Hon. Jared Golden, a Representative in Congress from the State of 
  Maine, opening statement.......................................    95
    Prepared statement...........................................    96
Hon. Robert J. Wittman, a Representative in Congress from the 
  Commonwealth of Virginia, opening statement....................    97
    Prepared statement...........................................    99
Hon. Tom Malinowski, a Representative in Congress from the State 
  of New Jersey, opening statement...............................   100
    Prepared statement...........................................   101
Hon. Jenniffer Gonzalez-Colon, a Representative in Congress from 
  the Territory of Puerto Rico...................................   103
    Prepared statement...........................................   106
Hon. Abby Finkenauer, a Representative in Congress from the State 
  of Iowa, opening statement.....................................   115
    Prepared statement...........................................   116
Hon. Rosa L. DeLauro, a Representative in Congress from the State 
  of Connecticut, opening statement..............................   117
    Prepared statement...........................................   119
Hon. Steve Cohen, a Representative in Congress from the State of 
  Tennessee, opening statement...................................   122
    Prepared statement...........................................   123
Hon. Troy Balderson, a Representative in Congress from the State 
  of Ohio, opening statement.....................................   125
    Prepared statement...........................................   126
Hon. Kevin Hern, a Representative in Congress from the State of 
  Oklahoma, opening statement....................................   128
    Prepared statement...........................................   129
Hon. Derek Kilmer, a Representative in Congress from the State of 
  Washington, opening statement..................................   131
    Prepared statement...........................................   134
Hon. Antonio Delgado, a Representative in Congress from the State 
  of New York, opening statement.................................   136
    Prepared statement...........................................   137
Hon. Fred Keller, a Representative in Congress from the 
  Commonwealth of Pennsylvania, opening statement................   139
    Prepared statement...........................................   140
Hon. Vicente Gonzalez, a Representative in Congress from the 
  State of Texas, opening statement..............................   142
    Prepared statement...........................................   143
Hon. Stacey Plaskett, a Representative in Congress from the 
  Territory of the Virgin Islands, opening statement.............   145
    Prepared statement...........................................   147

                           Submitted Material

Letter of February 15, 2019, from Mr. Bishop, et al., to Ms. 
  DeLauro and Mr. Cole, submitted by Mr. Pallone.................   150
List of Supporters, NEMT Medicaid, from Mr. Bishop, submitted by 
  Mr. Pallone....................................................   156
Letter of June 18, 2019, from Mr. Welch, et al, to President, 
  submitted by Mr. Pallone.......................................   158
Prepared statements of Hon. Elijah Cummings and Hon. C. A. Dutch 
  Ruppersberger, Representatives in Congress from the State of 
  Maryland.......................................................   166
Prepared statements of Hon. Mike Kelly, a Representative in 
  Congress from the State of Pennsylvania, and Hon. Marcy Kaptur, 
  a Representative in Congress from the State of Ohio............   167
Prepared statement of Hon. Jamie Raskin, a Representative in 
  Congress from the State of Maryland............................   174
Prepared statement of Hon. Jimmy Gomez, a Representative in 
  Congress from the State of California..........................   177
Prepared statement of Hon. Gwen Moore, a Representative in 
  Congress from the State of Wisconsin...........................   179
Prepared statement of Hon. Donald M. Payne, a Representative in 
  Congress from the State of New Jersey..........................   182
Prepared statement of Hon. Andy Biggs, a Representative in 
  Congress from the State of Arizona.............................   184
Prepared statement of Hon. Eric Swalwell, a Representative in 
  Congress from the State of California..........................   185
Prepared statement of Hon. Chris Smith, a Representative in 
  Congress from the State of New Jersey..........................   187
Prepared statement of Hon. Gil Cisneros, a Representative in 
  Congress from the State of California..........................   194
Prepared statement of Hon. Harley Rouda, a Representative in 
  Congress from the State of California..........................   196
Prepared statement of Hon. Doug Collins, a Representative in 
  Congress from the State of Georgia.............................   198
Letter from Mr. Biggs, to Mr. Pallone and Mr. Walden, submitted 
  by Mr. Pallone.................................................   200
Letter of December 20, 2018, from Mr. Biggs, et al., to Hon. Ajit 
  Pai, submitted by Mr. Pallone..................................   201

 
                           MEMBER DAY HEARING

                              ----------                              


                        THURSDAY, JULY 25, 2019

                  House of Representatives,
                  Committee on Energy and Commerce,
                                            Washington, DC.
    The committee met, pursuant to call, at 10:00 a.m., in the 
John D. Dingell Room 2123 Rayburn House Office Building, Hon. 
Frank Pallone, Jr., (chairman of the committee) presiding.
    Members present: Representatives, Pallone, Rush, Eshoo, 
Engel, DeGette, Doyle, Schakowsky, Butterfield, Matsui, Castor, 
Sarbanes, McNerney, Welch, Lujan, Tonko, Clarke, Loebsack, 
Schrader, Kennedy, Cardenas, Ruiz, Peters, Dingell, Veasey, 
Kuster, Kelly, Barragan, McEachin, Blunt Rochester, Soto, 
O'Halleran, Walden (ranking member), Upton, Shimkus, Burgess, 
Scalise, Latta, Rodgers, Guthrie, Olson, McKinley, Kinzinger, 
Griffith, Bilirakis, Johnson, Long, Bucshon, Flores, Brooks, 
Mullin, Hudson, Walberg, Carter, Duncan, and Gianforte.
    Staff present: Mohammad Aslami, Counsel; Kevin Barstow, 
Chief Oversight Counsel; Billy Benjamin, Systems Administrator; 
Jacquelyn Bolen, Professional Staff; Jesseca Boyer, 
Professional Staff Member; A. J. Brown, Counsel; Jeffrey C. 
Carroll, Staff Director; Jacqueline Cohen, Chief Environment 
Counsel; Sharon Davis, Chief Clerk; Luis Domingues, Health 
Fellow; Jennifer Epperson, FCC Detailee; Elizabeth Ertel, 
Office Manager; Adam Fischer, Policy Analyst; Jean Fruci, 
Energy and Environment Policy Advisor; Evan Gilbert, Press 
Assistant; Lisa Goldman, Counsel; Waverly Gordon, Deputy Chief 
Counsel; Tiffany Guarascio, Deputy Staff Director; Caitlin 
Haberman, Professional Staff Member; Alex Hoehn-Saric, Chief 
Counsel, Communications and Technology; Megan Howard, FDA 
Detailee; Zach Kahan, Outreach and Member Service Coordinator; 
Rick Kessler, Senior Advisor and Staff Director, Energy and 
Environment; Saha Khaterzai, Professional Staff Member; Chris 
Knauer, Oversight Staff Director; Brendan Larkin, Policy 
Coordinator; Una Lee, Senior Health Counsel; Jerry Leverich, 
Counsel; Jourdan Lewis, Policy Analyst; Perry Lusk, GAO 
Detailee; Dustin Maghamfar, Air and Climate Counsel; John 
Marshall, Policy Coordinator; Kevin McAloon, Professional Staff 
Member; Dan Miller, Policy Analyst; Jon Monger, Counsel; Elysa 
Montfort, Press Secretary; Phil Murphy, Policy Coordinator; 
Lisa Olson, FERC Detailee; Joe Orlando, Staff Assistant; 
Kaitlyn Peel, Digital Director; Mel Peffers, Environment 
Fellow; Alivia Roberts, Press Assistant; Tim Robinson, Chief 
Counsel; Chloe Rodriguez, Policy Analyst; Nikki Roy, Policy 
Coordinator; Samantha Satchell, Professional Staff Member; 
Andrew Souvall, Director of Communications, Outreach and Member 
Services; Sydney Terry, Policy Coordinator; Kimberlee Trzeciak, 
Senior Health Policy Advisor; Rick Van Buren, Health Counsel; 
Eddie Walker, Technology Director; Teresa Williams, Energy 
Fellow; Tuley Wright, Energy and Environment Policy Advisor; C. 
J. Young, Press Secretary; Jennifer Barblan, Minority Chief 
Counsel, Oversight and Investigations; Mike Bloomquist, 
Minority Staff Director; Adam Buckalew, Minority Director of 
Coalitions and Deputy Chief Counsel, Health; Robin Colwell, 
Minority Chief Counsel, Communications and Technology; Jerry 
Couri, Minority Deputy Chief Counsel, Environment and Climate 
Change; Jordan Davis, Minority Senior Advisor; Kristine 
Fargotstein, Minority Detailee, Communications and Technology; 
Margaret Tucker Fogarty, Minority Staff Assistant; Melissa 
Froelich, Minority Chief Counsel, Consumer Protection and 
Commerce; Theresa Gambo, Minority Human Resources/Office 
Administrator; Caleb Graff, Minority Professional Staff Member, 
Health; Brittany Havens, Minority Professional Staff, Oversight 
and Investigations; Peter Kielty, Minority General Counsel; 
Bijan Koohmaraie, Minority Counsel, Consumer Protection and 
Commerce; Tim Kurth, Minority Deputy Chief Counsel, 
Communications and Technology; Ryan Long, Minority Deputy Staff 
Director; Mary Martin, Minority Chief Counsel, Energy and 
Environment and Climate Change; Sarah Matthews, Minority Press 
Secretary; Brandon Mooney, Minority Deputy Chief Counsel, 
Energy; James Paluskiewicz, Minority Chief Counsel, Health; 
Brannon Rains, Minority Staff Assistant; Zach Roday, Minority 
Communications Director; Kristen Shatynski, Minority 
Professional Staff Member, Health; Alan Slobodin, Minority 
Chief Investigative Counsel, Oversight and Investigations; 
Peter Spencer, Minority Senior Professional Staff Member, 
Environment and Climate Change; Natalie Sohn, Minority Counsel, 
Oversight and Investigations; Danielle Steele, Minority 
Counsel, Health; Everett Winnick, Minority Director of 
Information Technology; and Greg Zerzan, Minority Counsel, 
Consumer Protection and Commerce.
    Mr. Pallone. I call the committee to order.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Today, we are going to hear from our colleagues about the 
issues of importance to them within our committee's 
jurisdiction.
    This hearing fulfils a new requirement that was approved as 
part of the House rules package for the 116th Congress and I 
think it's a good idea.
    The Energy and Commerce Committee is working hard to build 
a stronger economy, create more good-paying jobs, combat 
climate change, and protect consumers from skyrocketing costs 
that make it increasingly difficult to make ends meet.
    We are putting consumers first and I am proud that a lot of 
our work in this area has been done in a strong bipartisan 
fashion.
    Just yesterday, the House overwhelmingly approved a 
bipartisan bill that will put consumers back in control of 
their phones by targeting annoying and illegal robocalls, and 
just last week the Energy and Commerce Committee advanced a 
bill that will protect patients and families from surprise 
medical bills.
    This bipartisan cooperation is nothing new. This committee 
has a proud tradition of working together to meet the needs of 
the American people. We also have a proud tradition of 
listening to the ideas of members not on this committee and 
incorporating their ideas or advancing their proposals as we 
work to develop the best legislation possible.
    So we look forward to continuing to listen to the ideas of 
all Members and this hearing today will help with that in the 
coming months.
    So today we are going to break up the testimony. Well, let 
me say, we have asked members to tell us if they are coming and 
so we have kind of--we have created time slots, essentially, 
and we are going to try to stick to that.
    But if somebody does show up who is not--doesn't have a 
time slot we are still going to hear from them. But we are 
trying to do it that way. And we also broke it up by the 
jurisdiction of our five legislative subcommittees.
    The subcommittee chair--I have asked the subcommittee chair 
of that particular jurisdiction to be here when we concentrate 
on that issue. So, for example, right now, Mr. Doyle is here. 
He is the chairman of the Communications and Technology 
Subcommittee. And so the people that we scheduled for this time 
spot in the next hour or so will primarily focus on that.
    But you don't have to. You know, if you want to talk about 
other things, that is fine. But we try to do it that way. So we 
begin with the issues within the jurisdiction of our 
Communications and Technology Subcommittee, followed by 
Consumer Protection and Commerce, then Energy, then Environment 
and Climate Change, and then we are going to end with our 
Health Subcommittee.
    We have about 50 members who said they are going to testify 
before us. I don't know if they will all show up, but we will 
see.
    [The prepared statement of Mr. Pallone follows:]

             Prepared Statement of Hon. Frank Pallone, Jr.

    Today, we are going to hear from our colleagues about the 
issues of importance to them within our committee's 
jurisdiction.
    This hearing fulfills a new requirement that was approved 
as part of the House Rules Package for the 116th Congress, and 
I think it's a good idea.
    The Energy and Commerce Committee is working hard to build 
a stronger economy, create more good-paying jobs, combat 
climate change and protect consumers from skyrocketing costs 
that make it increasingly difficult to make ends meet. We are 
putting consumers first--and I'm proud that a lot of our work 
in this area has been done in strong, bipartisan fashion.
    Just yesterday, the House overwhelmingly approved a 
bipartisan bill that will put consumers back in control of 
their phones by targeting annoying and illegal robocalls. And 
just last week, the Energy and Commerce Committee advanced a 
bill that will protect patients and families from surprise 
medical bills.
    This bipartisan cooperation is nothing new--this committee 
has a proud tradition of working together to meet the needs of 
the American people. We also have a proud tradition of 
listening to the ideas of members not on this committee and 
incorporating their ideas or advancing their proposals as we 
work to develop the best legislation possible. We look forward 
to continuing to listen to the ideas of all Members and this 
hearing today will help with that in the coming months.
    Today we will break up the testimony by the jurisdictions 
of our five legislative subcommittees. We will begin with 
testimony on issues within the jurisdiction of our 
Communications and Technology Subcommittee, followed by 
Consumer Protection and Commerce, Energy, Environment and 
Climate Change, and then we will end with our Health 
Subcommittee.
    We have about 50 members who plan to testify before us 
today, and I look forward to hearing their ideas.

    Mr. Pallone. And everybody is asked to speak for 5 minutes. 
So now I will turn it over to our ranking member from Oregon, 
and, you know, again, he and I have been very--tried as much as 
possible to work in a bipartisan fashion and I appreciate that, 
Greg.

  OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF OREGON

    Mr. Walden. It is mutual. Thank you, Mr. Chairman, and 
welcome to our members who are here today. I think this is 
really an important improvement in how the committee operates.
    We have had Member Day before. They haven't been as wide 
ranging as this. But I think this is a good addition.
    As you may recall, Mr. Chairman, we did this for the 
opioid's legislation package last time and we ended up with 60 
individual pieces of legislation, all of which were bipartisan, 
that moved across the House floor and eventually became one 
bill called the SUPPORT Act--H.R. 6.
    But members come here to make a difference and offer up 
their ideas, not just here in this committee but also across 
the entire scope of the House, and for those that aren't 
members of the Energy and Commerce Committee we welcome you.
    We look forward to your ideas and concepts. My only regret 
is we didn't do this in January or February but at least we are 
doing it before the August break and so I think that is 
important, as I say, a good addition and we have got a lot of 
work to do in this committee and we wanted to hear from you.
    So with that, Mr. Chairman, I will yield back and we can 
get on about our business.
    Mr. Pallone. I thank our ranking member, and I should also 
mention that the--Mr. Latta from Ohio, who is the ranking 
member of the Telecommunications--I mean, the Communications 
and Technology Subcommittee is here as well.
    So what is our order?
    All right. So just so you know, Mr. Brindisi is first. I 
think, Mr. Takano, they have you a little later. But since you 
showed up early, we are going to put you second--recording you 
second. And we are not doing this, you know, D versus R. We are 
just, you know, based on the list that we put together.
    So we will start with the gentleman from New York. Thanks 
for being here.

OPENING STATEMENT OF HON. ANTHONY BRINDISI, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF NEW YORK

    Mr. Brindisi. Good morning, Chairman Pallone, Ranking 
Member Walden, Subcommittee Chairman Doyle, and Ranking Member 
Latta.
    Thank you for the opportunity to testify at today's Energy 
and Commerce Committee Member Day. I appreciate your strong 
leadership on several of these issues.
    So my largely rural district in upstate New York stretches 
from Lake Ontario in the north all the way down to the 
Pennsylvania border in the south.
    So when I hear cable executives talk about 5G access and 
10-gigabit connections, I am left shaking my head. For many 
families in my area, basic internet access remains out of 
reach.
    Worst of all, I have heard from countless constituents who 
have seen their cable bills go up every month as the service 
just gets worse and worse. I have heard stories from families 
who see their connections grind to a halt at home when they try 
to get online, and when they contact their cable company, they 
get no help, only excuses.
    As I see it, there are three areas where Congress can do 
the most good when it comes to delivering high-speed internet 
access to rural America.
    First, we need better data. Even the FCC agrees that the 
data they use to map homes with high-speed internet is woefully 
inadequate. We need better information from companies so we 
know exactly where federal investments are needed most.
    I want to thank the committee for making this issue a top 
priority.
    Second, we need to continue to expand programs which build 
out broadband access in rural areas. This includes maintaining 
the FCC Universal Service Fund programs and ensuring that each 
unique program receives the funding it requires.
    And as we continue to invest in these vital programs, we 
need strong oversight at the FCC to make sure internet service 
providers are fulfilling their obligations.
    And that brings me to my third point--accountability. These 
cable behemoths often operate as monopolies, leaving customers 
no choice but to overpay for subpar service.
    In New York, one cable company in particular failed to live 
up to the terms of their corporate merger agreement and had to 
be fined and threatened with expulsion from the state by our 
Public Service Commission.
    The first bill I introduced in Congress--the Transparency 
for Cable Consumers Act--would force companies like this to 
disclose information about their business practices to bring 
transparency and accountability to the market.
    By doing so, we can curb the worst monopoly practices and 
perhaps help introduce real competition into the market. I have 
been fortunate to work with many members of this committee, 
Republicans and Democrats, on these priorities this year.
    Expanding access to high-speed internet remains a task as 
large as rural electrification 100 years ago, and I look 
forward to continuing to work with this committee to ensure 
every home in rural America is connected.
    I want to thank you for your time and I am happy to answer 
any questions and yield back my time.
    Thank you.
    [The prepared statement of Mr. Brindisi follows:]

              Prepared Statement of Hon. Anthony Brindisi

    Chairman Pallone, Ranking Member Walden, Subcommittee 
Chairman Doyle and Ranking Member Latta, thank you for the 
opportunity to testify at today's Energy and Commerce Committee 
Member Day. I appreciate your strong leadership on these 
issues.
    My largely rural district in Upstate New York stretches 
from Lake Ontario in the north all the way down to the 
Pennsylvania border in the south. So when I hear cable 
executives talk about ``5G access'' and ``10-gigabit 
connections,'' I am left shaking my head. For many families in 
my area, basic internet access remains out of reach. Worst of 
all, I have heard from countless constituents who have seen 
their cable bills go up month after month as the service just 
gets worse and worse. I have heard stories from families who 
see their connections grind to a halt at home when they try to 
get online. And when they contact their cable company, they get 
no help--only excuses.
    As I see it, there are three areas where Congress can do 
the most good when it comes to delivering high-speed internet 
access to rural America.
    First, we need better data. Even the FCC agrees that the 
data they use to map homes with high-speed internet is woefully 
inadequate. We need better information from companies so we 
know exactly where federal investments are needed most. I want 
to thank the committee for making this issue a top priority.
    Second, we need to continue to expand programs which build 
out broadband access in rural areas. This includes maintaining 
the FCC Universal Service Fund programs and ensuring that each 
unique program receives the funding it requires. And as we 
continue to invest in these vital programs, we need strong 
oversight at the FCC to make sure internet service providers 
are fulfilling their obligations.
    And that brings me to my third point: Accountability. These 
cable companies often operate as monopolies, leaving customers 
no choice but to overpay for subpar service. In New York, one 
cable company in particular failed to live up to the terms of 
its corporate merger agreement and had to be fined and 
threatened with expulsion from the state by our Public Service 
Commission. The first bill I introduced in Congress, the 
Transparency for Cable Consumers Act, would force companies 
like this to disclose information about their businesses to 
bring transparency and accountability to the market. By doing 
so, we can curb the worst monopoly practices and perhaps even 
help introduce real competition into the market.
    I have been fortunate to work with many members of this 
committee--Republicans and Democrats--on these priorities this 
year. Expanding access to high-speed internet remains a task as 
large as rural electrification 100 years ago, and I look 
forward to continuing to work with this committee to ensure 
every home in rural America is connected.
    Thank you for your time, and I am happy to answer any 
questions you may have.

    Mr. Pallone. I thank the gentleman.
    Now, again, I mean, nobody has to ask questions but I think 
you should feel free to do so, or comments, and we would do--
oh, there's no questions at all? Oh, we are just listening?
    All right. Well, I didn't know that.
    Mr. Doyle. Mr. Pallone?
    Mr. Pallone. Yes.
    Mr. Doyle. Are we allowed to make a comment? I am not going 
to ask a question but----
    Mr. Pallone.I am shocked that you didn't like the idea of 
not asking questions.
    [Laughter.]
    Mr. Pallone. But yes, feel free to make a comment.
    Mr. Doyle. Actually, I do like that idea.
    Mr. Pallone. OK.
    Mr. Doyle. No, I was--just a couple comments. Anthony, 
there isn't anyone on this committee that doesn't agree that 
the mapping issue is a complete disaster and needs to be 
improved. That is something we have talked about on the 
committee for a long time.
    I just want to say with regards to getting broadband 
deployed into rural America, there is not a valid business case 
for that so we need money to do that, and every time we talk 
about expanding broadband to rural America, it is, like, how do 
we pay for it.
    Well, we have an opportunity to pay for it with C-band. 
There is going to be an auction. That hasn't been determined 
how that auction is going to take place.
    But I think it would be almost unimaginable that we would 
allow a private auction and for foreign satellite companies to 
keep the money. I am hopeful that is not going to happen.
    But we have an opportunity here on the committee to work on 
the C-band plan that will allow us to start deploying that mid-
range band, which is important for 5G and get it paid for--and 
to get some money into the Treasury which could help us deploy 
broadband in rural America.
    It is a way to close the digital divide and there is money 
to pay for it. So I am hoping that members on this committee on 
both our side and our friends on the Republican side can come 
together and do something legislatively to see that made a 
reality.
    Thanks, Mr. Chairman.
    Mr. Pallone. Look, I understand we weren't supposed to ask 
questions or comments. But, you know, you are here for a few 
hours, members of the committee.
    So if you want to briefly make a comment or ask a question 
I am not going to forbid it and I am going to be bad myself and 
say that I did want you to know--you may already know--that we 
had a bill called the LIFT America Act, which every member--
well, every Democratic member, at least, on the subcommittee--I 
mean, on the committee has signed, which has about $40 billion 
for broadband in underserved areas. So we are very not--we are 
very conscious of that.
    Thank you so much.
    I am going to go to Mark Takano next, the chairman of the 
Veterans Committee.

  OPENING STATEMENT OF HON. MARK TAKANO, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    Mr. Takano. Thank you, Chairman Pallone and Ranking Member 
Walden, and members of the committee. I appreciate the 
opportunity to testify today.
    I want to start off with a brief quotation from a 
constituent. My office obtained a consumer complaint to the FTC 
from a constituent, and this complaint--this excerpt--clearly 
demonstrates why many--what so many customers experience as 
online shoppers.
    I quote: ``When you place an order, you are automatically 
enrolled in a monthly membership which incurs an automatic 
charge each month to your account and credit card of $40 
without permission. This is not clear at all when ordering. I 
never agreed to it,'' end quote.
    Amazingly, the reason why my constituent and so many other 
online shoppers are getting swindled is really not in dispute. 
It is obvious. These deals rely on a murky sales tactic known 
as negative option billing, which reverses the structure of a 
typical consumer purchase.
    Many of us have been there. You are shopping online. You 
sign up for an enticing so-called risk-free trial offer, only 
to get hammered later with hidden fees and unexpected costs.
    I see nodding heads from the chairman and ranking member. 
Often, you know, we could feel foolish for having fallen for 
something, but actually it is very deceptive marketing and the 
specific tools of online sellers that I think are bilking 
consumers unfairly.
    Now, these transactions--these online deals have duped 
consumers out of more than a billion dollars during the last 
decade. Related complaints to the Federal Trade Commission more 
than doubled between the years 2015 and 2017.
    These transactions allow a business to interpret a 
customer's lack of action to reject an offer as an approval to 
be charged for goods and services. Expensive obligations can go 
misunderstood or unnoticed for months while the costs pile up.
    Making matters worse, customers seeking to terminate their 
purchase or enrollment are often met with cumbersome and 
confusing cancellation and return policies. These outcomes I 
think we would regard as unacceptable.
    That is why I encourage the committee to consider 
legislation that I have introduced which addresses this 
important topic.
    My bill, which is titled the Unsubscribe Act, will give 
shoppers the protections needed in today's online marketplace 
and ensure negative option deals cannot be used unfairly to 
deceive consumers.
    And this bill--my bill--would achieve this in three ways.
    First, require a straightforward cancellation process. 
Businesses are required on my bill to provide a cancellation 
mechanism that mirrors the enrollment process, ensuring 
consumers can escape an unwanted deal as easily as they were 
lured into it.
    It is common sense. If you sign up online you should be 
able to cancel online, not have to go and wait on a telephone 
line for 20 minutes before you talk to somebody who can say, 
OK, and explain to them. There should be an easy way for you to 
opt out again.
    Secondly, consumers--we need to protect consumers from 
getting stuck in an expensive unwanted deal. We will require 
sellers to obtain additional affirmative consent to bind 
consumers at the end of free-trial periods.
    This way consumers are protected from accidently enrolling 
in a pricey membership plan if they only intended on making a 
single purchase.
    Thirdly, we would ensure that consumers remain fully and 
fairly informed. Online shoppers are required to receive 
periodic notification of any and all obligations or changes to 
their contracts, proactively reminding buyers of recurring 
charges, reenrollment details, and agreement changes that will 
help decrypt the complex nature of negative option agreements.
    Now, members of this committee, I am sure, understand how 
critically important it is for consumers to receive protections 
that keep pace with today's gigantic online marketplace.
    In the first quarter of 2019 alone, U.S. online retailers 
raked in over $135 billion, and during the last--in the past 
decade, the proportion of online sales to our entire retail 
market jumped from about four percent to over ten percent.
    At a time when more and more Americans use their phone or 
computer to shop, Congress must step up to ensure no consumer 
is left unfairly vulnerable to misleading and abusive online 
deals.
    Thank you, I yield back my time.
    [The prepared statement of Mr. Takano follows:]

                 Prepared Statement of Hon. Mark Takano

    Chairman Pallone, Ranking Member Walden, and members of the 
committee, thank you for the opportunity to testify today.
    We've all been there. You are shopping online and sign-up 
for an enticing ``risk-free trial offer'' only to get hammered 
later with hidden fees and unexpected costs. You're not alone. 
Online deals like these have duped consumers out of more than a 
billion dollars during the last decade. Related complaints to 
the Federal Trade Commission more than doubled between 2015 and 
2017. My office obtained a consumer complaint to the FTC from a 
constituent in my district demonstrating what so many customers 
experience:
    ``When you place an order, you are automatically enrolled 
in a monthly ``membership'' which incurs an automatic charge 
each month to your account and credit card of $40 without 
permission! This is not clear at all when ordering. I never 
agreed to it!''
    Amazingly, the reason why my constituent and so many online 
shoppers are getting swindled isn't in dispute--its obvious. 
These deals rely on a murky sales tactic known as ``negative 
option billing'' which reverses the structure of a typical 
consumer purchase. These transactions allow a business to 
interpret a customer's lack of action to reject an offer as 
approval to be charged for goods or services. Expensive 
obligations can go misunderstood or unnoticed for months while 
costs pile up. Making matters worse, customers seeking to 
terminate their purchase or enrollment are often met with 
cumbersome and confusing cancellation and return policies. 
These outcomes are unacceptable.
    That's why I encourage the committee to consider 
legislation that I have introduced which addresses this 
important topic. My bill, the Unsubscribe Act, will hold 
companies accountable for deceptive marketing and ensure that 
buyers are less vulnerable to the confusing nature of online 
negative option agreements. The bill achieves this in three 
ways:
    One--require a straightforward cancellation process.
     Businesses are required to provide a cancellation 
mechanism that mirrors customers' method of enrollment. A 
simple ``click-to-cancel'' option allows buyers to escape an 
unwanted deal as easily as they were lured into it.
    Two--protect consumers from getting stuck in an expensive, 
unwanted deal.
     Sellers are required to obtain additional 
affirmative consent to bind consumers at the end of free-trial 
periods. This way consumers are protected from accidently 
enrolling in a pricey ``membership'' plan if they only intended 
on making a single purchase.
    And lastly, three--ensure consumers remain fully and fairly 
informed.
     The bill also ensures shoppers receive periodic 
notification of any and all obligations or changes to their 
contracts. Proactively reminding buyers of recurring charges, 
reenrollment details, and agreement changes will help decrypt 
the complex nature of negative option agreements.
    Members of this committee understand how critically 
important it is for consumers to receive protections that keep 
pace with today's gigantic online marketplace. During the first 
quarter of 2019 alone, U.S. online retailers raked in over $135 
billion dollars, and the proportion of online sales in the 
retail market jumped from under four percent to over ten 
percent during the past decade. At a time when more and more 
Americas use their phone or computer to shop, Congress must 
step up to ensure no consumer is left unfairly vulnerable to 
misleading and abusive online deals.
    Thank you, I yield back.

    Mr. Pallone. Thanks so much.
    Mr. Doyle?
    Mr. Doyle. It sounds like an issue for the Federal Trade 
Commission, probably Congresswoman Schakowsky's subcommittee.
    Mr. Pallone. Absolutely.
    Mr. Doyle. This would be more germane there. But, Mark, I 
think it is a great piece of legislation.
    Mr. Takano. Thank you.
    Mr. Pallone. And, Mark, we really have been trying to put a 
lot of focus on consumerism, if you will, and Jan Schakowsky, 
who chairs the Consumer Protection Subcommittee I am sure would 
be very interested in this.
    So thanks a lot. Thanks for coming.
    Mr. Walden. Mr. Chairman, could I say something as well?
    I appreciate it as well. I remember when we were in 
business, we would find these little charges on our phone bill. 
When we'd go to chase them out, they were things we had never 
agreed to. It was only a buck or two a month----
    Mr. Takano. Yes.
    Mr. Walden [continuing]. And then you fought with the phone 
company and they said, oh, we are just the biller--it is a 
third party. You will have to take it up with them. Things you 
never agreed to, and you would be months fighting this.
    And I just always wondered with bazillions of phone lines 
out there how much of this was going on where people didn't 
know they were getting an extra dollar or two a month.
    Just a little different than your shopping deal but it's 
the same thing.
    Mr. Takano. Yes, and sometimes----
    Mr. Walden. Consumers getting ripped off.
    Mr. Takano. Sometimes you have to take a couple of steps to 
figure out because the description----
    Mr. Walden. Yes.
    Mr. Takano [continuing]. On the bill is not all that clear 
and then it is not straightforward about how to find out. As 
you say, who do you go to?
    Mr. Walden. Yes, and somebody is making--the people doing 
the billing are making money and putting it on your bill.
    Mr. Takano. That is right. A little--everyone is taking a 
piece of it.
    Mr. Walden. Everybody is getting their piece out of our 
hide, and so I am interested in this as well.
    Mr. Takano. Thank you. Thank you, ranking member. I 
appreciate it. Thanks.
    Mr. Pallone. Thank you, Mr. Takano.
    Mr. Takano. Am I excused?
    Mr. Pallone. You're excused, yes.
    [Laughter.]
    Mr. Pallone. All right. So next we are going to go to the 
gentleman from Hawaii.
    Mr. Case, good to see you.

OPENING STATEMENT OF HON. ED CASE, A REPRESENTATIVE IN CONGRESS 
                    FROM THE STATE OF HAWAII

    Mr. Case. Moving right across the country, Chair Pallone, 
Ranking Member Walden and members, thank you so much for 
allowing me to share my thoughts on some issues of concern to 
Hawaii and to our country, I believe.
    I would like to focus today on what I believe are needed 
changes to the 1996 Communications Decency Act that are 
unintentionally preventing my state and its counties as well as 
many others throughout our country from enforcing our planning 
and zoning laws and implementing overall public policy in 
affordable housing, community safety, and other critical areas.
    The Internet has brought much progress to our world and 
Section 230 of the Communications Decency Act, which provides 
internet platforms with some broad immunity from liability for 
third-party content posted on their sites, has been a part of 
that.
    But today's massive internet platforms that offer services 
cannot be allowed to knowingly facilitate lawbreaking in our 
states and localities by hiding behind CDA 230 immunity.
    Congress first saw and addressed the modern misuse of CDA 
230 last year when we passed the Allow States and Victims to 
Fight Online Sex Trafficking Act--FOSTA--legislation which 
imposed accountability for internet platforms that were 
profiting from human trafficking.
    In a parallel situation, though, this issue is also 
especially acute with respect to platforms that advertise and 
sell illegal short-term vacation rentals, like Airbnb, 
TripAdvisor, Homeaway, VRBO, or Flipkey.
    In this area, the online host platforms claim that CDA 230 
prohibits states and counties from prohibiting and regulating 
such rentals and from penalizing platforms that knowingly sell 
them illegally.
    By one account, my own State of Hawaii alone hosts 
approximately 23,000 short-term vacation rental units, and that 
was 2017, meaning one out of every 24 of our housing units was 
a short-term rental.
    That was widely considered to be low then and has only 
grown since, driven largely by the ease of advertising and 
reserving these units online.
    The vast majority of these units are illegal since we know 
that legal permitted short-term vacation rentals are in the low 
thousands. The negative consequences of this unregulated 
disruption of our housing market impact all segments of our 
society.
    First, anytime we knowingly and practice widespread 
lawbreaking that has its own broader consequences. Second, 
these units operate as the functional equivalent of hotels and 
yet do not pay hotel-required taxes and fees and do not comply 
with labor, workplace safety, or consumer laws.
    Third, these units turn residential neighborhoods into the 
functional equivalent of hotel zones with the loss of those 
neighborhoods and the community sense.
    And fourth, and possibly most important, from my 
perspective, they completely distort our already sky-high 
housing market, which in Hawaii is one of the highest in the 
country, but his happens in any jurisdiction where this issue 
is prevalent.
    And because these residential dwellings are effectively 
converted to hotel rooms, the available owner and renter 
markets are compressed, leading to substantially higher rents 
and home prices that crowd out still more local residents in 
what is already one of the highest rent and lowest home 
ownership areas of our country.
    There should be a way to compel short-term rental platforms 
to remove these illegal units from their inventory, and yet CDA 
230 serves as a roadblock to that effort.
    In particular, the platforms have frequently asserted that 
CDA 230 does not allow full implementation and enforcement of 
these initiatives. They have sued cities such as San Francisco, 
Boston, Santa Monica, New York, and Miami Beach, and possibly 
others, claiming that CDA 230 preempts local regulatory efforts 
to take down illegal listings.
    Although the U.S. Court of Appeals for the Ninth Circuit 
upheld a lower court ruling in the Santa Monica case recently 
that found that the short-term rental companies did not have a 
valid claim under 230, the assertion still chills the remedy.
    This pattern has repeated itself throughout our country, as 
states and counties have continued to pursue a number of 
initiatives to prevent illegal rentals while attempting to 
withstand legal challenges from the online platforms.
    The state of Hawaii, for example, passed legislation in 
2016 which would require operators posting on rental platforms 
to list their legal tax identification number and platforms not 
to host advertising which does not contain such numbers.
    The city and county have followed suit in trying to 
regulate these illegal rentals recently and in that new 
ordinance, which was just enacted about two weeks ago, was a 
prohibition on the platforms facilitating short-term rentals 
for units that are not properly registered, permitted, or 
otherwise allowed.
    I strongly disagree that CDA 230, either in language or in 
intent, can be used as a legal shield against these types of 
common-sense regulations and I cannot accept that in any event 
that federal law does not allow states and cities to adopt and 
implement reasonable planning and zoning laws and instead to 
accept the broad negative social consequences of nonenforcement 
of the illegal rentals, especially when those platforms know 
full well that their business model relies largely on knowing 
breaches of the law by their operators and advertisers.
    My request to this committee is to formally examine this 
and other abuses of CDA 230. We can follow the FOSTA 
legislation which gives us a roadmap and I hope to work closely 
with you on this undertaking.
    Thank you very much.
    [The prepared statement of Mr. Case follows:]

                   Prepared Statement of Hon. Ed Case

    Thank you for allowing me to share my thoughts with the 
committee on issues of importance to my constituents and the 
state and county governments in Hawai`i. Today I would like to 
focus on needed changes to the Communications Decency Act that 
are unintentionally preventing my state and its counties as 
well as many others throughout our country from enforcing our 
planning and zoning laws and implementing overall public policy 
in affordable housing, community safety and other critical 
areas.
    The Internet has brought the world much progress and 
section 230 of the CDA, which provides internet platforms with 
broad immunity from liability for third-party content posted on 
their sites, has been a part of that. When the statute was 
passed in 1996 it had an important role to play in fostering 
the internet's growth. But today's massive internet platforms 
that offer services cannot be allowed to knowingly facilitate 
law breaking in our states and localities by hiding behind CDA 
230 immunity.
    Congress first saw and addressed the modern misuse of CDA 
230 last year when it passed the Allow States and Victims to 
Fight Online Sex Trafficking Act (``FOSTA'') legislation and 
imposed accountability for internet platforms that were 
profiting from human trafficking. In a parallel situation, this 
issue is also especially acute with respect to platforms that 
advertise and sell illegal short-term vacation rentals, like 
Airbnb, TripAdvisor, Homeaway, VRBO or Flipkey. In this area 
the online host platforms claim that CDA 230 prohibits states 
and counties from prohibiting and regulating such rentals and 
from penalizing platforms that knowingly sell them illegally.
    By one account my State of Hawaii alone hosted 
approximately 23,000 short-term vacation rental units in 2017, 
meaning one out of every 24 of our housing units was a short-
term rental. This number is widely considered to have been low 
then, and has only grown since, driven largely by the ease of 
advertising and reserving these units online.
    The vast majority of these rental units are illegal since 
legal, permitted short-term vacation rentals are known and 
number in the low thousands. The negative consequences of this 
unregulated disruption of our housing market impact all 
segments of our society.
    First, commonly known and practiced widespread derogation 
of any law has its own broader consequences. Second, these 
units operate as the functional equivalent of hotels and yet do 
not pay hotel-required taxes and fees and do not comply with 
labor, workplace safety or consumer laws. Third, these units 
turn residential neighborhoods into the functional equivalent 
of hotel zones with loss of neighborhoods and communities.
    Fourth, they completely distort our already sky-high 
housing market. Because residential dwellings are effectively 
converted to hotel rooms, the available owner and renter 
markets are compressed, leading to substantially higher rents 
and home prices that crowd out still more local residents in 
what is already one of the highest rent, lowest home ownership 
areas of our country.
    There should be a way to compel short-term rental platforms 
to remove these illegal units from their inventory, and yet CDA 
230 serves as a roadblock in that effort. The platforms have 
frequently asserted that CDA 230 does not allow full 
implementation and enforcement of these initiatives. They have 
sued the cities of San Francisco, Boston, Santa Monica, New 
York, and Miami Beach--and possibly others--claiming CDA 230 
preempts local regulatory efforts to take down illegal 
listings. Notably, the U.S. Court of Appeals for the Ninth 
Circuit upheld a lower court ruling in the Santa Monica case 
that found the short-term rental companies didn't have a valid 
claim under Section 230 or the First Amendment.
    This pattern has repeated itself throughout our country, 
and states and counties have continued to pursue a number of 
initiatives to prevent illegal rentals while attempting to 
withstand legal challenges from the online platforms. The State 
of Hawaii, for example, passed legislation in 2016 which would 
require operators posting on rental platforms to list their 
legal tax identification number and platforms not to host 
advertising which does not contain such numbers. The City and 
County of Honolulu just passed an ordinance for stricter 
enforcement of our local laws that limit short-term rental 
units on the island of O`ahu. Included in the new ordinance was 
a prohibition on platforms facilitating short term rentals for 
units that are not properly registered, permitted or otherwise 
allowed.
    I strongly disagree that CDA 230--either in language or in 
intent--can be used as a legal shield against these types of 
common-sense regulations. I cannot accept in any event that 
federal law does not allow states and cities to adopt and 
implement reasonable planning and zoning laws and instead to 
accept the broad negative social consequences of non-
enforcement, especially given that the platforms know full well 
that their business model relies largely on knowing breaches of 
the law by their operators and advertisers.
    I respectfully ask that the committee formally examine this 
and other abuses of CDA 230. We have a valuable template in the 
FOSTA legislation that passed the House by a vote of 388-25 and 
was signed into law last year, which could be replicated to 
cover other illegal online sales. I hope to work closely with 
you on moving such legislation forward and supporting our 
communities.
    Last, I would like to call to the Committee's attention the 
fact that a version of CDA 230 appears in the digital goods 
chapter (Article 19) of the draft United States-Mexico-Canada 
Agreement currently under consideration. While I understand 
that trade is not in this Committee's jurisdiction, to the 
extent you agree that CDA 230 needs Congressional review, we 
should carefully consider whether embedding a version of the 
statute in our international trade agreements is wise.
    Thank you very much for your consideration.

    Mr. Pallone. Thank you, and we will certainly look into it. 
You know, I represent the Jersey Shore, so, you know, when you 
talk about rentals and tourism and economy.
    And I guess it is an opportunity for me to say right now 
that I know the members are here today for this Member Hearing. 
But, you know, don't hesitate personally with me or the rest of 
us or with your staff to contact us as a follow up today. It's 
not like, you know, you're just here and we disappear. All 
right. We want you to understand that.
    Mr. Case. Appreciate that very much. We will be taking you 
up on that kind offer.
    Mr. Pallone. All right. Thanks a lot. Thanks, Ed.
    And next I think is my colleague from New Jersey. Have 
you--have you recovered from Prom Night or dare I ask that 
question?
    You have not? OK. Well, if you'll proceed, I appreciate it, 
my friend.

OPENING STATEMENT OF HON. BILL PASCRELL, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pascrell. Mr. Chairman Pallone and Ranking Member 
Walden, it is good to see you both this morning. I thank you 
for the opportunity to highlight the need for transparency and 
regulation in the badly corrupted primary and secondary live-
events ticket marketplace.
    Been in the press a lot lately. We tried nine years ago 
unsuccessfully and I think it's time again that we look here. 
So one of my favorite groups is Metallica where a lot of the 
young people today like to go to their concerts and spend--I 
think they have to give a point of blood, too, in order to get 
in there because the tickets are so expensive.
    I followed this marketplace for over a decade. ``Wherever I 
May Roam'' is one of Metallica's songs. Wherever I go across 
the country, Canada, I hear complaints from my constituents on 
their frantic Ticketmaster--frantic experience with ticket 
sales, and you can't believe the mail that we get on this 
subject. It is the furthest thing on all of our minds when we 
come to work in the morning but I am telling you a fact of life 
here.
    The combined behemoth dominates a $9 billion per year 
industry and holds over 80 percent of market share. They have 
sway over everything, including the peanuts you buy there.
    The record sales, licensing, the talent--the talent 
management, venue ownership, ticket sales, the concessions, 
down to selling hot dogs and pretzels--you name it, it is 
there. If there ever was a monopoly, this is it. Sorry, Mr. 
Holden, you blew it. You know what I am talking about. He 
permitted the merger of it.
    The GAO study of the live tickets industry that Chairman 
Pallone and I requested notes questionable industry practices, 
a surprise to no one who has tried to buy tickets.
    It is important to emphasize the marketplace has been 
governed by zero federal regulation. Live Nation operates with 
impunity. Another Metallica song, ``Nothing Else Matter'' to 
them but profits.
    It is time for Congress to turn the page, pass legislation 
to add regulation, impose some order, and stop bad actors who 
make a living by ripping off regular folks daily.
    The Better Oversight of Secondary Sales and Accountability 
of Concert Tickets, better known as the BOSS Act--I wonder why 
we named it that--is endorsed by all the consumer groups and 
attacks problems of both the primary and secondary ticket 
marketplace.
    The BOSS Act makes on easy fix, bans the last second fees, 
requires every seller advertising all fees up front, which 
most--none of them do.
    GAO estimated that primary and secondary ticketing 
companies charge fees averaging 27 and 31 percent of the ticket 
price. In my neighborhood in Paterson, New Jersey, that is 
called thievery.
    At the FTC's Ticket Forum last month, nearly every 
stakeholder agreed that they could accept such a law, and for 
fans all-in pricing would allow for easier comparison, stopping 
to find the best deal.
    The BOSS Act lets ticket buyers know how many tickets are 
going on sale, how many are going to be held back, and where 
those tickets are coming from. It will also prevent those with 
connections to venues and artists from knowingly reselling 
tickets at a jacked-up price. For the secondary marketplace, 
the BOSS Act addresses speculative ticket sales and so-called 
white label sites that trick consumers.
    I first introduced the bill 12 years ago when there was a 
major issue with Bruce Springsteen tour, and these problems are 
not going away. Just last week, Billboard Magazine uncovered 
the latest scam.
    Unbeknownst to fans, apparently Ticketmaster and Live 
Nation was working with the bands' management to hold back 
88,000 tickets and posted them directly on resale sites. That 
is sad but it is true. Ticketmaster has denied past 
participation in such schemes.
    In the case of Whiplash, Live Nation admitted to the scheme 
last week in about a dozen artists between 2016 and 2017. They 
could still be doing the same. This is wrong.
    I think we need a commitment to toll the bell for an end of 
the unregulated ticket marketplace by passing the BOSS Act, and 
I am open for any questions and I duly appreciate your time and 
your efforts on all the issues that you deal with.
    [The prepared statement of Mr. Pascrell follows:]

             Prepared Statement of Hon. Bill Pascrell., Jr.

    Chairman Pallone/Chairwoman Schakowsky, thank you for this 
opportunity highlight the need for transparency and regulation 
in the badly corrupted primary and second live events ticket 
marketplace. I have followed this marketplace for over a 
decade. Wherever I may roam across our country, and Canada too, 
I hear complaints from my constituents on their frantic 
experiences with ticket sales.
    And much of this can be traced to the Live Nation-
Ticketmaster merger. The combined behemoth dominates a $9 
billion per year industry and holds over 80% market share. They 
have sway over everything. The record sales, licensing, talent 
management, venue ownership, ticket sales, and concessions down 
to selling hot dogs and pretzels. The GAO study of the live 
tickets industry that Chairman Pallone and I requested notes 
questionable industry practices that surprise no one who has 
tried to buy tickets.
    It's important to emphasize the marketplace has been 
governed by zero federal regulation. Live Nation operates with 
impunity. Nothing else matters to them than profits.
    It's time for Congress to turn the page and pass 
legislation to add regulation, impose some order, and stop bad 
actors who make a living by ripping regular people off. The 
Better Oversight of Secondary Sales and Accountability in 
Concert Ticketing or BOSS ACT (H.R. 3248) is endorsed by all 
the consumers groups and attacks problems in both the primary 
and secondary ticket marketplace. The BOSS ACT makes one easy 
fix makes: bans last second fees and requires every seller 
advertise all fees up front. GAO estimated that primary and 
secondary ticketing companies charge fees averaging 27 and 31 
percent of ticket prices.
    At the FTC's ticket forum last month, nearly every 
stakeholder agreed that they could accept such a law. And, for 
fans, all-in pricing would allow for easier comparison shopping 
to find the best deals. The BOSS ACT lets ticket buyers know 
how many tickets are going on sale, how many are being held 
back, and where those tickets are coming from. It also prevents 
those with connections to venues and artists from knowingly 
reselling tickets at a jacked-up price.
    For the secondary marketplace, the BOSS Act addresses 
speculative ticket sales and so-called white label sites that 
can trick consumers.
    I first introduced this bill 12 years ago when there was a 
major issue with a Bruce Springsteen tour on sale. And these 
problems are not going away. Just last week, Billboard Magazine 
uncovered the latest scam perpetrated upon consumers. 
Unbeknownst to fans, apparently Live Nation was working with 
the band's management to hold back 88,000 tickets and post them 
directly on resale sites. Sad but true!
    Ticketmaster has denied past participation in such schemes. 
But, in a case of whiplash, Live Nation admitted to the scheme 
last week and ``about a dozen artists'' between 2016 and 2017. 
And could still be doing this today. This is wrong. And we 
should investigate these deceptive practices.
    Be the hero of the day help me support consumer 
transparency and give fans have a fairer chance to purchase 
live event tickets. John Donne, Earnest Hemingway, and James 
Hetfield have each asked for whom the bell tolls?
    I ask this committee to toll the bell for the end of an 
unregulated ticket marketplace by passing the BOSS ACT.
    Also, I wish to highlight the bipartisan Laboratory Access 
for Beneficiaries (LAB) Act (H.R. 3584) I helped Representative 
Scott Peters introduce. The ongoing cuts to clinical labs hurt 
patient access and erect further barriers to care. I encourage 
the committee to consider H.R. 3584 to ensure payment rates 
under the Clinical Lab Fee Schedule will reflect market prices 
and that data collection will be representative of the whole 
laboratory community. Clinical laboratory services account for 
less than two percent of Medicare fee-for-service spending, but 
the results of laboratory tests help guide critical decisions 
for diagnosis, treatment, and prevention for millions of 
patients. We must tear down any barriers to this critical 
resource so that we are improving healthcare for patients every 
day.

    Mr. Pallone. Well, I want to thank you. I know that you 
have been out front on this in trying to tackle this problem 
and we do consider it a priority and, you know, we will take it 
up in the fall, hopefully. You and I can talk more about it.
    And, of course, I appreciate you reminding me about the 
Boss and Bruce Springsteen because I am looking forward to 
being back to the Jersey Shore and the Asbury Park and all the 
venues, you know, that he hangs out in.
    Mr. Pascrell. The Stone Pony.
    Mr. Pallone. Yes, Stone Pony as well.
    The gentleman----
    Mr. Walden. Just a quick question.
    Mr. Pascrell, thank you for bringing this to our attention, 
and on a side note can you tell us how many Metallica song 
titles were in your testimony?
    Twelve.
    [Laughter.]
    Mr. Walden. I got 11 of them. All right.
    Turn on your mic. We want to hear this.
    Mr. Pascrell. They are advertising for--you know, they are 
coming out to New York City area. But that is the only reason 
why that I--and I happen to like the group myself.
    Mr. Walden. There is just--you know, you learn a lot at 
Member Day and knowing that Mr. Pascrell is a fan of Metallic 
is something I learned today. So this is----
    Mr. Pascrell. Yes.
    Mr. Pallone. Well----
    Mr. Walden. Thank you.
    Mr. Pascrell. I have to search for my talents. I don't 
have--I have so few.
    [Laughter.]
    Mr. Pascrell. But that interesting, and I close out my 
statement, Mr. Walden, on ``For Whom the Bells Toll.'' It is 
one of my favorite old movies and books.
    They have a song--Metallica--``For Whom the Bells Toll,'' 
and I hope it tolls for Ticket Master. It was the worst thing 
that happened, allowing them to join--they own the market. They 
own 85 percent of the entire--I mean, we go after airlines 
sometimes and this and that.
    Monopolies have become, you know, part of us now. That's 
not good. You know why? Our kids--well, my kids are grown--want 
to go to a concern. You know, you need a wheelbarrow full of 
money, literally, or else they can't go. Baseball games--you 
are getting--and, you know, nobody watches over this. It is 
entertainment. They say, well, if you don't want to spend the 
money don't go. Well, that is very true.
    Mr. Pallone. We promise to look into it, and although I 
have to say that I think I would have preferred the band that 
you had last night to Metallica myself. But, you know, all 
right. Thanks a lot, Bill. Appreciate it.
    Mr. Pascrell. My honor. Thank you.
    Mr. Pallone. Next, we are going to go to the gentleman from 
Georgia, Mr. Bishop.

      OPENING STATEMENT OF HON. SANFORD D. BISHOP, Jr., A 
      REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA

    Mr. Bishop. Thank you very much, Mr. Chairman.
    I would like to thank you, Chairman Pallone, and Ranking 
Member Walden, and the members of the House Energy and Commerce 
Subcommittee on Health for giving me the opportunity to testify 
this morning on an issue of great importance to the delivery of 
healthcare, especially in rural communities across the nation.
    The issue is non-emergency medical transportation, or NEMT, 
which currently provides Medicaid beneficiaries with rides to 
medical appointments every year.
    This benefit, which has been in place since Medicaid's 
inception in 1966, has come under attack recently by the 
Centers for Medicare and Medicaid Services, which has sought to 
roll it back by making it optional at the state level.
    Such a change would have wreaked havoc on millions of 
Americans' ability to get to and from their medical 
appointments quickly and, most importantly, safely.
    Individuals who bear the highest burden of chronic 
conditions, including cancer, HIV, substance abuse disorder, 
and end-stage renal disease, would not have been able to access 
vital medical services like chemotherapy, physical therapy, and 
dialysis.
    They also would not have been able to travel to pharmacies 
to obtain their drug prescriptions or their medical supplies.
    In Georgia alone, non-emergency medical transportation 
provided patients transportation nearly 60,000 times last year 
to pharmacies to pick up prescriptions that are important for 
their adherence to a plan of care.
    Ending Medicaid coverage for non-emergency medical 
transportation would literally have been a matter of life and 
death for many of these individuals.
    Earlier this year, I sent a letter to Representative Rosa 
DeLauro, who chairs the House Appropriations Subcommittee on 
Labor, Health and Human Services, Education, and Related 
Agencies, as well as to Ranking Member Tom Cole opposing this 
change.
    Our letter requested legislative language in the 
appropriations bill blocking funding for the implementation of 
that rule change. It was signed by the entire Congressional 
Black Caucus in the House and received important bipartisan 
support from a number of my Republican colleagues in the House.
    I would like to ask unanimous consent that the letter be 
included in the record with my testimony.
    Mr. Pallone. Without objection, so ordered.
    [The information appears at the conclusion of the hearing.]
    Mr. Bishop. Fifty-six non-emergency medical transportation 
stakeholders including groups representing Medicaid 
beneficiaries with substance user disorder, behavioral 
disorders, and end-stage renal disease also sent a letter 
opposing the rule change.
    I would like to ask unanimous consent that the list of 
those people be included in the record also.
    [The information appears at the conclusion of the hearing.]
    Mr. Bishop. I am pleased to report that the language was 
successfully added to the fiscal year 2020 Labor-HHS 
Appropriations bill in an amendment that was offered as a 
manger's amendment by Chairwoman DeLauro.
    Following its inclusion in the bill, we heard word from CMS 
that they won't try to promulgate the rule until after the 2020 
elections.
     Although this is welcome news, we still have to be 
vigilant and ensure that this important benefit remains 
available to our most vulnerable citizens.
    Yesterday, I joined my colleagues Tony Cardenas, Tom 
Graves, and Buddy Carter in introducing bipartisan legislation 
that would codify the Title XIX of the Social Security Act, the 
Medicaid transportation benefit.
    The bill, H.R. 3935, would simply preserve the status quo. 
It would add non-emergency medical transportation services for 
individuals without other means of transportation to the list 
of mandatory benefits that every state Medicaid program is 
required to provide by law.
     According to CBO, the bill would have no cost provided 
that we act before CMS publishes the proposed rule. I am 
hopeful that the legislation will be considered quickly by this 
subcommittee for inclusion in the extenders package by the end 
of the year.
    In the coming weeks, we plan on introducing legislation on 
the Medicare front as well. The legislation will provide 
coverage for non-emergency medical transportation for patients 
who qualify for Medicare based on their end-stage renal 
disease.
    The measure is being finalized as we speak and the details 
are still being worked out. I was inspired to work on this 
issue by a staff member in my Albany, Georgia office whose 
daughter had end-stage renal disease and subsequently had a 
successful kidney transplant in 2015.
    I look forward to working with all of you in the days, 
weeks, and months ahead to ensure that these important 
transportation services are protected now and into the future.
    So I thank you for allowing me to appear before you this 
morning.
    [The prepared statement of Mr. Bishop follows:]

              Prepared Statement of Hon. Sanford D. Bishop

    I would like to thank Chairman Pallone, Ranking Member 
Walden, and members of the House Energy and Commerce 
Subcommittee on Health for giving me the opportunity to testify 
this morning on an issue of great importance to the delivery of 
healthcare, especially in rural communities across the nation.
    The issue is Non-Emergency Medical Transportation, or NEMT, 
which currently provides Medicaid beneficiaries with rides to 
medical appointments each year. This benefit, which has been in 
place since Medicaid's inception in 1966, has come under attack 
recently by the Centers for Medicare and Medicaid Services, 
which has sought to roll it back by making it optional at the 
state level.
    Such a change would have wreaked havoc on millions of 
Americans' ability to get to and from their doctor quickly and, 
most importantly, safely.
    Individuals who bear the highest burden of chronic 
conditions including cancer, HIV, substance abuse disorder, and 
end stage renal disease would not have been able to access 
vital medical services like chemotherapy, physical therapy, and 
dialysis.
    They also would not have been able to travel to pharmacists 
to obtain drug prescriptions or medical supplies. In Georgia 
alone, non-emergency medical transportation transported 
patients nearly 60,000 times last year to the pharmacy to pick 
up prescriptions that are important to their adherence to a 
plan of care.
    Ending Medicaid coverage for non-emergency medical 
transportation would literally have been a matter of life and 
death for many of these individuals.
    Earlier this year, I sent a letter to Representative Rosa 
DeLauro, the Chair of the House Appropriations Subcommittee on 
Labor, Health and Human Services, Education, and Related 
Agencies, and Ranking Member Tom Cole opposing this change. The 
letter requested legislative language in the appropriations 
bill blocking funding for the implementation of the rule 
change. It was signed by the entire House Congressional Black 
Caucus and received important bipartisan support from a number 
of my Republican colleagues in the United States House of 
Representatives. I ask unanimous consent that the letter be 
included in the record.
    Sixty NEMT stakeholders including groups representing 
Medicaid beneficiaries with substance user disorder, behavioral 
disorders and end stage renal disease also sent a letter 
opposing the rule change.
    I am pleased to report that the language was successfully 
added to the Fiscal Year 2020 Labor-HHS Appropriations bill in 
an amendment offered by Chairwoman DeLauro.
    Following its inclusion in the bill, we heard word from CMS 
that they will not try to promulgate the rule until after the 
2020 elections. Although this news is welcome, we still have to 
be vigilant and ensure that this important benefit remains 
available to our most vulnerable citizens.
    Yesterday, I joined my colleagues Tony Cardenas, Tom 
Graves, and Buddy Carter in introducing bipartisan legislation 
that would codify, in Title XIX of the Social Security Act, the 
Medicaid transportation benefit.
    The bill would simply preserve the status quo. It would add 
Non-Emergency Medical Transportation services for individuals 
without other means of transportation to the list of mandatory 
benefits that every state Medicaid program is required to 
provide by law.
    According to CBO, the bill would have no cost provided we 
act before CMS publishes the proposed rule. I am hopeful that 
the legislation will be considered quickly by this subcommittee 
for inclusion in an extenders package by the end of this year.
    In the coming weeks, I also plan on introducing legislation 
on the Medicare front as well. The legislation provide coverage 
for non-emergency medical transportation for patients who 
qualify for Medicare based on their end-stage renal disease. 
The measure is being finalized as we speak and the details are 
still being worked out.
    I was inspired to work on this issue by a staff member in 
my Albany office whose daughter had end stage renal disease and 
subsequently had a successful kidney transplant in 2015.
    I look forward to working with all of you in the days, 
weeks, and months ahead to ensure that these important 
transportation services are protected now and into the future.

    Mr. Pallone. I thank the gentleman.
    So you want us to look into a permanent fix, basically?
    Mr. Bishop. Yes.
    Mr. Pallone. All right. We will certainly look into it. 
Thanks a lot. Thanks.
    And now we go to Mr. Westerman.

OPENING STATEMENT OF HON. BRUCE WESTERMAN, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF ARKANSAS

    Mr. Westerman. Chairman Pallone, Ranking Member Walden, 
thank you for hosting today's Member Hearing. I appreciate the 
time that you are giving to members like me who are not on this 
committee, but who share your concerns and wish to be involved 
in reforming issues related to the Energy and Commerce 
Committee.
    As a bit of background, I represent a very large and rural 
district in the Fourth District of Arkansas. My constituents 
are hard-working men and women who love our country and are 
busy raising families and trying to make ends meet.
    Our current system of healthcare is failing them. As 
Members of Congress with the ability to address this broken 
system, we are failing them every day we do not take action.
    Health insurance premiums are spiraling out of control, 
patients can barely afford essential medications that keep them 
alive, and costs to obtain care are outrageously unaffordable.
    Furthermore, access is limited. Individuals in my district 
must often drive hours just to get basic medical care because 
local providers are out of network or because telemedicine is 
not an option.
    Our healthcare policy and delivery system affects everyone. 
Most people don't give a lot of thought to healthcare when they 
don't need it. But when they do, it is all they think about.
    In the United States of America, we can do much better in 
healthcare. We can cover more people. We can cover preexisting 
conditions. We can lower cost and we can provide Americans with 
more options, transparency, and the best care on the planet.
    We are all quick to point out the problems. But I am here 
today, hopefully, to provide solutions. I am not a doctor. I am 
not a pharmacist or insurance actuary, though friends of mine 
who are experts in those fields do serve in Congress and bring 
much to the table.
    I am an engineer. I was educated to approach problems 
logically, methodically, and with common sense and reason. When 
the American Health Care Act and its Senate counterparts proved 
unsuccessful to address our nation's healthcare crisis, I 
thought, why leave the heavy lifting to the traditional 
healthcare policymakers? Might a fresh set of eyes make a 
difference? Might a different approach be something that we 
need?
    With that mind set, I set out to develop a bipartisan 
healthcare bill that would provide the people of this nation 
with some relief and I spent a year and a half doing a deep 
dive into the policy.
    The Fair Care Act, which I introduced earlier this year, 
can be the bipartisan framework to our nation's healthcare 
crisis.
    In it, I address public and private payers, drug prices, 
provider competition, and healthcare innovation. My legislation 
would increase access to insurance provided on the ACA 
exchanges, create competition between providers and drug 
makers, and ensure long-term solvency of the Medicaid program 
without abandoning those who are currently covered.
    It would continue to cover patients with pre-existing 
conditions and states would have increased opportunities to 
design healthcare programs that meet the unique needs of their 
population.
    And please, before you assume that a Republican from the 
South couldn't possibly introduce legislation with provisions 
from both parties, familiarize yourself with its content.
    For example, the bill limits the exclusivity period for 
certain drugs and biologic products. I see that Representative 
Schakowsky is here today. She and I have already introduced a 
bipartisan bill to address that particular issue.
    It reforms payment structures for Medicare Parts B and D 
for wealthy individuals. It creates fair access and reduces 
income cliffs so more individuals can afford to enroll in 
insurance plans. It reestablishes anti-trust laws that apply to 
health and dental insurers.
    It holds Pharmacy Benefit Managers accountable for their 
actions, discourages hospital consolidation, and increases 
transparency throughout the system, plus it does a whole lot 
more.
    I have developed this legislation from my personal 
convictions as well as evidence-based research about what is 
best for the greatest number of Americans, without the 
influence of interest groups, lobbyists, or enterprises.
    We have a choice as lawmakers, as representatives sworn to 
serve our constituents. I have found that the healthcare 
problems are not unsolvable.
    We can either fight and bicker about trivial political 
matters or we can work together to make progress and actually 
address the healthcare crisis. Waiting until the next election 
cycle doesn't help the American people.
    Waiting for the system to collapse doesn't help the 
American people. Working together on real solutions does.
    I bring this legislation to you today in the hopes that it 
will serve as a starting point for objective discussions and 
legitimate negotiations on these issues.
    I am willing to meet with any of you to discuss working 
together, and I sincerely hope that we do. Healthcare cannot 
and should not be a political issue if we truly hope to help 
all Americans.
    Again, I thank you again for this opportunity today and I 
would welcome any questions you may have.
    [The prepared statement of Mr. Westerman follows:]

               Prepared Statement of Hon. Bruce Westerman

    Chairman Pallone, Ranking Member Walden--Thank you for 
hosting today's Member Hearing.
    I appreciate the time you are giving to members like me who 
are not on this committee, but who share your concerns and wish 
to be involved in reforming issues related to Energy and 
Commerce.
    As a bit of background, I represent a very large and rural 
district, the Fourth District of Arkansas.
    My constituents are hard-working men and woman often just 
trying to make ends meet.
    Our current system of healthcare is failing them. And as 
Members of Congress with the ability to address this broken 
system, we are failing them every day we do not take action.
    Health insurance premiums are spiraling out of control, 
patients can barely afford essential medications that keep them 
alive, and costs to obtain care are outrageously unaffordable.
    Furthermore, access is limited.
    Individuals in my district must often drive hours just to 
get basic medical care because local providers are out of 
network or because telemedicine is not an option.
    It's simple--no one gives a lot of thought to healthcare 
when they don't need it, but when they do, it's all they think 
about.
    There is no reason for this to be the case in the United 
States of America.
    But I'm not here to simply to discuss the problems. I'm 
here to promote solutions.
    I am not a doctor, pharmacist, or insurance actuary--though 
friends of mine who are experts in those fields do serve in 
Congress.
    I am an engineer, trained to approach problems logically 
and methodically.
    When the American Health Care Act and its Senate 
counterparts proved unsuccessful in attempts to address our 
nation's healthcare crisis, I thought, why leave the heavy 
lifting to the traditional healthcare policymakers?
    Might fresh eyes be useful?
    With that mindset, I set out to develop a bipartisan 
healthcare bill that would provide the people of this nation 
with some relief.
    The Fair Care Act, which I introduced earlier this year, is 
my answer to our nation's healthcare crisis.
    In it, I address public and private payers, drug prices, 
provider competition, and healthcare innovation.
    My legislation would increase access to insurance provided 
on the ACA exchanges, create competition between providers and 
drug makers, and ensure long-term solvency of the Medicaid 
program without abandoning those who are currently covered.
    It would continue to cover patients with pre-existing 
conditions.
    And states would have increased opportunities to design 
healthcare programs that meet the unique needs of their 
population.
    And please, before you assume that a Republican from the 
South couldn't possibly introduce legislation with provisions 
from both parties, familiarize yourself with its content.
    For example, the bill limits the exclusivity period for 
certain drugs and biologic products, eliminates Medicare Parts 
B and D for wealthy individuals, funds subsidies for more 
individuals to enroll in insurance plans, reestablishes anti-
trust laws that apply to health and dental insurers, holds 
Pharmacy Benefit Managers accountable for their actions, 
discourages hospital consolidation, and increases transparency 
throughout the system.
    I've developed this legislation from my personal 
convictions as well as evidence-based research about what is 
best for the greatest number of Americans, without the 
influence of interest groups, lobbyists, or enterprises.
    We have a choice as lawmakers, as Representatives sworn to 
serve our constituents.
    We can either fight and bicker about trivial political 
matters for the next sixteen months, or we can work together to 
make progress and actually address this healthcare crisis.
    Waiting until the next election cycle doesn't help the 
American people.
    Waiting for the system to collapse doesn't help the 
American people.
    Working together on real solutions does.
    I bring this legislation to you today in the hopes that it 
will serve as a starting point for objective discussions and 
legitimate negotiations on these issues.
    I'm willing to meet with any of you to discuss working 
together, and I sincerely hope that we do.
    Healthcare cannot, and should not, be a political issue if 
we truly hope to help all Americans.
    I thank you again for welcoming me today, and I look 
forward to working with you, my colleagues, to solve this 
problem once and for all.

    Mr. Pallone. All right. I want to thank you and I assure 
you that we will look into your bill. And I do want to say it 
really drives me crazy, and members have heard me say it many 
times in this committee, that we have these disparities between 
rural America and the rest of the country.
    I mean, it just should not be that, you know, if you are in 
a rural area that you can't get--and I understand it is not 
always true but that you often can't get access or quality 
healthcare or resources, and I have had a chance over the last 
couple years because my son was in Japan in a rural area 
teaching English.
    And I was amazed how it didn't really matter whether you 
went there in this small town a thousand miles from Tokyo or 
you were in Tokyo. You basically had access to the same level 
of care. And it is just not true here and we have got to do 
something about it.
    Did you want to----
    Mr. Walden. No, I just want to thank the gentleman from 
Arkansas and also concur with you, Mr. Chairman, on the 
disparity in access to care.
    I got three countries with no hospitals and no doctors 
because they are so remote. One person for every nine miles of 
power lines. I mean, these are wide open spaces and yet if a 
heart attack or a stroke occurs, that golden hour is the same 
length of time as it is in an urban setting.
    So expansion of telehealth is essential in these basic 
services. But I know Mr. Westerman has worked really hard and 
put a lot of thought into this plan and I hope if there is an 
opportunity we can dig into it a little further because has 
really worked on this for a couple of years now. So I 
appreciate it.
    Mr. Westerman. I appreciate that, and I believe it's a 
policy that works for rural America and urban America.
    Mr. Pallone. Ms. Schakowsky?
    Ms. Schakowsky. Yes, I just wanted to thank the gentleman. 
I am so happy that we are co-sponsoring a bill to lower the 
price of prescription drugs and it is an honor to be working 
with you on that.
    Thank you.
    Mr. Westerman. Thank you.
    Mr. Pallone. Thanks again. Appreciate it.
    Mr. Westerman. Thank you.
    Mr. Pallone. The gentleman from California, Mr. Lieu. Thank 
you for being here.

  OPENING STATEMENT OF HON. TED W. LIEU, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    Mr. Lieu. Thank you, Chairman Pallone, Ranking Member 
Walden, Chairwoman Schakowsky, and Ranking Member McMorris 
Rodgers, for allowing me to testify.
    Today, I am here to urge you to consider my legislation 
H.R. 3570, the Therapeutic Fraud Prevention Act, which aims to 
prevent for-profit conversion therapy.
    This legislation has been co-sponsored by 89 of our 
colleagues including 14 members of the Energy and Commerce 
Committee, and six members of the Consumer Protection and 
Commerce Subcommittee.
    It is supported by a wide range of organizations including 
the American Academy of Pediatrics, the American Psychoanalytic 
Association, and the Human Rights Campaign.
    When I was in the California State Senate, I authored the 
first law in the nation to ban gay conversion therapy. Since 
then, 18 states have banned this practice and this is a 
bipartisan issue. In seven of those states Republican governors 
signed the legislation and in a number of those states the 
state bill had bipartisan support.
    Now, conversion therapy has three main problems.
    Number one, it doesn't work. It is fraudulent. Number two, 
not only does it not work and in some cases, it could severely 
harm the patients who undergo it, and number three, it could be 
very costly.
    According to the Williams Institute, nearly 700,000 folks 
in the United States have been subjected to conversion therapy, 
and one group known as JONAH, was charging about $100 for 
weekly individual sessions. A lawsuit filed by former victims 
of JONAH represented by the Southern Poverty Law Center, 
revealed that individuals could spend more than $10,000 per 
year on conversion therapy.
    JONAH was ordered to shut down in 2015 for violating New 
Jersey's Consumer Fraud Act. So in addition to being costly and 
being fraudulent, we know that the entire medical community is 
arrayed against this.
    The American Psychiatric Association has said that no 
credible evidence exists that any mental health intervention 
can reliably and safety change sexual orientation nor from a 
mental health perspective does sexual orientation need to be 
changed.
    There is simply no disease known as being gay. It's simply 
being human. That was removed out of the DSM-IV manual decades 
ago. So when a for-profit mental health professional comes and 
says, I am going to charge you money to get rid of a disease 
that does not exist, that is called fraud.
    In addition, studies have shown that patients can undergo 
severe harm from this. Patients have committed suicide or 
thought about committing suicide.
    When I did this legislation in the California State Senate, 
we had witnesses come up to talk about going through this 
practice and then wanting to commit suicide later.
    So this can also greatly harm people.
    I also want to note that this legislation that I introduce 
here only applies to for-profit conversion therapists. So if 
you are a priest and you want to talk about this with members 
of your church, that is fine. It doesn't apply to you. It 
applies to these groups that are scamming consumers with this 
fraudulent practice.
    I note that this bill will protect individuals from being 
defrauded by conversion therapists and falls clearly within the 
subcommittee's mission to protect consumers.
    So I respectfully request that either the subcommittee or 
the entire committee consider this bill, and thank you for the 
opportunity to testify and happy to answer any questions that 
you may have.
    [The prepared statement of Mr. Lieu follows:]

                 Prepared Statement of Hon. Ted W. Lieu

    Chairman Pallone, Ranking Member Walden, Chairwoman 
Schakowsky, and Ranking Member McMorris Rodgers, thank you for 
allowing me to testify.
    Today, I am here to urge you to consider my legislation 
H.R. 3570, the Therapeutic Fraud Prevention Act, which aims to 
prevent for-profit conversion therapy. This legislation has 
been cosponsored by 89 of our colleagues in the House of 
Representatives, including 14 members of the Energy and 
Commerce Committee, and six members of the Consumer Protection 
and Commerce Subcommittee. It is supported by a wide range of 
organizations including the American Academy of Pediatrics, the 
American Psychoanalytic Association, the Southern Poverty Law 
Center, and the Human Rights Campaign.

    About Conversion Therapy

    Conversion therapy, also known as reparative therapy or 
sexual orientation change efforts, refers to the practice of 
attempting to change an individual's sexual orientation or 
gender identity. According to the Williams Institute at the 
University of California Los Angeles, nearly 700,000 adults in 
the United States have been subjected to conversion therapy. 
Not only is conversion therapy common, but it also costly. One 
conversion therapy organization, People Can Change, charges 
$650 to $850 for weekend conversion therapy retreats in the 
woods. Another, Jews Offering New Alternatives to Healing 
(JONAH), charged about $100 for weekly individual sessions and 
$60 for group therapy sessions. A lawsuit filed by former 
victims of JONAH revealed that individuals could spend more 
than $10,000 per year on conversion therapy. JONAH was ordered 
to shut down in 2015 for violating New Jersey's Consumer Fraud 
Act.

    Inefficacy, Harms of Conversion Therapy

    The national community of professionals in education, 
social work, health, mental health, and counseling has 
recognized universally that conversion therapy is a wholly 
useless and risky pseudoscience. In reality, it is not possible 
to change an individual's sexual orientation or gender 
identity, nor should we seek such change. Moreover, 
administering conversion therapy causes serious harms to its 
victims including depression, self-harm, and suicide. In 2013, 
the American Psychiatric Association released the following 
statement:
    ``The American Psychiatric Association does not believe 
that same-sex orientation should or needs to be changed, and 
efforts to do so represent a significant risk of harm by 
subjecting individuals to forms of treatment which have not 
been scientifically validated and by undermining self-esteem 
when sexual orientation fails to change. No credible evidence 
exists that any mental health intervention can reliably and 
safely change sexual orientation; nor, from a mental health 
perspective does sexual orientation need to be changed.'' \1\
---------------------------------------------------------------------------
    \1\ APA Reiterates Strong Opposition to Conversion Therapy. 
November 15, 2018. Accessed July 22, 2019. https://www.psychiatry.org/
newsroom/news-releases/apa-reiterates-strong-opposition-to-conversion-
therapy.
---------------------------------------------------------------------------
    So-called conversion therapists should not be able to sell 
their services by claiming that they are effective and 
harmless, especially when forced upon minors. As legislators, I 
believe that we have a responsibility to protect our 
constituents from being swindled by these individuals and 
organizations.

    About the Therapeutic Fraud Prevention Act

    In June, I re-introduced H.R. 3570, the Therapeutic Fraud 
Prevention Act. This legislation makes it unlawful for any 
person to provide for-profit conversion therapy or to advertise 
for the provision of conversion therapy. It allows the Federal 
Trade Commission to enforce the prohibition under the Federal 
Trade Commission Act and provides additional enforcement 
authority to the Department of Justice and state attorneys 
general.
    Because this legislation targets only those who charge for 
conversion therapy, it does not infringe on First Amendment 
rights. At the same time it is an incredibly effective way to 
ensure that for-profit practitioners are not allowed to engage 
in this fraudulent behavior.

    State Progress

    Across the nation, we are seeing growing support for laws 
preventing conversion therapy. In 2012, California enacted the 
first law in the nation to protect minors from conversion 
therapy. Since that time, seventeen states-including Illinois 
and Washington-the District of Columbia, and several more 
municipalities have passed similar laws. Seven of these state 
laws were signed by Republican governors and several received 
bipartisan support in their respective state legislatures.
    These bans are working. The aforementioned Williams 
Institute study found that 10,000 LGBT youth living in states 
that ban conversion therapy have been protected from the harm. 
Still, the report also showed that 16,000 LGBT youth living in 
states without such bans will receive conversion therapy from a 
licensed professional before they turn 18. Clearly, we need 
federal action.

    Conclusion

    The Therapeutic Fraud Prevention Act will protect 
individuals from being defrauded by conversion therapists and 
falls clearly within the subcommittee's mission to protect 
consumers. I respectfully request that the subcommittee 
consider this important piece of legislation and thank you for 
the opportunity to testify before you.

    Mr. Pallone. I thank the gentleman. Again, we will take a 
look and we certainly are always concerned about anything that 
relates to consumer fraud and trying to prevent consumer fraud.
    So unless anyone else, I thank you again for being here and 
we will follow up.
    Mr. Lieu. Thank you.
    Mr. Pallone. Thanks.
    And next we go to the gentleman from Wisconsin is next. 
Thank you.
    Mr. Grothman. I voted for one of your nice amendments 
yesterday.

 OPENING STATEMENT OF HON. GLENN GROTHMAN, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF WISCONSIN

    I am here to talk about H.R. 380. It deals with requiring--
well, right now when it comes to dams, environmental agencies 
frequently feel that we need fish passageways so the fish can 
swim upstream.
    We have a major dam in the state of Wisconsin, which is 
actually in Congressman Pocan's district but it's kind of very 
close to my district, and right now that dam is the only thing 
that prevents Asian carp, a huge invasive species, from 
swimming upstream in the Wisconsin River.
    It is a very important thing to the state of Wisconsin. 
Asian carp have gone all the way from the Gulf of Mexico into 
Wisconsin River, which is the most important river in the state 
of Wisconsin.
    Wisconsin River is not only important in its own right but 
as you work your way up the river you wind up in many, many 
lakes in northern Wisconsin.
    The only thing that has prevented these massive Asian carp 
from doing so much to destroy the upper Wisconsin River and 
lakes in northern Wisconsin is a dam on the southern Wisconsin 
River.
    Right now, the secretary of interior is doing a study to 
see whether they can put a fish passageway up there. I can 
understand why in most circumstances you want a fish 
passageway. I can think of other examples in other parts of my 
district where they work well.
    However, in this era of invasive species, some of these 
dams are so valuable in protecting our rivers and lakes and for 
that reason, myself, with the assistance of Mr. Pocan, we 
drafted a bill requiring the Department of Interior to look at 
it, and I think if we do we can rest easy in knowing that not 
only the upper Wisconsin River but all the lakes in northern 
Wisconsin could be protected from the Asian carp. I am sure 
there are other places around the country where this must be a 
problem as well.
    Do you have any questions for me?
    [The prepared statement of Mr. Grothman follows:]

               Prepared Statement of Hon. Glenn Grothman

     Mr. Chairman Rush, Ranking Member Upton, and members of 
the committee, thank you for giving me the chance to speak in 
favor of amending the Federal Power Act to require the 
Secretary of Commerce or the Secretary of Interior to consider 
the threats posed by invasive species before mandating a new 
fish passageway be built through a dam.
     My bill is bipartisan and enjoys the support of 
Congressman Mark Pocan also of Wisconsin.
     Our home state currently faces an invasive species 
threat that may affect the entire Great Lakes Region.
     Invasive species are not just a problem in 
Wisconsin but are causing serious large-scale environmental and 
economic problems across the country. According to the 
Department of the Interior, the prevalence of invasive species 
is estimated to cost the U.S. economy over $100 billion 
annually, including impacts to business and industry, 
recreation, and public health.
     A hydroelectric dam in Prairie du Sac, Wisconsin, 
offers a case in point.
     The United States Fish and Wildlife Service has 
ordered the installation of a fish passageway located at the 
hydroelectric plant in Prairie du Sac dam. Asian Carp, which is 
an invasive species that can grow nearly three feet in length, 
have been found at the base of this dam.
     Fish passageways can serve an important role of 
preserving and enhancing the populations of desirable, native 
fish by allowing them a way to travel safely, timely, and 
effectively around dams.
     However, invasive species use these same fish 
passageways to invade rivers and lakes and devastate native 
species and their habitats.
     Installing a fish passageway at the Prairie du Sac 
dam could allow the Asian Carp to migrate upstream to the 
Wisconsin River, Lake Wisconsin and eventually the Great Lakes.
     Currently, the dam acts as a physical barrier to 
upstream movement of Asian Carp and other invasive species. 
None of the invasive species established in the Mississippi 
River Basin are currently known to exist upstream of the dam.
     In fact, Asian Carp have been captured by 
Wisconsin Officials below the dam as recently as 2014.
     The presence of these invasive species in the 
lower Wisconsin River raises concerns that these fish could 
penetrate past the protective wall of the dam and travel 
upstream if a fish passage is installed.
     If they do indeed move upstream through the 
Wisconsin waterways, and eventually into the Great Lakes, there 
would be significant adverse effects to the environment, native 
fish populations, and the recreation industry of Wisconsin.
     This bill would simply ensure that federal 
officials have to consider this threat before prescribing and 
finalizing fishway conditions like the one in Prairie du Sac.
     We believe that there are viable non-fishway 
alternative approaches which can both support the maintenance 
of native fish populations, while also eliminating the risk of 
spreading invasive species into protected waterways.
     Allowing for greater flexibility and discretion 
from Department of Interior, with respect to considering non-
fishway alternatives will protect watersheds and local 
economies in the Great Lakes region from the detrimental 
effects of invasive species.
     I would like to thank the Committee again for 
holding this hearing and am happy to answer any questions you 
may have.

    Mr. Pallone. Well, I just want--you know that we worked 
with you and Mr. Pocan on this in the last Congress and we will 
continue to work on it. I just want you to know that.
    Yes, Mr. Upton?
    Mr. Upton. Well, thank you for being here today, and I know 
that as a member of the Great Lakes Caucus--I think you are 
too--that fighting the Asian carp from getting further north is 
a tremendous priority for all of us.
    And we had a bipartisan group from Michigan go down to 
Illinois during the 4th of July break to look at one of the 
locks down there just literally about an hour south of Midway 
Airport.
    The Corps of Engineers, as you know, has come up with a 
study that I think we need to implement that would block that 
carp then from going north and infiltrating, causing 
irreversible damage to the Great Lakes Region, and it appears 
as though it is going to be a bipartisan effort.
    The Corps assured us that they were on board to try and do 
this, but I appreciate your commitment and your work and your 
interest, and there is a lot of people that are on your side.
    Mr. Grothman. Yes. I should point out that not only is this 
important for the Wisconsin River but it is important for all 
the Great Lakes because near where this dam is the tributaries 
that flow into Lake Michigan go there as well. I mean, it is 
right on the Continental Divide and a lot of people feel that 
if the carp got north it wouldn't only affect the lakes in 
Wisconsin but it would work its way to Lake Michigan.
    Mr. Upton. Thank you.
    Mr. Pallone. I thank the gentleman and we will work on it 
again. Thanks.
    Mr. Grothman. Thanks much.
    Mr. Pallone. And now the gentlewoman from New Mexico. 
Thanks for being here.

       OPENING STATEMENT OF HON. XOCHITI TORRES SMALL, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW MEXICO

    Ms. Torres Small. Thank you, Chairman Pallone, thank you, 
Congressman Upton, and members of the Energy and Commerce 
Committee.
    It is an honor to get to speak with you today about the 
issues relevant to New Mexico's 2nd Congressional District.
    I first want to applaud the Energy and Commerce Committee's 
work to lift up rural and underserved communities. Our rural 
communities are important threads to the fabric of our nation. 
They provide the food we put on our tables and the energy that 
powers our day-to-day lives.More importantly, they represent 
the American values and traditions that are at the heart of who 
we are.
    I love our values and way of life, but our rural 
communities are facing increased hardships like never before. 
Since I was sworn in, I have visited all 19 counties in New 
Mexico's 2nd Congressional District and in each place, I 
visited, residents voiced the same message. They want the same 
economic opportunities and healthcare access that cities and 
suburbs have.
    These are the issues I came to Congress to tackle, and it 
is why I am here today speaking before the committee with broad 
and far-reaching jurisdiction to address these problems.
    When meeting with my constituents, access to basic 
healthcare leads nearly every conversation, because in southern 
New Mexico it's not just about healthcare affordability; it is 
also about healthcare accessibility.
    I have met expecting mothers who have to drive for hours 
for every single prenatal appointment. I have met veterans who 
have to get on a bus in the middle of the night to get to a 
doctor's appointment in Albuquerque the next day.
    I have met with teenagers in the midst of a crisis who face 
a long waiting list for a much-needed mental health 
appointment, and I have visited rural and community hospitals 
on the verge of closing.
    These are daily challenges for the six million Americans 
living in rural communities. I am by no means an expert, but I 
think it is clear that one way to increase healthcare access in 
rural areas is increasing the number of doctors serving in 
them.
    In March, along with a bipartisan group of colleagues, I 
helped introduce the Resident Physician Shortage Reduction Act 
of 2019, H.R. 1763.
    This bipartisan legislation takes critical steps towards 
reducing nationwide physician shortages, with an emphasis in 
rural areas, by increasing the number of Medicare-supported 
residency positions by 15,000 positions.
    H.R. 1763 already has 139 co-sponsors, including 16 members 
of this committee. I strongly encourage the committee to 
support this bill.
    Similar in mission, I also helped introduce the Training 
the Next Generation of Primary Care Doctors Act alongside 
Representative Ruiz in May.
    H.R. 2815 reauthorizes and expands the Teaching Health 
Center Graduate Medical Education Program.
    The program has helped address physician shortages in low-
income regions of the country such as the district I serve, 
because many medical students go on to serve the communities 
where their residency program was located.
    In the 2018-19 academic year, the THCGME Program supported 
the training of 728 residents in 56 primary care residency 
programs across 23 states.
    These graduates are almost three times more likely to 
remain in primary care practice than traditional GME graduates, 
almost two times more likely to practice in underserved 
communities, which is most of New Mexico, and more than two 
times more likely to serve in rural America.
    The THCGME program's success thus far helps meet this 
mission and I will continue to advocate for its expansion. 
Other issues that impact New Mexico include transportation. We 
have transportation programs that help rural residents get to 
their medical appointments and we have seen that that helps 
everyone's health.
    We have also seen the devastating impact that high drug 
prices have and we have an obligation to address them. Let us 
keep building on the momentum of the legislation passed in June 
and continue putting forth measures to protect our constituents 
suffering from inflated and unregulated drug prices.
    Members of this committee, even with the hardships rural 
communities face, we are often the first to be forgotten when 
legislators and healthcare experts discuss healthcare quality, 
access, and affordability.
    Thank you again, Chairman Pallone and Ranking Member 
Walden, for holding this hearing and for your work delivering 
better healthcare to all our constituents.
    [The prepared statement of Ms. Torres Small follows:]

            Prepared Statement of Hon. Xochiti Torres Small

    Chairman Pallone, Ranking Member Walden, and members of the 
committee, thank you for the opportunity to speak about the 
pressing issues facing New Mexico's Second Congressional 
district.
    I first want to applaud the Energy and Commerce Committee's 
work to lift up rural and underserved communities.
    Our rural communities are important threads in the fabric 
of our nation. They provide the food we put on our tables and 
the energy that powers our day-to-day lives.
    More importantly, they represent the American values and 
traditions that are at the heart of who we are.
    I love our values and way of life, but our rural 
communities are facing increased hardships like never before.
    Since I was sworn-in, I've visited all 19 counties in New 
Mexico's Second Congressional District.
    And in each place I visited, residents voiced the same 
message. They want the same economic opportunities and 
healthcare access that the bustling cities and growing suburbs 
have.
    These are the issues I came to Congress to tackle, and it 
is also why I am here today speaking before the committee with 
broad and far-reaching jurisdiction to address these problems.
    When meeting with my constituents, access to basic 
healthcare leads nearly every conversation, because in southern 
New Mexico, it's not just about healthcare affordability, it's 
also about healthcare accessibility.
    I have met expecting mothers who have to drive for hours, 
often across state lines, for prenatal appointments.
    I have met veterans who have to get on a bus in the middle 
of the night to get to a doctor's appointment in Albuquerque 
the next day.
    I have met teenagers in crisis who face a long waiting list 
for a much-needed mental health appointment.
    And I have visited rural and community hospitals on the 
verge of closing.
    These are daily challenges for the 60 million Americans 
living in rural communities.
    I'm by no means an expert, but I think it is clear that one 
way to increase healthcare access in rural areas is increasing 
the number of doctors serving them.
    In March, along with a bipartisan group of colleagues, I 
helped introduced The Resident Physician Shortage Reduction Act 
of 2019, H.R. 1763.
    This bipartisan legislation takes critical steps toward 
reducing nationwide physician shortages, with an emphasis in 
rural areas, by increasing the number of Medicare-supported 
residency positions by 15,000 positions.
    If passed, H.R. 1763 will significantly increase training 
programs for rural physicians and take the first steps towards 
expanding rural healthcare access and incentivizing medical 
students to serve our rural communities.
    H.R. 1763 already has 139 cosponsors, including 16 members 
of this committee. I strongly encourage the committee to 
support this bill.
    Similar in mission, I also helped introduce the Training 
the Next Generation of Primary Care Doctors Act alongside 
Representative Ruiz in May.
    H.R. 2815 reauthorizes and expands the Teaching Health 
Center Graduate Medical Education (THCGME) Program.
    The program has helped address physician shortages in low-
income regions of the country such as the district I serve, 
because many medical students go on to serve the communities 
where their residency program was located.
    In the 2018-19 academic year, the THCGME Program supported 
the training of 728 residents in 56 primary care residency 
programs across 23 states. Of these graduates,

     1A82 percent remain in primary care practice, 
compared to 23 percent of traditional GME graduates;
     1A55 percent of practice in underserved 
communities, compared to 26 percent of traditional GME 
graduates; and
     1A20 percent practice in rural America, compared 
to eight percent of traditional GME graduates.

    Training the next generation of rural healthcare providers 
means investing in the programs that have proven to keep them 
in areas with the highest need.
    The THCGME program's success thus far helps meet this 
mission and I will continue to advocate for its expansion.
    In the coming weeks, I plan to introduce legislation to 
address the maternal morbidity crisis faced in rural 
communities.
    The bill will likely be directed to this committee and I 
look forward to working with each of you to move this critical 
legislation for a full floor vote.
    Additionally, it is essential that we help those in rural 
communities get to their healthcare providers, even if they 
live several towns or counties away. When lack of 
transportation prevents people from attending routine or 
preventative care appointments, it increases healthcare costs 
and leads to worse health outcomes.
    Currently, there are several federal programs that help 
patients in rural communities reach their medical providers 
with non-emergency medical transportation. Studies have proven 
that programs like these not only increase access to healthcare 
but also pay for themselves through healthcare savings.
    However, these programs can't meet the immense need. We 
need to do more to expand federal patient transportation 
programs to ensure that no American is prevented from seeing 
their doctor due to issues with transportation.
    Last, I can attest that across my diverse district, 
Republicans, Democrats, and independents all agree drug prices 
are too high and that Congress has an obligation to lower them.
    Let's keep building on the momentum of the legislation 
passed in June and continue putting forth measures to protect 
our constituents suffering from inflated and unregulated drug 
prices.
    Members of this committee, even with the hardships rural 
communities face, we are often the first to be forgotten when 
legislators and healthcare experts discuss healthcare quality, 
access, and affordability.
    By working to solve these issues, this committee can be on 
the forefront of advancing healthcare, no matter where a person 
lives.
    Thank you again, Chairman Pallone and Ranking Member Walden 
for holding this hearing, and for your work delivering better 
healthcare to all our constituents.

    Mr. Pallone. I want to thank the gentlewoman.
    You know, what you said about training people and then they 
are staying in the community is so true and, you know, I have 
seen that. You know, one of the things that we did when we did 
the--I think it was in the ACA--that we said that you could get 
additional slots for--you know, for residency programs if you 
did it--if you set it up at a community health center, and 
because they were outside of the regular system.
    And I saw that--I can't remember what tribe it was but we 
were--we were on the Puget Sound, I guess, in Washington 
State--one of the tribes, and they had actually done that with 
their Indian Health Service where they had set up a residency 
program and they just got the additional slots without having 
to transfer or buy them anywhere.
    And they said in every--in almost every case the doctors 
that were trained there stayed, you know, with the community 
health center or with the tribe in that area, and that is--it 
is true.
    I mean, if you have those training programs in those 
underserved areas, people tend to stay there. It's just a 
reality.
    So the other thing that the gentleman from Arkansas 
mentioned is trying to be innovative with technology too in 
telemedicine, which is important.
    So we will definitely look into it. Thanks again.
    Thanks.
    And next is the gentleman from Minnesota, Mr. Phillips.

 OPENING STATEMENT OF HON. DEAN PHILLIPS, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF MINNESOTA

    Mr. Phillips. Thank you, Chairman Pallone, Mr. Upton, and 
members of the committee for the invitation to speak today 
about some important issues facing my community.
    Minnesota is fortunate to be home to many pristine waters 
and natural treasures, including the Mississippi River, our 
infamous 10,000 lakes--and those are just ones with names--and 
the Boundary Waters.
    The Boundary Waters is the most visited wilderness in our 
country and a special place for Minnesotans and many throughout 
our nation. People from across the world also visit to canoe, 
hike and to fish.
    In May, the Department of the Interior decided to renew two 
mining leases for a proposed copper sulfide mine right on the 
edge of the Boundary Waters, despite scientific evidence, 
economic data, ongoing litigation, and a public record of 
opposition dating back over 50 years.
    This unilateral action from the Trump administration to 
move forward on the copper sulfide Twin Metals mine is 
irresponsible and unacceptable. We must continue to protect our 
public lands and waters and ensure that Minnesota's and the 
nation's wilderness areas can be enjoyed by future generations.
    Minnesota's 3rd District is home to one of the most visited 
lakes in our state, Lake Minnetonka, made famous by Prince's 
movie, ``Purple Rain.'' I am sure that is the first time that 
has been uttered in this room.
    Right now, Lake Minnetonka and the rest of our state's 
waters face the grave threat of aquatic invasive species, 
something to which my colleague from Wisconsin referred to just 
moments ago.
    Aquatic invasive species including Asian carp, spiny water 
fleas, and zebra mussels--none of them native to Minnesota and 
all of which cause major harm to our waters' ecosystems.
    These species have been moving throughout Minnesota, 
clogging our lakes and rivers, and killing off native animals 
and plants. Life in our district revolves around these lakes, 
so this problem is of grave concern to our community.
    In June, I convened a roundtable of local experts to 
discuss the threat posed by these invasive species and the 
consensus was very clear. Congress must invest resources and 
support state and local governments to prevent the further 
spread of invasive species in our lakes and our rivers.
    And unfortunately, the problem of aquatic invasive species 
is exacerbated by our changing climate. Invasive species can 
now live in waterways that were uninhabitable just a few 
decades ago, while native species are struggling to adapt fast 
enough to compete with them.
    Climate change is right in our backyards and it is time to 
act. I hear it from my constituents every day. Middle and high 
school students in particular who contact my office to express 
their distress that our federal government has refused to take 
bold steps or any meaningful action to solve this issue.
    These young people are motivated to organize and contact 
their representatives because they feel it is their only 
option; their life and future depends on it.
    And I also hear from their parents and their grandparents, 
worried about the world they will leave behind for their 
families. Climate change is complex and requires a multi-
pronged approach. We need to consider solutions and policies 
like federal support for research and development of renewable 
energy, extending and supporting new tax credits for 
renewables, supporting consumer purchase of electric vehicles, 
and other thoughtful proposals.
    Another policy we need to explore is placing a price on 
carbon, like the Energy Innovation and Carbon Dividend Act.
    This legislation places a fee on fossil fuels at the 
source, beginning at $15 per metric ton of CO2 equivalent 
emissions, and steadily increases annually by $10 per metric 
ton.
    The fees would be deposited into a carbon dividend trust 
fund and allocated as dividend payments to all U.S. citizens 
and lawful residents. Thus, the bill would use market forces to 
provide incentives for the reduction of carbon emissions.
    This is an achievable solution that both parties can 
support and should, and I urge all who are present to consider 
doing so.
    The American people have sent a clear message to Congress: 
please take action on climate change, and I hope you'll join me 
in doing all we can to keep our planet safe and prosperous for 
generations to come.
    Thank you, Mr. Chair.
    [The prepared statement of Mr. Phillips follows:]

                Prepared Statement of Hon. Dean Phillips

    Thank you, Chairman Tonko, Ranking Member Shimkus, and 
members of the committee for the invitation to speak today 
about these important issues facing my community.
    Minnesota is fortunate to be home to many pristine waters 
and natural treasures, including the Mississippi River, our 
infamous 10,000 lakes, and the Boundary Waters.
    The Boundary Waters is the most visited wilderness in our 
country and a special place for Minnesotans. People from across 
the world visit to canoe, hike and fish.
    In May, the Department of the Interior decided to renew two 
mining leases for a possible copper sulfide mine on the edge of 
the Boundary Waters in Minnesota, despite scientific evidence, 
economic data, ongoing litigation and a public record of 
opposition dating back 50 years.
    This unilateral action from the Trump Administration to 
move forward on the copper sulfide Twin Metals mine is 
irresponsible and unacceptable. We must continue to protect our 
public lands and waters and ensure that Minnesota's wilderness 
can be enjoyed by future generations.
    Minnesota's third district is home to one of the most 
visited lakes in our state, Lake Minnetonka--made famous by 
Prince's film Purple Rain.
    Right now, Lake Minnetonka and the rest of our state's 
waters face the grave threat of Aquatic Invasive Species.
    Aquatic Invasive Species including Asian carp, spiny 
waterfleas and zebra mussels, are not native to Minnesota and 
cause major harm to our waters' ecosystems. These species have 
been moving throughout Minnesota, clogging our lakes and 
rivers, and killing off native animals and plants. Life in our 
district revolves around lakes, so this problem is of high 
concern to our community.
    In June I convened a roundtable of local experts to discuss 
the threat posed by these invasive species and the consensus 
was clear. Congress must invest resources and support state and 
local governments to prevent the further spread of invasive 
species in our lakes and rivers.
    And unfortunately, the problem of Aquatic Invasive Species 
is exacerbated by our changing climate. Invasive species can 
now live in waterways that were uninhabitable a few decades 
ago, while native species are struggling to adapt fast enough 
to compete with them.
    Climate change is right in our backyard and we must act.
    I hear it from my constituents every day. Middle and High 
School students contact my office regularly to express their 
distress that our federal government has not taken bold steps 
to solve this issue. These young people are motivated to 
organize and contact their representative because they feel it 
is their only option--their life and future depends on it. I 
also hear from parents and grandparents worried about the world 
they will leave behind for their families.
    Climate change is complex and will require a multi-pronged 
approach. We need to consider solutions and policies like 
federal support for research and development into renewable 
energy, extending and supporting new tax credits for 
renewables, supporting consumer purchase of electric vehicles, 
and other proposals. Another policy we need to explore is 
placing a price on carbon--like in the Energy Innovation and 
Carbon Dividend Act.
    This legislation places a fee on fossil fuels at the 
source, beginning at $15/metric ton of CO2 equivalent 
emissions. It will steadily increase annually by $10/metric 
ton.
    The fees would be deposited into a Carbon Dividend Trust 
Fund and allocated as dividend payments to U.S. citizens and 
lawful residents.
    Thus, the bill would use market forces to provide 
incentives for the reduction of carbon emissions. This is an 
achievable solution that both parties could support, and I urge 
all who are present to do just that.
    The American people have sent a message to Congress: take 
action on climate change. I hope you'll join me in doing all we 
can to keep our planet safe for generations to come.
    Thank you.

    Mr. Pallone. Thank you, and I did want to mention that just 
this week myself, Mr. Tonko, and Mr. Rush, we had--we made an 
announcement earlier this week that we were going to try to 
achieve a goal of 100 percent, I guess I will say carbon 
neutral by 2050 and that we were going to begin a series of 
hearings, which actually started yesterday, and Mr. Tonko of 
the Environment and Climate Change Subcommittee, to see what 
legislative proposals that we have before the committee or 
others with the idea that by the end of the year, if not 
sooner, we would come up with legislation--you know, sort of a 
climate action plan, if you will, that we will then try to sell 
to the rest of not only Democrats but Republicans as well.
    So we certainly want to look at your proposal in the 
context of that, and we will.
    Mr. Phillips. Thank you. And Mr. Chair, if I might say, you 
know, we are in this together and to the extent that we can 
identify best practices as practiced by other countries in many 
cases ahead of us on this issue I would encourage----
    Mr. Pallone. Right. And it is true. We mentioned that, you 
know, the scientific community basically says that by 2050 if 
we don't--you know, if we don't take action now to get to 
carbon neutral by 2050 we are going to have a catastrophe, and 
several countries have used that date--you know, France, 
Germany, Japan, and others.
    Did you want to say----
    Mr. Upton. I just want to say thank you, Mr. Phillips, for 
being here. I know that Minnesota is known as the land of 
10,000 lakes. Michigan has more.
    Mr. Phillips. I knew that was coming.
    [Laughter.]
    Mr. Upton. Yes. Yes.
    But last year I went down the Paw Paw River which is--
merges into Lake Michigan, and when you take the jigs and jogs 
you go about 35 miles inland from Lake Michigan and you 
actually get 100 miles upriver, because it goes like this.
    And we were working on identifying lamprey eel larva and 
eggs, and that is how far we went up to look at the lampricide 
that then forced the younglings of the lamprey eels to surface 
and then we were able to collect and, of course, that has been 
an issue that we have had at the Great Lakes for many decades, 
and that is why it is so important as we look at Asian carp and 
other invasive species that came in maybe with ballast water, I 
think, with those eels--lamprey eels. But it is a tremendous 
impact on the fisheries and tourism and everything else, and 
when you look at zebra mussels as well a huge issue for all of 
us.
    Mr. Phillips. Thank you.
    Mr. Pallone. Thank you. Thanks again. Appreciate your being 
here.
    And we now go to the gentlewoman from Ohio, the chairwoman 
of the Energy and Water Appropriation Subcommittee who we have 
worked with on quite a few issues because of the overlap 
between your Appropriations Subcommittee and this committee. 
Thank you for being here.

  OPENING STATEMENT OF HON. MARCY KAPTUR, A REPRESENTATIVE IN 
                CONGRESS FROM THE STATE OF OHIO

    Ms. Kaptur. Thank you, Mr. Chairman and members of the 
committee, and I want to thank you for your openness to working 
across committees to even do greater things for our country, 
Chairman Pallone.
    It is a real honor to be before you today, and I want to 
thank Ranking Member Walden and all members of the committee 
for the opportunity to address you this afternoon. I see my 
great friend, Fred Upton, from our sister Wolverine state up 
there and it is wonderful to have you there as well.
    As chair of the Energy and Water Appropriations 
Subcommittee, I deeply value the collaborative relationship and 
consultation between our two subcommittees and I believe we can 
accomplish so much more working together.
    In addition to my verbal testimony, I also have highlighted 
several priorities that relate to the Health Subcommittee in my 
longer written testimony that I will submit. But I want to 
concentrate on three areas this morning. I know you were really 
busy last week in several areas of overlapping jurisdiction.
    But the three I want to talk about this morning are 
workforce development, weatherization, and energy efficiency at 
our drinking water and wastewater treatment plants across this 
country.
    The Energy and Commerce Committee was extremely active last 
week in several areas of overlapping jurisdiction.
    I want to applaud first on workforce development Chairman 
Rush and the full committee for your attention to the workforce 
development and pipeline issues at the Department of Energy.
    Last week, you approved H.R. 1315, the Blue Collar to Green 
Collar Jobs Development Act of 2019, and in March of this year, 
our Appropriations Subcommittee on Energy and Water also held a 
workforce development hearing.
    We have a lot of work to do together on this one. As you 
know, our nation has a serious pipeline and workforce 
development crisis in the energy and nuclear security 
industries, both at the Department of Energy as well as in the 
private sector.
    According to the Energy and Employment Report for 2018, 
roughly, 12 percent of today's energy workforce is eligible to 
retire--we are talking about hundreds of thousands of people--
and 70 percent--70 percent--of industry employers in energy 
report hiring difficulty.
    I hear this over and over and over again, whether it is 
electrical engineers, whether it is nuclear, staff for our 
nuclear power plants. In STEM fields, our nation is not meeting 
demand.
    The Department of Energy must be more proactive about 
recruiting and training a new generation of innovators because 
our country needs to compete in a new world economic order in 
which our nation is skills short.
    I believe that we need to be as aggressive as Members of 
Congress in exploring how to create this more aggressive 
recruitment opportunity in the same way as we do when we select 
individuals from our district working with our service 
academies to move young Americans into fields and into places 
that perhaps they hadn't imagined when they were much younger.
    But I don't think we are going to meet the demand based on 
current trends and I would be more than willing to work with 
this excellent committee on the workforce development issue, 
engaging--fully engaging the Department of Energy in that 
effort.
    Number two, I want to focus on weatherization and I can't 
thank your committee and subcommittees enough for recently 
approving H.R. 2041, Representative Tonko's Weatherization 
Enhancement and Local Energy Efficiency Investment and 
Accountability Act.
    The Department of Energy's Weatherization program has a 
direct positive impact on the lives of everyday Americans, and 
it is a great training ground for people going into the various 
specialty sectors in the building trades as well, particularly 
drawing in low-income Americans, spanning all 50 states, our 
territories and our Native American tribes.
    H.R. 2041 expands flexibility for the program and creates 
new opportunities to innovate, and I hope to work with your 
committee to ensure we can get a floor vote on the 
weatherization reauthorization.
    In addition, I hope that we can work together to add 
language to encourage initiatives that encompass neighborhood 
scale weatherization. I think we have to tiptoe our way into 
that one, but the innovation fund encourages innovative 
roofing, energy efficiency, and new outreach and assistance 
programs, and I would like to provide slightly more clarity to 
the Department of Energy on this front.
    This is an older program that operates well. The states are 
fully engaged and I think we can give them a hand up by 
augmenting that particular language in the bill. Specifically, 
the legislation I believe should include within innovative 
outreach, a neighborhood scale weatherization.
     At the ground level, the community action agencies work 
seamlessly between various federal programs and I am on a 
mission to ensure that other federal agencies, including HUD, 
the Department of Health and Human Services, and the Veterans 
Department collaborate with the Department of Energy to ensure 
that these programs work together more seamlessly for maximum 
impact at the neighborhood level.
    And finally, on energy efficiency at drinking water and 
waste water treatment plants, the largest segment of most 
cities' and large regions' electric bills--power bills come 
from their having to provide their drinking water and 
wastewater treatment facilities with the--with the regular 
power.
    We have important work to do in making our wastewater and 
drinking water facilities more energy efficient. In many cities 
as much as 30 to 40 percent of their entire power bill attends 
to operating those facilities.
    On behalf of ratepayers, consumers, and the general public, 
we have an opportunity to help our country immensely by 
reducing energy usage at these facilities.
    Both EPA Green Project Reserve and DOE's Office of Energy 
Efficiency and Renewable Energy have a major role to play. We 
need to focus that a bit.
    I am glad to see the Energy and Commerce Committee is 
continuing to take decisive action to improve the lives of the 
American people across our nation and I want to thank you for 
the opportunity to highlight some of these issues of concern to 
our committee and want to thank again the chairman and ranking 
member for the opportunity to testify.
    [The prepared statement of Ms. Kaptur follows:]

                Prepared Statement of Hon. Marcy Kaptur

    Colleagues, thank you for the opportunity to address you 
this afternoon. As chair of the Energy and Water Appropriations 
Subcommittee, I deeply value the collaborative relationship 
between our two subcommittees. We can accomplish so much 
together. In addition, I will highlight several priorities that 
relate to the Health Subcommittee.
    The Energy and Commerce Committee was extremely active last 
week in several areas of overlapping jurisdiction.

    A. Workforce Development

    I applaud Chairman Rush and the committee for your 
attention to the workforce development and pipeline issues at 
DOE. Last week, you approved H.R. 1315, the Blue Collar to 
Green Collar Jobs Development Act of 2019. In March, my 
committee also held a workforce development hearing.
    As you know, we have a pipeline and workforce development 
crisis in the energy and nuclear security industries, both at 
the Department of Energy and in the private sector. According 
to the Energy and Employment Report for 2018, roughly 12 
percent of today's energy workforce is eligible to retire and 
70 percent of energy industry employers reported hiring 
difficulty.
    DOE must be more proactive about recruiting and training a 
new generation of innovators because our country needs to 
compete in a new world economic order.

    B. Weatherization

    This committee recently approved H.R. 2041, Rep. Tonko's 
Weatherization Enhancement and Local Energy Efficiency 
Investment and Accountability Act.
    DOE's Weatherization program has a direct, positive impact 
on the lives of every day Americans, particularly low-income 
Americans, spanning all 50 states, U.S. territories, and Native 
American Tribes.
    H.R. 2041 expands flexibility for the program and creates 
new opportunities to innovate. I hope to work with you to 
ensure we can get a floor vote on the weatherization 
reauthorization. In addition, I hope that we can work together 
to add a tweak to add what I call ``neighborhood scale'' 
weatherization. The innovation fund encourages innovative 
roofing, energy efficiency, and new outreach and assistance 
programs and I would like to provide slightly more clarity to 
DOE on this front.
    Specifically, the legislation should include within 
innovative outreach, ``neighborhood scale'' weatherization. At 
the ground, the community action agencies work seamlessly 
between federal programs. I am on a mission to ensure that 
other federal agencies, including HUD, HHS, and the VA 
collaborate to ensure that these programs work together.
    But, DOE can also be a focal point for innovation. We must 
think about weatherization eligible individuals as part of a 
larger pool of people, and take a neighborhood scale approach 
to ensure mobile homes, multi-family units, or neighborhoods 
participate in the weatherization program. These communities 
are yearning to participate in the weatherization program but 
just need a small lift from DOE and the community partners.
    The needs of our nation are evolving, and with neighborhood 
scale weatherization, we can connect multiple units with 
integrated solar, geothermal, community scale wind, and achieve 
efficiency of scale by ensuring groups of individuals are 
enrolled in the weatherization program together.

    C. Energy Efficiency at Drinking and Wastewater Treatment 
Facilities

    We also have important work to do in making our waste and 
drinking water facilities more energy efficient. Drinking and 
Wastewater facilities are one of the largest industrial users 
of electricity. On behalf of ratepayers, consumers, and the 
general public, we have an opportunity to help our country by 
reducing energy usage at these facilities. Both EPA and DOE 
have role to play.
    The State Revolving Loan Fund can and must do better. The 
Green Project Reserve (GPR) sets aside 10% of the SRF to energy 
efficiency and green infrastructure. But the states have not 
been given adequate direction about how to utilize the set 
aside. The Green Project Reserve is misunderstood, 
undersubscribed and does not serve its purpose. I am working on 
a legislative solution and hope to work together with the 
environment subcommittee with jurisdiction over the Safe 
Drinking Water Act.
    DOE provides technical assistance to drinking and 
wastewater facility operators to help them determine what types 
of energy efficiency measures would work best in specific 
plants and provides them a path to realize those savings. DOE's 
research and development programs, such as those within the 
Office of Energy Efficiency and Renewable Energy, help develop 
the next generation of efficiency technologies.
    Congress must examine the SRF and chart out a path to 
ensure that federal dollars put aside for green projects are 
being used for their intended purpose.

    D. Drug Pricing

    I've discussed some of my energy priorities, and it is also 
important to recognize the value of energy and its role in 
keeping the American public healthy--especially after the 
blazing summer heat last weekend. I would like to address a 
couple of my priorities within the Health Subcommittee's 
jurisdiction as well.
    The current state of play in drug pricing involves the 
corporate consolidation of Big Pharma and company monopolies 
which have created a closed market--where not even capitalism 
can breathe. Fundamental to capitalism is competition in the 
marketplace. From patent thicketing to the stalling and 
prevention of generics from entering the market for consumers, 
the unfair business practices of Big Pharma have allowed greed 
to overtake innovation.
    I appreciate the Energy and Commerce Committee's work on 
pay for delay, which takes an important first step-but there's 
more work to be done. The legislative framework Big Pharma has 
enjoyed for too long must be reformed. Finding cures for 
diseases should not involve various entities being rewarded by 
inflated prices at the expense of patients inability to afford 
lifesaving medicine.
    I come before you today as an advocate for thousands of my 
constituents in Ohio's 9th congressional district who are 
struggling to afford their prescription medicine. In recent 
months I have been hearing alarming concerns from seniors, 
patients and families in my district who are rationing their 
prescription drugs and making life-altering decisions because 
the cost of their medicine continues to rise. I am glad the 
committee has held public hearings on the matter and is taking 
steps to address this crisis.
    Recent data has shown that the price of pharmaceuticals 
continues to rise. Politico reported in the first six months of 
2019, prescription drug prices for over 3,400 drugs rose by an 
average of 10.5 percent--outpacing the rate of inflation four 
times. Congressional rhetoric alone will not force companies to 
engage in moral business standards, which is why we must enact 
stronger backstops into law to protect patients from industry's 
predatory practices. The American public is relying on us to 
bring down the costs of pharmaceuticals, and the time to act is 
now. I appreciate many of the ideas Reps. Doggett and 
Schakowsky have proposed, and encourage action on H.R. 1046 the 
Medicare Negotiation and Competitive Licensing Act of 2019. We 
must continue to urge fair market competition to lower 
healthcare costs, and allow Medicare to negotiate prescription 
drug prices in a similar manner as the Veterans Administration.

    E. Opioids

    Not only are we witnessing pharmaceutical companies price 
gouge consumers, Big Pharma has fueled and exacerbated our 
nation's deadly opioid epidemic. According to the Ohio Health 
Department, from 2000 to 2017, Ohio's death rate due to 
unintentional drug poisonings increased by over 1,000 percent. 
This is absolutely devastating, and just last week, federal 
prosecutors in our state filed criminal charges against an 
opioid distributor and two of their former executives. These 
bad actors must be held accountable.
    Additional data released by the Washington Post last week 
has shed more light into the destruction unleashed on our 
communities. Between 2006 and 2012, the nation's top 
pharmaceutical companies distributed 76 billion oxycodone and 
hydrocodone pills, according to evidence from the largest civil 
action in U.S. history--and with six distributors dispersed 75 
percent of the opioids, we know pharmacies also share some 
blame in worsening the crisis.
    The opioid epidemic has ravaged too many families and 
neighborhoods, and the Energy and Commerce Committee has 
crucial judication in reigning this in. In addition to the 
Health Subcommittee, the Oversight and Investigations 
Subcommittee also has a key role in ensuring drug companies are 
held accountable.
    May our federal courts too, in Cleveland, bring justice for 
the victims and cities who have been devastated by opioids, and 
may we work to find ways to break up corporate consolidation in 
healthcare.
    I can see the Energy and Commerce Committee is continuing 
its tradition as a legislative powerhouse. I do not pretend to 
have all the answers but I hope to work with you to help find 
solutions together. I want to again thank the committee for the 
opportunity to testify and I hope my colleagues will consider 
the issues I have discussed with you today before both the 
Energy and Health Subcommittees. Thank you for your time.

    Mr. Pallone. I want to thank the gentlewoman, you know, for 
continuing to work with us on common issues between your 
subcommittee and our committee.
    The energy weatherization package that we did pass out of 
committee, we expect to bring that up fairly quickly on the 
floor, you know, when we come back in September.
    I know we are running out of time, but you had mentioned to 
me about an initiative that was similar to the service 
academies but you didn't get into it.
    What was that idea again?
    Ms. Kaptur. Well, I'll tell you, I am getting frustrated in 
going around to our national labs and----
    Mr. Pallone. Oh, it was on the labs. Right.
    Ms. Kaptur [continuing]. And looking at the--also the 
private sector that comes into the labs, and listening to what 
they are saying to me about the lack of talent from our country 
that is available to hire.
    You know that in many--in most of our labs we must hire 
American citizens to do work and----
    Mr. Pallone. So you wanted to do something like the service 
academies with the labs, right?
    Ms. Kaptur. I have been thinking about a model, and, again, 
I don't have it all thought out. But I know how much our office 
is involved as I am sure yours are.
    Every year we select a certain number of individuals and we 
nominate them for West Point, Annapolis, the Air Force, the 
Coast Guard, the Merchant Marines, and we work with the 
Department of Defense on that.
    And we have--I am on the Defense Subcommittee--we every 
year have the heads of these academies come before us and we 
have a very aggressive recruitment, and I believe we need to do 
the same in terms of the STEM fields for these jobs.
    We simply do not have enough people coming in to the 
nuclear power industry, for example, and I was with--I went to 
one of the lab showcases here on the Hill yesterday. We are 
talking about thousands of jobs that are unfilled that must be 
filled by American citizens. And I don't have the magic answer. 
I am not the authorizing----
    Mr. Pallone. Well, get back to us. Yes.
    Ms. Kaptur. I am not the authorizing committee. But I would 
love to explore with you a better model----
    Mr. Pallone. Please.
    Ms. Kaptur [continuing]. To the Department of Energy into 
more aggressive recruitment. Maybe we work with the labs. Maybe 
my subcommittee has to provide money that would provide for the 
education of these individuals.
    Many who go into electrical engineering by the time they 
get to the junior year they go, yes, I can make more money in 
business; why should I be going into debt, you know, to go into 
electrical engineering. I represent----
    Mr. Pallone. Well, get to back to us and we will work on an 
initiative, all right?
    Mrs. Kaptur. Thank you, Mr. Chairman. Thank you very much 
for your openness to that.
    Mr. Pallone. Mr. Upton?
    Mr. Upton. I just want to say thanks for being here. As you 
know, these bills that you reference--workforce development, 
particularly, on weatherization--they were strongly bipartisan.
    I will tell you in advance that we did raise the 
authorization levels higher than they have been before. So you 
are now in a perfect position to fit that within your 
subcommittee along with nuclear waste.
    So I look forward to working with you on that as you come 
back to us in September on the floor.
    I yield back.
    Ms. Kaptur. Thank you, Ranking Member Upton. Thank you so 
much.
    Mr. Pallone. All right. Thanks a lot.
    Ms. Kaptur. Just for the record, this year we were able in 
the House with bipartisan support to move the appropriated 
level for the weatherization program from about $254 million to 
$290 million, and I don't know what the Senate is going to do, 
obviously, but we are serious about aggressively modernizing 
this program.
    It has a terrific track record in the states and we can do 
so much more, and if I could just move on a side road just a 
second here.
    Yesterday, again, in going to a weatherization display here 
yesterday from many, many communities, it became clear that the 
workforce development pathway from these various weatherization 
programs so people can get training and go into the various 
trades is not so streamlined, and I am very interested in how 
to use these weatherization programs to identify talented 
people around the country who can be skilled up to do jobs that 
are needed in every single trade, craft, around this country, 
and I think this can be one of the feeder programs if we are 
more focused on it.
    Mr. Pallone. All right. Thanks a lot.
    You should know that she--Mr. Rush, she started out by 
praising you, just so you know.
    Mr. Rush. Well, thank you so very much for praise. I have 
to give someone the credit for all that she said to her and she 
is my neighbor in terms of where our offices are located. She 
has been my co-collaborator for a number of years on many 
policy issues.
    She has been my co-conspirator. We have been conspiring in 
the interests of leadership on many occasions. She has really 
been a spiritual ally of mine on so many, many occasions and 
she has come into my--seeing my district on many occasions 
because, you know, in Chicago the largest community of Polish 
American citizens are located in Chicago. So she has been such 
an eminent friend of mine and been such a wonderful, wonderful, 
and true friend.
    So I really want to welcome her here before us. I want to 
also say that in regard to weatherization, one of the 
amendments that we passed in the bills that we just marked up 
and passed out of the full committee amends weatherization 
programs to allow for training of community residents that--in 
the local areas that weatherization dollars are being spent and 
they are mandated to hire--to train and hire community-based 
residents for those programs. So it is line with the spirit of 
what you have been discussing.
    And you mentioned the workforce development area, and we, 
thanks to--in a bipartisan way, thanks to our eminent ranking 
member on the Energy Committee, Mr. Upton, we have and under 
the leadership of Chairman Pallone and the ranking member, we 
have been able to come up with some significant legislation as 
it relates to workforce development.
    We call it the green jobs and--blue and green jobs, and 
this would impact those out-of-work coal miners, minorities, 
women and veterans. It is a real, real world comprehensive bill 
that would try to amp up our workforce in the energy sector.
    And so I am just excited to work with you and with the 
others as we embark on this space of using National Labs and 
others, the Department of Energy and other programs to really 
create opportunities for Americans who need work, quality work, 
fulfilling work, and need to have a living wage while they are 
working and be able to take care of their families.
    So but your spirit permeates a lot of what we do, and so I 
am just so pleased to have you with us. I am pleased to be your 
friend. I recall some years ago when you and I created a 
conference--Jobs Now conference--you know, the Jobs Now 
conference, which was way out in front of all of these things 
that we are discussing.
    So, again, thank you for your stellar work and for your 
involvement.
    Mr. Pallone. Thank you. Thanks, Bobby.
    I saw that you got--I knew when you mention anything about 
nuclear that Mr. Shimkus was going to get all energized here. 
So I will recognize the gentleman from Indiana.
    Mr. Shimkus. Thank you, Mr. Chairman. I will be brief. I 
appreciate all my colleagues being here and as the Chairman 
Kaptur knows, I attended her Member Day and she knows, as I 
know, that there are 39 states, 121 locations.
    We have a law--an authorization law on the book that the 
appropriators failed to fund. Bipartisan failure to fund. As we 
talk about the Green New Deal or the chairman's zero in 2050, 
nuclear has to be part of that portfolio.
    It is only going to be around here longer and we have to 
address the waste. So I would just respectfully plead with the 
chairman to help us do this because we need to comply with the 
law and we need to finalize this so for the 39 states and the 
121 locations at--in places.
    Like I know John from Chicago Land. I know Levin's in the 
back row. We have got these places on major waterways, lakes, 
streams and in environmental sensitive areas--that I am just 
pleading with the appropriators to help us do the right thing 
and follow the law.
    With that, Mr. Chairman, I will yield back.
    Mr. Pallone. Thank you.
    As you can see, Marcy, you created a lot of interest here, 
needless to say. So----
    [Laughter.]
    Ms. Kaptur. Well, Mr. Chairman, if I could just say to, 
first, Mr. Shimkus, believe me, we have heard you. We have 
heard you. I represent a state that has several power plants 
that have waste on site.
    So I--and Ohio just passed special legislation to allow 
those plants to continue in operation. Other states have chosen 
other options. We have a serious challenge in the nuclear 
industry in this country.
    I honestly believe it should not have been bucked to the 
states. I think there should have been a federal financing 
solution. It was not done by this administration and shame on 
them, and so the states have had to struggle.
    So I share your concern about nuclear. I understand what 
you are saying about the waste. I hope to be someone that 
contributes to a real solution here that is both practically--
practical from an engineering stand but also politically 
realizable, and I think we have to keep pushing. No one has 
been a stronger advocate than you have and we welcome you any 
time before our subcommittee as we struggle with this very, 
very important issue.
    So you have been heard and I admire your work. I want to 
say to Congressman Rush also you are my Great Lakes buddy. You 
are my great, great friend and advisor from the city of 
Chicago, which needs our attention, but also across the country 
where the needs of those whose voices here are limited, and I 
reciprocate the admiration.
    Mr. Pallone. Thank you.
    Ms. Kaptur. Thank you, and Congressman Tonko I also 
complimented before your arrival today and mentioned the bill 
that you worked so very hard on along with Congressman Rush, 
and I thank you for your leadership in moving this forward.
    And thank you, Mr. Chairman----
    Mr. Pallone. Thank you. Thank you, Chairwoman. Appreciate 
your being here and all that you said.
    Now I have to say we are half an hour late and I don't want 
to keep holding everybody up. So what we may do is go back to 
what we were supposed to do and not even ask questions or make 
any comments at all.
    So I may just go through the next five or six and ask 
everybody not to even comment on what you say, which I hate to 
do, but otherwise we are never going to get through it.
    So next is the gentleman from Illinois, Mr. Casten. 
Although I do have to say he is a Middlebury graduate.
    [Laughter.]

  OPENING STATEMENT OF HON. SEAN CASTEN, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF ILLINOIS

    Mr. Casten. Thank you, Chairman. I will do my best to be 
very boring.
    Chairman Pallone, Chairman Tonko, the members of the 
committee, I want to, you know, first really thank you for 
giving us an opportunity today to share the thoughts on--as you 
think about your priorities this Congress.
    Chairman Tonko, your subcommittee, I would submit to you, 
is the most important subcommittee in Congress right now. The 
work that we do in this Congress is going to be pivotal to 
determining whether or not we survive as a species. I do not 
say that lightly.
    The climate crisis is existential. I greatly appreciate 
your leadership, Chairman Pallone's leadership, in addressing 
this crisis head on. I have been encouraged by your work to 
hold this administration and the EPA accountable for upholding 
existing climate policies, including CAFE standards.
    I thank Chairman Tonko for his work developing the climate 
principles this past week, which is an integral first step 
towards finding consensus within our own caucus and across the 
chamber, and I believe the document lays out many important 
ideas currently missing from our conversations regarding 
climate policy.
    If we are going to address the climate crisis, we have to 
acknowledge a couple facts that may be politically difficult, 
but that doesn't mean we can duck them.
    First is that the climate crisis is urgent. We do not have 
time to debate settled science any more than we have time to 
debate gravity. It is real. It is now.
    Every day that we fail to act the consequences of our 
inaction become more costly and more dire. History is going to 
judge us not by how we message to our political base but how we 
rose to this challenge.
    However, that does not mean that the necessary changes in 
our energy and environmental policy are going to be simple. Our 
standard of living, our economy, our social safety nets, and 
our government itself depends on energy access.
    It is the height of naivete to assume that the changes we 
have to make are going to have simple little fixes. We can't 
allow ourselves to be deluded into thinking that just because 
the problem is urgent any problem will--any solution will 
suffice.
    If we ignore the urgency it is suicide. If we ignore the 
complexity it is irresponsible. So we have to account for both. 
We can't just issue edicts from on high. We also can't shy away 
from expertise.
    We cannot act with the purpose of scoring easy political 
points. That may feel good, but we do at our own peril. The 
urgency of the crisis demands we act with serious determination 
and in a measured and deliberative manner that is not 
inconsistent with urgency.
    So if I can only persuade you to do one thing today, please 
unleash the nerds. Those nerd-driven solutions may not be 
exciting. They may not be sexy. They may not have a great 
little sound bit around them.
    They may not make prime time news headlines and many of the 
solutions are in fact already known. A lot of them are low-
hanging fruit we could enact tomorrow.
    That is a good thing. It is a great opportunity. Some of 
the solutions would build on policies that are already working. 
CAFE standards have helped increase the average fuel economy of 
our light-duty vehicle fleet.
    I hope this committee could encourage policies like a 
feebates program that could build on this success by rewarding 
consumers who buy more efficient, cleaner vehicles.
    The committee should also consider complementary policies 
to help get less efficient vehicles off the road. Many, many 
years ago when I did some work for California, we found that 
the single most cost effective they could do was just pay 
everybody with an old Dodge Dart $10,000.
    [Laughter.]
    Mr. Casten. We can get those clunkers off the road and make 
a big difference.
    Other climate policies have broad bipartisan support. I 
think members of both parties have agreed that we should 
prioritize the deployment and development of grid-scale energy 
storage technologies. Those technologies will not only lower 
electricity costs for consumers but make our grid more 
resilient and efficient while lowering greenhouse gas 
emissions.
    That is why I was proud to sponsor H.R. 2909, the 
bipartisan and bicameral Promoting Grid Storage Act, alongside 
many members of the Energy and Commerce Committee, and I'd urge 
this committee to take up and pass the measure.
    There are other solutions that require that we look back at 
existing laws with renewed scrutiny for how they worked in 
practice. The Federal Power Act, for instance, makes it clear 
that FERC should ensure that electricity rates are just and 
reasonable, and yet rates across the country fail to account 
for the cost of carbon pollution.
    FERC has been hesitant to address that massive externality 
because some there believe they do not have the authority. I 
disagree. I don't think it's what Congress intended.
    I think the deregulation of energy markets did not mean 
that we still don't have social obligations to set prices that 
account for externalities and we need to say so and we need to 
say so loudly.
    Now, to be clear, economy wide measures need to be taken to 
address the full scope of the issue and these policies should 
be technology neutral.
    They need to put the goal of reducing CO2 above the path of 
how we get there and they need to embrace climate action as a 
once in a generation investment opportunity.
    I have spent 20 years in the clean energy space. I have 
built over 80 projects in 30 different states. Every single 
project that I built lowered CO2 emissions and saved money. 
With one exception, none of my clients ever did those projects 
because they were as passionate about climate change as I was. 
They were greedy.
    In Washington, to invest--I have invested about $300 
million. If we view that from the lens of Washington that is a 
cost we have to score and figure out how to pay for.
    Outside of Washington, that is an investment opportunity. 
Let us embrace it as that investment opportunity.
    Let us use this to goad the economy, and to be sure, not 
all these solutions are within the jurisdiction of your 
subcommittee or even the broader committee.
    But each illustrates the kind of task we need to be willing 
to take on if we are going to address the climate crisis. The 
task is urgent. The task is complicated and I hope the 
committee will consider some of the proposals I have mentioned 
here today along with about 3,000 others that I am working on.
    And I look forward to working with any and all of you in 
any way I can to help combat this crisis. Thank you again for 
having me today and thank you so much for your leadership.
    [The prepared statement of Mr. Casten follows:]

                 Prepared Statement of Hon. Sean Casten

    Chairman Tonko, Chairman Pallone, members of the committee, 
thank you for providing members the opportunity to share our 
thoughts on the work of this subcommittee as you consider your 
priorities this Congress. This subcommittee has perhaps a more 
important role than almost any other. The work this 
Subcommittee does this Congress will be pivotal in addressing 
the greatest existential threat to life on Earth, the climate 
crisis.
    I appreciate your leadership and dedication in addressing 
this crisis head-on. I have been encouraged by the Committee's 
work to hold this administration and the EPA accountable for 
upholding existing climate policies, including the CAFE 
Standards. I also thank Chairman Tonko for his work developing 
his climate principles--an integral first step toward finding 
consensus within our caucus and across this chamber and I 
believe the document lays out many important ideas currently 
missing from conversations regarding climate policy.
    If we are going to address the climate crisis, we must 
acknowledge certain facts that are politically difficult, but 
that must guide the course of action we take.
    The first is that the climate crisis is an urgent one. 
Regardless of what many of my colleagues may think, we do not 
have time to debate settled science, and we cannot avoid this 
issue. The climate crisis is here. The climate crisis is now. 
And every day we fail to act, the consequences of our inaction 
become more costly and more dire. Future generations of 
Americans, and those from across the globe, will remember how 
each of us responded now. It is up to us to put aside partisan 
disagreements and act as quickly as this body can possibly act.
    But that does not mean that the problem at hand is not a 
complex one. It is. And it requires a complex solution. Any 
actions we take to address the climate crisis that is not 
predicated on this fact, will not be successful in the long 
run. We cannot allow ourselves to become deluded into thinking 
that because the problem is urgent, any action will solve the 
problem.
    We cannot simply issue edicts from on high. We cannot shy 
away from expertise. And we cannot act with the purpose of 
scoring easy political points. These things may make us feel 
good but do so at our own peril. The urgency of this crisis 
demands we act with seriousness, determination, and in a 
measured and deliberative manner. In essence, to best address 
the climate crisis, I'd urge this committee to unleash the 
nerds.
    This also means that the solutions to the climate crisis 
may not be exciting, sexy, or ready-made for primetime news 
headlines. Many of the solutions are already known. And many 
solutions are low-hanging fruit that we could enact tomorrow. 
But that's a good thing and a great opportunity.
    Some of these solutions build upon policies that are 
already working. For example, while CAFE Standards have helped 
increase the average fuel economy of our light-duty vehicle 
fleet, this committee should consider other policies like a 
feebates program that could build upon this success by 
rewarding consumers who buy more efficient, cleaner vehicles. 
The committee should also consider complementary policies to 
help get less efficient vehicles off the road--such as a cash 
for clunkers program.
    Other climate policies have broad bipartisan support. For 
instance, members of both parties have agreed that we should 
prioritize the deployment and development of grid-scale energy 
storage technologies. These technologies will not only lower 
electricity costs for consumers but will make our grid more 
resilient and efficient, all while lowering greenhouse gas 
emissions. That is why I was proud to introduce H.R. 2909, the 
bipartisan and bicameral Promoting Grid Storage Act, alongside 
many members of the Energy and Commerce Committee. I'd urge the 
committee to take up and pass this measure.
    Other solutions require we look back at existing laws with 
renewed scrutiny for how they have worked in practice. The 
Federal Power Act, for instance, makes clear that FERC should 
ensure that electricity rates are just and reasonable--and yet 
rates across the country fail to account for the devastating 
impacts and high costs of carbon pollution. While FERC has been 
hesitant to act to address this massive externality because 
some there believe they do not have the authority. This cannot 
be what Congress intended. And we should say so. Loudly.
    Of course, economy-wide measures should be undertaken to 
address the full scope of this issue. Preferably, these 
policies will embrace the principle of technology-neutrality 
and will resist the well-intentioned but misplaced dual urges 
to either craft a plan that pleases all but does little or the 
urge to reject any good plan in search of perfection. We cannot 
wait for perfect. We cannot please everyone. We need climate 
action. We need it now.
    Not all of the solutions I have mentioned today fall solely 
within the jurisdiction of this subcommittee or even the Energy 
and Commerce Committee as a whole. Yet, each illustrates the 
kinds of tasks we must be willing to take on if we are going to 
address the climate crisis. This task is urgent. This task is 
complex.
    I hope the committee will consider some of the proposals I 
have mentioned here today. And I look forward to working with 
any of you in any way I can to combat this crisis. Chairman 
Tonko, thank you again for having me here today and thank you 
all for your leadership.

    Mr. Pallone. Thank you, Mr. Casten.
    It's hard for me not to ask you questions because you 
raised a lot of points but I've got to move on. So thanks 
again. Appreciate it.
    Now, the way that--the way this is set up Ms. Slotkin 
should be next. But I am told, Mr. Levin, you have a markup 
that is occurring right now?
    Mr. Levin of California. Yes, sir.
    Mr. Pallone. Would you mind, Ms. Slotkin, if we let him go 
back to his markup and then we will go to you? It's OK? All 
right.
    Go ahead, Mr. Levin.

   OPENING STATEMENT OF HON. MIKE LEVIN, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    Mr. Mike Levin. Thank you, Mr. Chairman. I very much 
appreciate the opportunity to be here. Thank you to all my 
colleagues and friends who are on this committee. Some of the 
top priorities that I hear about from my constituents in 
southern California are issues that come before this committee 
so I am grateful for the opportunity to raise their voices here 
today.
    One of those priorities that I hear about from my 
constituents is the need to move the spent nuclear fuel in our 
district at the San Onofre Nuclear Generating Station to a site 
that is not surrounded by millions of people, threatened by sea 
level rise, and located near active earthquake faults.
    It's critical that the Federal Government establish a 
consolidated interim storage, or CIS, facility for this waste 
and other spent nuclear fuel across the country.
    I strongly endorse Congresswoman Matsui's Store Nuclear 
Fuel Act, which would authorize the Department of Energy to 
take title to spent nuclear fuel in order to store it at a CIS 
facility.
    I have also introduced common sense legislation that would 
prioritize sites like San Onofre that are in locations with 
high population density and high seismic risk.
    My constituents are concerned for their safety and it is 
long past time that we start moving this waste to a safer 
location. I urge the committee to prioritize this pressing 
issue and I thank my colleagues who are equally concerned.
    Another issue that I hear about from my constituents is the 
climate crisis and we need to take aggressive action that is 
commensurate with the scale of the challenge we face.
    The science is clear. Climate change will have increasingly 
devastating effects on our plant if we do not make significant 
changes to the way we live.
    I am grateful to Chairman Pallone and my friend, Chairman 
Tonko, for your continued leadership on this issue and I look 
forward to working with you for a long time to come.
    I am also proud to have introduced legislation that 
presents an ambitious plan for transitioning auto sales in the 
United States to zero emissions.
    We have got to position the United States to lead the world 
in clean energy and that includes clean vehicles. I encourage 
all of my colleagues to support the Zero Emission Vehicles Act 
of 2019.
    I stand ready to work with anyone on either side of the 
aisle who is serious about combating the climate crisis and I 
look forward to supporting climate legislation that comes from 
this committee and I am very grateful for all the work that you 
are doing.
    Lastly, I hear from constituents often about the need to 
lower healthcare costs and expand access to affordable care 
that covers people with preexisting conditions.
    Nobody I talk to supports this administration's efforts in 
the courts to destroy the Affordable Care Act and rip insurance 
from millions of families.
    Thank you to Chairs Pallone and Eshoo for working to defend 
the Affordable Care Act and lower drug prices. I believe that 
as we defend the ACA we must also work together to improve our 
healthcare system to achieve universal coverage.
    We must also do more to address the substance abuse crisis 
plaguing our country and that must include measures to address 
problems with the addiction, treatment, and recovery system.
    Many facilities do amazing work but there are outliers that 
do not. It's abhorrent that some treatment centers and recovery 
housing operators engage in bad practices at the expense of 
vulnerable patients and residents.
    This includes deceptive marketing techniques, depriving 
individuals of needed medication, failing to monitor those who 
are suicidal or in withdrawal, and evicting vulnerable 
residents out on the street.
    I hope this committee will join me in closely monitoring 
the development of recovery housing guidelines at the Substance 
Abuse and Mental Health Administration to ensure a robust 
framework.
    Additionally, as the committee considers legislation 
regarding substance abuse disorder, I hope that you will 
consider ways that we can assist states in their enforcement 
efforts with an eye towards stronger oversight and 
accountability so that those in need actually receive the help 
they deserve and are not taken advantage of.
    I appreciate the amazing work of this committee in tackling 
a wide range of issues--the widest range of any committee--and 
I thank all of my colleagues for their dedication to address 
the challenges that I've highlighted today.
    Thank you, Mr. Chairman.
    [The prepared statement of Mr. Mike Levin of California 
follows:]

                 Prepared Statement of Hon. Mike Levin

    Thank you, Chairman Pallone, for the opportunity to testify 
today. Some of the top priorities that I hear about from my 
constituents in Southern California are issues that come before 
this committee, so I am grateful for the opportunity to raise 
their voices here today.
    One of those priorities that I hear about from my 
constituents is the need to move the spent nuclear fuel at the 
San Onofre Nuclear Generating Station to a site that is not 
surrounded by millions of people, threatened by sea level rise, 
and located near active earthquake faults. It is critical that 
the Federal Government establish consolidated interim storage, 
or CIS, facilities for this waste and other spent nuclear fuel 
across the country. I strongly endorse Congresswoman Matsui's 
STORE Nuclear Fuel Act, which would authorize the Department of 
Energy to take title to spent nuclear fuel in order to store it 
at a CIS facility. I have also introduced common sense 
legislation that would prioritize sites like San Onofre that 
are in locations with high population density and high seismic 
risk. My constituents are concerned for their safety, and it is 
long past time that we start moving this waste to a safer 
location. I urge the committee to prioritize this pressing 
issue.
    Another issue that I hear about from my constituents is the 
climate crisis, and our need to take aggressive action that is 
commensurate with the scale of the challenge we face. The 
science is clear: climate change will have increasingly 
devastating effects on our planet if we do not make significant 
changes to the way we live. I am grateful to Chairman Pallone 
and Congressman Tonko for your leadership on this crisis, and I 
look forward to working with you on this issue. I am proud to 
have introduced legislation that presents an ambitious plan for 
transitioning auto sales in the United States to zero-emission 
vehicles. We must position the United States to lead the world 
in clean vehicle innovation. I urge all of my colleagues to 
support the Zero-Emission Vehicles Act of 2019. I stand ready 
to work with anyone who is serious about combating the climate 
crisis on either side of the aisle, and I look forward to 
supporting climate legislation that this committee considers.
    Lastly, I hear from constituents often about the need to 
lower healthcare costs and expand access to affordable care 
that covers people with pre-existing conditions. Nobody I talk 
to supports this Administration's efforts in the courts to 
destroy the Affordable Care Act and rip insurance from millions 
of families. Thank you to Chairs Pallone and Eshoo for working 
to defend the Affordable Care Act and lower drug prices. I 
believe that as we defend the ACA, we must also work together 
to improve our healthcare system to achieve universal coverage.
    We must also do more to address the substance abuse crisis 
plaguing our country, and that must include measures to address 
problems with the addiction treatment and recovery system. Many 
facilities do amazing work, but there are outliers that do not. 
It is abhorrent that some treatment centers and recovery 
housing operators engage in bad practices at the expense of 
vulnerable patients and residents. This includes deceptive 
marketing techniques, depriving individuals of needed 
medication, failing to monitor those who are suicidal or in 
withdrawal, and evicting vulnerable residents out on the 
street. I hope this committee will join me in closely 
monitoring the development of recovery housing guidelines at 
the Substance Abuse and Mental Health Administration to ensure 
a robust framework. Additionally, as the committee considers 
legislation regarding substance abuse disorder, I hope that it 
will consider ways we can assist states in their enforcement 
efforts with an eye towards stronger oversight and 
accountability so that those in need actually receive the help 
they deserve and are not taken advantage of.
    I appreciate the amazing work of this committee in tackling 
a wide range of issues, and I thank all of my colleagues for 
their dedication to addressing the challenges I've highlighted 
today.

    Mr. Pallone. Thank you. And, again, I would like to ask you 
some questions but we are running out of time. So thanks for 
coming.
    Thank you, Ms. Slotkin, for bearing with us.
    Mr. Burgess. Mr. Chairman?
    Mr. Chairman, may I just say something on the--on the 
recovery centers? Because it is important and we spent some 
time on that, as you know, in the last Congress in developing 
the SUPPORT Act.
    And I do think that is important and, of course, we had 
really an oversight but it was a hearing on the implementation 
of CURES because we had a large mental health title in the 
CURES initiative and we had SAMHSA here. Unfortunately, that 
hearing kind of got sidetracked on some other issues.
    But I would just agree that that is an important topic and 
we should be in the lead on that and asking SAMHSA what is 
the--what is the current state of--in the Oversight and 
Investigations Subcommittee we heard some really tough stories 
about some of the things that were happening in the recovery 
centers.
    We need to be on top of that. We are pumping a lot of money 
into that. A lot of grants are being made available. We need to 
make sure we are not hurting people in the process.
    Mr. Pallone. Thank you. Thank you, Dr. Burgess, and thank 
you, Mike.
    Ms. Slotkin?

 OPENING STATEMENT OF HON. ELISSA SLOTKIN, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF MICHIGAN

    Ms. Slotkin. Thank you, Chairman Pallone and Ranking 
Member, for the opportunity to testify today on something that 
is a scourge. I know we are all dealing with it--robocalls.
    If you are like me and like most Michiganders, you hate 
these calls and whether you're a Democrat, a Republican, and 
Independent, I think they drive everybody equally crazy.
    Everyone has a story about robocalls. I have two. They both 
relate to the same time period right after I got elected. I 
went in to meet one of the mayors of our towns, Rochester, 
Michigan--a wonderful guy named Rob Ray--and it was our first 
in call and I thought--I wasn't even sworn in--I thought he was 
going to tell me about all the grants he needs and all the 
information he wanted and I was ready for a bunch of asks.
    And I said, you know, if I could do one thing when I go to 
Congress what would it be, and he said stop the dang robocalls. 
And then I came to Congress and I was given a cell phone, 
right. We are all given phones when we become Members of 
Congress.
    I cannot answer that phone because I am constantly getting 
robocalls. So I'll see a number. I am sure, like most people 
here, you'll see a number. It's pretty similar to your number. 
You think is that someone calling with something important--
congressional business. I cannot answer my phone. Let it all go 
to Voicemail because of the robocalls.
    So I am particularly energized on this issue. Let me just 
give you some specifics. Michigan last year alone we had 1.2 
billion robocalls made to us. Maybe because we are a swing 
state it's even worse. We are estimating that already this year 
784 million robocalls have been made. It is getting worse.
    A year ago we were--we were at a certain terrible number. 
We are now up 143 percent in one year, and it's important to 
note that it isn't just an annoyance that we all share.
    Most of these calls are calling with some sort of scam, 
right. They are looking for your money. They are looking to 
lure you into something. Americans lost about $10.5 billion due 
to robocall scams last year. They prey on the most vulnerable, 
particularly the elderly.
    We know that they use the number spoofing so it looks 
really close to your number. You think it's someone calling 
from your neighborhood, someone calling who knows you. But it 
does cause serious problems in our communities and many people 
are like me. They don't--actually don't answer the calls 
anymore.
    So if something came in--a hospital, some emergency 
happened--how many of us would let that call go to voicemail? 
And I just--I think it's--it is pesky but it also is important.
    So the good news is I co-sponsored the Stopping Bad 
Robocalls Act. It was a bill that was introduced in this 
committee and I co-sponsored it. It passed the House yesterday. 
I am thrilled about that.
    It is a really important first step to stemming the scourge 
of robocalls. I am really hoping the Senate takes it up but I 
would urge your help in making sure that in this day and age 
some of these things that are very bipartisan actually get 
through.
    Please keep your foot on the gas on this. And I know there 
is a number of pending pieces of legislation you're also 
looking at around these issues. I urge you to take them up.
    This is something that affects all of our constituents in 
their daily lives. In an era when sometimes people feel like 
government can't get anything done, I think this would be a 
huge positive step that we are actually still working up here. 
So thank you very much, Mr. Chairman.
    [The prepared statement of Ms. Slotkin follows:]

               Prepared Statement of Hon. Elissa Slotkin

    Thank you Mr. Pallone for the opportunity to testify before 
you today.
    Mr. Pallone, if you're like me, and if you're like most 
Michiganders, you hate getting robocalls.
    Certainly in Michigan, whether you're a Democrat or 
Republican, this is an issue that unites us all in shared 
frustration.
    In fact, shortly after I was elected, I had a meeting with 
a local, Republican mayor in our district, and asked him what 
was one thing I should be sure to work on in Congress.
    I expected him to talk about a particular grant, or maybe 
roads or water--but he said, ``robocalls,'' and we spent a long 
time that day talking about just how pervasive this issue is in 
our community, and what Congress can do it about.
    Let me tell you a bit about how this issue is affecting us 
in Michigan specifically: Last year alone, an estimated 1.2 
billion robocalls were made to people who live in Michigan. 
Experts are estimating that, already in 2019 Michiganders have 
already received over 784 million robocalls.
    It feels like they're getting worse--and they are: the 
number of robocalls in Michigan has already gone up 143% since 
this time last year.
    It's important to note that this problem is more than just 
a daily annoyance--these calls are scamming consumers out of 
their moneyand stealing personal information.
    Americans lost an estimated $10.5 billion dollars this year 
due to robocall scams. These scammers prey on the most 
vulnerable among us, particularly seniors.
    We also know that scammers use ``number spoofing'' to make 
it look like they're calling from a local number.
    This causes serious problems in our communities as people 
have begun ignoring calls they don't recognize from their same 
area code.
    This can have serious ramifications when you think about 
healthcare professionals, business-owners, parents,
    Clearly, this problem is pervasive and serious. Everywhere 
I go in Michigan's 8th district, I get the question, ``by the 
way, is there anything you can do about those pesky 
robocalls?''
    The good news is that we can.
    I was proud to see the Stopping Bad Robocalls Act, a bill 
that was introduced in this committee and which I co-sponsored, 
pass in the House yesterday.
    This bill is a really important first step to stemming the 
scourge of robocalls, and I sincerely hope the Senate takes it 
up.
    And I am here today to say: let's keep our foot on the gas. 
I want to encourage this committee to take up the pending 
legislation you are considering on this topic, so that we can 
put an end to these bothersome and threatening robocalls.
    This is an issue that has broad bipartisan support, and 
directly responds to a pervasive issue that affects our 
constituents' daily lives.
    That is our duty as Members of Congress, and I'm glad that 
we get to do it on an issue where there is such strong demand 
from our constituents.
    Thank you.

    Mr. Pallone. And I appreciate your emphasis on the 
robocalls bill that passed yesterday. We will keep our foot on 
the gas. There is a Senate equivalent. It's not exactly the 
same.
    But we are working with the Senate and we think we can get 
this done. So thanks so much. Appreciate it.
    Ms. Slotkin. Great. Thank you, Mr. Chairman.
    And now we go to Mr. Perry.

  OPENING STATEMENT OF HON. SCOTT PERRY, A REPRESENTATIVE IN 
         CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA

    Mr. Perry. Thank you, Chairman Pallone and Ranking Member 
Shimkus, members of the committee and staff. I appreciate the 
opportunity to testify this morning regarding some of my 
priorities within the committee's jurisdiction.
    As the focus of the nation's energy policy has shifted in 
recent years towards reducing greenhouse gas emissions, the 
policies pursued have increasingly been to the benefit of the 
wealthy and politically connected at the expense of the 
American people.
    The Solyndra scandal, the various environmental tax credits 
that go to most--that go almost exclusively to wealthy 
individuals, the regulatory effort, and the last administration 
at the behest of the environmental organizations intent to 
eliminate the coal industry, et cetera.
    Not only do these regressive policies have an outsized 
impact on the most vulnerable among us, they have significantly 
degraded the American people's trust in their government.
    Yesterday's Environment and Climate Change Subcommittee 
hearing entitled ``Building America's Clean Future: Pathways to 
Decarbonizing the Economy'' was the next step in this 
disturbing trend.
    Giving legitimacy to the fringe ``keep it in the ground'' 
movement--that is what that did. The proposed ideas would have 
crippling effects on the bottom line of each and every one of 
our constituents while having little to no impact on global 
greenhouse gas emissions.
    Despite the usual platitudes about just transitions for 
affected workers or environmental justice and the like, there 
was no real answer to how destroying the economic driver of my 
home state of Pennsylvania as well as numerous others could be 
done in a just manner.
    Little explanation of how these climate actions would be 
and could be tailored in a way to create economic opportunity 
for low-income communities and even less evidence was presented 
showing that this would work.
    Similar environmental policies are currently being pursued 
in the state of California and these same promises were made to 
low-income Californians.
    The result? According to a study by the Center for 
Demographics and Policy at Chapman University, and I'll read, 
``In summary, the imposition by the state's Democratic Party 
leaders of highly regressive climate schemes have engendered 
disparate financial hardships on middle- and lower- income 
workers and minority communities while providing direct 
economic subsidies to wealthier Californians in 
environmentalist strongholds,'' end quote.
    In light of these findings, I think it's imperative that 
the conversation shifts from an all-out attempt to destroy 
entire industries to a more productive conversation about the 
impact of such actions on the financial wellbeing of our 
constituents as well as the massive restrictions on personal 
freedoms required by this type of policy.
    If the majority is dead set on imposing onerous 
restrictions on reliable sources of energy, the least it can do 
is try to blunt the negative impacts to the American people. 
Yet, in many cases, mitigating efforts are being stalled either 
through overt action by this committee or a failure to act.
    Continuing to prioritize the development of intermittent 
renewable sources through subsidies and incentives comes at the 
expense of baseload power operators, many of whom have closed 
their doors.
    This government intrusion into the market is unhelpful and 
actually increases emissions where nuclear plants close. The 
issues of intermittence, frequency, cost effectiveness, supply 
chain security and integrity, and land use requirements' impact 
on endangered species and environmental degradation is 
conveniently left out of the conversation about wind, solar, 
and battery storage.
    However, these are very real issues and need to be 
addressed before any attempts to decarbonize the economy are 
pursued.
    In the meantime, if the committee wants to take actions 
that will result in increased renewable generation, not just 
capacity, it should move forward with the efforts to remove the 
regulatory burdens inhibiting the further development of the 
only baseload renewable power source, hydropower.
    Federally imposed regulatory burdens leave hydropower 
projects with the longest and most complex development time 
lines of any renewable technology, often in excess of 10 years, 
while wind and solar can easily go from concept to development 
in two to three years.
    This disparate treatment of the only baseload renewable 
source is nonsensical and significantly undermines any 
regulatory framework aimed at lowering greenhouse gases as it 
drives private capital away from hydropower projects. These 
burdens are a major limiting factor on the ability of the 
industry to expand its footprint.
    Currently, only three percent--only three percent of the 
80,000 dams in the United States generate electricity so there 
is a significant potential growth in the industry if these 
burdens are lessened or removed.
    Despite the significant regulatory burden on hydropower and 
the preferential tax treatment received by wind and solar 
projects, hydropower still accounted for 52 percent of all 
domestic renewable generation in 2018.
    This is both a testament to hydropower's reliability and a 
damning indictment of wind and solar power. The playing field 
could not be more favorable for wind and solar and yet, 
combined, they don't make up a majority of generation.
    And I'll close with this. Rather than pursuing a policy to 
replace working power generation with one that can continues to 
fail in the most favorable of market environments, we should be 
leveling the playing field and allowing the free market to 
drive down prices and clean up the environment has it has for 
the past century.
    And with that, I thank the committee and I yield.
    [The prepared statement of Mr. Perry follows:]

                 Prepared Statement of Hon. Scott Perry

    Chairman Pallone and Ranking Member Walden, I'd like to 
thank the Energy and Commerce Committee for the opportunity to 
testify this morning regarding my priorities within the 
committee's jurisdiction. As the focus of the nation's energy 
policy has shifted in recent years toward reducing greenhouse 
gas emissions; the policies pursued have increasingly been to 
the benefit of the wealthy and politically connected at the 
expense of the American people--the Solyndra scandal, the 
various ``environmental'' tax credits that go almost 
exclusively to wealthy individuals, the regulatory effort under 
the last administration at the behest of environmental 
organizations intended to eliminate the coal industry, etc. Not 
only do these regressive policies have an outsized impact on 
the most vulnerable among us, but they have significantly 
degraded the American people's trust in their government.
    Yesterday's Environment and Climate Change Subcommittee 
hearing entitled, ``Building America's Clean Future: Pathways 
to Decarbonize the Economy'' was the next step in this 
disturbing trend; giving legitimacy to the fringe ``keep it in 
the ground'' movement. The proposed ideas would have crippling 
effects on the bottom line of each and every one of our 
constituents while having little to no impact on global 
greenhouse gas emissions. Despite the usual platitudes about 
``just transitions for affected workers, environmental 
justice'', and the like, there was no real answer to how 
destroying the economic driver of my home state of Pennsylvania 
as well as numerous others could be done in a ``just'' manner. 
Little explanation of how these climate actions could be 
tailored in a way to create economic opportunity for low-income 
communities and even less evidence was presented showing that 
this would work.
    Similar environmental policies are currently being pursued 
in the state of California and these same promises were made to 
low-income Californians. The result, according to a study by 
the Center for Demographics and Policy at Chapman University:
    ``In summary, the imposition by the state's Democratic 
party leaders of highly regressive climate schemes have 
engendered disparate financial hardships on middle and lower 
income workers and minority communities, while providing direct 
economic subsidies to wealthier Californians in 
environmentalist strongholds.''
    In light of these findings, I think it is imperative that 
the conversation shifts from an all-out attempt to destroy 
entire industries to a more productive conversation about the 
impact of such actions on the financial well-being of our 
constituents as well as the massive restrictions on personal 
freedoms required by this type of policy.
    If the Majority is dead-set on imposing onerous 
restrictions on reliable sources of energy, the least it can do 
is try to blunt the negative impacts to the American people. 
Yet, in many cases, mitigating efforts are being stalled either 
through overt action by this committee or a failure to act. 
Continuing to prioritize the development of intermittent 
renewable sources through subsidies and incentives comes at the 
expense of baseload power operators; many of whom have closed 
their doors. This government intrusion into the market is 
unhelpful and actually increases emissions where nuclear plants 
close. The issues of intermittency, frequency, cost-
effectiveness, supply-chain security and integrity, land use 
requirements, impact on endangered species and environmental 
degradation is conveniently left out of the conversation about 
wind, solar, and battery storage. However, these are very real 
issues and need to be addressed before any attempts to 
``decarbonize'' the economy are pursued.
    In the meantime, if the committee wants to take actions 
that will result in increased renewable generation, not just 
capacity, it should move forward with efforts to remove the 
regulatory burdens inhibiting the further development of the 
only baseload renewable power source; hydropower. Federally 
imposed regulatory burdens leave hydropower projects with the 
longest and most complex development timeline of any renewable 
technology, often in excess of 10 years while wind and solar 
can easily go from concept to development in two to three 
years.
    This disparate treatment of the only baseload renewable 
source is nonsensical and significantly undermines any 
regulatory framework aimed at lowering greenhouse gases as it 
drives private capital away from hydropower projects. These 
burdens are a major limiting factor on the ability of the 
industry to expand its footprint. Currently, only three percent 
of the 80,000 dams in the U.S. generate electricity so there is 
significant potential growth in the industry if these burdens 
are lessened or removed. Despite this significant regulatory 
burden on hydropower and the preferential tax treatment 
received by wind and solar projects, hydropower accounted for 
52 percent of all domestic renewable generation in 2018. This 
is both a testament to hydropower's reliability and a damning 
indictment of wind and solar power. The playing field could not 
be more favorable for wind and solar and yet, combined they 
don't make up the majority of generation.
    Rather than pursuing a policy to replace working power 
generation with one that continues to fail in the most 
favorable of market environments, we should be leveling the 
playing field and allowing the free market to drive down prices 
and clean up the environment; as it has for the past century.

    Mr. Pallone. I thank the gentleman.
    Dr. Burgess, did you want to make a point?
    Mr. Burgess. Yes. It was this committee, after all, that 
did pass the Energy Policy Act of 2005 when Joe Barton was 
chairman and part of that was loans for the development of 
nuclear electricity or nuclear power.
    And, unfortunately, since then we haven't done much with 
that. In fact, the loans have been changed through subsequent 
administrations and gone to projects that actually haven't 
really delivered very much in the way of energy as they were 
diverted to renewable energy.
    I really don't think you can seriously talk about a zero 
carbon future regardless of the time frame if you do not 
include nuclear energy as part of your baseload, and this 
committee should remember that.
    So I thank you for bringing it back to our attention.
    Mr. Pallone. And I don't want to belabor the point because 
I know we have got to move on. But we really stressed yesterday 
at the hearing that, you know, we were technology neutral.
    We are not, you know, saying that this is all--this goal is 
reached just with renewables. Hydropower is important. We 
certainly want to include nuclear, carbon capture. You know, so 
I don't want you to think that we are just saying that this 
goal has to be reached just with renewables.
    But I know we have got to move on. So thanks again.
    Next is--oh, yes, the gentlewoman from New Mexico. And I 
did want to mention, because I know you're--you and your 
colleague from Kansas, right, are the first American Indian or 
Native American women--Congresswomen.
    You may not even mention it but we are determined that in 
the fall we will have a hearing on the Native--on the Indian 
Health Care Improvement Act because I know that that's a 
commitment that I made and I just wanted to mention it to you.
    Ms. Haaland. Thank you. Thank you, Chairman.
    Mr. Pallone. So thank you.
    Ms. Haaland. Thank you.

 OPENING STATEMENT OF HON. DEBRA HAALAND, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF NEW MEXICO

    Chairman, ranking member, members of the committee, thank 
you for the opportunity to testify.
    My district has over 300 days of sunshine each year and 
abundant wind resources. That's why I am working with several 
of my colleagues on legislation to set a nationwide goal of 100 
percent clean energy economy by 2050.
    Thank you, Chairman Tonko, for being part of this effort. 
This will protect public health and our environment, create 
millions of jobs, and mitigate the impacts of climate change 
for all communities and all generations, especially those 
disproportionately impacted.
    I urge the committee to support this effort broadly and 
through intermediate steps that will enable the transition to 
clean energy.
    The transition to clean energy requires a modernized smart 
electric grid to increase integration of renewable energy and 
support adoption of zero emission vehicles.
    I urge you to encourage deployment of smart meters and 
other technologies which make our electric grid more responsive 
and capable of supporting distributed energy resources.
    I recommend improving the performance, affordability, and 
deployment of energy storage systems to enhance grid 
flexibility and reliability, and expanding advanced 
transmission technologies to get power to demand centers more 
efficiently.
    Improving energy efficiency and transitioning from fossil 
fuels to electricity are keys to a clean energy future. I urge 
you to increase energy efficiency in new and existing public 
and private housing, and provide incentives to implement energy 
efficiency retrofits in public buildings.
    I also recommend that you help homeowners shift from gas-
powered appliances to electric, expand consumer choices for 
power consumption and production, and support the development 
and integration of new technologies such as advanced insulation 
windows, HVAC systems, and lighting.
    It's essential to make these measures affordable for low-
income families by providing grants to utilities to make energy 
efficient upgrades accessible to these communities while also 
providing direct assistance to individual families and Indian 
tribes.
    The Federal Government can also reduce our impact on the 
climate and environment by providing grants to communities to 
build recycling and composting facilities and promote waste 
prevention.
    Composting reduces greenhouse gas emissions from landfills 
and incinerators, returns carbon to the ground, and reduces the 
need for chemical fertilizers. These investments can help us 
move toward a national goal of zero waste.
    As chair of the Native American Caucus, I am working to 
address the federal neglect and under investment in Indian 
Country.
    One of the most pressing needs is broadband service in 
tribal and rural areas and, of course, that is a necessary 
addition for family farms across the country.
    The FCC reports that 92 percent of Americans have access to 
high-speed internet compared to 65 percent of Indian Country, 
more comparable to a developing country than the world's most 
prosperous nation.
    The federal government is creating new digital reservations 
for Native Americans, leaving Indian Country to fall farther 
and farther behind.
    As you work on broadband policy, I urge the committee to 
pay particular attention to the needs and challenges in Indian 
County and rural America, which not only include education and 
healthcare but also public safety and which includes remedies 
to the crisis of missing and murdered indigenous women.
    American Indian and Alaska Native communities also face a 
maternal mortality crisis. According to the U.S. Commission on 
Civil Rights' ``Broken Promises'' report, Native American women 
are 4.5 times more likely than non-Hispanic white women to die 
while pregnant or within 42 days post-partum.
    To address this crisis, I joined Congresswomen Gwen Moore 
and Debbie Dingell to introduce the Mamas First Act. I urge the 
committee to support this bill that would allow Medicaid 
reimbursements for doulas and midwives to combat maternal 
mortality among the nearly two million on Medicaid giving birth 
each year.
    I thank you so much for the opportunity to address you this 
morning.
    Thank you, Chairman.
    [The prepared statement of Ms. Haaland follows:]

                Prepared Statement of Hon. Debra Haaland

    Chairman Rush, Ranking Member Upton, members of the 
committee, thank you for the opportunity to testify.
    My district is blessed with over 300 days of sunshine each 
year and abundant wind resources. That is why I am working with 
several of my colleagues on legislation to set a nationwide 
goal of a 100 percent clean energy economy by 2050. This will 
protect public health and our environment; create millions of 
well-paying green jobs; and mitigate the impacts of climate 
change for all communities and all generations, especially 
those disproportionately impacted by its effects. I urge the 
committee to support this effort broadly and through 
intermediate steps that will enable the transition to clean 
energy.
    The transition to clean energy will require a modernized, 
smart electric grid to increase integration of renewable energy 
and support adoption of zero-emissions vehicles. I urge you to 
encourage deployment of ``smart'' meters and other 
technologies, which make our electric grid more responsive and 
capable of supporting distributed energy resources. I recommend 
improving the performance, affordability, and deployment of 
energy storage systems to enhance grid flexibility and 
reliability; and expanding advanced transmission technologies 
to get renewable power to demand centers more efficiently.
    Improving energy efficiency and transitioning from fossil 
fuels to electricity are keys to a clean energy future. I urge 
you to increase energy efficiency in new and existing public 
and private housing and provide incentives to implement energy 
efficiency retrofits in municipal buildings, hospitals, and 
schools. I also recommend that you help homeowners shift from 
gas-powered appliances to electric; expand consumer choices for 
power consumption and production; and support the development 
and integration of new technologies such as advanced 
insulation, windows, appliances, HVAC systems, and lighting. It 
is essential to make these measures affordable for low-income 
families by providing grants to utilities to make energy 
efficient upgrades accessible to low-income communities while 
also providing direct assistance to individual families and 
tribes.
    The Federal Government can also reduce our impact on the 
climate and environment by providing grants to communities to 
build recycling and composting facilities and promote waste 
prevention. Composting reduces greenhouse gas emissions from 
landfills and incinerators, returns carbon to the ground, and 
reduces the need for chemical fertilizers for crops. These 
investments can help us move toward a national goal of zero 
waste.
    As co-chair of the Native American Caucus, I am working to 
address the federal neglect and underinvestment in Indian 
Country. One of the most pressing needs is broadband service in 
tribal and other rural areas.
    The FCC reports that 92 percent of Americans are able to 
access high-speed internet compared to just 65 percent of 
Indian Country, more comparable to a developing country than 
the world's most prosperous nation. The Federal Government is 
creating new digital reservations for Native Americans, leaving 
Indian Country to fall further behind in the twenty-first 
century. As you work on broadband policy, I urge the committee 
to pay particular attention to the needs and challenges in 
Indian Country and rural America.
    American Indian and Alaska Native communities also face a 
maternal mortality crisis. According to the U.S. Commission on 
Civil Rights ``Broken Promises'' report, Native American women 
are 4.5 times more likely than non-Hispanic white women to die 
while pregnant or within 42 days post-partum. To address this 
crisis, I joined with Congresswomen Gwen Moore and Debbie 
Dingell to introduce the Mamas First Act. I urge the committee 
to support this bill that would allow Medicaid reimbursements 
for doulas and midwives to combat maternal mortality among the 
nearly two million on Medicaid giving birth each year.
    Thank you again for the opportunity to testify.

    Mr. Pallone. Thank you, and let me just say quickly, you 
know, part--last week when we did a full committee sort of 
marathon markup we had this energy efficiency package that has 
provisions for grants to communities and a lot of the things 
that you mentioned, and that is part of this LIFT America Act, 
which is sort of our infrastructure--our piece of an 
infrastructure bill if we ever get to one, you know, with the 
president and with the Senate, and that has $40 billion for 
expansion of broadband in underserved areas, and part of that 
was in reaction to mine and others visiting some of the 
reservations.
    I remember we went to the Gila River in Arizona and this is 
all they talked about was how, you know, so many of the tribes 
don't have access to the internet. So a lot of the ideas that 
you are including, you know, we want to move on. So thanks 
again. Appreciate it.
    Ms. Haaland. Thank you, Chairman. Thank you.
    Mr. Pallone. Thank you.
    And now we go to Congresswoman Shalala, who needs no 
introduction. So proud of the things that we did when you were 
the secretary and so progressive on so many things and working 
with this committee. Thanks for being here.

OPENING STATEMENT OF HON. DONNA E. SHALALA, A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF FLORIDA

    Ms. Shalala. Thank you, Chairman Pallone. Thank you very 
much.
    I, as you can imagine, had 25 things I wanted to talk to 
you about but I picked out three.
    This week we will celebrate the 29th anniversary of the 
signing of the Americans with Disabilities Act--the ADA. So I 
have come today to talk to those who often don't have a voice.
    This crucial landmark civil rights legislation prohibits 
discrimination against people with disabilities in all areas of 
public life, including at work, at school, and public 
accommodations.
    Last month was the 20th anniversary of the landmark 
Olmstead case. This case affirmed the rights of Americans with 
disabilities under the ADA to live independently and in their 
communities.
    Despite this recognition that the ADA prohibits the 
segregation of people with disabilities into institutions, 
integration has not yet been achieved. We have a lot more work 
to do.
    States have long wait lists for community services and many 
people with disabilities are not able to receive them. Many 
people with disabilities live in fear that their fundamental 
right to live in their communities, the communities that they 
love will be taken away from them and they will be forced into 
an institution.
    This must change and I am hopeful that this committee will 
consider in the coming months legislation to ensure that all 
people have the fundamental right to remain in their 
communities and in their homes.
    Earlier this year, Congressman Sensenbrenner introduced 
legislation called the Disability Integration Act, which would 
create a right to home and community-based services as an 
alternative to institutionalization.
    This bill is bipartisan, bicameral. I am the lead Democrat. 
It now has 234 co-sponsors in the House. I hope this committee 
will consider this critical legislation in this Congress.
    In a similar vein, it is my hope that the committee will 
consider H.R. 3215, the Disaster Relief Medicaid Act, which I 
introduced earlier this year with Congressman Langevin and 
Congresswomen Gonzalez-Colon and Holmes Norton.
    Natural disasters are occurring at increased rates across 
this country and in the aftermath of such disasters thousands 
of people are often forced to abandon their homes and relocate, 
often to a different state.
    After Hurricane Katrina over one million evacuees relocated 
to another state. More recently, after Hurricane Maria, between 
140,000 and 180,000 people left Puerto Rico. Many of them moved 
to Florida.
    The stress of moving after a natural disaster is immense, 
but it is even greater for individuals and families that are 
eligible for Medicaid healthcare and long-term services and 
supports.
    These are the most severely disabled people that we knew. 
The move from one's home state to a host state as a result of 
disaster can mean the loss of access to critical long-term 
services and supports.
    In this bill we fill a very important niche. You'll 
remember that after these disasters we often allocate money but 
it often takes months or even years for the money to reimburse 
the states.
    In this Act, the Disaster Relief Medicaid Act would ensure 
that individuals eligible for Medicaid who need these long-term 
services that are forced to relocate during a disaster that 
they are able to continue their Medicaid supported services.
    In other words, we would reimburse the states--the host 
states--at 100 percent for some period of time. So as Dr. 
Burgess will confirm, their services are seamless so they can 
go to the host state and get those long-term care services 
without the state having to absorb the costs.
    Between wildfires and floods and tornadoes and hurricanes, 
all of our constituents are threatened by natural disasters. No 
one should have to choose between evacuating and losing access 
to lifesaving services and staying and possibly losing their 
life to a natural disaster.
    Finally, I want to implore this committee to consider the 
critical issue of youth tobacco and e-cigarette usage. Many of 
us in this room have been working on this for decades.
    We have achieved one of the great public health 
achievements of both the last and this century. We have driven 
down the number of kids that are smoking, and I joined you, Mr. 
Chairman, in introducing the Reversing the Youth Tobacco 
Epidemic Act of 2019.
    We have made extraordinary progress in this area, and the 
FDA and CDC have now reported an alarming 78 percent increase 
in e-cigarette use by high school students.
    Something has to be done to combat youth use of e-cigarette 
products and our legislation would raise the age to buy tobacco 
products to 21, which now has bipartisan and bicameral support.
    It would also create a universal ban on flavors on all 
tobacco products and prohibit the marketing of e-cigarette 
products to people under the age of 21.
    This will be our second big public health accomplishment 
certainly of this century and it's very important to do, and I 
hope you'll be able to markup the bill in this session.
    Thank you very much.
    [The prepared statement of Ms. Shalala follows:]

              Prepared Statement of Hon. Donna E. Shalala

    Chairwoman Eshoo and Ranking Member Burgess, thank you for 
having me today. I would like to touch on a few things that are 
important to me and my district which I hope the committee will 
consider this Congress.

    Disability Integration Act

    This week we will celebrate the 29th anniversary of the 
signing of the Americans with Disabilities Act -the ADA. This 
landmark civil rights legislation prohibits discrimination 
against people with disabilities in all areas of public life, 
including at work, in school, and in public accommodations.
    And last month was the 20th anniversary of the Olmstead 
case. This case affirmed the rights of Americans with 
disabilities under the ADA to live independently and in their 
community-as most people want to do.
    Despite the Supreme Court recognizing that the ADA 
prohibits the segregation of people with disabilities into 
institutions-in practice this has not come to pass. More work 
needs to be done.
    States have long wait lists for community services and many 
people with disabilities are not able to receive them. Many 
people with disabilities live in fear that their fundamental 
right to live in the community that they love will be taken 
away from them and they will be forced into an institution.
    This must change. I am hopeful that this committee will 
consider in the coming months legislation to ensure a right to 
remain in your community.
    Congressman Sensenbrenner introduced legislation called the 
Disability Integration Act which would provide home and 
community-based services as an alternative to 
institutionalization. This bill is bipartisan and bicameral-I 
am the lead Democrat-and it now has 234 cosponsors.
    I hope this committee will consider this critical issue and 
legislation this Congress.

    Medicaid and Disasters

    In a similar vein, it is my hope that the committee will 
consider H.R. 3215, The Disaster Relief Medicaid Act which I 
introduced earlier this year with Congressman Langevin, 
Congresswomen Gonz lez-Colon and Holmes Norton.
    Natural disasters are occurring at increased rates across 
this country and in the aftermath of such disasters thousands 
of people are often forced to abandon their homes and relocate. 
It happened after Hurricane Katrina when over on million 
evacuees relocated to another state. More recently, after 
Hurricane Maria an estimated 140,000 to nearly 185,000 left the 
island-many of whom moved to Florida.
    The stress of moving after a natural disaster is immense, 
but it is even greater for individuals and families that are 
eligible for Medicaid healthcare and long-term services and 
supports. The move from one's home state to a host state as a 
result of a disaster can mean the loss of access to long-time 
services and supports.
    The Disaster Relief Medicaid Act would ensure that 
individuals eligible for Medicaid who are forced to relocate 
due to a disaster are able to continue to access their Medicaid 
supported services. It would also provide states with resources 
to support the Medicaid needs of individuals forced to relocate 
following a disaster.
    This legislation would designate an individual who resides 
in an area covered under a presidential disaster declaration as 
a Relief-Eligible Survivor and allow them to continue to access 
their Medicaid services if they are forced to relocate to 
another state as a result of the disaster.
    All of our constituents are threatened by natural 
disasters-whether it is a wildfire, a flood, a tornado or a 
hurricane. No one should have to choose between evacuating and 
losing access to lifesaving services and staying and possibly 
losing their life to a natural disaster.

    Tobacco

    I would also implore this committee to consider the 
critical issue of youth tobacco and e-cigarette usage.
    Recently, I joined Chairman Pallone in introducing the 
Reversing the Youth Tobacco Epidemic Act of 2019.
    The FDA and CDC have reported an alarming 78 percent 
increase in e-cigarette use by high school students and a 48 
percent increase among middle school students from 2017 to 
2018.
    Something must be done to combat the youth use of e-
cigarette products and to continue our longstanding public 
health battle against smoking and tobacco use.
    Our legislation would raise the age to buy tobacco products 
to 21-which now has bipartisan and bicameral support. It would 
also create a universal ban on flavors in all tobacco products 
and prohibit the marketing of e-cigarette products to people 
under the age of 21.
    Thank you for having me today and I look forward to working 
with the committee on these issues as well as a number of other 
issues that you have within in your jurisdiction.

    Mr. Pallone. Thank you. And again, as you know, I really 
value your expertise, you know, not only because you were the 
secretary but spent so much time over the years on so many of 
these health issues.
    With regard to the disabilities, it's really important that 
we do whatever we can to keep people in their homes and the 
community, not have them institutionalized. We will work--we 
will continue to work on that, and all your work on tobacco we 
appreciate.
    And I really appreciate too that you didn't just say, you 
know, we need to raise the age to 21. I know Senator Collins 
has been, you know, stressing that. But we need to address 
vaping and, you know, the flavored cigarettes and these other 
things.
    Ms. Shalala. Exactly. Clearly, the tobacco companies 
pivoted to find--to target youth again. So now we need to do 
another piece of legislation to prevent that, and the American 
people are right there with us.
    Mr. Pallone. Thank you.
    Dr. Burgess?
    Mr. Burgess. Well, Mr. Chairman, as you know, we took a 
bipartisan field hearing to Puerto Rico. It's been almost two 
years ago. I think it's appropriate to consider a follow-on to 
the island.
    Basically, we were concerned about electricity grid 
problems at the time but healthcare is, obviously, a big issue 
for the island and we ought to include that in a field hearing 
in the near future.
    Ms. Shalala. Thank you.
    Mr. Pallone. Thank you, Dr. Burgess, and thank you, 
Secretary Shalala. Appreciate it.
    Now, I just so I am told that, you know, we are trying to 
follow the order that we said when we asked people to come. So 
that's going to mean, what, that we have Congresswoman Meng 
next, Congressman Sablan, and then we are going to go to 
Chairman Roybal-Allard--the two together, I guess.
    So is that accurate? All right. We will go to Congresswoman 
Meng. Thank you.

   OPENING STATEMENT OF HON. GRACE MENG, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF NEW YORK

    Ms. Meng. Chairman Pallone, Ranking Member Walden, 
Chairwoman Eshoo and Ranking Member Burgess, and distinguished 
members of this committee, thank you for this opportunity to 
discuss several of my priorities as it pertains to the 
Subcommittee on Health but also more broadly across the full 
house committee.
    I sincerely ask this committee to move forward with the 
following bills and priorities.
    Protecting women and children from harmful chemicals is one 
of my top priorities. That is why I introduced a package of 
bills to ensure safeguards are in place to bolster consumer 
confidence that the products they purchase are safe for their 
loved ones.
    First, H.R. 2267, the Infant Formula Act, would prohibit 
the sale of expired baby formula. Although regulations require 
expiration dates to be placed on formula, federal law does not 
prohibit the sale of infant formula after its expiration has 
passed.
    I was shocked to learn that parents who unknowingly bought 
these expired formulas reported their infants being violently 
sick. Busy parents need to be able to rely on the safety of 
products, like formula, that they buy in grocery stores to make 
sure their newborns are well-fed and healthy.
    Second, H.R. 2268, the Menstrual Products Right To Know, 
would require companies to list ingredients in feminine hygiene 
products, such as scented and unscented pads, cups, scented and 
unscented tampons, and therapeutic douche apparatuses.
    We can easily see the ingredients used in the shampoo we 
put in our hair or in the foods that we eat. The same 
transparency requirements must apply to products that touch, or 
are inserted to, our most sensitive and absorbent parts of the 
body.
    Third, H.R. 2269, the Get Additives Out Act, would require 
a GAO report on the physical and behavioral health risks of 
food additives on children.
    The food additives and its effects are dramatically 
understudied, particularly on the impact on children as they 
enter critical stages of development.
    I am committed to ensuring more transparency in the foods 
that we eat and the foods that my boys eat.
    In the coming months, I will also be introducing 
legislation to address the Consumer Product Safety Commission's 
inability to effectively oversee recalls, particularly with 
products that threaten the safety of infants and children.
    The Britax jogging stroller recall rollout was a shameful 
fiasco with failed missteps and a clear abuse of consumers' 
trust. Sadly, this incident is not the exception, which is why 
I will tackle this issue head on.
    As the co-chair of the Congressional Hepatitis Caucus, I 
also recently introduced H. Res. 505, which recognized July 
28th as ``World Hepatitis Day.''
    This legislation also encourages people from across the 
world to take preventative action and urges greater 
partnerships between federal, state, and local health 
departments to eliminate new infections in the U.S.
    Another one of my priorities is to ensure access to 
affordable menstrual hygiene products. One might think these 
products are ubiquitous and cheap, but many women face 
difficulty when it comes to affording and accessing them.
    I know this because I have heard the heartbreaking 
testimonies from girls and women across our nation. That is why 
I introduced H.R. 1882, the Menstrual Equity for All Act, which 
is a comprehensive solution to ensuring this basic healthcare 
need for over 51 percent of the U.S. population.
    No girl should have to choose between their dignity or 
their education, no one should have to lose their dignity just 
because they are incarcerated, and no family should have to 
choose between buying these products or groceries.
    Additionally, I am deeply committed to the issue of our 
environment and its impact on the health of our constituents 
and their families. That is why, yesterday, I introduced the 
Safe Drinking Water in Playgrounds and Parks Act, which would 
ensure that states, schools, and municipalities have the 
necessary resources to replace drinking water fountains in 
those places.
    As you know, no amount of lead is safe for consumption, and 
if consumed, its effects are dangerous to children. 
Furthermore, aviation noise is a critical issue that impacts my 
district in Queens. That is why, as the founding member and 
former co-chair of the Quiet Skies Caucus, I introduced H.R. 
3001, the Quiet Communities Act.
    This bill would reestablish the Office of Noise Abatement 
and Control in the U.S. Environmental Protection Act. Chronic 
exposure to excessive noise can have short and long-term 
negative health impacts, including hearing loss, stress, high 
blood pressure, and diminished cognitive performance.
    Noise pollution is not just a minor inconvenience; it is a 
health issue that needs to be addressed.
    Thank you again to the subcommittee and the committee for 
allowing me to testify. I ardently hope that we can work 
together on the priorities I have set forth today.
    [The prepared statement of Ms. Meng follows:]

                 Prepared Statement of Hon. Grace Meng

    Chairman Pallone, Ranking Member Walden, Chairwoman Eshoo 
and Ranking Member Burgess, and distinguished members of this 
committee, thank you for this opportunity to discuss several of 
my priorities as it pertains to the Subcommittee on Health--but 
also more broadly across the Full House Committee on Energy and 
Commerce. I sincerely ask this committee move forward with the 
following bills and priorities.
    Protecting women and children from harmful chemicals is one 
of my top priorities. That is why, I introduced a package of 
bills to ensure safeguards are in place to bolster consumer 
confidence that the products they purchase are safe for their 
loved ones.
    First, H.R. 2267--the Infant Formula Act would prohibit the 
sale of expired baby formula. Although regulations require 
expiration dates to be placed on formula, federal law does not 
prohibit the sale of infant formula after its expiration has 
passed. I was shocked to learn that parents who unknowingly 
bought these expired formula reported their infants being so 
violently sick. Busy parents need to be able to rely on the 
safety of products, like formula, that they buy in grocery 
stores to make sure their newborns are well-fed and healthy.
    Second, H.R. 2268--the Menstrual Products Right To Know 
would require companies to list ingredients in feminine hygiene 
products, such as scented and unscented pads, cups, scented and 
unscented tampons, and therapeutic douche apparatuses. We can 
easily see the ingredients used in the shampoo we put in our 
hair, or in the foods that we eat; the same transparency 
requirements must apply to products that touch, or are inserted 
to, our most sensitive and absorbent parts of the body.
    Third, H.R. 2269--the Get Additives Out Act would require a 
GAO report on the physical and behavioral health risks of food 
additives on children. The food additives and its effects are 
dramatically under-studied, particularly on the impact on 
children as they enter critical stages of development. I am 
committed to ensuring more transparency in the foods that we 
eat--and the foods that my two boys eat.
    In the coming months, I will also be introducing 
legislation to address the Consumer Product Safety Commission's 
inability to effectively oversee recalls, particularly with 
products that threaten the safety of infants and children. The 
Britax jogging stroller recall rollout was a shameful fiasco 
with failed missteps and a clear abuse of consumers' trust. 
Sadly, this incident is not the exception, which is why I will 
tackle this issue head-on.
    As the co-chair of the Congressional Hepatitis Caucus, I 
also recently introduced H.Res.505--which recognizes July 28th 
as ``World Hepatitis Day.'' This legislation also encourages 
people from across the world to take preventative action, and 
urges greater partnerships between federal, state, and local 
health departments to eliminate new infections in the United 
States.
    Another one of my priorities is to ensure access to 
affordable menstrual hygiene products. One might think these 
products are ubiquitous and cheap, but many women face 
difficulty when it comes to affording and accessing them. I 
know this, because I have heard the heartbreaking testimonies 
from girls and women across our nation. That is why I 
introduced H.R. 1882--the Menstrual Equity for All Act, which 
is a comprehensive solution to ensuring this basic healthcare 
need for the 51 percent of the U.S. population. No girl should 
have to choose between their dignity or their education; no one 
should have to lose their dignity just because they are 
incarcerated; and no family should have to choose between 
buying these products or groceries.
    Additionally, I am deeply committed to the issue of our 
environment and its impact on the health of our constituents 
and their families. That is why, yesterday, I introduced the 
Safe Drinking Water in Playgrounds and Parks Act which would 
ensure that states, schools, and municipalities have the 
necessary resources to replace drinking water fountains in 
those places. As you know, no amount of lead is safe for 
consumption, and if consumed, its effects are dangerous to 
children.
    Furthermore, aviation noise is a critical issue that 
impacts my district of Queens. That is why, as the founding 
member and former co-chair of the Quiet Skies Caucus, I 
introduced H.R. 3001--the Quiet Communities Act. This bill 
would reestablish the Office of Noise Abatement and Control in 
the U.S. Environmental Protection Act. Chronic exposure to 
excessive noise can have short and long-term negative health 
impacts, including hearing loss, stress, high blood pressure, 
and diminished cognitive performance. Noise pollution is not 
just a minor inconvenience; it is a health issue that needs to 
be addressed.
    Thank you again to the subcommittee and the committee for 
allowing me to testify. I ardently hope that we can work 
together on the priorities I have set forth today.

    Mr. Pallone. Thank you, and we will certainly follow up on 
those bills. I am not surprised there is so much emphasis on 
kids when I see you, you know, taking those two boys around all 
the time. So thanks again.
    Did you--Mr. Griffith, go ahead.
    Mr. Griffith. Mr. Chairman, I do think we should probably 
take a look at the food additives and the impact they have on 
folks. I have a number of food additives that I avoid. So it's 
not just children, but children may not know what's going on. 
Usually I can, through elimination, figure out what's causing 
the reaction. But it's something we should probably take a look 
at.
    Mr. Pallone. Absolutely. All right.
    Thanks again, unless you wanted to say something else.
    Ms. Eshoo. I do.
    Mr. Pallone. Oh, I am sorry.
    Ms. Eshoo. That's all right.
    Mr. Pallone. The chairwoman of our Health Subcommittee, Ms. 
Eshoo.
    Ms. Eshoo. Thank you.
    I want to thank our colleagues that are at the witness 
table. I have to say it's refreshing to have other members 
that--members that are not on the committee come in and be with 
us.
    You have important ideas and what--in terms of the 
jurisdiction of my subcommittee, I am going to take your bills 
seriously. So this is not a waste of your time here.
    Grace, thank you for your work on Quiet Skies. My 
congressional district is practically turned inside out upside 
down by that new FAA program NextGen, and I don't know if other 
members realize this but the FAA there is no responsibility 
today for noise--no responsibility--and other health impacts. 
So I want to work with you on that.
    So thank you to each one of you. It's wonderful to see you. 
You're wonderful legislators. You're great friends and you're 
always welcome here.
    Mr. Pallone. Thank you, and as Chairwoman Eshoo said, you 
know, this Members Day is not just you come here and that's the 
end of it. Do not hesitate to contact us or have your staff 
contact our staff to follow up on these things that you 
mentioned, please.
    Thank you.
    Mr. Sablan, good to see you.
    Mr. Sablan. Good morning.
    Mr. Pallone. Good morning.
    Mr. Sablan. Good morning, Mr. Chairman.
    Mr. Pallone. Well, I guess it's the afternoon actually, but 
go ahead.
    [Laughter.]

OPENING STATEMENT OF HON. GREGORIO SABLAN, A REPRESENTATIVE IN 
       CONGRESS FROM THE TERRITORY OF THE MARIANA ISLANDS

    Mr. Sablan. OK. Well, I'd like to thank Chairs Pallone and 
Eshoo and to Ranking Members Walden and Burgess for the 
opportunity to provide testimony to the Health Subcommittee 
today and to the full committee actually, and thanks to all the 
members for reporting favorably the REACH Act last week.
    This health extenders package is good news for the Marianas 
and all the insular areas. It reauthorizes critically important 
Community Health Centers, of which the Marianas has one.
    Most importantly, it includes the Territories Health Care 
Improvement Act and addressing the Medicaid cliff the insular 
areas face when special Obamacare funding ends this year.
    Thanks also to Mr. Soto and Mr. Bilirakis of the committee 
for understanding the urgency of this insular Medicaid crisis. 
They put together the Territories Health Care Improvement Act 
with myself and seven other original bipartisan co-sponsors to 
give Puerto Rico the help it needs, and the bill also becomes 
the means to help the four insular areas.
    It provides just what the Marianas Medicaid director told 
this committee she needed--$60 million per year. No local match 
is required for the first two years, of which will allow the 
Marianas government to direct more money to help recover from 
last year's typhoons. And after six years, we will get the best 
FMAP that any state is currently offered.
    This legislation will make the insular Medicaid programs 
more state-like in other important ways. New program integrity 
requirements, which I support, assure that every federal dollar 
is used as intended.
    Having a better record of utilization, enrollment, and 
expenditures will allow for a greater understanding of the 
unique healthcare challenges the insular areas face and, I 
hope, provide a basis for the policy that comes after.
    Because, as grateful as we are that the Medicaid cliff is 
being addressed, and in a way that matches need, we know three 
things from experiences with the ACA's Medicaid fix.
    Time will pass quickly. The ACA fix lasted eight years. 
Then we had the present crisis. The current legislation will 
last for six years.
    Perhaps with the better understanding we expect to gain 
over that time we will be able to fix the problem once and for 
all and treat Americans living in the insular areas like all 
other Americans when it comes to Medicaid.
    The second lesson--humility. We may think that the funding 
we are providing to each insular area meets their needs and 
their capacity to use the money. But we learned over the course 
of the ACA that our predictions are not always accurate.
    Some of the insular areas used their ACA money. Some did 
not. Some ran out of funding because their needs were greater 
than Congress foresaw and Congress had to intervene with 
stopgap measures. Some areas are leaving money unspent after 
eight years.
    We should learn from that experience. Emergencies arise 
that cannot be predicted. The recently-enacted disaster 
supplemental included my amendment to provide an additional $36 
million in Medicaid funds for the Marianas because with last 
year's typhoons our program was down to its last dollars.
    In the seven weeks since enactment 60 percent of those 
funds are already expended and the balance is scheduled for 
expenditure by September 30. Emergencies arise.
    So I would humbly suggest that some mechanism be built into 
the REACH Act to make sure its funds can be reallocated, if 
necessary.
    I know our staffs have discussed this problem but without 
resolution, and I would suggest that all of us ask our staffs 
to work a little harder so we do not repeat that mistake of the 
Affordable Care Act.
    I thank the Health Subcommittee for favorably reporting the 
Territories Health Care Improvement Act and I thank the full 
committee for bundling it into the REACH Act.
    You have made a great step forward to ensure that 
healthcare in the insular areas can be as good as healthcare 
anywhere in America.
    And finally, and always, gratitude. I am ever so grateful 
to the American people for the assistance they provide to my 
constituents in the Northern Mariana Islands.
    Medicaid provides the means to keep our only hospital open 
and to allow specialized services to patients who need to 
travel off island for their services.
    I say this will full sincerity. I am always truly grateful 
for America's help for so many of the needs of Americans in the 
insular areas, especially the Northern Mariana Islands.
    So for the many Americans in the Northern Marianas and from 
a grateful nonvoting delegate, Mr. Chairman and other members 
of the committee, thank you.
    Thank you very much.
    [The prepared statement of Mr. Sablan follows:]

               Prepared Statement of Hon. Gregorio Sablan

    Thanks to Chairs Pallone and Eshoo and to Ranking Members 
Walden and Burgess for the opportunity to provide testimony to 
the Health Subcommittee today. And thanks to all the members of 
the committee for reporting favorably the Reauthorizing and 
Extending America's Community Health ``REACH'' Act last week.
    This health extenders package is good news for the Marianas 
and all the insular areas. It reauthorizes critically important 
Community Health Centers, of which the Marianas has one. Most 
importantly, it includes the Territories Health Care 
Improvement Act, addressing the Medicaid cliff the insular 
areas face, when special Obamacare funding ends this year.
    Thanks, also, to Mr. Soto and Mr. Bilirakis of the 
committee for understanding the urgency of this insular 
Medicaid crisis. They put together the Territories Health Care 
Improvement Act with myself and seven other original, 
bipartisan cosponsors to give Puerto Rico the help it needs. 
And the bill also becomes the means to help the four smaller 
insular areas.
    It provides just what the Marianas Medicaid director told 
this committee she needed - $60 million per year. No local 
match is required for the first two years, which will allow the 
Marianas government to direct more money to help recover from 
last year's typhoons. And, after six years, we will get the 
best FMAP that any state is offered.
    This legislation will make the insular Medicaid programs 
more ``state-like'' in other important ways. New program 
integrity requirements, which I support, assure that every 
federal dollar is used as intended. Having a better record of 
utilization, enrollment, and expenditures will allow for a 
greater understanding of the unique healthcare challenges the 
insular areas face and, I hope, provide a basis for the policy 
that comes after.
    Because, as grateful as we are that the Medicaid cliff is 
being addressed--and in a way that matches need--we know two 
things from experience with the ACA's Medicaid fix:
    1) Time will pass quickly. The ACA fix lasted eight years. 
Then we had the present crisis. The current legislation will 
last for six years. Perhaps, with the better understanding we 
expect to gain over that time we will be able to fix the 
problem once and for all, and treat Americans living in the 
U.S. insular areas like all other Americans when it comes to 
Medicaid.
    2) The second lesson: Humility. We may think that the 
funding we are providing to each insular area meets their needs 
and their capacity to use the money. But we learned over the 
course of the ACA that our predictions are not always accurate. 
Some of the insular areas used their ACA money. Some did not. 
Some ran out of funding because their needs were greater than 
Congress foresaw--and Congress had to intervene with stopgap 
measures. Some areas are leaving money unspent after eight 
years.
    We should learn from that experience. Emergencies arise 
that cannot be predicted. The recently enacted disaster 
supplemental included my amendment to provide an additional $36 
Million in Medicaid funds for the Marianas, because with last 
year's typhoons our program was down to its last dollars. In 
the seven weeks since enactment 60% of those funds are already 
expended and the balance is scheduled for expenditure by 
September 30.
    Emergencies arise. So, I would humbly suggest that some 
mechanism be built into the REACH Act to make sure its funds 
can be reallocated, if necessary. I know our staff have 
discussed this problem, but without resolution. And I would 
suggest that all of us ask our staff to work a little harder, 
so we do not repeat that mistake of the Affordable Care Act.
    Again, I thank the Health Subcommittee for favorably 
reporting the Territories Health Care Improvement Act. And I 
thank the full committee for bundling it into the REACH Act. 
You have made a great step forward to ensure that healthcare in 
the insular areas can be as good as healthcare anywhere in 
America.

    Mr. Pallone. Thank you, Mr. Sablan. You know, I really 
appreciate your input and that of the representatives from the 
other territories not only on the Medicaid issue which, as you 
mentioned, from Ms. Eshoo's subcommittee--we addressed that 
pretty long-term considering where we have been before with 
these stopgap measures, and we are hoping that, you know, in 
the fall that we can take this issue up very quickly.
    But I know we have to address so many of these concerns in 
the territories and make sure that whether it's healthcare or 
energy or whatever else that it's equal to, you know, 
continental U.S. or whatever.
    And you have been very helpful in pointing things out and, 
you know, giving us ideas about what we need to do. So I want 
to thank you for that in particular.
    Thanks for being here.
    Now we are going to go to--I understand that we have two 
Congresswomen who kind of wanted to testify together here on--I 
think it was on maternal health issues. But I am not surprised 
because I several times saw Ms. Beutler on the--with her--what 
was the--Azzana, was that it?
    Ms. Herrera Beutler. Isana.
    Mr. Pallone. Isana was--you're carrying her around, and I 
asked you what it meant and you said strong willed or something 
like that.
    Ms. Herrera Beutler. Strong willed woman.
    Mr. Pallone. All right. Well, do you want to start or 
Lucille? Lucille will start. OK. Chairwoman of the 
Appropriations and Homeland Security Subcommittee.

      OPENING STATEMENTS OF HON. LUCILLE ROYBAL-ALLARD A 
  REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA AND 
 HON. JAIME HERRERA BEUTLER, A REPRESENTATIVE IN CONGRESS FROM 
                    THE STATE OF WASHINGTON

    And thanks for--I am glad we were able to work things out 
last night. I know we were here late but we finally got the 
bill done. So that was good.
    Ms. Roybal-Allard. Before this meeting.
    Ms. Herrera Beutler. Yes.
    Ms. Roybal-Allard. Thank you.
    Mr. Chairman, thank you for this opportunity to submit our 
testimony in support of maternity caucus priorities in 
Congress.
    Ms. Herrera Beutler. We co-founded the bipartisan 
congressional caucus on maternity care to raise awareness about 
the status of childbirth in this country and the challenges 
facing America's maternity care system.
    It often takes a visible catalyst to get the attention of 
policy makers and for maternity care that catalyst has been the 
worsening maternal mortality crisis, which this committee, I 
know, has delved into.
    The CDC estimates 700 women die every year because of 
pregnancy or delivery complications and, tragically, 60 percent 
of those losses are preventable.
    Ms. Roybal-Allard. We must do everything that we can to 
ensure the safety of women. It is also critical to recognize 
that maternal mortality is just the tip of the iceberg.
    More than 50,000 women experience severe complications of 
pregnancy that adversely impact their health. Our infant 
mortality rates are higher than 33 other similar wealth 
countries and we have made some of the slowest progress in the 
world in reducing stillbirth rates.
    Adding to these concerns is the extraordinary cost of U.S. 
maternity care, estimated at over $50 billion. With Medicaid 
financing 43 percent of all births, the Federal Government must 
ensure cost effective maternal newborn care.
    Ms. Herrera Beutler. Our communities also face growing 
shortages of maternity care providers. The March of Dimes 
estimates that more than five million women in the U.S. live in 
a maternity care desert, including areas in our district--
southwest Washington--or greater Los Angeles.
    We believe it's time to make these issues a national 
priority. We encourage this committee to schedule more hearings 
to address the maternal and infant health issues and explore 
solutions to advance safe and cost-effective maternity care for 
mothers and babies.
    Ms. Roybal-Allard. We have several policy recommendations 
for your consideration.
    One, midwives are a critical part of the solution to 
addressing these problems in our maternity care system. But 
compared to many other countries, they are vastly underused as 
providers.
    Increasing access to midwives will help address maternity 
care shortages while lowering costs and providing high-quality 
care.
    Last week as co-chairs of the maternity care caucus we 
introduced H.R. 3849, the Midwives for Moms Act, to expand 
midwifery education and address the lack of provider diversity 
by prioritizing students from minority and disadvantaged 
communities. We hope that you will consider this legislation.
    Ms. Herrera Beutler. The bipartisan Preventing Maternal 
Deaths Act was signed into law in December and was the first 
legislation of this kind. This will improve data collection on 
maternal--excuse me, number two. I switched. You probably 
figured that out.
    It's the first of its kind and it's going to improve that 
data collection on maternal mortality so we can begin 
understanding why mothers are dying.
    This was a critical first step but this is just a first 
step. More work needs to be done and we believe there are 
bipartisan opportunities to ensure that vulnerable populations 
of women have access to care during pregnancy and the post-
partum period.
    We would also like to work with you on implementing best 
practices through initiatives like the Alliance for Innovation 
on Maternal Health.
    Ms. Roybal-Allard. Number three, despite World Health 
Organization recommendations to eliminate unnecessary 
childbirth interventions, the U.S. continues to have some of 
the highest Cesarean birth and induction rates, and yet 
continues to under use proven models of care such as group 
model prenatal care and birth centers.
    After the August recess we will be introducing the Moms and 
Babes Act to prioritize evidence-based care across all federal 
maternity care programs and promote research about 
physiological birth and best practices to achieve optimal birth 
outcomes. We would like to work with you on this effort.
    Ms. Herrera Beutler. As members of the House Appropriations 
Subcommittee on Labor, Health, and Human Services and 
Education, we have worked in a bipartisan fashion to support 
critical programs and initiatives to improve the lives of both 
mom and baby, including robust funding for the maternal 
mortality review committees, the maternal and child health 
block grant, Healthy Starts, and many others.
    We look forward to working collaboratively with this 
committee to build on this work.
    Ms. Roybal-Allard. Mr. Chairman, Chairwoman Eshoo, and 
Ranking Member Burgess, we thank you for your leadership and we 
look forward to partnering with you to advance solutions to 
improve maternity care outcomes for all our nation's mothers 
and their children.
    Together, we can make maternal and infant health a national 
priority. We believe this is long overdue.
    Thank you.
    Ms. Herrera Beutler. Thank you.
    [The prepared statements of Ms. Roybal-Allard and Ms. 
Herrera Beutler follows:]

   Prepared Statements of Hon. Roybal-Allard and Hon. Herrera Beutler

    We thank Chairwoman Eshoo, Ranking Member Burgess, and 
distinguished members of the subcommittee for today's 
opportunity to submit our testimony in support of the 
Congressional Caucus on Maternity Care priorities for the 116th 
Congress. We ask unanimous consent to submit extended testimony 
for the hearing record.
    First, please allow us to express our appreciation for your 
many years of public service and dedication to protecting and 
improving the health of this nation. Your bipartisan leadership 
is an example for the rest of the House, and we are honored to 
appear before you today.
    We started the Maternity Care Caucus in the 114th Congress 
to raise awareness among our Congressional colleagues about the 
status of childbirth in this country and the challenges facing 
America's maternity care system. At that time there was a 
widespread perception in Congress that childbirth was safe and 
that the U.S. had the best maternity healthcare system in the 
world.
    Childbirth advocacy groups had been trying to raise the 
alarm for years that this was not the case. The U.S. spends 
significantly more per capita on childbirth than any other 
industrialized nation. However, despite this investment, 
America continues to rank far behind almost all other developed 
countries in birth outcomes for both mothers and babies.
    But as so often happens, it takes a visible catalyst to get 
the attention of policy makers. That catalyst was the worsening 
maternal mortality crisis in this country. According to the 
CDC, each year about 700 women die because of pregnancy or 
delivery complications, or about two women every day. Despite 
many other countries around the world having successfully 
reduced their maternal mortality rates since the 1990s, the 
U.S. rate remains higher than most other high-income countries, 
and the U.S. maternal mortality rate has increased over the 
last few decades.
    The racial and geographic disparities in these maternal 
mortality numbers are staggering: African-American women have 
nearly a four-time greater risk of dying from pregnancy-related 
complications than their White counterparts, and Native 
American women are dying at two to three times the rate of 
White women. And these disparities in maternal deaths for 
African-American women have not improved in more than 20 years. 
Maternal mortality is also significantly higher in rural areas. 
Scientific American analyzed public mortality data from the CDC 
and found that in 2015 the maternal mortality rate in large 
central metropolitan areas was 18.2 per 100,000 live births - 
but in most rural areas it was 29.4 per 100,000 live births.
    The Maternal Mortality crisis in our minority and rural 
communities is alarming, and we absolutely must do everything 
we can to address it and ensure the safety of all childbearing 
women. But it is also critical that this subcommittee keeps 
sight of the fact that maternal mortality is just the tip of 
the iceberg when it comes to problems in our maternity care 
system.
    According to the CDC, Severe maternal morbidity (SMM) 
includes unexpected outcomes of labor and delivery that result 
in significant short- or long-term consequences to a woman's 
health. SMM has been steadily increasing in recent years and is 
currently estimated to affect more than 50,000 women in the 
United States. That means that more than 135 expectant and new 
mothers each day endure dangerous and even life-threatening 
complications that have an adverse effect on their health.
    And mothers are not the only victims of our maternity care 
system.
    Infant mortality, the death of an infant before his or her 
first birthday, is an important marker of the overall health of 
a society. According to the United Health Foundation, the 
infant mortality rate in the United States in 2018 was 5.9 
deaths per 1,000 live births. While this rate has been slowly 
decreasing it has not kept up with other wealthy countries, and 
in 2018 the U.S. ranked 33 out of 36 other developed nations. 
The CDC reports that Black and Native American infants are two 
to three times more likely to die than their white 
counterparts.
    Additionally, each year about 24,000 babies are stillborn 
in the United States, and we have made some of the slowest 
progress in the world in reducing our stillbirth rates, behind 
154 out of 159 other countries. We also have unacceptably high 
rates of preterm births and cesarean sections in this nation. 
We are not adequately diagnosing and treating postpartum 
depression, and preventive care is underused and poorly 
integrated in our maternity care system.
    All these poor outcomes are even more concerning because we 
face a growing shortage of trained maternity care providers. 
According to the March of Dimes, there are currently more than 
five million women in the United States who live in a maternity 
care desert. This includes women in both of our districts in 
Southwest Washington and greater Los Angeles areas who live in 
a maternity care desert area. An estimated 1,085 counties in 
the United States have hospitals without services for pregnant 
women, nearly half the counties in the United States do not 
have a single ob-gyn and 56 percent are without a certified 
nurse-midwife or certified midwife. And the American Congress 
of Obstetricians and Gynecologists estimates these shortages 
will grow significantly: there will be a shortage of up to 
8,800 OB-GYNs by 2020, with the shortfall approaching 22,000 by 
2050.
    Adding to all these concerns is the extraordinary economic 
burden of U.S. maternity care, with cumulative costs estimated 
to be well over $50 billion. According to AHRQ, Maternity and 
newborn care constitutes the single biggest category of 
hospital payouts for most commercial insurers and state 
Medicaid programs. And the Kaiser Family Foundation reports 
Medicaid is the largest single payer of pregnancy-related 
services, financing 43% of all U.S. births in 2016. In five 
states and DC, Medicaid covers more than 60% of all births. 
With this significant investment, the federal government has a 
major responsibility for ensuring the quality and value of 
maternal-newborn care.
    As Co-Chairs of the Maternity Care Caucus, we believe it is 
time for policymakers to prioritize optimal birth outcomes for 
all families in the United States. Towards that end we 
encourage the Energy and Commerce Health Subcommittee to 
schedule hearings to address the inequities in birth outcomes 
and the looming maternity care shortage, and to explore the 
most promising solutions to advance safe and cost-effective 
maternity care for all mothers and babies in all communities.
    We have several policy recommendations we would like this 
subcommittee to consider:
    1. Increase Access to Midwives

    Midwives are widely cited as being an important part of the 
solution to addressing these problems in our maternity care 
system. However, Midwives currently attend less than 10 percent 
of all births in the United States, compared to countries like 
Great Britain where midwives deliver half of all babies, and 
Sweden, Norway and France where midwives oversee the majority 
of expectant and new mothers. All these countries have much 
lower rates of maternal and infant mortality than we do in the 
US.
    Last week we introduced H.R. 3849, the Midwives for 
Maximizing Optimal Maternity Services, or Midwives for MOMS Act 
to address the growing maternity care provider shortage, to 
improve maternity care outcomes for mothers and babies, and to 
reduce maternity care costs for families and state and federal 
governments, by expanding educational opportunities for 
Midwives.
     This bill will establish two new funding streams 
for midwifery education, one in the Title VII Health 
Professions Training Programs, and one in the Title VIII 
Nursing Workforce Development Programs.
     Additionally, the bill will address the 
significant lack of diversity in the maternity care workforce 
by prioritizing students from minority or disadvantaged 
backgrounds.

    2. Take the next steps towards Reducing Maternal Mortality

    The Preventing Maternal Deaths Act that was passed in the 
115th Congress and signed into law in December 2018 will vastly 
improve data collection on the maternal mortality crisis so we 
can begin to understand why mothers are dying from preventable 
causes. It will also help states to sustain the health of 
mothers during the entire pregnancy cycle. This was a critical 
first step to addressing maternal mortality, but there are more 
work to be done.
    We believe there are bipartisan opportunities to ensure 
that vulnerable populations of women have access to care during 
pregnancy and throughout the postpartum period. Additionally, 
supporting the implementation of best practices throughout 
hospital systems is something we would like to work with the 
Committee to address.

    3. Prioritize Evidence Based Maternity Care and Optimal 
Physiologic Birth Outcomes

    In 1996, the World Health Organization called for the 
elimination of unnecessary intervention in childbirth. However, 
two decades later the United States still has some of the 
highest primary and repeat Cesarean birth rates, labor 
induction and augmentation practices, and regional anesthesia 
usage. At the same time, we are underusing proven models of 
care such as group model prenatal care and birth centers, and 
practices such as smoking cessation intervention and continuous 
labor support. In 2018 a multidisciplinary group of maternity 
care experts found that ``Current maternal-newborn practice 
involves evidence-practice gaps and unwarranted practice 
variation, reflecting overuse of unneeded practices, underuse 
of beneficial practices and limited use of implementation 
science and quality improvement methods.''
    After the August recess we will be introducing the 
Maximizing Optimal Maternity Services and Building a Best 
Evidence System, or MOMS and BABES Act that is based on the 
recommendations in the 2018 Blueprint for Advancing High-Value 
Maternity Care Through Physiologic Childbearing. In that 
blueprint these experts recommended that ``mobilizing innate 
capacities for healthy childbearing processes and limiting use 
of consequential interventions that can be safely avoided . . . 
can contribute to health equity across the childbearing 
population.''
    We look forward to working with the Subcommittee to 
prioritize evidence-based care in all federal maternity care 
efforts, to ensure consumers have access to the best evidence 
in maternity care practices and outcomes, and to promote 
research that will further our knowledge base about physiologic 
birth and the best practices to achieve optimal birth outcomes 
for all women.
    As members of the House Appropriations Committee, 
Subcommittee on Labor, Health and Human Services, Education, 
and Related Agencies, we have worked in a bipartisan fashion to 
support critical programs and initiatives to improve the lives 
and health of both mom and baby. We are proud to have helped 
secure robust funding for programs such as Safe Motherhood 
Maternal Mortality Review Committees, the Title V Maternal and 
Child Health Block Grant, Healthy Start, the Alliance for 
Innovation on Maternal Health, Breastfeeding Promotion, the 
Task Force for Research in Pregnant and Lactating Women, and so 
many others. Additionally, we were able to commission a 
National Academies of Science Study on Research Issues in Birth 
Settings that is currently underway and will be concluding with 
consensus policy recommendations in early 2020. We will 
continue our work to support maternal health in the federal 
appropriations process and we look forward to working 
collaboratively with the Committee to build on this work.
    Chairwoman Eshoo and Ranking Member Burgess, we thank you 
for your leadership and for extending us this opportunity to 
share our major priorities with the Subcommittee. We look 
forward to working with you to advance awareness, education and 
solutions to improve maternity care outcomes for all our 
nation's mothers and their children. Together we can make 
maternal and infant health a national priority. We believe this 
is long overdue.

    Mr. Pallone. Well, thank you both for being here and being 
here on a bipartisan basis. You both are appropriators so, you 
know, obviously, you can--we can work with you on a lot of 
these things and we certainly will take them up.
    You know, I do think it's a disgrace when we talk about 
maternal mortality and, you know, how we compare with other 
countries, and just one thing and I am supposed to move on 
here.
    But, you know, when you mention C-sections--and it's a 
while ago now, but I remember with my wife, you know, we have 
three kids and the first two were born--were C-section, right. 
But she always wanted to have--to not do the C-section if she 
could.
    And so when the third one came along, you know, she said, 
well, if it's at all possible I'd rather not have the C-
section, and all the doctors, oh, you already had two--you 
just--it's not a good idea. You should have a C-section again. 
Let's just schedule in advance. And she absolutely refused and 
our daughter was born without the C-section. Sort of proved 
them wrong.
    But that's always been the case and it's still the case 
that they always try to push a C-section when it's not 
necessarily--not necessary sometimes. So I appreciate you 
bringing that up. But there are so many of these issues that 
you raise that are just so important.
    Chairwoman Eshoo and the Dr.----
    Ms. Eshoo. Thank you, Mr. Chairman.
    I want to thank both of you for being here today and all of 
the work that you're doing with your caucus, the legislation 
that you highlighted today, and I love the way you double 
teamed it.
    At the Health Subcommittee, we have been trying to find out 
from CRS if the Health Committee has ever had a hearing on the 
state of women's health in the United States of America and we 
can't find one, and I think it's about time that we do one.
    You know that as we--when we are part of a congressional 
delegation to a foreign country on one of the first pages of 
the handbook from the State Department is how that country is 
measured.
    One of the yardsticks is infant mortality and maternal 
mortality, and now our numbers keep going up. So your work is 
critically essential and I look forward to post-August where we 
actually do something that will represent and, hopefully, touch 
the lives of the largest percentage of our country and that is 
women. So bravo to you. Bravo to you for your beautiful work. 
Thank you.
    Mr. Pallone. Thank you.
    Dr. Burgess?
    Mr. Burgess. Well, I just--I don't know if people recognize 
what an extraordinary accomplishment it was for Jaime Herrera 
Butler to get that stand-alone maternal mortality bill through 
and signed in the last Congress. It really was a milestone. 
There were days I didn't think it was actually going to happen.
    Certainly, the representatives put a lot of effort into it. 
Our subcommittee staffs on both sides of the dais did and did 
get it across the finish line. Another milestone that we were 
able to accomplish in the last Congress was on the health 
professions shortage areas including maternal care providers.
    Without actually changing the appropriation we changed the 
authorizations that we could include maternity care providers 
in health profession shortage areas.
    So we can build on those accomplishments. I know the past 
is just a prelude and we can continue to do that. I've got some 
ideas and we will continue to work on those things.
    So I appreciate you both being here. It is an important 
topic and one that we need to maintain our focus.
    Thank you.
    Mr. Pallone. Thank you, and thank you both, really, for 
what you're doing. We appreciate it. Continue to work with us.
    And now we will go to my friend, Congresswoman Napolitano. 
Thanks for being here.

OPENING STATEMENT OF HON. GRACE F. NAPOLITANO A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF CALIFORNIA

    Mrs. Napolitano. Thank you for having me, Mr. Chairman, and 
thank the ranking member.
    My bill is H.R. 1109, which I feel we must pass--the Mental 
Health Services for Students Act. This is my sixth Congress and 
I am hoping this time we will be able to get it off the ground.
    I have a Senate co-sponsor. Senator Tina Smith of Minnesota 
has the companion bill, Senate bill 1122. Sixteen members of 
the House Energy and Commerce Committee--this committee--
support my bill: Cardenas, Barragan, Tonko, Clarke, Rush, 
Matsui, Castor, McNerney, Welch, Lujan, Kennedy, Dingell, 
Veasey, Kuster, Kelly, and Soto, and we hope to add more.
    My bill would provide $200 million per year for five years 
for 100 school-based pilot programs on mental health 
nationwide. It expands the scope of the Project Advancing 
Wellness and Resilience Education called AWARE--the program--by 
providing on-site licensed mental health professionals in 
schools in the community.
    The funding for the program would do the following: provide 
for comprehensive staff development for school personnel and 
personnel working in the schools. It includes administrators 
and teachers assistance to recognize mental health issues.
    It would support and implement comprehensive culturally and 
linguistically appropriate services. It would deliver 
assistance to local communities in the development of policies 
to address their own child and adolescent childhood trauma and 
mental health issues, and violence when and if it occurs.
    Establish mechanisms for children and adolescents to report 
incidents of violence or plans by other children, adolescents, 
or adults to commit violence.
    It would also promote positive mental health education and 
support for parents and siblings and other family members of 
children with mental health disorders, as well as concerned 
members of the community.
    H.R. 1109 is supported by the Mental Health Liaison Group, 
which consists of 51 mental health organizations. It's 
supported by the Los Angeles County Board of Supervisors, also 
by the National Education Association, the American Federation 
of Teachers, and others.
    The bill is modeled off of a school-based mental health 
program developed in 2001. The Pacific Clinics and I started 
with half a million dollars for SAMHSA with seed money, which 
ended in 2009.
    SAMHSA no longer funds it. It is taken over by the county 
of Los Angeles and been instrumental and have grown the project 
to 35 schools instead of four.
    The program began in three middle schools and one high 
school and as I said, it has already grown and we are hoping to 
add more schools pretty soon.
    But I thank you very much for the opportunity and I hope 
that you will consider this in the future.
    Thank you.
    [The prepared statement of Mrs. Napolitano follows:]

             Prepared Statement of Hon. Grace F. Napolitano

    Chairwoman Eshoo and Ranking Member Burgess, thank you for 
the opportunity to testify today.
    It is vital that we pass my bill, HR 1109, the Mental 
Health Services for Students Act. In the Senate, Senator Tina 
Smith of Minnesota has a companion bill, S. 1122. Sixteen 
members of the House Energy and Commerce Committee are 
currently co-sponsors of my bill: Cardenas, Barragan, Tonko, 
Clarke, Rush, Matsui, Castor, McNerney, Welch, Lujan, Kennedy, 
Dingell, Veasey, Kuster, Kelly, and Soto.
    My bill would provide $200 million per year for five years 
for 100 school-based mental health programs nationwide. It 
expands the scope of the Project Advancing Wellness and 
Resilience Education (AWARE) program by providing on-site 
licensed mental health professionals in schools across the 
country, and funding will be distributed by the Substance Abuse 
and Mental Health Services Administration (SAMHSA), which will 
set guidelines and measure the outcomes of the funded programs.
    Funding for this program would:

     Provide for comprehensive staff development for 
school and personnel working in schools
     Support and implements comprehensive culturally 
and linguistically appropriate services
     Deliver assistance to local communities in the 
development of policies to address child and adolescent trauma 
and mental health issues, and violence when and if it occurs
     Establish mechanisms for children and adolescents 
to report incidents of violence or plans by other children, 
adolescents, or adults to commit violence
     Promote positive mental health education and 
support for parents, siblings, and other family members of 
children with mental health disorders, as well as concerned 
members of the community
     HR 1109 is supported by the Mental Health Liaison 
Group (which consists of 51 Mental Health Organizations), Los 
Angeles County Board of Supervisors, National Education 
Association, and the American Federation of Teachers.
    The bill is modeled off of a school-based mental health 
program Pacific Clinics and I started in 2001 with a half a 
million dollars in SAMSHA seed money. The program began in 
three middle schools and one high school and has since grown to 
thirty-five schools. The Los Angeles County Board of 
Supervisors and the County Department of Mental Health have 
also been instrumental in the success of this program, taking 
over funding the program in 2009.
    Thank you again for the opportunity to testify.

    Mr. Pallone. We certainly will consider it and we know that 
a lot more needs to be done with regard to mental health 
issues. So thanks again. I appreciate it.
    Next is the gentlewoman from Georgia, Ms. McBath.

   OPENING STATEMENT OF HON. LUCY McBATH A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF GEORGIA

    Mrs. McBath. Thank you very much, Mr. Chairman, and the 
esteemed committee. Thank you so much for allowing me to 
discuss a very important topic to me once again as we have 
heard a little bit earlier today--maternal mortality.
    I'd like to thank my colleague and member of this 
committee, Representative Robin Kelly, for being a champion on 
this issue. The importance of her legislation, the Mothers and 
Offspring Mortality and Morbidity Awareness Act, or MOMMA's 
Act, cannot be overstated, and that is House Bill H.R. 1897.
    The United States has an atrocious record when it comes to 
maternal mortality. As many on this committee already know, our 
rates of maternal mortality are the highest among other 
developed nations in the world.
    What's more concerning is that there has been a significant 
increase in the maternal death rate. From 1991 to 2004, the 
rate has more than doubled.
    This is absolutely unacceptable. We need a comprehensive 
solution to this crisis. Progress on this important issue has 
stalled and represents an incredible failure.
    It is a failure to women throughout this country, 
especially women of color, who experience maternal mortality at 
rates three times that of their white counterparts.
    We have a responsibility to mothers and to their families 
to make sure that safety and health is our number-one priority.
    The research is absolutely clear. Comprehensive care for 
pregnant women saves lives. According to the Centers for 
Disease Control and Prevention, 60 percent of maternal deaths 
are completely preventable.
    Extending coverage for a full year will simply save the 
lives of many of those mothers, and while maternal mortality is 
certainly the worst outcome, it's not the only outcome.
    Many women suffer from complex illnesses that complicate 
their pregnancy and endanger their health. I shared the story 
of a constituent of mine recently on the House floor. Her name 
is Phiffer. She struggles with a mental health disorder.
    During her pregnancy in 2014, she had to have an immediate 
surgical correction for an irregularity in her cervix. The 
surgery failed, and at 20 weeks she was confined to bed rest 
for the duration of her pregnancy.
    Her mental health was not addressed. At 30 weeks, she gave 
birth to a beautiful baby boy but then her mental health was 
yet again not addressed.
    Almost immediately she began to suffer from post-partum 
anxiety. She abandoned many things that once gave her joy and 
it took 12 months for her diagnosis to actually come to 
fruition.
    This story is just like millions of other mothers 
throughout our country. We must do more to improve the range of 
services available to these young mothers.
    We must do more to care for the coordination for these 
young mothers. We must do everything that we can to give these 
young mothers the best possible care they deserve.
    And so we are faced with a challenge. Make no mistake that 
maternal health in this country is in crisis. The MOMMA Act 
will help save the lives of mothers across the country.
    The Congress has this opportunity to act in the interest of 
these mothers and their families. And as you know, the MOMMA 
Act would provide access to life-saving healthcare for a year 
after conception for women who use Medicaid.
    It would also allow for Medicaid coverage of doulas and 
midwives, expanding access for people who lack access to an OB/
GYN doctor.
    Not only does this legislation extend coverage for low-
income women, but it improves maternal health for all women by 
increasing care coordination by health systems and ensuring 
that every mother has access to the best possible care.
    This legislation would help America keep the promise of 
safety and happiness to these new mothers and their infants.
    Thank you for the opportunity to testify. Thank you so much 
for hearing my heart.
    [The prepared statement of Mrs. McBath follows:]

                 Prepared Statement of Hon. Lucy McBath

    Thank you for allowing me to appear before this committee 
to discuss an important topic to me, maternal mortality. I'd 
like to thank my colleague, and member of this committee, Rep. 
Robin Kelly, for being a champion on this issue. The importance 
of her legislation, the Mothers and Offspring Mortality and 
Morbidity Awareness Act, or Momma's Act, cannot be overstated.
    The United States has an atrocious record when it comes to 
maternal mortality. As many on this committee know, our rates 
of maternal mortality are the highest among other developed 
nations. What's more concerning is there has been a significant 
increase in the maternal death rate. From 1991 to 2004, the 
rate has more than doubled.
    That is unacceptable. We need a comprehensive solution to 
this crisis.
    Progress on this important issue has stalled and represents 
an incredible failure. It is a failure to women throughout this 
country--especially women of color--who experience maternal 
mortality at rates three times that that of their white 
counterparts.
    We have a responsibility to mothers, and their families, to 
make sure that safety and health is our number one priority.
    The research is clear. Comprehensive care for pregnant 
women saves lives. According to the Centers for Disease Control 
and Prevention, sixty percent of maternal deaths are completely 
preventable. Extending coverage for a full year will save the 
lives of many of those mothers. And while maternal mortality is 
certainly the worst outcome, it's not the only outcome. Many 
women suffer from complex illnesses that complicate their 
pregnancy and endanger their health.
    I shared the story of a constituent of mine recently on the 
House floor. Her name if Phiffer. She struggles with a mental 
health disorder. During her pregnancy in 2014, she had to have 
an immediate surgical correction for an irregularity in her 
cervix. The surgery failed, and at 20 weeks she was confined to 
bedrest for the duration of her pregnancy. Her mental health 
was not addressed. At thirty weeks, she gave birth to a 
beautiful baby boy. Her mental health was not addressed. Almost 
immediately, she began to suffer from postpartum anxiety. She 
abandoned many things that once gave her joy. It took 12 months 
for her to finally be diagnosed.
    This story is just like millions of others throughout this 
country. We must do more to improve the range of services 
available to these young mothers. We must do more to improve 
care coordination for these young mothers. We must do 
everything we can to give these young mothers the best possible 
care.
    And so, we are faced with a challenge. Make no mistake that 
maternal health in this country is in crisis.
    The Momma Act will help save the lives of mothers across 
the country. This Congress has the opportunity to act in the 
interest of these mothers and families. As you know, the MOMMA 
Act would provide access to life-saving healthcare for a year 
after conception for women who use Medicaid. It would also 
allow for Medicaid coverage of doulas and midwives, expanding 
access for people who lack access to an OB-GYN doctor.
    Not only does this legislation extend coverage for low 
income women, but it improves maternal health for all women by 
increasing care coordination by health systems and ensuring 
that every mother has access to the best possible care. This 
legislation would help America keep the promise of safety and 
happiness to these new mothers and infants.
    Thank you for the opportunity to testify and I yield back 
the balance of my time.

    Mr. Pallone. I agree when you said maternal health is in 
crisis and we need to address it, as you heard the testimony of 
your colleagues. So we will--we will follow through. Thanks so 
much.
    My colleague from New Jersey is next.

       OPENING STATEMENT OF HON. BONNIE WATSON COLEMAN A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY

    Ms. Watson Coleman. Thank you very much, Mr. Chairman, and 
to the ranking member and to members who are here today. Thank 
you very much for holding this Member Day Hearing.
    I want to begin by stressing that the Affordable Care Act 
has been a literal lifeline for many in my district, New 
Jersey's 12th Congressional district, as well as in communities 
of colors across the nation.
    Since 2010, the rates of uninsured African Americans have 
nearly been cut in half, going down from 20 percent to 11 
percent.
    In my district, if the ACA were to be struck down by the 
courts in Texas v. Azar, nearly 50,000 people would lose their 
healthcare insurance.
    So while the law isn't perfect, I know you, Mr. Chairman, 
and your subcommittee are committed to protecting the ACA and 
expanding access to healthcare for all Americans.
    And in the spirit of that, I come before you today to ask 
for your commitment to addressing the inequities that our 
healthcare institutions and structures create, which put women 
and patients of color at elevated risks for certain morbidities 
and even mortality.
    For black mothers, who are often provided lower quality 
maternal care when they can access care at all, the ACA's 
requirement to cover pregnancy, labor, delivery, and newborn 
care as essential benefits in health plans was absolutely 
critical.
    However, since nearly half of pregnancies are unplanned, 
many women don't have a plan when they find that they are 
pregnant. Or if they have a short-term plan, it doesn't cover 
pregnancy care.
    Surprisingly, while our system currently considers getting 
married or giving birth to a child a ``qualifying life event'' 
allowing one to sign up for health insurance, pregnancy does 
not currently trigger one of these special enrollment periods.
    This is particularly alarming when black maternal mortality 
rates in the United States are similar to rates in developing 
countries at 40 deaths per 100,000.
    This is why, as a founding member of the Congressional 
Caucus on Black Women and Girls, I made it a priority to 
address the gaps in our healthcare system which result in black 
mothers dying at two to six times the rate of their white 
peers.
    In addition to organizing stakeholder convenings to talk 
about this disparity, we are pushing legislation that is 
important to addressing health disparities among black women 
and girls.
    One of the first bills that I introduced when I was elected 
to Congress was the Healthy Maternal and Obstetric Medicine 
Act, or commonly referred to as Healthy MOM Act.
    The Healthy MOM Act would create a special enrollment 
period in the insurance market for women when they become 
pregnant so that they and their child are able to receive the 
healthcare that they need.
    This Congress, the Healthy MOM Act is H.R. 2278 and 
currently has more than 75 cosponsors.
    Chairman Pallone, as you and your committee explore ways to 
protect and expand access to healthcare for American families, 
I implore you to also work to address racial and ethnic 
disparities in our system. The Healthy MOM Act has the 
potential to be part of that solution.
    Before I yield back, I would be remiss to not mention that 
this year is the 20th anniversary of the REACH program, which 
stands for Racial and Ethnic Approaches to Community Health.
    REACH remains one of the CDC's only programs specifically 
dedicated to addressing racial and ethnic health disparities.
    Started during the Clinton administration, REACH is unique 
because it follows a community-led model which includes robust 
engagement of the population impacted by health disparities, 
and multi-sector representation in all aspects of program 
planning, development, and implementation to successfully 
tailor programing for communities of color with the greatest 
chronic disease burdens.
    As this subcommittee looks to address racial and ethnic 
disparities, I do hope you will look to REACH grantees for 
lessons learned in how to address racial health disparities and 
to incorporate them into your own policy proposals.
    And with that I yield back and I want to thank you for this 
opportunity to address these issues today.
    [The prepared statement of Ms. Watson Coleman follows:]

              Prepared Statement of Bonnie Watson Coleman

    I. Introduction--Affordable Care Act (ACA)

     Thank you, Chairwoman Eshoo, Ranking Member 
Burgess, and other members of the Subcommittee for holding this 
Member Day hearing.
     I want to begin by stressing that the Affordable 
Care Act (ACA) has been a literal lifeline for many in my 
district, New Jersey's 12th Congressional district, as well as 
in communities of color across the nation.
     Since 2010 the rates of uninsured African 
Americans have nearly been cut in half, going down from 20 
percent to 11 percent.
     In my district, if the ACA were to be struck down 
by the courts in Texas v. Azar, nearly 50,000 people would lose 
their health insurance.
     So while the law isn't perfect, I know that you, 
Madame Chair, and this subcommittee are committed to protecting 
the ACA and expanding access to healthcare for all Americans.
     And in that spirit, I come before you today to ask 
for your commitment to addressing the inequities that our 
healthcare institutions and structures create, which put women 
and patients of color at elevated risks for certain 
morbidities, and even mortality.
     For black mothers, who are often provided lower 
quality maternal care when they can access care at all, the 
ACA's requirement to cover pregnancy, labor, delivery and 
newborn care as essential benefits in health plans was 
absolutely critical.
     However, since nearly half of pregnancies are 
unplanned, many women don't have a plan, when they find out 
they are pregnant. Or if they have a short-term plan, it 
doesn't cover pregnancy care.
     Surprisingly, while our system currently considers 
getting married or giving birth to a child a ``qualifying life 
event'' allowing one to sign up for health insurance, pregnancy 
does not currently trigger one of these ``special enrollment 
periods.''
     This is particularly alarming when Black maternal 
mortality rates in the United States are similar to rates in 
developing countries at 40 deaths per 100,000.

    II. Healthy Mom Act

     This is why, as a founding member of the 
Congressional Caucus for Black Women and Girls, I made it a 
priority to address the gaps in our healthcare system which 
result in black mothers dying at 2-6 times the rate of their 
white peers.
     In addition to organizing stakeholder convenings 
to talk about this disparity, we are pushing legislation 
important to addressing health disparities among black women 
and girls.
     One of the first bills I introduced when I was 
elected to Congress was the Healthy Maternal and Obstetric 
Medicine Act, or Healthy MOM Act.
     The Healthy MOM Act would create a special 
enrollment period in the insurance marketplace for women when 
they become pregnant so that they and their child are able to 
receive the healthcare they need.
     This Congress, the Healthy MOM Act is HR 2278, and 
currently has [more than] 75 cosponsors.
     Madam Chair, as you and your Subcommittee explore 
ways to protect and expand access to healthcare for American 
families, I implore you to also work to address racial and 
ethnic disparities in our system. The Healthy MOM Act has the 
potential to be part of that solution.

    III. Reach--Racial And Ethnic Approaches To Community 
Health

     Before I yield back, I would be remiss to not 
mention that this year is the 20th anniversary of the REACH 
program--which stands for Racial and Ethnic Approaches to 
Community Health.
     REACH remains one of the CDC's only programs 
specifically dedicated to addressing racial and ethnic health 
disparities.
     Started during the Clinton administration, REACH 
is unique because it follows a community-led model includes 
robust engagement of the populations impacted by health 
disparities, and multisector representation in all aspects of 
program planning, development, implementation to successfully 
tailor programing for communities of color with the greatest 
chronic disease burdens.
     As this subcommittee looks to address racial and 
ethnic disparities, I hope you will look to REACH grantees for 
lessons learned in how to address racial health disparities and 
incorporate them into your own policy proposals.
     And with that I yield back. Thank you for the 
opportunity to address these issues today.

    Mr. Pallone. Well, let me thank you. I know you have a long 
history of working on a lot of these healthcare issues both 
here and in the state legislature.
    And, you know, I will certainly follow on the Healthy MOM's 
Act, and you know that the CDC for years has had this, you 
know, healthcare disparities issue that they highlight. I guess 
they have their brain trust--is that what it's called? Robin 
Kelly for a long time--I don't know if she still is--but was 
the head of that and she's on our committee now.
    So, you know, we'll--we have incorporated some of those 
things but I know a lot more needs to be done so we will work 
with you. Thank you, Bonnie. Thank you.
    Oh, and Chairwoman Eshoo wants to make----
    Ms. Eshoo. I just wanted to say, Bonnie, thank you for the 
courage that you've exhibited to all of us and you----
    Ms. Watson Coleman. Thank you, Madam Chairman. Thank you.
    Ms. Eshoo. Yes, and I think our prayers are answered and 
now we have got to get your legislation done.
    Ms. Watson Coleman. Thank you.
    Mr. Pallone. Thank you, Chairwoman Eshoo. Thanks, Bonnie.
    Next, we have Mr. Levin of Michigan. Thanks for being here.

   OPENING STATEMENT OF HON. ANDY LEVIN A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF MICHIGAN

    Mr. Andy Levin. Thanks so much, Chairman Pallone. I am 
learning while I am here. Of our four kids, the first three 
were all delivered by midwives. So I've got to get on board 
with the MOMMA Act, if I am not already.
    So but I want to thank you and Ranking Member Walden, 
Chairwoman Eshoo, Ranking Member Burgess, members of the 
subcommittee or allowing me to testify today and I am here 
today to talk about drug pricing, a topic that I know has been 
a tremendous priority for this subcommittee and for our 
constituents.
    And I want to applaud the hard work that Energy and 
Commerce has already done this year to tackle this issue. But, 
as you know and all of us know, we have more work to do.
    Personally, my family knows this all too well because two 
of my sons live with Crohn's disease, and actually in the 
anteroom I got a call from someone trying to get to one of my 
sons to give him an infusion that he needs, you know, to be 
healthy and survive.
    My wife, Mary, and I would do anything to keep our kids 
healthy, and I know parents across this country feel the exact 
same way, even if it means waiting to pay another bill or 
neglecting necessities for themselves.
    Families in every community are making incredibly hard 
choices for the sake of their kids. They should not have to.I 
came to Congress to raise the standard of living for working 
people in Michigan's 9th District and across our country and to 
ensure that the deck isn't stacked against American families.
    That is why I've introduced the Stop The Overuse of 
Petitions and Get Affordable Medicines to Enter Soon, or the 
STOP GAMES Act. This common-sense bipartisan bill that I 
authored with Congressman Francis Rooney of Florida will help 
to stop pharmaceutical companies from gaming the system to 
block competition.
    There have been multiple reports of drug makers attempting 
to use the Food and Drug Administration's ``citizen petition'' 
tool to keep generic competition from coming to market.
    While the citizen petition is meant to ensure that 
stakeholders can flag legitimate issues with drugs awaiting FDA 
approval, reports indicate that drug makers have filed baseless 
petitions to protect their monopolies.
    In fact, in October, then FDA Commissioner Scott Gottlieb 
listed the misuse of citizen petitions among anti-competitive 
techniques of concern.
    Even if FDA doesn't ultimately agree with a petition's 
argument, the agency must investigate and respond to what are 
sometimes unsubstantiated claims. This prevents more affordable 
drugs from reaching consumers quickly, forcing American 
families to pay more.
    For example, in 2017, the Federal Trade Commission filed a 
complaint arguing that ViroPharma's use of the citizen petition 
process constituted an anti-trust violation.
    According to the FTC, ViroPharma's ``repetitive, serial, 
and meritless filings lacked any supporting clinical data'' and 
``succeeded in delaying generic entry at a cost of hundreds of 
millions of dollars.''
    The STOP GAMES Act would, as the title suggests, stop these 
kinds of games. Our bill outlines circumstances under which the 
FDA can promptly reject a petition meant to delay the approval 
of a generic competitor and directs the secretary of Health and 
Human Services to report any such incidents to the FTC.
    The bill also requires drug makers to file a petition 
within 60 days of learning the information it's based on, not 
right before a patent or exclusivity period expires and rival 
drugs are ready to come to market.
    Finally, the bill requires enhanced reporting to keep 
Congress informed of efforts to game the FDA approval process.
    As your subcommittee continues its important work to bring 
down drug prices, I urge you to consider the STOP GAMES Act and 
ensure the FDA's citizen petition tool cannot be misused to 
keep prices high.
    I thank the members of this committee who have already co-
sponsored the bill--Congressman Tonko and Congresswoman 
Schakowsky--and I would welcome the chance to talk with more of 
you about this important fix.
    Again, I want to thank you all for the privilege of 
testifying before your subcommittee and truly look forward to 
working with you on this bill and others on behalf of working 
families.
    [The prepared statement of Mr. Andy Levin follows:]

                 Prepared Statement of Hon. Andy Levin

    Chairman Pallone, Ranking Member Walden, Chairwoman Eshoo, 
Ranking Member Burgess, members of the subcommittee: thank you 
for allowing me to testify before you today.
    I am here today to talk about drug pricing--a topic that, I 
know, has been a tremendous priority for this subcommittee and 
for our constituents. And I want to applaud the hard work 
Energy and Commerce has already done this year to tackle this 
issue.
    But, as you all know, we have more work to do.
    My family knows this all too well. Two of my sons live with 
Crohn's disease. My wife, Mary, and I would do anything to keep 
our kids healthy, and I know parents across this country feel 
the exact same way--even if it means waiting to pay another 
bill, or neglecting necessities for themselves, families in 
every community are making incredibly hard choices for the sake 
of their kids. They should not have to.
    I came to Congress to raise the standard of living for 
working people and ensure the deck isn't stacked against 
American families. That is why I've introduced the Stop The 
Overuse of Petitions and Get Affordable Medicines to Enter 
Soon--or ``STOP GAMES''--Act. This commonsense, bipartisan bill 
that I authored with Congressman Francis Rooney will help stop 
pharmaceutical companies from gaming the system to block 
competition.
    There have been multiple reports of drugmakers attempting 
to use the Food and Drug Administration's ``citizen petition'' 
tool to keep generic competition from coming to market. While 
the citizen petition is meant to ensure stakeholders can flag 
legitimate issues with drugs awaiting FDA approval, reports 
indicate that drugmakers have filed baseless petitions to 
protect their monopolies. In fact, in October, then-FDA 
Commissioner Scott Gottlieb listed the misuse of citizen 
petitions among ``anticompetitive techniques of concern.''
    Even if FDA doesn't ultimately agree with a petition's 
argument, the agency must investigate and respond to what are 
sometimes unsubstantiated claims. This prevents more affordable 
drugs from reaching consumers quickly, forcing American 
families to pay more.
    For example, in 2017, the Federal Trade Commission filed a 
complaint arguing that ViroPharma's use of the citizen petition 
process constituted an antitrust violation. According to the 
FTC, ViroPharma's ``repetitive, serial, and meritless filings 
lacked any supporting clinical data'' and ``succeeded in 
delaying generic entry at a cost of hundreds of millions of 
dollars.''
    The STOP GAMES Act would, as the title suggests, stop these 
kinds of games. Our bill outlines circumstances under which the 
FDA can promptly reject a petition meant to delay the approval 
of a generic competitor and directs the Secretary of Health and 
Human Services to report any such incidents to the FTC.
    The bill also requires drugmakers to file a petition within 
60 days of learning the information it's based on-not right 
before a patent or exclusivity period expires and rival drugs 
can come to market. Finally, the bill requires enhanced 
reporting to keep Congress informed of efforts to game the FDA 
approval process.
    As your subcommittee continues its important work to bring 
down drug prices, I urge you to consider the STOP GAMES Act and 
ensure the FDA's citizen petition tool can't be misused to keep 
prices high. I thank the members of this committee who have 
already cosponsored the bill--Congressman Tonko and 
Congresswoman Schakowsky--and I would welcome the chance to 
talk with more of you about this important fix.
    Again, I want to thank you all for the privilege of 
testifying before your subcommittee, and truly look forward to 
working with you on this bill and others on behalf of working 
families.

    Mr. Pallone. Let me thank the gentleman and, you know, you 
certainly raise issues that we care a lot about, you know, in 
terms of trying to reduce drug prices. You know, this is 
bipartisan.
    Mr. Levin. Right.
    Mr. Pallone. It includes the president as well. You know, 
we did the generic competition bills--passed the House. We did 
transparency bills last week.
    They are going to come to the floor probably in September. 
And I know that, you know, the citizen petitions, you know, has 
been abused. So we will certainly follow up.
    Mr. Levin. Thank you so much. I really appreciate your 
help. Thank you, and I yield back.
    Mr. Pallone. Thanks. I am going to ask Mr. Schweikert to 
replace Mr. Levin because he has come back and forth several 
times and we have passed him over so why don't you go next 
because we have passed you over several times, and then we will 
go to another three? Thanks.

OPENING STATEMENT OF HON. DAVID SCHWEIKERT A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF ARIZONA

    Mr. Schweikert. Thank you, Mr. Chairman, Mr. Griffin.
    So this is where all the cool kids hang out, right?
    Mr. Pallone. Yes, right.
    [Laughter.]
    Mr. Schweikert. And I appreciate doing this and having sat 
up there through the Ways and Means Member Hour, I know 
sometimes it's interesting seeing the inbound of different 
concepts and thoughts coming from fellow members.
    I have two. One I just want to share with you. It's a 
little conceptual though we are working on the legislation. And 
the other it's a bill that's sat in the Energy and Commerce for 
a couple years now.
    One, I want to argue just conceptually, and this is for 
every Republican and Democrat. We are having the wrong argument 
about healthcare over and over and over. So if you and I were 
to strip away some of the noise, the ACA--who got subsidized, 
who had to pay. Our Republican alternative--who got subsidized, 
who got to pay.
    I want to argue we are living in a world right now that if 
we could legalize technology--there are wearables coming, 
something coming very soon where you can blow into it and it 
would diagnose whether you have a viral infection or a 
bacterial infection. The algorithm can write a prescription.
    There is technology coming and it's on the cusp right now 
if we can remove the barriers to it that can crash the price of 
healthcare.
    Wouldn't it be a much more--if we really care about our 
comments about, we need to reduce the price of this or the 
price of that--it's time for that sort of Blockbuster video 
moment where one day you stop going and picking up this little 
silver disc because you're hitting a button at home. That 
technology exists, and yes, it is going to be disruptive.
    We are going to have hallways full of incumbents who are 
saying, you're putting us out of business--why are you letting 
an algorithm write a prescription--why are you allowing data to 
actually be. We know that data is actually the Holy Grail in 
healthcare.
    So please, we are working on it. We are actually working on 
it with a couple members of your committee, both Republican and 
Democrat, who sort of see the vision that we are at that 
inflection point where we can use technology to crash the price 
of healthcare.
    And as a simple request also, I had Congressman Andy Briggs 
grab me, sitting here, and he just asked me to put his 
testimony and a letter into the record if----
    Mr. Pallone. Without objection, so ordered.
    [The information appears at the conclusion of the hearing.]
    Mr. Schweikert. So I will put that--hand that to staff.
    So here's the piece of legislation we have had in the 
committee now for a couple years. Let me also make sure I have 
the right number for this year. It is H.R. 1284.
    Think about how many members will come in front of you 
today and actually express real concern about the environment. 
Are we tracking what's happening out there? Do we know what's 
happening?
    Back to that same sort of techno utopia that's rolling out 
right now, there is now sensors you can wear on yourself that 
talk to your supercomputer we call your smart phone.
    How about the concept of crowd sourcing environmental data? 
And why this is so important--it's not Republican or Democrat--
it's just data. But the elegance of it if you have some clowns 
painting cars in the back yard behind your house, how do you 
catch them?
    In today's environmental regulatory system, it's a 
paperwork system. So we have our fixed towers that cost about a 
million dollars a year to maintain and then we have 
manufacturers, companies, those, fill out lots and lots and 
lots and lots of paperwork.
    Does paperwork shoved into file cabinets make our 
environment cleaner? I want to argue how about a system that's 
less about the paperwork and actually more about keeping the 
air cleaner?
    And now that there's this revolution of these new sensors 
that we could have a few thousand in a community that tell you, 
hey, we have a bad act happening over here--hey, a business 
over here may be having a problem with its scrubbers.
    Instead of spending two years putting paperwork in a file 
cabinet so one day you can sue them, how about knocking on the 
door and saying, hey, we have a hot spot here--let's fix it?
    Now, it's a revolutionary concept because you have to 
understand the current environmental regulatory model in many 
ways is lots of people sitting in office chairs processing 
paperwork.
    How about the concept just like you may use Waze when 
you're driving through a crowded area, it's the collection of 
the data that gets you there faster?
    Why wouldn't we do that same technology, that citizen 
science technology, to say maybe file cabinets full of 
paperwork isn't the best way to protect our environment but 
living data of--is there something of difficulty here.
    For those of us that live in the desert Southwest we 
actually have real concerns because we don't know some of our 
baseline numbers. What's baseline ozone? How much stuff comes 
in from the L. A. basin and blows in?
    And if you have enough data points--if you have enough data 
points that the crowd sourcing--it's much more elegant in being 
able to protect the environment.
    And I would argue that whether it be air or in Flint, 
Michigan, the simple little thing they could have put under a 
faucet that's under $100 that would have told you there's a 
problem. It's time we embrace the fact there's a technology 
disruption that can fix so many of these goals and it--yes, 
it's a threat to the bureaucracy. But the benefit is we live in 
a cleaner world.
    With that, I yield back, Mr. Chairman.
    [The prepared statement of Mr. Schweikert follows:]

              Prepared Statement of Hon. David Schweikert

    Chairman Pallone, Ranking Member Walden, Subcommittee 
Chairman Tonko and Ranking Member Shimkus, and members of the 
committee, thank you for allowing me this opportunity to speak 
with you today.
    I'd like to talk with you today about one of my priorities 
in this Congress, which is ensuring technology can play a key 
role in our environment, including measuring our air quality.
    We all have the same common goals when it comes to the 
environment: accurate data that is publicly available, 
achievable compliance standards, and ultimately a cleaner 
environment.
    The current system of monitoring environmental quality, 
assessing the quality of the data, and enforcement around that 
information, is entirely dependent on EPA's stationary monitors 
throughout the country. The current system by which a state 
must prove compliance, known as `attainment', could be vastly 
improved and benefit our environmental process.
    We can and should practice better science by leveraging 
publicly available, crowdsourced data.
    Currently, stationary monitoring stations, at times in 
precarious locations, create a rigid algorithm of measurements 
that fail tell a complete story. But what if we incorporated 
mobile monitoring devices to increase the size, scope, and 
density of data collected?
    Imagine if affordable air monitors, some that can be 
seamlessly purchased on places like Amazon, are deployed on 
city or private commuting vehicles. Or if your child has asthma 
and wants to go play at the neighborhood park. I challenge you 
to consider the magnitude of data these mobile monitors could 
provide a city or better inform parents or schools. This form 
of robust data collection is being used by Google Maps and WAZE 
produces, but its potential value for being deployed to improve 
the environment is, by comparison, untapped.
    I have introduced legislation, H.R. 1284, the Crowd 
Sourcing of Environmental Data Act of 2019, that would amend 
the Clean Air Act to give States the option of monitoring 
covered criteria air pollutants in designated areas by greatly 
increasing the number of air quality sensors in exchange for 
greater regulatory flexibility in the methods of monitoring.
    My bill enjoys bipartisan support, including from 
Congressman Cardenas, a member of this committee, as well as 
Congressman Aguilar. I thank them both for their support.
    This legislation would provide a city, county or state with 
optionality, not a mandate. Under this legislation, states 
would annually produce the information gathered from their own 
crowdsourced environmental data for submission to the state's 
EPA for technical review. Upon review, and if the data is found 
to be as good or better than the current data collected by the 
EPA's stationary monitors, it is then submitted to the federal 
EPA Administrator for final verification.
    Upon successful review, the state is granted a year of 
authority to monitor and act upon its own data faster and more 
effectively. All the while, the current EPA monitoring stations 
are running in the background to ensure that a failure in the 
state's monitoring would not result in a lack of environmental 
data collection.
    Imagine being able to identify bad actors to the 
specificity of city blocks rather than an entire county. 
Through this technology we could tackle the problems in non-
attainment areas and factually see where the bad actors 
operate.
    I very respectfully urge this Committee consider my 
legislation, H.R. 1284, and please join me in harnessing 21st 
century technology.
    Thank you again Mr. Chairman and ranking member for holding 
this hearing.

    Mr. Pallone. Well, thank you. I am sorry you had to keep 
coming back. But I love all these innovative ideas and use of 
technology because that's kind of what we pride ourselves on on 
this committee. So----
    Mr. Schweikert. Well, you--Mr. Chairman, you have the 
legislation. If your Environment Subcommittee would ever--and I 
have Republican and Democrat sponsors.
    Mr. Pallone. Take a look.
    Mr. Schweikert. I know you've been incredibly busy but it 
has sat here now for a couple years.
    Mr. Pallone. Yes, we will take a look at it and thank you 
for coming. Appreciate it.
    OK. Congressman Trone, you're next. Thank you.

   OPENING STATEMENT OF HON. DAVID TRONE A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF MARYLAND

    Mr. Trone. Thank you, Mr. Chairman, and members of the 
committee for this opportunity to testify.
    As many of you know, addressing the addiction crisis in 
America is my number-one priority in Congress. My constituents 
sent me here in large part because we firmly agree that more 
must be done to stop the 192 drug overdose deaths happening 
every day, two-thirds of which involve opioids.
    Every death from addiction connects another family and 
community to the crisis. My own connection is devastating but 
will sound all too familiar.
    On New Year's Eve in 2016, my nephew, Ian Trone, died from 
a fentanyl overdose. He was 24. He died alone in a hotel room.
    One of my first actions as a representative was creating 
the Freshmen Working Group on Addiction. I know our historic 
freshman class could make real progress if we worked together 
across party, geographic, and demographic lines.
    It's bipartisan with 64 members from 31 states across the 
country. Despite our diverse backgrounds and viewpoints, we are 
united in our understanding of the necessity to put aside our 
differences and come together to save lives.
    Members of our working group, 64 strong, have introduced 
legislation to ease access to naloxone, to put sanctions on 
producers of illegal fentanyl, increasing training for 
prescribers and law enforcement, and to require better warning 
labels, beef up research on addiction, and coordinate and track 
federal demand reduction activities.
    I was proud to work with fellow freshmen Representatives 
Denver Riggleman, Kelly Armstrong, and Mikie Sherrill to 
introduce H.R. 2466, the State Opioid Response Grant 
Authorization Act.
    This bill would authorize $1 billion in funding for State 
Opioid Response Grants and Tribal Opioid Response Grants for 
each of the next five years to fight the opioid epidemic in 
every community across the country.
    Each state receives at least $4 million through the 
program, with additional funding to the ten states with the 
highest mortality rates due to drug overdoses.
    The bill came from conversations with real people in our 
districts. In the early days of our roles, we toured our 
districts. We spoke with health departments, hospitals, first 
responders, elected officials, police officers, incarcerated 
individuals, mental health professionals, early childhood 
organizations, and, of course, those suffering from addiction.
    We heard loud and clear we need additional and, most 
importantly, consistent funding to end this crisis--funding 
that allows local communities to provide individualized and 
specific services to their community.
    This legislation does just that. It gives certainty--the 
certainty that states need that will provide them the funding 
so they can expect that to continue for at least the next five 
years.
    There is no committee better positioned to make real and 
impactful progress on this issue than the Energy and Commerce 
Committee. You hold the power to advance legislation to 
authorize additional funding for prevention and treatment 
programs, require more robust training for our medical 
professionals, ease restrictions on prescribing lifesaving 
medication-assisted treatment, and so much more.
    I urge you to use the power of that to take further 
meaningful steps to combat the addiction crisis, including 
passing a large package of legislation that will dramatically 
increase our response to the worst public health crisis our 
country has ever seen.
    I recognize the committee has taken bold action in the past 
by passing the Comprehensive Addiction and Recovery Act, CARA, 
the 21st Century CURES Act, and the SUPPORT for Patients and 
Communities Acts.
    I commend you for that and thank you. But the last two 
years we have lost 141,000 people from our country--141,000 
people in the last two years.
    This is a call to action. It's important what we have done. 
But we need to continue to take bold action to save lives.
    Thank you for the chance to share our thoughts with you 
today and for your engagement in this important work, and we'd 
like to partner with you in these efforts.
    [The prepared statement of Mr. Trone follows:]

                 Prepared Statement of Hon. David Trone

    Thank you Chairman Pallone and members of the committee for 
the opportunity to testify.
    As many of you know, I consider addressing the addiction 
crisis in America to be my number one priority in Congress. My 
constituents sent me here in large part because we firmly agree 
that more must be done to stop the 192 drug overdose deaths 
happening every day, two-thirds of which involve opioids.
    Every death from addiction connects another family and 
community to this crisis. My own connection is devastating but 
will sound all too familiar. On New Year's Eve in 2016, my 
nephew Ian died from a fentanyl overdose. He was 24 years old, 
and he died alone in a hotel room.
    One of my first actions as a Representative was creating 
the Freshmen Working Group on Addiction. I knew that our 
historic freshman class could make real progress if we worked 
together--across party, geographic, and demographic lines. It's 
bipartisan--with 64 members from 31 states across the country. 
Despite our diverse backgrounds and viewpoints, we are united 
in our understanding of the necessity to put aside our 
differences and come together to save lives.
    Members of our working group have introduced legislation to 
ease access to naloxone, to put sanctions on producers of 
illegal fentanyl, to increase training for prescribers and law 
enforcement, to require better warning labels, to beef up 
federal research on addiction, and to coordinate and track 
federal demand reduction activities.
    I was proud to work with fellow freshmen Reps. Denver 
Riggleman, Kelly Armstrong, and Mikie Sherrill to introduce 
H.R. 2466, the State Opioid Response Grant Authorization Act.
    This bill would authorize $1 billion in funding for State 
Opioid Response Grants and Tribal Opioid Response Grants for 
each of five years to fight the opioid epidemic in every 
community across the country. Each state receives at least $4 
million through the program, with additional funding provided 
to the ten states with the highest mortality rates due to drug 
overdoses.
    The bill came from conversations we had with real people in 
our districts. In the early days of our roles, we toured our 
districts. We spoke with health departments, hospitals, first 
responders, elected officials, police officers, incarcerated 
individuals, mental health professionals, early childhood 
organizations, and those suffering from addiction. We heard 
loud and clear that we need additional and consistent funding 
to end this crisis--funding that allows local communities to 
provide individualized and specific services to their 
community. And this legislation does just that. It gives 
certainty to states that we will provide them funding, and they 
can expect that to continue for at least the next five years.
    There is no committee better positioned to make real and 
impactful progress on this issue than the Energy and Commerce 
Committee. You hold the power to advance legislation to 
authorize additional funding for prevention and treatment 
programs, to require more robust training of our medical 
professionals, to ease restrictions on prescribing life-saving 
medication-assisted treatment, and so much more. I urge you to 
use that power to take further meaningful steps to combat the 
addiction crisis, including passing a large package of 
legislation that will dramatically increase our response to the 
worst public health crisis our country's ever seen.
    I recognize the committee has taken bold action in the past 
by passing the Comprehensive Addiction and Recovery Act (CARA), 
the 21st Century CURES Act, and the SUPPORT for Patients and 
Communities Act. I commend you for that. Over 141,000 have died 
from drug overdoses in the last two years. We should see this 
as a call for additional action. What this committee has done 
is important, but we must continue taking action in order to 
save lives.
    Thank you for the chance to share these thoughts with you 
today. You are engaging in important work, and I would like to 
be a partner with you in these efforts.

    Mr. Pallone. Well, I want to thank the gentleman. I mean, 
you're right on point in terms of raising the issue of fentanyl 
you mentioned with your nephew, unfortunately.
    We just had a hearing on that. And we know that we have to 
do more in terms of funding. The biggest concern I have is 
that, you know, that $6 billion that we appropriated on a 
bipartisan basis over two years--$3 billion a year--that 
expires in February.
    So if we want to continue with the state grants we have to, 
you know, come up with a way of funding that.
    And, you know, there's a lot of concern. Also Congressman 
Cummings came to visit me earlier this week about getting that 
money--you know, getting money or grants down to the county and 
the local level as well.
    So we are going to definitely follow up and I appreciate 
your bringing this to our attention, and go ahead, Mr. 
Griffith.
    Mr. Griffith. Thank you, Mr. Chairman.
    I do appreciate your comments. You know, the Washington 
Post has been doing a whole series of articles on opioids, and 
my district has been particularly hard hit and that's one of 
the reasons I would agree with Mr. Cummings.
    We need to get down to the local level as well because 
while the state of Virginia has issues--I don't know whether 
it's in the top ten--but the Washington Post article pointed 
out that the most number of pills, number one was in my 
district.
    Number two was in my district--two communities that were 
one and two on the rank of pills that were sent out from '06 to 
'12. We have had a number of deaths. A book has been written, 
``Dopesick`` by Beth Macy about the problem in the Appalachian 
region of Virginia in the Shenandoah Valley.
    The other parts of the state may not have as many deaths 
per capita as we have. And so we may need to look at some of 
the programs where we can go into the hot spots and deal with 
those as opposed to look--because some of the states like Texas 
are huge. Texas, California--they are huge. Some of the smaller 
states may have hot spots that need help but they may not 
register because they are not as large as some of the others.
    But we also--in talking about treatment, the deepest part 
of my district in coal country there are no treatment 
facilities. No overnight treatment facilities. You can get some 
day stuff but that's about it. So we need to work on that.
    And I think we need Mr. Chairman to push the FDA to come up 
with non-opioid-based pain relievers and to push those as hard 
as we can--non-addictive pain relievers.
    But I will say this has been a bipartisan effort by this 
committee and, Mr. Chairman, I know that will continue and we 
are going to all work together to try to see what we can do and 
I am so sorry that--it hits every family but not a death hits 
every family and I am so sorry for your family that a death 
resulted from an addiction.
    Mr. Pallone. Thank you.
    Chairwoman Eshoo?
    Ms. Eshoo. Thank you, Mr. Chairman.
    Mr. Trone, thank you for coming and testifying today and 
for your passion for running and coming to Congress with this 
as your top issue.
    Regarding the Washington Post article, it is a blockbuster 
and I really think that post-August recess that we have a 
hearing on this because there are some very important 
responsibilities that federal agencies have in this issue and I 
think that we have to learn from what has taken place so that 
it doesn't repeat itself with another product down the road.
    But for those that have--that are affected by it, we have 
to do much better. I mean, what my colleague just described 
that in coal country there are simply no services, we can't 
have that in our country.
    So you carry the weight of the loss of your family. But I 
do think that as you carry that, that that story can help 
change the overall story in our country.
    So thank you for being here today, and I look forward to 
working with you.
    Mr. Trone. Thank you.
    Mr. Pallone. Thank you, Chairman.
    Mr. Griffith go ahead.
    Mr. Griffith. Mr. Chairman, if I might add, too. I know 
that Subcommittee Chairwoman Diana DeGette and you and I and 
some others worked really hard on trying to make sure that our 
agencies are doing what they are supposed to and particularly 
the DEA--that we don't have some glitches in the law that 
prevents us from doing the things we need to do to stop the 
flow of these horrible drugs into our community.
    So I know that we will continue to work on that and 
hopefully we will have a hearing in Oversight, as the gentle 
lady suggested.
    Mr. Pallone. Thank you, and thank you, Mr. Trone.
    Now, the bells went off. We are down to 13 minutes. I'd 
like to get some of you in but I don't think we can get all 
four, right?
    So what's the order?
    Chairman McGovern, Mr. Lipinski. We can certainly get two. 
I don't know if we can get three.
    Why don't the--we are never going to get to----
    Mr. McGovern. I'll read fast.
    Mr. Pallone. All right. We are not going to get to 
Malinowski then, I don't think.
    All right. Do you want to come back?
    Mr. McGovern. No, I----
    Mr. Pallone. No, not you. I am going to try to get the 
three of you in. But Tom, can you come back after the votes?
    We will see.
    Mr. Malinowski. I'll try. Yes.
    Mr. Pallone. All right. All right. Go ahead, Jim.

OPENING STATEMENT OF HON. JAMES P. McGOVERN A REPRESENTATIVE IN 
        CONGRESS FROM THE COMMONWEALTH OF MASSACHUSETTS

    Mr. McGovern. Well, thank you, Mr. Chairman, members of the 
committee. I am here to testify on behalf of two bills, H.R. 
2502, the Medical Nutrition Equity Act, and H.R. 3332, which 
would provide coverage for medical wigs under Medicare.
    Mr. Chairman and members of the committee, Americans 
struggle every day to navigate treatments for life-threatening 
health conditions and all too often this battle comes with cost 
barriers that prevent people from securing treatments that fit 
their health and personal needs.
    A few months ago, Congresswoman Herrera Beutler and I 
introduced H.R. 2501, the bipartisan Medical Nutrition Equity 
Act. Each year, more than 7,000 infants are diagnosed with an 
inherited metabolic disorder. These life-threatening conditions 
prevent patients from digesting or metabolizing most ``normal'' 
foods.
    Patients often manage their complex nutritional needs with 
prescribed specialized formulas and, without them, risk brain 
damage, repeated hospitalizations, and in some cases, even 
death.
    Currently, children and adults who are diagnosed with 
serious digestive disorders must pay out-of-pocket for 
medically necessary food, which can often cost four to five 
times as much as the foods that we find at a grocery store.
    And to make matters worse, most health insurance companies 
do not cover medically necessary nutrition unless the 
medication is administered through a surgically placed tube--a 
costly and, ultimately, dangerous procedure that in some cases 
can be avoided.
    While 35 states have already passed laws to ensure some 
level of coverage for medical necessary nutrition, that 
coverage is highly variable and excludes all patients covered 
under federal programs.
    The Medical Nutrition Equity Act would establish treatment 
parity by requiring coverage for specialized formulas, 
including medically necessary foods, vitamins, and amino acids 
under private insurance, Medicare, Medicaid, and the Children's 
Health Insurance Program.
    And by the way, this coverage--this is coverage that 
Congress already approved for military families enrolled in 
TRICARE.
    The other important piece of legislation that I am here to 
talk about is H.R. 3332, which would amend Title 8 of the 
Social Security Act to provide coverage for wigs as durable 
medical equipment under the Medicare program.
    Many patients living with medical hair loss suffers from a 
variety of diseases, including cancer, alopecia areata, and for 
those undergoing chemotherapy or suffering from alopecia 
areata, an incurable autoimmune skin disease that causes 
unpredictable hair loss, a wig is not just medically necessary 
but also essential to alleviating the emotional and social 
burdens of hair loss.
    I was inspired to introduce this bill after meeting with 
one of my constituents, Mary Aframe, who runs the Women's Image 
Center located in Worcester and Leominister, Massachusetts.
    Ms. Aframe has worked tirelessly to help raise awareness 
about the many women undergoing chemotherapy who have trouble 
affording wigs, particularly those who use Medicare.
    Wigs can cost thousands of dollars and are out of reach for 
many patients without help from their insurance provider. While 
many private insurance plans cover wigs for those undergoing 
treatments that cause hair loss, this bill re-categorizes wigs 
as durable medical equipment to allow Medicare to provide 
coverage if a doctor certifies that the wig is medically 
necessary.
    This bill will help ensure that every cancer patient and 
alopecia patient who loses their hair can afford a wig and 
undergo treatment with the dignity and respect they deserve.
    So, Mr. Chairman, I strongly encourage you to consider 
hosting hearings and markups on H.R. 2501 and H.R. 3332, and I 
look forward to the opportunity to work with you and the 
members of the Energy and Commerce Subcommittee on this, and I 
think we need to do right by our constituents and ensure that 
consistent coverage is standard for all Americans no matter the 
illness they have or the healthcare coverage they require.
    Thank you.
    [The prepared statement of Mr. McGovern follows:]

              Prepared Statement of Hon. James P. McGovern

    I want to thank Chairman Pallone and Ranking Member Walden 
for allowing me the opportunity to testify in support of H.R. 
2501, the Medical Nutrition Equity Act, and H.R. 3332, which 
would provide coverage for medical wigs under Medicare.
    Mr. Chairman, Americans struggle every day to navigate 
treatments for life-threatening health conditions and all too 
often, this battle comes with cost barriers that prevent people 
from securing treatments that fit their health and personal 
needs.
    A few months ago, Congresswoman Herrera Beutler and I 
introduced H.R. 2501, the bi-partisan Medical Nutrition Equity 
Act. Each year, more than 7,000 infants are diagnosed with an 
inherited metabolic disorder. These life-threatening conditions 
prevent patients from digesting or metabolizing most ``normal'' 
foods. Patients often manage their complex nutritional needs 
with prescribed, specialized formulas and without them, risk 
brain damage, repeated hospitalizations, and in some cases, 
death.
    Currently, children and adults who are diagnosed with 
serious digestive disorders must pay out-of-pocket for 
medically necessary food, which can often cost four to five 
times as much as the foods we find in grocery stores. And to 
make matters worse, most health insurance companies do not 
cover medically necessary nutrition unless the medication is 
administered through a surgically placed tube-a costly and 
ultimately dangerous procedure that in some cases can be 
avoided.
    While thirty-five states have already passed laws to ensure 
some level of coverage for medical necessary nutrition, that 
coverage is highly variable and excludes all patients covered 
under federal programs. The Medical Nutrition Equity Act would 
establish treatment parity by requiring coverage for 
specialized formulas, including medically necessary food, 
vitamins, and amino acids under private insurance, Medicare, 
Medicaid and the Children's Health Insurance Program-and by the 
way, this is coverage that Congress already approved for 
military families enrolled in TRICARE.
    The other important piece of legislation that I'm here to 
talk about is H.R. 3332, which would amend title XVIII of the 
Social Security Act to provide coverage for wigs as durable 
medical equipment under the Medicare program.
    Many patients living with medical hair loss suffer from a 
variety of diseases, including cancer and Alopecia Areata. For 
those undergoing chemotherapy or suffering from Alopecia 
Areata-an uncurable autoimmune skin disease that causes 
unpredictable hair loss-a wig is not just medically necessary, 
but also essential to alleviating the emotional and social 
burden of hair loss.
    I was inspired to introduce this bill after meeting with 
one of my constituents, Mary Aframe, who runs the Women's Image 
Center located in Worcester and Leominister. Ms. Aframe has 
worked tirelessly to help raise awareness about the many women 
undergoing chemotherapy who have trouble affording wigs-
particularly those who use Medicare.
    Wigs can cost thousands of dollars and are out of reach for 
many patients without help from their insurance provider. While 
many private insurance plans already cover wigs for those 
undergoing treatments that cause hair loss, this bill re-
categorizes wigs as durable medical equipment to allow Medicare 
to provide coverage if a doctor certifies that the wig is 
medically necessary. This bill will help ensure that every 
cancer patient and Alopecia patient who loses their hair can 
afford a wig and undergo treatment with the dignity and respect 
they deserve.
    Mr. Chairman, I strongly encourage you to consider hosting 
markups and hearings on H.R. 2501 and H.R. 3332 and I look 
forward to the opportunity to work with you and the Energy and 
Commerce Health Subcommittee on advancing this legislation. We 
need to do right by our constituents and ensure that consistent 
coverage is standard for all Americans-no matter the illness 
they have or healthcare coverage they require.

    Mr. Pallone. Thank you, Chairman McGovern. You've been very 
helpful to us in the Rules Committee. I appreciate that. And 
Congresswoman Herrera Beutler actually mentioned the bill that 
you highlighted earlier. So we are going to--we will follow up. 
Thanks again.
    Mr. Lipinski?

  OPENING STATEMENT OF HON. DAN LIPINSKI A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF ILLINOIS

    Mr. Lipinski. Mr. Pallone and Mr. Griffith--Chairman 
Pallone and Mr. Griffith, Chairwoman Eshoo, I want to thank for 
the opportunity to testify today.
    I want to draw the committee's attention to H.R. 1165, a 
bill I introduced to address the serious public health issue 
from a chemical called ethylene oxide, or EtO.
    Just outside my district in Willowbrook, Illinois, a 
company called Sterigenics has been using EtO to sterilize 
medical equipment. This sterilization method is used at many 
facilities across the country.
    EtO is a known carcinogen. Last summer, the EPA released a 
report indicating disturbingly high cancer risk in communities 
across the country that are home to commercial sterilization 
facilities including Sterigenics that admit EtO.
    The risk was determined after a lengthy advisory Integrated 
Risk Information System, or IRIS, process, which included 
extensive reviews of the scientific literature.
    This review found that the probable cancer risk posed by 
EtO is 30 times greater than previously estimated. Further, a 
report released in April by the Illinois Department of Public 
Health found that certain types of cancer linked to EtO 
exposure were higher in the Willowbrook community than 
elsewhere in the state.
    Specifically, when looking at neighborhoods near the 
Sterigenics facility, the report found higher rates of 
Hodgkin's lymphoma in women, pediatric lymphoma in girls, as 
well as ovarian, breast, and pancreatic cancers.
    This was, obviously, frightening news for every community 
and family in the vicinity of Sterigenics and a cause of great 
alarm to others with similar facilities nearby.
    Thankfully, the Illinois EPA stepped in last February to 
issue a CO order at Sterigenics and prevent it from using EtO 
in its sterilization process.
    But just last week, an agreement was reached to allow the 
facility to reopen pending approval by a district court. 
Meanwhile, the EPA has stated for months that it is considering 
new emission standards for facilities that use EtO, which would 
be based on the most recent risk data available.
    This would provide for direct EPA regulation of EtO 
emissions and protect people living in communities around EtO-
emitting facilities.
    But the EPA has still not promulgated the standard, slow-
walking an issue of profound concern to my constituents. It is 
also unclear whether the EPA will continue utilizing the best 
available science to inform the standard by basing its decision 
on rigorously reviewed IRIS risk values.
    The EPA must not be allowed to undermine the integrity of 
scientific process by ignoring established research methods 
that may reveal unfavorable results.
    I've been very vocal about this issue because I not only 
represent thousands of people who live and work downwind of the 
Sterigenics facility, but I also live nearby.
    In order to get the EPA to act, earlier this year I 
introduced H.R. 1165, the EtO is Toxic Act. This bill requires 
the EPA to take IRIS assessment data into consideration when 
setting an EtO emissions standard.
    I request the committee to act on this bill to ensure that 
EPA decisions on this matter use the best science available. 
Further, I urge the committee to use its oversight authority 
over the EPA to investigate whether it's taking appropriate 
action to protect public health from the dangers of EtO.
    After years of breathing air with an unsafe cancer-causing 
pollutant, my constituents and others across the country cannot 
wait.
    I thank you for your time and your attention, and I yield 
back.
    [The prepared statement of Mr. Lipinski follows:]

                Prepared Statement of Hon. Dan Lipinski

    Thank you, Chairman Pallone, Ranking Member Walden, and all 
members of the committee on Energy and Commerce, for the 
opportunity to testify today about important issues within the 
committee's jurisdiction. The primary topic I wish to address 
is the problem of skyrocketing prices for healthcare and 
medicine. This committee has recently taken action to move 
forward legislation to start addressing this problem, including 
legislation dealing with surprise bills and drug pricing, some 
of which I have cosponsored. I look forward to this legislation 
moving to the floor so we can pass it and get it signed into 
law. But we must do more. I urge the committee to promote 
healthcare price transparency as it prepares to bring 
healthcare legislation to the House floor.
    Every single one of us has hundreds and thousands of 
constituent families who have struggled with the high prices of 
medical care - including sky-high charges for drugs and 
incomprehensible bills from hospitals and other providers. But 
even aside from the charges patients directly see, the economy 
as a whole suffers from the runaway growth in healthcare 
spending as charges covered by insurance are passed on to 
patients in the form of higher insurance premiums and higher 
taxpayer costs for public programs. Even with a lifesaving drug 
like insulin, which was first discovered nearly 100 years ago, 
prices are climbing through the roof--something I have seen 
firsthand as a diabetic. I have also directly seen how inflated 
hospital bills can be after being treated for a bike accident. 
But my own experiences are just a drop in the ocean of the 
experiences of millions of patients across the U.S.
    Earlier this month, the courts derailed an attempt to fight 
the high cost of prescription drugs by blocking an 
Administration rule requiring drug companies to include the 
price of a drug when it is advertised on TV. This is an idea 
that drug companies fought against - they clearly believe they 
have something to be hide. But Congress has the power to fix 
this court decision. I joined on as a co-sponsor of the Drug 
Price Transparency for Medicare Patients Act, which would give 
the Administration the authority it needs for this rule. While 
there are many of the President's policies I and many others in 
this room disagree with, this should be one we can all get 
behind. I urge the committee to consider this bill or similar 
proposals as legislation is prepared for a vote on the floor.
    Similarly, I urge the committee to support transparency 
into hospital prices. The first bill I introduced after I was 
first elected was the Hospital Price Reporting and Disclosure 
Act in 2006. I will shortly introduce an updated version which 
will build on and strengthen an ACA requirement for hospitals 
to publish their list of standard charges on their websites. My 
bill will create penalties for non-compliance with the ACA 
rule; require an identical format for published data so that 
information can be easily compared create a central website for 
collecting charge information; facilitate access to this data 
by the public so they can create new consumer tools from the 
data; require HHS to develop a way to provide insight into 
actual negotiated charges while taking steps to prevent market 
collusion or price increases from this data; and require 
reporting on trends in standard and negotiated charges over 
time, including trends in comparison to Medicare rates.
    In addition to the issue of healthcare costs and prices, I 
also want to draw the Committee's attention to a public health 
issue from a pollutant called ethyne oxide, or EtO. Just 
outside my district in Willowbrook, IL, a company called 
Sterigenics has been using EtO to sterilize medical equipment. 
The EPA released an updated National Air Toxics Assessment last 
summer, which indicated a significantly elevated cancer risk in 
the surrounding communities because of EtO emissions. This risk 
was determined after a lengthy Integrated Risk Information 
System, or IRIS, process, which included extensive reviews of 
the scientific literature. The EPA has stated for months that 
it is considering an emissions standard for facilities that use 
EtO, which would protect people living in communities around 
them. However, the EPA has still not promulgated such a 
standard. Furthermore, it remains unclear whether the EPA will 
continue utilizing the best available science to inform any 
potential standard by basing its decisions on rigorously 
reviewed IRIS risk values.
    I worked with my colleagues to introduce the Expanding 
Transparency of Information and Safeguarding Toxics Act, or the 
EtO is Toxic Act for short. That bill requires the EPA to take 
IRIS assessment data into consideration when setting an 
emissions standard with respect to EtO. I request the 
committee's support for this bill to ensure that EPA decisions 
on this matter use the best science available. Additionally, I 
urge the committee to use its oversight authority over the EPA 
to investigate whether it is taking appropriate action to 
protect public health from the dangers of EtO.
    Thank you for your time and attention.

    Mr. Pallone. Thank you, Mr. Lipinski. I want to comment but 
we are running out of time before the vote. So thanks again for 
being here.
    Mr. Golden, if you want to be quick, we could do it now. 
But if not, we'd ask you to come back. What do you prefer?
    Mr. Golden. I'll go ahead and be as fast as I can.
    Mr. Pallone. All right. All right. Thanks.
    Mr. Golden. And I am sure you're trying to keep on track 
today.
    Mr. Pallone. All right. Thanks.
    Mr. Golden. Thank you very much. Of course, I defer to you 
if you would prefer to wait.

  OPENING STATEMENT OF HON. JARED GOLDEN A REPRESENTATIVE IN 
                CONGRESS FROM THE STATE OF MAINE

    Chairman Pallone, Mr. Griffith, Ms. Eshoo, thank you very 
much for the opportunity.
    I am here to testify to testify about the FLAT Prices Act, 
H.R. 1188. It's a bill that I am proud to lead to address the 
issue of rapid increases in prescription drug prices.
    I am honored to have the support of Mr. Casten, Ms. 
Slotkin, Mr. Cisneros, Mr. Rose, Ms. Pingree, and Ms. 
Finkenauer. I am glad to be working in partnership with Senator 
Durbin, who leads a companion bill in the Senate.
    Traveling around Maine's 2nd District, this is a top 
issue--the rising price of prescription drugs. We are a very 
old state. We, in fact, per capita we are the oldest state--my 
constituents. Prescription drug prices is critically important 
to them.
    And we have seen, obviously, over the years a lot of 
coverage about spiked prices, efforts to make a quick buck on 
the backs of people who are relying upon these prescription 
drugs.
    Examples such as Martin Shkreli, raising the price of HIV/
AIDS drugs, you know, by about 5,000 percent. I know you're all 
familiar with this. Mylan and EpiPen prices going from $50 to 
over $600. Insulin prices have consistently increased in recent 
years as well with the average price nearly doubling between 
2012 and 2016.
    This issue isn't just a few well-known bad actors. 
According to AARP, retail prices for a set of more than 250 
widely-used brand name prescription drugs increased by an 
average of more than 10 percent each year from 2012 to 2016.
    These price increases have forced some families, 
particularly seniors, to make very difficult decisions between 
buying lifesaving medications and putting food on the table, 
paying rent. In a place like Maine--very cold in the 
wintertime--often that tradeoff has to do with heating your 
home or getting your medications.
    I've introduced the FLAT Prices Act with this data and 
these real-world impacts in mind. The bill would help put a 
stop to immoral price gouging by helping generic competition 
come to the market faster.
    The FLAT Prices Act would reduce a drug's market 
exclusivity period if its price spikes by more than 10 percent 
in one year, 18 percent over two years, or 25 percent over a 
three-year period.
    The penalty for exceeding these thresholds would be a 
reduction of 180 days for the drug's exclusive monopoly period, 
and the period would shorten by an additional 30 days for each 
five percent price increase above these thresholds.
    With this bill in place, pharmaceutical companies would be 
discouraged from steeply hiking their prices, and if they did 
so anyway, consumers would have less time to wait before 
generic alternatives would become available to them.
    I applaud this subcommittee for its recent action to 
advance a number of bills related to drug pricing, and I hope 
that you will consider including the FLAT Prices Act, which has 
been referred to this committee in a future set of bills to 
control healthcare costs.
    I particularly like the bill because I think it takes a 
tiered approach that matches the issue. For those who are most 
abusive, this bill would be most effective in doing something 
about price gouging.
    For those who perhaps, you know, are price gouging a little 
bit less so than some of these worst of examples it would be 
less of a penalty.
    But it does recognize that these companies have an 
exclusivity period because they have made big investments up 
front. You know, they start with a price and costs may 
increase.
    We are not--we are not trying to stop companies from 
recovering the investments they have made. We are just trying 
to protect consumers from abusive behaviors.
    [The prepared statement of Mr. Golden follows:]

                Prepared Statement of Hon. Jared Golden

    Chairwoman Eshoo, Ranking Member Burgess, distinguished 
members of the committee: I appreciate the opportunity to 
testify about the FLAT Prices Act, H.R. 1188, a bill that I am 
proud to lead to address the issue of rapid increases in 
prescription drug prices.
    I am honored to have the support of Mr. Casten, Ms. 
Slotkin, Mr. Cisneros, Mr. Rose, Ms. Pingree, and Ms. 
Finkenauer on this bill, and I am glad to be working in 
partnership with Senator Durbin, who leads a companion bill in 
the Senate.
    As I travel around Maine's Second District, one issue I 
hear about constantly is the rising price of prescription 
drugs. For too long, big pharma has spiked prices to make a 
quick buck on the backs of those who cannot survive without 
these treatments.
    We all remember the ``Pharma Bro'' Martin Shkreli (Skrell-
ee), whose company Turing Pharmaceuticals raised the price of 
the HIV/AIDS drug Daraprim from $13.50 per pill to $750 per 
pill--a 5,000% price increase.
    Similarly, Mylan, a company that has exclusive rights to 
distribute the lifesaving allergy medication auto-injector 
``EpiPen'', raised the price from $50 to over $600.
    Additionally, insulin prices have consistently increased in 
recent years, with the average price nearly doubling between 
2012 and 2016.
    This issue isn't just about a few well known bad actors. 
According to AARP, retail prices for more than 250 widely used 
brand name prescription drugs increased by an average of more 
than 10% each year from 2012 to 2016.
    These price increases have forced some families to make the 
excruciating decision between buying life saving medications 
and putting food on the table, or paying rent.
    I introduced the FLAT Prices Act with this data--and these 
real-world impacts--in mind. The bill would help put a stop to 
immoral price gouging by helping generic competition come to 
the market faster. The FLAT Prices Act would reduce a drug's 
market exclusivity period if its price spikes by more than 10% 
in one year, 18% over two years, or 25% over a three-year 
period.
    The penalty for exceeding these thresholds would be a 
reduction of 180 days for the drug's exclusive monopoly period, 
and the period would shorten by an additional 30 days for each 
5% price increase above these thresholds.
    With this bill in place, pharmaceutical companies would be 
discouraged from steeply hiking their prices, and if they did 
so anyway, consumers would have less time to wait before 
generic alternatives would become available to them.
    I applaud this subcommittee for its recent action to 
advance a number of bills related to drug pricing, and I hope 
that you will consider including the FLAT Prices Act, which has 
been referred to this subcommittee, in a future set of bills to 
control healthcare costs.
    Thank you again for the opportunity to testify today.

    Mr. Pallone. Well, thank you, and we have just got to wrap 
up. But, obviously, this is a huge priority for us in the fall.
    You know, we are going to be having--we are going to 
moving--you know, be moving and looking at these various bills 
on negotiated prices under Medicare and we know the problem is 
particularly acute for seniors.
    And Ms. Eshoo is certainly--this is a priority for her, 
too. So I am just going to adjourn now if that's all right. We 
are going to--not adjourn. We are going to recess until 2:00 
o'clock.
    But I thank the gentleman from Maine.
    Mr. Golden. Thank you for the opportunity.
    [Recess.]
    Mr. Pallone. The committee will reconvene and I assume Mr. 
Wittman is--thank you for being here.
    Proceed.

OPENING STATEMENT OF HON. ROBERT J. WITTMAN A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF VIRGINIA

    Mr. Wittman. Thank you, Mr. Chairman. I want to thank you 
and the committee members for the opportunity to come and speak 
to you today.
    I represent the 1st District of Virginia, which faces a 
number of unique challenges in expanding broadband. The 1st 
District spans the I-95 corridor in Northern Virginia, which 
includes some of the foremost tech companies and data centers 
in the nation and continues southeast to the Northern Neck and 
Middle Peninsula, which is home to some of the most underserved 
rural populations in Virginia.
    Citizens in more urban areas in the northern part of my 
district benefit from the highest quality broadband the market 
has to offer.
    With access to speeds upwards of one gigabit, these 
citizens have unfettered access to services such as 
telemedicine, online education, and modern business 
applications and technologies that allow businesses to compete 
in the 21st century.
    These services are a convenience that many folks have come 
to take for granted in 2019. This is not the case in the more 
rural parts of my district. As population density decreases, 
the business case for providers simply is not there to extend 
service to these unserved areas.
    Many communities and neighborhoods throughout the Northern 
Neck, Middle Peninsula, and stretches of Stafford County and 
localities east of Richmond, like the localities of New Kent 
and Hanover, struggle to gain access to reliable broadband.
    As a resident of this area who drives back and forth to DC 
every day during session, I understand firsthand the plight of 
rural residents when it comes to gaining quality high-speed 
access.
    In rural areas, broadband is oftentimes the top issue I 
hear about as mothers and fathers complain about late nights 
sitting in the McDonald's parking lot as their kids use the 
WiFi to finish their homework; children of elderly parents 
plead for quality broadband to access telemedicine services so 
their parents don't have to drive an hour plus to the nearest 
health facility; or business owners that know better quality 
broadband would allow them to grow their businesses.
    Demand for high-speed broadband has never been greater.
    Closing the digital divide is the key to lifting up 
countless communities and populations in unserved areas. While 
Congress has made great strides in tackling this issue, more 
can and should be done.
    Further emphasizing policies that promote public-private 
partnerships is essential. As I mentioned earlier, as the 
population densities decrease in rural areas, P3s incentivize 
providers through an influx of capital funds to build in areas 
where the business case would often not exist without it.
    Addressing our nation's broadband mapping capabilities is 
also important to closing the digital divide. It is no secret 
our broadband maps can be wildly inaccurate and often lead to 
overbuilding on already existing networks.
    I am an original co-sponsor of H.R. 3162, The Broadband 
Data Improvement Act of 2019, which would require providers to 
report data on a geolocation basis to create an improved 
National Broadband Map that better targets funding to the areas 
that need it most.
    Another important element in preventing overbuilding is 
through instituting challenge processes. H.R. 3162 establishes 
a periodic challenge process at the FCC by which the public and 
incumbent providers may challenge data on the National 
Broadband Map.
    The FCC must then analyze any challenges that may suggest 
the map is inaccurate and resolve any disputes to update the 
map accordingly.
    I strongly urge the committee to markup and pass this 
legislation and any other similar legislation with such 
measures so that we can advance them to the floor for a vote.
    Lastly, we must continue to eliminate the labyrinth of red 
tape and regulations that continue to hinder shovel-ready 
projects and streamline our federal permitting process.
    Mr. Chairman, I want to thank you and Ranking Member Walden 
and members of the committee for the opportunity to testify 
today.
    Thanks so much for your leadership, and as co-chair of the 
Rural--House Rural Broadband Caucus, I offer my assistance on 
the subject and would certainly love to work with you on these 
items to help close the digital divide not only in my district 
but across our United States.
    [The prepared statement of Mr. Wittman follows:]

              Prepared Statement of Hon. Robert J. Wittman

    Chairman Doyle and Ranking Member Latta, I represent the 
First District of Virginia, which faces unique challenges to 
expanding broadband. The First District spans the I-95 Corridor 
in Northern Virginia, which includes some of the foremost tech 
companies and data centers in the nation and continues 
southeast to the Northern Neck and Middle Peninsula, which is 
home to some of the most unserved rural populations in 
Virginia.
    Citizens in more urban areas in the northern part of my 
district benefit from the highest quality broadband the market 
has to offer. With access to speeds upwards of one Gigabit, 
these citizens have unfettered access to services such as 
telemedicine, online education, and modern business 
applications and technologies that allow businesses to compete 
in the 21st Century. These services are a convenience that many 
folks have come to take for granted in 2019.
    This is not the case in the more rural parts of my 
district. As population density decreases, the business case 
for providers simply is not there to extend service to these 
unserved areas. Many communities and neighborhoods throughout 
the Northern Neck, Middle Peninsula, stretches of Stafford 
County and localities east of Richmond struggle to gain access 
to reliable broadband. As a resident of this area who drives 
back and forth to DC every day during session, I understand 
first-hand the plight of rural residents when it comes to 
gaining quality high-speed internet.
    In rural areas, broadband is oftentimes the top issue I 
hear about-as mothers and fathers complain about late nights 
sitting in the McDonalds parking lot as their kids use the WiFi 
to finish their homework; children of elderly parents plead for 
quality broadband to access telemedicine services so their 
parents don't have to drive an hour to the nearest health 
facility; or business owners that know better quality broadband 
would allow them to grow their businesses. Demand for high-
speed broadband has never been greater.
    Closing the digital divide is the key to lifting up 
countless communities and populations in unserved areas. While 
Congress has made great strides in tackling this issue, more 
can and should be done.
    Further emphasizing policies that promote Public-Private 
Partnerships (P3s) is essential. As I mentioned earlier, as the 
population densities decrease in rural areas, P3's incentivize 
providers through an influx of capital funds to build in areas 
where the business case would often not exist without it.
    Addressing our nation's broadband mapping capabilities is 
also important to closing the digital divide. It is no secret 
our broadband maps can be wildly inaccurate and often lead to 
overbuilding on already existing networks. I am an original 
cosponsor on H.R. 3162, The Broadband Data Improvement Act of 
2019, which would require providers to report data on a 
geolocation basis to create an improved National Broadband Map 
that better targets funding to the areas that need it most.
    Another important element in preventing overbuilding is 
through instituting challenge processes. H.R. 3162 establishes 
a periodic challenge process at the FCC, by which the public 
and incumbent providers may challenge data on the National 
Broadband Map. The FCC must then analyze any challenges that 
may suggest the map is incorrect and resolve any disputes to 
update the map accordingly.
    I strongly urge the Committee to markup and pass this 
legislation so that it can advance to the floor for a vote.
    Lastly, we must continue to eliminate the labyrinth of red 
tape and regulations that continue to hinder shovel ready 
projects and streamline our federal permitting process.
    I want to thank Chairman Doyle, Ranking Member Latta, and 
members of the committee for this opportunity to testify today. 
As co-chair of the House Rural Broadband Caucus, I offer my 
assistance on the subject and would certainly love to work with 
you on these items to help close the digital divide in my 
district.

    Mr. Pallone. Thank you.
    We--several members have talked about the need to expand 
broadband into rural and underserved areas, and that's one of 
the things that we definitely are striving for.
    We have a bill called the LIFT America Act that would 
spend, like, $40 billion on that as part of a larger 
infrastructure package.
    So, you know, we are going to look at this very seriously. 
Thank you.
    Mr. Flores. I concur. Thanks, Rob, for joining us today.
    Mr. Pallone. Thanks a lot. Appreciate it.
    Mr. Wittman. Thank you, Mr. Chairman.
    Mr. Pallone. Take care.
    Mr. Malinowski, thank you for coming back after the votes.
    Mr. Malinowski. Thank you for having me back.

 OPENING STATEMENT OF HON. TOM MALINOWSKI A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF NEW JERSEY

    Thank you, Mr. Chairman, Mr. Flores, members of the 
committee. I very much appreciate the chance to testify.
    You have a very broad jurisdiction. Obviously, I am going 
to focus on just one issue. I am here on behalf of the 168,000 
people in New Jersey who have been hit with medical debt due to 
surprise billing.
    Each year, through no fault of their own, in my state, in 
our state, these folks owe an extra $420 million. We often hear 
about surprise billing happening during medical emergencies--a 
person is sick or injured. An ambulance is called, and later 
they are hit with a huge bill because either the ambulance or 
the hospital or the doctor they saw was out of network.
    I recently spoke with a constituent whose husband had a 
cardiac emergency. She called local emergency services, who 
then called a local hospital to send an ambulance with cardiac 
equipment.
    After her husband was release they received four separate 
bills totaling thousands of dollars. Their insurance was 
covering less than half.
    While the hospital where he was taken was covered by the 
family's insurance, the couple was unaware that the ambulance, 
which was associated with the hospital, was out of network. How 
could they know? How could they be expected to know such a 
thing?
    It is a true testament to how broken our healthcare system 
is that during our worst moments when we are most vulnerable, 
when we are sick, injured, worried about getting better, 
staying alive, we are also burdened with the responsibility of 
ensuring that our ambulance, our hospital, every single doctor 
that examines us is covered under the insurance we pay for each 
month.
    Surprise billing, of course, does not just happen during 
emergencies. A patient can book an appointment with a doctor in 
network and only find out later that one of the medical 
professionals she saw actually worked for a third party and was 
not covered.
    Anesthesiologists, radiologists, surgical assistants, often 
entire departments within an in-network facility might be 
operated by subcontractors and, therefore, be out-of-network.
    Seven in ten people who have been hit with unaffordable 
out-of-network medical bills were not aware that the healthcare 
provider they saw was not in their plan's network at the time 
of receiving care.
    Now, last year New Jersey passed our own law that clearly 
prohibits charging patients more than what we would normally 
owe under our insurance plans for urgent and medically 
necessary services or inadvertent out-of-network services.
    There is no good reason why we should not do the same for 
every American. Patients who are no way at fault should not be 
responsible for astronomical fees they were not warned they 
were incurring.
    Mr. Chairman, one last broader point on this. There are 
many things that Republicans and Democrats sincerely disagree 
about in this body. I don't think that this is one of them. I 
don't see any philosophical difference among us--amongst us 
about whether people should be stuck with massive surprise 
medical bills, just a challenge on agreeing on the practical 
details.
    It is one thing to have gridlock when we disagree. If we 
cannot deliver on one of the few issues where we do stand on 
common ground that would further diminish our constituents' 
faith in this institution.
    So I would say the stakes are pretty high.
    I thank you for your work on this issue, which I know has 
been bipartisan in this committee. I look forward to being part 
of that and hope very much that we will come to a solution 
soon.
    Thank you very much.
    [The prepared statement of Mr. Malinoski follows:]

                Prepared Statement of Hon. Tom Malinoski

    Thank you Chairman Pallone and Ranking Member Walden. I 
appreciate the opportunity to testify in front of the House 
Energy and Commerce Health Subcommittee.
    I am here today to advocate for the 168,000 New Jersians 
who have been hit with crippling medical debt due to surprise 
billing, including my constituents in the 7th district.
    Surprise billing arises when an insured individual 
unknowingly receives care from an out of network provider, and 
is later hit with an unexpected medical bill.
    Throughout New Jersey it is estimated that approximately 
$420 million is owed by these patients each year due to 
surprise billing.
    In many instances those out-of-network bills are shifted to 
health insurers, who then pass along their costs to an 
estimated five million residents who pay up to $956 million 
more per year more for their commercial insurance premiums.
    We often hear about surprise billing happening during 
medical emergencies. A person is sick or injured, an ambulance 
is called, and later they are hit with a huge bill because 
either the ambulance or the hospital or the doctor they saw was 
out of network.
    I recently spoke with a constituent whose husband had a 
cardiac emergency. She called local Emergency Medical Services, 
who then called a local hospital to send an ambulance with 
cardiac equipment.
    After her husband was released they received four separate 
bills totaling thousands of dollars, and insurance was covering 
less than half.
    While the local hospital he was taken too was covered by 
their insurance, the couple was unaware that the ambulance, 
which was associated with the hospital, was actually out of 
network.
    It is a true testament to how broken our medical system is 
that during a person's worst moments--when they are at their 
most vulnerable--they are also burdened with the responsibility 
of ensuring that their ambulance, their hospital, and every 
single doctor that examines them, are covered under the 
insurance they pay for each month.
    Surprise billing does not just come about during 
emergencies. A patient can book an appointment with a doctor in 
their network, and only find out later that one of the medical 
professionals they saw, actually worked for a third party and 
was not covered.
    Anesthesiologists, radiologists, surgical assistants, often 
entire departments within an in-network facility might be 
operated by subcontractors and are therefore out of network.
    Seven in ten individuals who have been hit with 
unaffordable out-of-network medical bills were not aware that 
the healthcare provider they saw was not in their plan's 
network at the time of receiving care.
    According to a 2018 poll from the Kaiser Family Foundation 
Two-thirds of Americans say they are either ``very worried'' or 
``somewhat worried'' about their ability to afford unexpected 
medical bills.
    Last year New Jersey took steps to address surprise billing 
and increase transparency. Providers must now inform non-
emergency patients anytime they will be responsible for any out 
of network fees. Changes were also made to lower costs for out 
of network care in emergency and urgent care scenarios.
    There is still much to be done, and this issue needs to be 
addressed at a national level. Patients, who are in no way at 
fault, should not be responsible for astronomical fees they 
were not warned they were incurring. Billing should remain 
between the provider and the health insurance provider.
    Party doesn't matter when you get hit with an unexpected 
medical bill. Congress must come together to provide solutions 
for Americans who are being saddled with debt they never agreed 
to take on.
    Thank you, and I look forward to working with the Committee 
on this very important issue.

    Mr. Pallone. Well, thank you.
    Ms. Eshoo?
    Ms. Eshoo. I want to thank you for being here today and I 
agree with everything that you've said. Actually, the chairman 
and the ranking member of the full committee are the chief 
sponsors of what you just described.
    And we have worked hard on the bill. It came through the 
Health Subcommittee to the full committee on a bipartisan 
basis, and I don't know if you've read the bill.
    Mr. Malinowski. I have, yes. Yes.
    Ms. Eshoo. You have? And do you have any--if you have any 
particular views where you don't agree or you think the 
legislation can be improved, let us know.
    Mr. Malinowski. I will.
    Ms. Eshoo. I think it's on its way and we look forward to 
it going to the floor for the full House to pass it post August 
recess.
    Mr. Malinowski. I hope so, too.
    Mr. Pallone. I appreciate what the gentlewoman has said.
    The--I just want to make two remarks. First of all, I was 
surprised to find out that in our state, you know, generally, 
across the country the federal bill--well, I think there are 
about 12 states that have their own laws including California 
and New Jersey.
    And so, obviously, for the states that don't this would be 
even more important, right, because they don't have any state 
legislation.
    But even if the states that do, it generally doesn't cover, 
you know, the large self-insured, you know, ERISA plans. And we 
have figured that about a third of the people nationally, you 
know, are in those types of plans.
    But interestingly enough, I had an event with the Speaker 
Coughlin, you know, who's from my district, and he said that in 
New Jersey it was reverse.
    In other words, the state law only covers about a third and 
the federal law would cover the other two-thirds, which was, I 
thought, interesting.
    Mr. Malinowski. Yes. Even people covered by the state law 
don't always--aren't necessarily aware that they are protected. 
We have actually--my district offices have to help some of our 
constituents who actually are covered.
    Mr. Pallone. Yes.
    Mr. Malinowski. Obviously, you know, we have referred them 
to the state government, and the insurance companies and the 
hospitals have not fully adjusted to the new reality in our 
state.
    So I think a national law, even in states where we have 
taken this step, would be very, very important in ensuring that 
everybody in the complicated system understands that this has 
changed and must change.
    Mr. Pallone. And then the other thing--not to belabor it--
as you mention ambulances, we would very much like to cover 
ambulance. We do cover the air ambulance--the helicopters.
    The problem in covering ambulances it was just so 
complicated because a lot of them are, you know, some's 
private. A lot in New Jersey, in particularly, is, you know, 
the community for state squad, the local government.
    So we are looking at it but it is--it is difficult for us 
to cover ambulances because the way they are set up and paid 
for. But we are looking at it so I wanted to mention that.
    Mr. Malinowski. Good. Thank you.
    Mr. Pallone. Did you want to add something, Mr. Flores?
    Mr. Flores. Yes. Mr. Malinowski, thanks for joining us 
today. This is an issue that cuts across all states and all 
populations, and we appreciate your input.
    Mr. Malinowski. Thank you, sir.
    Mr. Pallone. Thank you, Tom.
    Mr. Malinowski. All righty.
    Mr. Pallone. Thank you.
    And now the gentlewoman from Puerto Rico. Good to see you 
here.
    [Laughter.]

     OPENING STATEMENT OF HON. JENNIFFER GONZALEZ-COLON A 
  REPRESENTATIVE IN CONGRESS FROM THE TERRITORY OF PUERTO RICO

    Miss. Gonzalez-Colon. Thank you, Chairman Pallone, for your 
visit to Puerto Rico and the commitment you have shown many 
years for the island. Ranking Member Flores, again, and 
Chairwoman Eshoo for all the help during the legislation of the 
past week, and same thing to Peters here today.
    I want to thank all for giving me the opportunity to 
discuss legislation I have introduced that could be brought 
before the committee.
    I also want to thank this committee for taking a critical 
action last week by passing the Territories Health Care 
Improvement Act, which provides critically needed resources to 
the territory's Medicaid programs to ensure sustainability 
while a more permanent legislative solution is developed.
    According to analysis undertaken by the Department of 
Health and Human Services, Americans living in poverty have 
significantly constrained budgets that limits their ability to 
pay out-of-pocket healthcare costs.
    Those in poverty have literally no available income after 
they pay for their most basic necessities each month, 
necessities which do not include healthcare, childcare, or 
transportation.
    People in poverty tend to be less healthy than those in 
higher--with higher incomes and therefore need more medical 
care. However, people in poverty are often unable to afford 
even nominal premiums and co-payments.
    Research shows that they may forgot necessary medical 
treatment as a result of required cost sharing. Having said 
that, Puerto Rico's population is a prime example of all these 
findings.
    With a median annual income of $19,000, close to half of 
Puerto Rico's residents live below poverty level and depend 
upon the public health system for their medical care.
    Additionally, residents of Puerto Rico are ineligible for 
supplemental security income solely because they live on the 
island because of our zip code.
    They are also ineligible to receive assistance in payments 
other than Medicare Part B and Part D premiums. Residents of 
Puerto Rico bear the heavier burden of healthcare costs than 
residents of the states and the District of Columbia.
    In order to triage this situation while Congress develops a 
permanent solution, I filed the following bills that await 
action before this committee, all of them in a bipartisan way.
    H.R. 813, the Puerto Rico Integrity in Medicare Advantage 
Act, gives Puerto Rico almost--more than 80 percent of our 
people are using the Advantage program. This bill revises the 
Medicare Advantage payments for three years by establishing a 
.7 percent adjusted general average floor to any county in the 
nation that exceeds this benchmark.
    Two, it requires that at least half of the regional funding 
above and beyond the 85 percent rule be used to increase 
provider payments, and the reason for that is we are losing a 
lot of our physicians and service providers.
    And it will support Medicare Advantage Coordinated Care 
Platform, which with performance base and equality standards in 
care, which serves as the backbone of the healthcare system in 
Puerto Rico as well.
    I also introduce H.R. 2172, which removes the matching 
requirement for Medicare Part D drugs in Puerto Rico. While 
assistance is available for Medicare beneficiaries in the 
states and in the District of Columbia, beneficiaries who 
resides in the territories are not eligible for low-income 
subsidy or LIS.
    In lieu of the LIS, Social Security provides a block grant 
to each territory for Medicaid coverage for low-income 
beneficiaries prescription drugs. In the case of the island, 
FMAP has been set to 55 percent.
    Between fiscal years 2010 and 2016, Puerto Rico has been 
able to draw down only 51 percent of its available federal 
funding for prescription drugs and for low-income Medicare 
beneficiaries.
    Lastly, I introduced H.R. 2310, the Fairness in Medicare 
Part B Enrollment Act, to address the fact that the residents 
of every states and territories other than Puerto Rico who are 
receiving Social Security benefits are automatically enrolled 
in both Part A, Part B with coverage beginning the first day of 
the month when they turn 65.
    When someone who is receiving SSI in Puerto Rico turns 65, 
they are enrolled in Medicare Part A but not in Part B, which 
has resulted in 38,000 Medicare beneficiaries paying a lifetime 
late enrollment penalty of $20 million a year.
    And with that, Puerto Ricans deserve equality in healthcare 
just like every other U.S. jurisdiction by enrolling in Part B 
automatically.
    Approximately 40 percent of the residents of Puerto Rico 
who are 60 years and older live below the poverty level with an 
annual income of less than $12,000.
    The Part B premium, or about 15 percent of their monthly 
income, can be cost prohibitive in the absence of other 
Medicare savings program options available across the nation.
    With that, I would like to thank you all and, again, I ask 
the committee to take up these bills in a favorable way.
    Mr. Pallone. I thank the gentlewoman.
    I mean, you know, I feel personally--I know a lot on this 
committee that we really need to do a lot more with Puerto Rico 
and the territories.
    And when we went on that two-day mission or whatever CODEL 
with you and Stacey Plaskett we learned a lot and not only 
about what we had to do with Medicaid but also the electricity 
grid and so many other things that we will still follow up 
with.
    And thanks for all your input in putting together the 
Medicaid plan, which we expect will move, you know, hopefully 
the first week or soon after we get back, and we are working 
with the Senate on it, too. So thanks again.
    Did you want to add anything, Ms. Eshoo, or----
    Ms. Eshoo. Well, I think that--I am very glad that we got 
the legislation done when we did, and it is--I think it's going 
to go a long way.
    It's not going to close the loop on everything because the 
territories are still not going to be treated the way they 
should. There is not equity there in American citizens. But 
thank you for the work that you've done on it and I look 
forward to it passing when we come back, right?
    Mr. Pallone. Right. Thank you.
    Ms. Eshoo. So we will have some good full floor days just 
from what comes out of our committee, Mr. Chairman.
    Thank you.
    [The prepared statement of Miss. Gonzalez-Colon follows:]

          Prepared Statement of Hon. Jenniffer Gonzalez-Colon
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    Mr. Pallone. And we will still look to, you know, beyond 
the four years, too. You know, we know we have to do a 
permanent replacement. So thanks again, Jenniffer. Thanks.
    All right. Next we have the gentlewoman from Iowa, Ms. 
Finkenauer.

 OPENING STATEMENT OF HON. ABBY FINKENAUER A REPRESENTATIVE IN 
                CONGRESS FROM THE STATE OF IOWA

    Ms. Finkenauer. Well, thank you, Chairwoman Eshoo, and also 
Chairman Pallone for the opportunity to speak here today.
    While I don't serve on this committee, I am proud to be a 
voice for Iowa's working families and am committed to making 
sure that they have a seat at the table on the issues affecting 
their lives.
    And one of the most significant burdens Iowa families are 
facing is the skyrocketing cost of prescription drugs. It's 
something that I've heard from folks all around my district at 
town halls but then also things that I call ``Conversations 
with your Congresswoman,'' which are modeled after kitchen 
table conversations I'd have with my grandfather and my uncle.
    My grandfather was a Democrat. My uncle was a Republican. 
And we'd sit around the table talking about issues that 
mattered and I remember, you know, we could leave and, you 
know, disagree on some issues but still have respect for each 
other.
    And when it comes to prescription drugs, that's something 
where Democrats and Republicans especially in my district are 
concerned about and can find common ground.
    You know, in the first half of this year alone, we have 
seen over 3,400 drugs boost their prices. The average price 
hike? Ten percent--five times the rate of inflation.
    The cost of insulin, for instance, has risen over 500 
percent in recent years. It's left a lot of Iowans with 
diabetes who have been managing their condition for years 
wondering what's changed.
    Seniors on fixed incomes are especially burdened by the 
rising costs. No one should have to choose between retiring in 
dignity, keeping their home, or affording the medicine that 
allows them to live their lives.
    Yet, three in ten Americans report not taking their 
medicines as prescribed because of cost.
    Stevie is a mom in Iowa. She has said she has her son's 
doctor write her son a prescription for a less effective 
medicine because that is all she could afford.
    She couldn't afford to pay for the drug that the doctor 
originally prescribed for her son. She told the doctor that 
giving her son a less effective medicine was better than none.
    No mother, no American, should be put in this situation. We 
live in the most innovative country in the world. There is no 
reason we cannot come together and find the best policy 
solutions to reduce costs, putting money back in the pockets of 
Iowa families and families across the country, and getting 
folks the care that they need.
    I have proudly supported bills like the CREATES Act and the 
Protecting Consumer Access to Generic Drugs Act. I appreciate 
this committee's work to bring legislation to the House floor 
that would require more transparency from drug manufacturers 
and will make it faster and easier for more affordable generics 
to come to market.
    I encourage this committee to just continue its important 
work to hold drug companies accountable and bring down the 
costs for patients through common sense bipartisan legislation.
    I'll continue to work with anybody who is serious about 
helping Iowans and helping Americans get better, more 
affordable healthcare, and I am ready to work with you and I 
support you in your efforts to tackle the skyrocketing costs of 
prescription drugs.
    I am truly grateful again, Chairwoman Eshoo, for inviting 
us today to have these voices heard and thank you for your 
efforts, and I am continuing ready to keep the work going with 
you guys.
    Thank you.
    [The prepared statement of Ms. Finkenauer follows:]

               Prepared Statement of Hon. Abby Finkenauer

    Thank you, Chairwoman Eshoo and Ranking Member Burgess, for 
the opportunity to speak today.
    While I do not serve on this committee, I am proud to be a 
voice for Iowa's working families and am committed to making 
sure that they have a seat at the table on the issues affecting 
their lives.
    And one of the most significant burdens Iowa families face 
is the skyrocketing cost of prescription drugs.
    It's something that I'm hearing from folks at townhalls and 
Conversations with Your Congresswoman events across my 
district.
    In the first half of this year alone, we've seen over 3,400 
drugs boost their prices.
    The average price hike? Ten percent--five times the rate of 
inflation.
    The cost of insulin, for instance, has risen 500 percent in 
recent years. It's left a lot of Iowans with diabetes--who have 
been managing their condition for years wondering, what 
changed? Seniors on fixed incomes are especially burdened by 
these rising costs.
    No one should have to choose between retiring in dignity--
or keeping their home--and affording the medicine that allows 
them to live a full life.
    Yet, three in ten Americans report not raking their 
medicines as prescribed because of cost.
    We live in the most innovative country in the world. There 
is no reason we cannot come together and find the best policy 
solutions to reduce costs, putting money back in the pockets of 
Iowa families and getting Iowans the care they need.
    I have proudly supported bills like the CREATES Act and the 
Protecting Consumer Access to Generic Drugs Act. I appreciate 
this Committee's work to bring legislation to the House floor 
that would require more transparency from drug manufacturers 
and will make it faster and easier for more affordable generics 
to come to market.
    I encourage this Committee to continue its important work 
to hold drug companies accountable and bring down costs for 
patients through common-sense, bipartisan legislation.
    I'll continue to work with anyone who's serious about 
helping Iowans get better, more affordable healthcare. While I 
do not serve as a member of this Committee, I am ready to work 
with you and support your efforts to tackle the sky-rocketing 
costs of prescription drugs.
    I am grateful to Chairwoman Eshoo and Ranking Member 
Burgess for the opportunity to speak about an issue that is 
important to me and to so many other Iowans.

    Mr. Pallone. Thank you, and, you know, many members today 
talked about prescription drugs as their priority, and we 
appreciate your mentioning that we did, as you know, move the--
and these are bipartisan--the generic competition bills, the 
transparency bills, which we did last week, which should move 
when we come back and we are working on a negotiated prices 
bill under Medicare as well.
    So, you know, you're right on point in terms of what we are 
trying to accomplish. Thank you.
    And now we have the chairwoman of the Appropriations Labor 
HHS Education and practically everything else subcommittee, 
long time champion of trying to expand access and affordability 
for healthcare. Thank you for being here.

 OPENING STATEMENT OF HON. ROSA L. DeLAURO A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CONNECTICUT

    Ms. DeLauro. Thank you very, very much, Mr. Chairman. It's 
wonderful to be here with you today. I thank the ranking 
member. Please give him my best.
    But also to my colleague, Congresswoman Eshoo, Dr. Burgess, 
Congressman Carter, and Mr. Peters, thank you all very, very 
much. This is a wonderful committee which is dealing with some 
of the most important issues that we do face in our country 
today and particularly those around healthcare.
    I am here to advocate for Medicare for America, which is a 
proposal in your jurisdiction that I have introduced with the 
chair of the Consumer Protection and Commerce Subcommittee, 
Congresswoman Jan Schakowsky.
    It is our proposal to achieve affordable quality universal 
healthcare. Right now, families are struggling with the 
skyrocketing costs of prescription drugs and healthcare costs, 
costs which continue to far outpace people's wages today.
    They are paying more for worse coverage than they may have 
had previously. In fact, according to the Kaiser Family 
Foundation, premiums increased 65 percent in 10 years for a 
single person who gets their health insurance.
    Meanwhile, their average deductible went from $303 in 2008 
to $1,350 in 2018. As a result, one-third of Americans have 
delayed care due to cost, and that's according to Gallup.
    All the while, the administration is making intentional 
policy choices to undermine the Affordable Care Act, raise 
prices for middle class families and for working people.
    In the Labor, Health, and Human Services Subcommittee, we 
hosted a hearing about what--I regard this as sabotage of the 
Affordable Care Act.
    A study out this week found that 15,600 deaths would have 
been prevented if all states expanded Medicaid and the 
Affordable Care Act as intended. It was those problems we aimed 
to solve long term with Medicare for America.
    Medicare for America achieves universal affordable high-
quality health coverage by creating a program based on Medicare 
and Medicaid.
    It expands the benefits and services to include items like 
prescription drugs, dental, vision, hearing services, and long-
term services and supports.
    Medicare for America would be accessible to all Americans 
through auto-enrollment while maintaining private insurance for 
those employers who provide comprehensive, high-quality, and 
affordable plans.
    Right now, 165 million Americans receive their coverage 
through their employer, and what we--and so what we do is to--
we maintain employer-sponsored healthcare.
    Many people are happy with it. Companies may continue, as I 
said, to offer these plans, or they can enroll employees in 
Medicare for America, contribute eight percent of annual 
payroll to the Medicare Trust Fund.
    Employees have a choice as well. They can choose to enroll 
in Medicare for America instead of their employer-sponsored 
plan and have their employer contribute to it.
    Medicare for America addresses costs. Annual out-of-pocket 
costs are no more than $3,500 for individuals, $5,000 for 
families on a sliding scale.
    There are never out-of-pocket costs for preventive and for 
chronic disease services, long-term services and supports, and 
prescription drugs, generic or brand name as necessary.
    There are also zero deductibles. Zero. And premiums are 
capped--no more than eight percent of income for enrollees. So 
for those between 200 and 600 percent of the federal poverty 
level--between $50,000 and $150,000 for a family of four--
premiums are subsidized.
    For those under 200 percent of the federal poverty level--
$50,000 for a family of four--there are zero premiums and zero 
out-of-pocket costs.
    Second, we address benefits. Currently, healthcare benefits 
are largely dependent on your zip code, and Medicare for 
America fixes that.
    Regardless of whether you live in Connecticut, Mississippi, 
Utah, and California, every single American should have robust 
comprehensive health coverage.
    So we set a very high standard for benefits. We cannot wait 
for states to do the right thing and increase benefits and 
services. Doing so will only continue and compound the 
inequalities that we are trying to rid from our healthcare 
system.
    Third, we ensure Americans have access to long-term 
services and supports, and this is with regard to disabilities 
as well, emphasizing home and community-based care that 
recognizes the central role that family care givers play.
    Fourth, we restrain system-wide costs with all-payer rate 
setting and by allowing the government to negotiate for better 
prescription drug prices. What we have included as well in 
Medicare for America is how we will be paying for it.
    Medicare for America sunsets the Republican tax bill. It 
imposes a five percent surtax on adjusted gross income 
including on capital gains above $500,000.
    It increases the Medicare payroll tax and investment income 
tax. We also increase the excise taxes on all tobacco products, 
beer, wine, liquor, and sugar-sweetened drinks.
    State will also need to make maintenance of effort payments 
equal to the amounts that they currently spend on Medicaid and 
on CHIP.
    This is a quick overview of the bill. When working people 
are struggling with stagnating wages, skyrocketing healthcare 
costs, we need to do more to help them out.
    So as the committee continues to consider how to bring down 
costs for families of working people, I urge you to consider 
Medicare for America.
    I believe it would achieve universal coverage, which is, I 
know, our shared goal, and I thank you so much for the 
opportunity to be with you today.
    Thank you.
    [The prepared statement of Ms. DeLauro follows:]

               Prepared Statement of Hon. Rosa L. DeLauro

    Thank you, Chairman Frank Pallone and Ranking Member Greg 
Walden for welcoming me today. I am here to advocate for 
Medicare for America, a proposal in your jurisdiction that I 
have introduced with the chair of the Consumer Protection and 
Commerce Subcommittee, Congresswoman Jan Schakowsky. It is our 
proposal, to achieve affordable, quality universal healthcare.
    Right now, families are struggling with the skyrocketing 
costs of prescription drugs and healthcare, costs which 
continue to far outpace wages. They are paying more for worse 
coverage than they may have had previously. In fact, according 
to the Kaiser Family Foundation, premiums increased 65% in 10 
years for a single person who gets their health insurance. 
Meanwhile, their average deductible went from $303 in 2008 to 
$1,350 in 2018.
    As a result, one-third of Americans have delayed care due 
to cost, according to Gallup.
    All the while, the Trump administration is making 
intentional policy choices to undermine the Affordable Care Act 
and raise prices for middle class families and working people. 
In the Labor-Health and Human Services subcommittee, we hosted 
a hearing about this sabotage. A study out this week found that 
15,600 deaths would have been prevented if all states expanded 
Medicaid and the ACA as intended.
    It was those problems we aimed to solve long term with 
Medicare for America.
    Medicare for America achieves universal, affordable, 
highquality health coverage by creating a program based on 
Medicare and Medicaid. It expands the benefits and services to 
include items like prescription drugs, dental, vision, hearing 
services, and longterm services and supports. And Medicare for 
America would be accessible to all Americans through auto-
enrollment, while maintaining private insurance for those 
employers who provide comprehensive, high-quality, and 
affordable plans.
    Right now, 165 million Americans receive their coverage 
through their employer. Many are happy with it, and companies 
may contain to offer these plans. Or, they can enroll employees 
in Medicare for America and contribute 8% of annual payroll to 
theMedicare Trust Fund. Employees have a choice, too. They can 
choose to enroll in Medicare for America instead of their 
employer-sponsored plan and have their employer contribute to 
it.
    Medicare for America address costs. Annual out of pocket 
costs are no more than $3,500 for individuals and $5,000 for 
families on a sliding scale.
    There are never out-of-pocket costs for preventive and 
chronic disease services, Long Term Services and Supports, and 
prescription drugs (generic or brand name as necessary).
    There are also zero deductibles. Zero. And premiums are 
capped: no more than 8% of income for enrollees. So, for those 
between 200% and 600% of the Federal Poverty Level-between 
$50,000 and $150,000 for a family of four -premiums are 
subsidized. For those under 200% of the Federal Poverty Level-
$50,000 for a family of four--there are zero premiums and zero 
out of pocket costs.
    Second, we address benefits. Currently, healthcare benefits 
are largely dependent on your zip code, and Medicare for 
America will fix that. But, regardless of whether you live in 
Connecticut or Mississippi or Utah or California, every single 
American should have robust, comprehensive health coverage. And 
so, we set a very high standard for benefits. We cannot wait 
for states to do the right thing and increase benefits and 
services. Doing so will only continue and compound the 
inequalities that we are trying to rid from our healthcare 
system.
    Third, we ensure Americans have access to long-term 
services and supports, emphasizing home and community-based 
care that recognizes the central role family caregivers play.
    Fourth, we restrain system-wide costs: with all-payer rate 
setting and by allowing the government to negotiate for better 
prescription drug prices.
    That is a quick overview of the bill.
    When working people are struggling with stagnating wages 
and skyrocketing healthcare costs, we must do more to help. So, 
as the committee continues to consider how to bring down costs 
for families and working people, I urge to you to consider 
Medicare for America. It would achieve universal coverage, 
which is our shared goal.
    Thank you for the opportunity to talk with you today.

    Mr. Pallone. I thank the gentlewoman--the chairwoman.
    You know, you have been involved with so many of these 
healthcare affordability and accessibility issues for so long I 
don't even know where to begin to thank you.
    But I do want to say, obviously, we will take a look at 
Medicare for America. But in terms of what the committee has 
done, you know, in our first six months here before the August 
recess we have been trying to basically look at shoring up the 
existing programs and marketplace, you know, whether it's the 
Affordable Care Act or generic competition or the transparency 
bills.
    But, you know, we are--in the fall we will start looking 
at, you know, innovative things. You know, when you talk about 
long-term care, you know, you and I both wanted to include a 
long-term care initiative in the Affordable Care Act and we 
just ran into the costs problem with CBO. I usually blame CBO 
for everything, in case you haven't noticed.
    And, you know, in terms of the negotiated prices for 
Medicare, that is something that we are certainly working on. 
Home and community-based care--the list goes on.
    So I just--you know, I just want to thank you. I want you 
to know that we are going to be looking at a lot of these gaps 
that exist because there are some and certainly, you know, idea 
of capping or trying to reduce out of pocket cost is very 
important as well.
    So thank you. I don't know----
    Ms. DeLauro. Appreciate that very much and long-time 
supporter of, obviously, the Affordable Care Act, and I don't 
see--I mean, what I do see is that, you know, our being able to 
achieve universal healthcare, build on that, take a look at new 
opportunities at the time when you can also be very, very 
mindful of employer-sponsored insurance and those 165 million 
people who take advantage of that, and you just can't put them 
aside.
    But to allow them to be able to either opt in or their 
employer to opt in, and at the same time look at a way in which 
we begin to auto enroll people from birth so that we get--begin 
to get them into the system.
    And above all, I know you're conscious about cost, and so 
that what we do do is to provide a way and to look at how one 
pays for this.
    So appreciate the opportunity.
    Mr. Pallone. Absolutely. Thank you.
    Dr. Burgess or Ms. Eshoo, did you want to say--no?
    Chairwoman Eshoo?
    Ms. Eshoo. Rose, I thank you for coming here today.
    Your energy is infectious. You're a force of nature, and 
your ideas are always very important ones and large ones. It 
represents big thinking, but underneath it the thinking 
continues. It's not just the big tag line.
    So I remember years and years ago in the Clinton 
administration we tried to set up an early buy-in to Medicare 
for people younger than 65. We weren't successful with that.
    But I think that you make a very important point about the 
following. It's estimated to be anywhere from 165 million to 
180 million people who receive their healthcare through their 
employer.
    That is not something we can ignore. But those of us who 
have spent our adult lifetimes working for universal coverage 
for every person in this country so that every person in this 
country is covered, we want to make sure that they are not 
thrown on the scrap heap of humanity if they lose their jobs.
    So we don't know what's going to happen to the Affordable 
Care Act. But I think that you've brought forward a thoughtful 
plan.
    You might think of doing some workshops with members on 
both sides of the aisle so that they understand what are in--
what's in your proposal, and what the estimates would be--you 
know, what it would cost a family, an individual, how long, 
what it would include.
    I mean, you've talked about some of those things today. But 
thank you.
    Ms. DeLauro. Thank you very, very much. Thank you for the 
suggestion. I appreciate it.
    Ms. Eshoo. Good. And I'll come, too. Thank you.
    Thank you. Thank you, Rosa.
    Mr. Burgess. So you brought some interesting ideas, most of 
which I probably don't agree with. But the concept that we 
should be talking about that----
    Ms. DeLauro. Agree with universal healthcare, Dr. Burgess.
    Mr. Burgess [continuing]. In this committee I think is 
important, and the--I suppose a competing bill with yours would 
be the Jayapal bill. I know Representative Dingell on our 
committee has been interested in that.
    We actually had a hearing in the Rules Committee much 
earlier in this Congress. I don't understand why it was the 
Rules Committee and not our committee. I think we are the 
committee. We are the authorizing committee of jurisdiction. 
This should be--this should be open for our consideration.
    I know the chairman does not like association health plans 
but I think that is going to be part of the argument. Health 
reimbursement accounts, which recently were allowed under 
rulemaking by the administration and yes, I did complain about 
executive actions under the previous administration.
    I do think we ought to be doing the--if ideas are good 
ideas, we ought to authorize them and bring them through the 
legislative process.
    A health reimbursement account where a person is--where an 
employer is allowed to give a person a fixed amount of money 
outside of what would be taxable so that they could walk that 
into whatever exchange or insurance product that they want.
    After all, that's what most members of Congress have in the 
DC exchange in the Affordable Care Act. So if it's good enough 
for Members of Congress it should be good enough for the 
general population.
    But I am willing to consider all of these ideas and I think 
we should have a robust and lengthy hearing and hear--have this 
same sort of perhaps Member Day structure on this because I 
know many members do have their own ideas.
    Interestingly enough, the--when all of the excitement was 
toward the Medicare for all when we had that hearing in the 
Rules Committee and, yes, as you point out it would end 
employer-sponsored insurance. It would end Medicare Advantage. 
It would end TRICARE.
    So there were a lot of things that would--if people were 
doing today that they liked that they would lose and that--I 
think that is a valid consideration and one that I perhaps 
brought up that morning in the Rules Committee.
    And then lost in the translation--the same day the Mueller 
report came out coverage numbers were released by the 
Congressional Budget Office, and I guess we have all--have our 
differences with the Congressional Budget Office. But 2.6 
million more people had multi--I am trying to say the employer-
sponsored insurance.
    Two point six million people since January of 2017 now have 
this coverage. So that's a good thing and we should celebrate 
that. In my opinion, we shouldn't try to take that away from 
them.
    So it's an interesting concept. This committee is where it 
belongs. We are the only committee that hasn't really had a 
hearing, and Budget Committee's had a hearing. Rules Committee 
has had a hearing. Ways and Means Committee has had a hearing. 
Our turn, and we are next.
    Thank you.
    Ms. DeLauro. Thank you very, very much. I appreciate 
staying in your lane, too. So I understand the relevance of the 
Energy and Commerce Committee.
    Thank you.
    Mr. Pallone. Thank you, Madam Chairwoman.
    The gentleman from Tennessee.
    Mr. Cohen. Thank you, Mr. Chair.
    I appreciate you and I appreciate Rosa for that pat on the 
back. That was nice of you.
    Ms. DeLauro. North and South.

   OPENING STATEMENT OF HON. STEVE COHEN A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF TENNESSEE

    Mr. Cohen. And I want to thank the Members for allowing us 
to bring our suggestions to the Energy and Commerce Committee 
and this Subcommittee on Health. I appreciate your time and the 
leadership of Chairman Pallone and the committee in this 116th 
Congress.
    As we meet in a room named for the champion of healthcare, 
Mr. Dingell, and as I look at Henry Waxman looking down on me, 
I know that there are giants in this committee that have done 
much for healthcare over the years. I am a proud sponsor of 
H.R. 117, the Nationally--it is an acronym, NEWBORN, and that's 
Nationally Enhancing the Wellbeing of Babies through Outreach 
and Research Now. Pretty good of an acronym. Thanks, staff. 
Which builds from the belief that healthcare is a basic human 
right.
    The NEWBORN bill was introduced way back in, like, 2010 or 
2009 the first time, and it was part of the Affordable Care 
Act. And it would have been included therein but for some 
mistake that Chris Dodd made. And I haven't forgiven him. The 
Democrats used it as a way to promote the healthcare, and it 
was a highlight of what we were doing, without the members that 
we were going to have this NEWBORN Act as part of the 
healthcare bill.
    I guess it is when we had to deal with the Senate bill that 
we had the problem.
    The NEWBORN Act gives a voice to children who have been 
taken by our country's ongoing crisis of infant mortality. 
Fifty-four developed countries have lower rates of infant 
mortality than the United States. As the wealthiest country in 
the world, the United States, we should not be 55th. Members of 
Congress, we should be ashamed.
    In fact, Jon whatever his name is of The Daily Show ought 
to be here giving us hell, Jon Stewart.
    The NEWBORN Act would help address this problem by creating 
infant mortality-focused pilot programs in the highest risk 
areas of our country. The pilot programs should focus on 
addressing the top five reasons for infant mortality: birth 
defects, pre-term birth, and low birth rate, Sudden Infant 
Death Syndrome, maternal pregnancy complications, and injuries 
to the infant.
    These deaths disproportionately affect black women. My 
district is proportionately, is predominantly black and 
predominantly black women. It is estimated that nine out of 
every 1,000 children born in the district will not see their 
first birthday. By focusing studies on the highest risk areas 
of our country, the NEWBORN Act directly confronts this 
disparity. Pilot programs will provide insightful data and 
immediate support to the areas with the highest rates of infant 
mortality.
    So, I would encourage the committee, ask the committee, 
beseech the committee to have a hearing to consider the 
immediate threats the maternal and infant mortality crisis 
poses to women and children, especially African American women. 
It is our duty to act, and I believe the NEWBORN Act would be 
crucial, and a crucial step forward.
    And I know Dr. Burgess knows these issues, too. As a 
pediatrician he sees it. It is really awful in Memphis. We have 
rights with Third World countries.
    So that is my ask. And I appreciate the opportunity to 
address you.
    [The prepared statement of Mr. Cohen follows:]

                 Prepared Statement of Hon. Steve Cohen

    Chairwoman Eshoo, Ranking Member Burgess, I want to thank 
you for allowing members to testify about our legislative 
priorities within the Energy and Commerce Committee's 
Subcommittee on Health. I appreciate your time and Chairman 
Pallone's leadership of the Committee in the 116th Congress.
    As we meet in the room named for a champion of healthcare, 
I am reminded of Mr. Dingell's remarkable legacy of advocacy 
for access to comprehensive care.
    I introduced H.R. 117, the Nationally Enhancing the 
Wellbeing of Babies through Outreach and Research Now (NEWBORN) 
Act, which builds from his belief that healthcare is a basic 
human right.
    The NEWBORN Act gives a voice to children who have been 
taken by our country's ongoing crisis of infant mortality. 
Fifty-four developed countries have lower rates of infant 
mortality than the United States. As the wealthiest country in 
the world, the United States has no excuse. We as Members of 
Congress have no excuse.
    The NEWBORN Act would help address this problem by creating 
infant mortality-focused pilot programs in the highest-risk 
areas of the country. The pilot programs would focus on 
addressing the top five reasons for infant mortality: birth 
defects, preterm birth and low birth weight, sudden infant 
death syndrome, maternal pregnancy complications, and/or 
injuries to the infant.
    These deaths disproportionately affect black women. In my 
district that is predominately black, it is estimated that nine 
out of every 1,000 children born will not live to see their 
first birthday. \1\
---------------------------------------------------------------------------
    \1\ https://wreg.com/2019/02/20/report-85-percent-of-tennessee-
maternal-deaths-preventable/
---------------------------------------------------------------------------
    By focusing studies in the highest-risk areas of the 
country, the NEWBORN Act directly confronts this disparity. Its 
pilot programs would provide insightful data and immediate 
support to areas with the highest rates of infant mortality.
    I encourage the Committee to hold a hearing to consider the 
immediate threats the maternal and infant mortality crisis 
poses to women and children--especially black women. It is our 
duty to act, and I believe the NEWBORN Act would be crucial 
step forward.

    Mr. Pallone. I want to thank the gentleman. You know, I 
know your interest in this NEWBORN. It is very important and we 
are certainly going to take a look at it.
    We did a Newborn Screening Act bill yesterday.
    Mr. Cohen. Yes.
    Mr. Pallone. But this is different.
    Mr. Cohen. This is different. It has a pilot program for 
the more difficult, highest districts with the highest risk.
    Mr. Pallone. Right, right. All right, so we will take a 
look at it and get back to you.
    Mr. Cohen. When it was in the ACA everybody thought it was 
great.
    Mr. Pallone. Yes.
    Mr. Cohen. Held it up, this is great. And Chris Dodd messed 
up. So we need to help Chris Dodd redeem his reputation.
    Mr. Pallone. All right. And let me mention to all of you, 
you know, we are having this hearing today but you can follow 
up with either of us on a member-to-member basis, or your 
staff, on anything that you might want to mention as well. So, 
thanks a lot, Steve.
    Mr. Cohen. Thank you.
    Mr. Pallone. Thank you.
    Mr. Burgess. Mr. Chairman, just----
    Ms. Eshoo. I just----
    Mr. Pallone. Oh, I am sorry. Go ahead, Chairwoman.
    Ms. Eshoo. Thank you for coming Steve. I think that you 
have a very good bill. And as the chairman said, we will take 
it under consideration.
    I just, I know that, I assume that you are just casting 
Chris' name around tongue in cheek; correct? Yes, OK. This is a 
brother friend, so we just have to make sure. OK.
    Thank you.
    Mr. Pallone. Dr. Burgess.
    Mr. Burgess. I thank the chairman. Just to correct the 
record, I am not a pediatrician. My specialty was obstetrics 
and gynecology.
    Mr. Cohen. Then you were even more informed, and I just 
knew it but didn't say it.
    Mr. Pallone. Thank you, Mr. Cohen.
    Next is the gentleman from Ohio, Mr. Balderson.

 OPENING STATEMENT OF HON. TROY BALDERSON A REPRESENTATIVE IN 
                CONGRESS FROM THE STATE OF OHIO

    Mr. Balderson. Thank you, Mr. Chairman, members of the 
subcommittee. I am here today to discuss an issue that is 
important not only to me personally but also to the thousands 
of Ohioans I represent.
    Roughly a quarter of the district I represent, Ohio's 12th 
Congressional District, is comprised of rural area. I was born 
and raised in one of those rural areas, the Appalachian 
community of Zanesville, Ohio, where rural broadband is of 
critical importance.
    As you know, this subcommittee has jurisdiction over 
telecommunications issue. Unfortunately, many of my 
constituents, as well as millions of Americans, don't currently 
have access to highspeed broadband internet, which puts them at 
great disadvantage to their peers who live in more urban 
connected areas. As a Congress, we are failing those Americans. 
In an increasingly digital era, rural Americans in Ohio--rural 
Ohioans and Americans from around the country require access to 
modern broadband e-connectivity as much as those in urban and 
suburban communities.
    With a connection to highspeed internet, rural Americans 
gain every important access to healthcare services through the 
option of telemedicine, and tools to fight the opioid epidemic, 
have increased capacity to grow their small businesses by 
opening up the digital marketplace to small businesses so they 
can compete and benefit from drastically improved educational 
opportunities by providing rural students the same ability to 
research, access educational materials as their urban and 
suburban peers.
    Without access to these high-speed internet standards, 
rural Americans suffer from a disadvantage in connectivity to 
the online world. According to the U.S. Census Bureau, one in 
five Americans live in a rural area. Rural farmers supply food 
for our country. Rural labor keeps our manufacturing base 
strong. And rural energy exports keep America powered.
    Yet, for all they do for our country, the Federal 
Communications Commission recently found that more than 30 
percent of rural America Americans do not have access to basic 
broadband services. In comparison, only two percent of urban 
Americans experience this same lack of connectivity.
    We, as a Congress, have the opportunity to level the 
playing field by helping rural Americans access critical 
services by supporting rural broadband e-connectivity. 
According to the USDA, rural broadband e-connectivity puts the 
United States at the top of the world's productivity by 
fostering economic development, job growth, rural 
entrepreneurship, and innovative technologies.
    The USDA also found that enhanced connectivity in rural 
communities leads to important markers for success, including 
an increase in productivity for farmers through use of smart 
farm equipment and crop-focused innovation; expansion of 
entrepreneurship in a global digital marketplace; an 
improvement in business operations through small towns' ability 
to respond to market conditions; support farmers' ability to 
predict production inputs, increase yields, and access 
potential customers worldwide; an expansion of educational 
opportunities; and, finally, an enhancement of healthcare 
options by enabling healthcare professionals to spread 
awareness of local resources.
    As you can tell, rural broadband access would do a world of 
good for millions of Americans currently living without this 
resource and would give our country an advantage in the global 
space. This is why I will continue to be a vocal advocate of 
this issue, and why I am a proud cosponsor of H.R. 3162, which 
would require broadband providers to create an improved 
national broadband map that is significantly more accurate and 
granular, as well as subject to an ongoing and multi-facet 
challenge and reinforcement process, refinement process.
    I ask you all to consider the millions of Americans who are 
starving of access to rural broadband e-connectivity. These 
rural Americans are no less deserving of the opportunities to 
succeed than their peers.
    Thank you all for your time, and I welcome any questions 
that you may have.
    [The prepared statement of Mr. Balderson follows:]

               Prepared Statement of Hon. Troy Balderson

    Mr. Chairman, members of the subcommittee, I am here today 
to discuss an issue that is important not only to me 
personally, but also to the thousands of Ohioans I represent.
    Roughly a quarter of the district I represent, Ohio's 12th 
Congressional District, is comprised of rural areas. I was born 
and raised in one of those more rural areas, the Appalachian 
community of Zanesville, Ohio, where rural broadband is of 
critical importance. As you know, this subcommittee has 
jurisdiction over telecommunications issues.
    Unfortunately, many of my constituents, as well as millions 
of Americans, don't currently have access to high-speed 
broadband internet, which puts them at a disadvantage to their 
peers who live in more urban, connected areas. As a Congress, 
we are failing those Americans. In an increasingly-digital era, 
rural Ohioans and Americans from around the country require 
access to modern broadband e-Connectivity as much as those in 
urban and suburban communities.
    With a connection to high-speed internet, rural Americans 
gain ever important access to healthcare services through the 
option of telemedicine and tools to fight the opioid epidemic, 
have increased capability to grow their small businesses by 
opening up the digital marketplace to small businesses so they 
can compete, and benefit from drastically-improved educational 
opportunities by providing rural students the same ability to 
research and access educational materials as their urban and 
suburban peers. Without access to these high-speed internet 
standards, rural Americans suffer from a disadvantage in 
connectivity to the online world.
    According to U.S. Census Bureau, one in five Americans 
lives in a rural area. In my home of Central Ohio, we know that 
rural Americans are the backbone of our nation's economy. Rural 
farmers supply food for our country, rural labor keeps our 
manufacturing base strong, and rural energy exports keep 
America powered. Yet for all they do for our country, the 
Federal Communications Commission recently found that more than 
thirty percent of rural Americans do not have access basic 
broadband services. In comparison, only two percent of urban 
Americans experience this same lack of connectivity. We, as a 
Congress, have the opportunity to level the playing field by 
helping rural Americans access critical services by supporting 
rural broadband e-Connectivity.
    According to the FCC, ``Rural and Tribal areas continue to 
lag behind urban areas in mobile broadband deployment. Although 
evaluated urban areas saw an increase of 10 Megabits per second 
(Mbps) download and 3 Mbps upload mobile LTE from 81.9% in 2014 
to 90.5 % in 2016, such deployment in evaluated rural and 
Tribal areas remained flat at about 70% and 64%, respectively. 
Approximately 14 million rural Americans and 1.2 million 
Americans living on Tribal lands still lack mobile LTE 
broadband at speeds of 10 Mbps download, 3 Mbps upload.''
    According to USDA, rural broadband e-Connectivity puts the 
United States ``at the top of the world's productivity by 
fostering economic development, job growth, rural 
entrepreneurship, and innovative technologies.'' The USDA also 
found that enhanced connectivity in rural communities leads to 
important markers for success, including:
     An increase in productivity for farmers through 
the use of smart farm equipment and crop- focused innovation;
     An expansion of entrepreneurship in a global 
digital marketplace;
     An improvement in business operations through 
small towns' ability to respond to market conditions as well as 
the ability to manage their finances;
     Support for farmers' ability to predict production 
inputs, increase yields, and access potential customers 
worldwide;
     An expansion of educational opportunities by 
reversing current trends that show rural students suffer 
without access to high-speed internet because they lag behind 
in school, must drive miles into town for a Wi-Fi hotspot to do 
their homework, have trouble completing college applications, 
and fail to access important online learning tools that help 
students pursue a career in certain trades or attain a 
professional certification;
     And finally, an enhancement of healthcare options 
by enabling healthcare professionals to spread awareness of 
local resources, prevent prescribing mistakes and pharmacies 
through access to controlled substance registries, and provide 
addiction care in remote locations through telemedicine.
    As you can tell, rural broadband access would do a world of 
good for millions of Americans currently living without this 
resource and would give our country an advantage in the global 
space. This is why I will continue to be a vocal advocate of 
this issue and why I am a proud cosponsor of H.R. 3162, which 
would require broadband providers to create an improved 
National Broadband Map that is significantly more accurate and 
granular as well as subject to an ongoing and multi-faceted 
challenge, validation, and refinement process. I ask you all to 
consider the millions of Americans who are starving of access 
to rural broadband e-Connectivity. These rural Americans are no 
less deserving of the opportunity to succeed than their peers.
    Thank you all for your time and I welcome any questions you 
may have.

    Mr. Pallone. I want to thank the gentleman. We stressed 
earlier, you know, a number of the people, a number of our 
colleagues that have been here have talked about more attention 
to rural areas, particularly with broadband. And we are very 
much aware of that and want to prioritize expansion of 
broadband in rural and underserved areas. And that is part of 
our Lift America Act, you know, which would be a larger 
infrastructure bill.
    So, I just want you to know that we are very cognizant and, 
you know, follow up on the things you mentioned.
    Did either of you want to? No?
    Go ahead, Dr. Burgess.
    Mr. Burgess. Mr. Chairman, I don't know if you're aware 
that Mr. Balderson, of course, joined us as a result of a 
special election last year. So this is not his first term 
technically. But his predecessor was my counterpart on the Ways 
and Means Committee, the chairman of the Health Subcommittee on 
Ways and Means, Pat Tiberi.
    So, welcome, Mr. Balderson, we are glad you are here. I 
acknowledge, as the chairman does, that the issue that you 
bring to us is important. My district is, the district that I 
represent is no longer as rural as it was when I grew up. We 
are half rural and half urban now. But the rural half certainly 
the broadband issues are significant and an issue that I have 
worked on for several years.
    We have worked on things like telehealth. It is important 
that that be available, reliable, and be within the range that 
people can use it.
    So, thank you for bringing this to our attention.
    Mr. Balderson. Thank you very much.
    Mr. Pallone. Thank you again.
    And now we have--oh, I am sorry, Mr. Peters has a comment 
or question.
    Mr. Peters. I just want to quickly comment to Mr. 
Balderson, I have not heard any discussion of large 
infrastructure package in this building on either side of the 
aisle which doesn't include rural broadband. We see it as an 
access issue, as an investment issue, and as an infrastructure 
issue. And so we will look forward to working with you on that.
    Mr. Balderson. Yes. Thank you very much.
    Thank you, Mr. Chairman.
    Mr. Pallone. Thank you.
    And now we go to Mr. Hern from Oklahoma.

   OPENING STATEMENT OF HON. KEVIN HERN A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF OKLAHOMA

    Mr. Hern. Thank you, Mr. Chairman, and the members here for 
allowing me to testify today. I want to thank the Energy and 
Commerce Committee for passing H.R. 3375, the Stopping Bad 
Robocalls Act. This is an important piece of legislation that I 
proudly cosponsored and the House of Representatives passed 
overwhelmingly yesterday.
    We have all received spam phone calls before. They are 
annoying, harassing, frustrating calls during all hours of the 
day and night. I sometimes get as many as 20 fake phone calls 
per day. These robocalls are frequently coming from your own 
area code, a trick that makes us all extra vulnerable to this 
epidemic.
    Con artists are manipulating the incoming phone numbers in 
order to gain the trust of the American people to steal money 
and personal information from the unsuspecting victims. It is a 
criminal--it is criminal and it is long overdue that we do 
something about this breach of trust. It is urgent that we 
shine some light on the pressing and increasingly frustrating 
issues of robocalls. Currently robocalls make up about 50 
percent of all phone calls.
    In 2018, there were more than 47 billion robocalls in the 
United States, an increase of 17 billion from the previous 
year. And this is--and this year, according to AARP, we are on 
track to receive a record 60 billion illegal robocalls. In my 
home state of Oklahoma, robocalls are received over 55 million 
times per month, about 75,000 calls per hour. That is 
completely absurd.
    Oklahoma state officials are working tirelessly to solve 
this issue on a local level, but the scope of this abuse 
requires federal intervention. Therefore, I want to thank 
Oklahoma's Attorney General Mike Hunter, who has met with 
Federal Communications Commission Chairman Pai, to do his part 
in ending the robocall epidemic in Oklahoma.
    For rural Oklahomans, their phone may very well be their 
lifeline, and robocalls block the lines, putting their very 
lives in danger.
    Additionally, robocall epidemic is also a public health 
crisis that is plaguing our hospitals and healthcare 
facilities' phone lines. For people with life-threatening 
illness and the elderly who rely on their phone as their 
lifeline these phone calls can get in the way of lifesaving 
help. When a person is trying to contact a hospital, every 
second counts. A blocked phone line due to a spam call can mean 
life or death to a patient.
    For example, in the heart of Boston, at Tufts Medical 
Center, administrators registered more than 4,500 calls within 
a 2-hour window just last year. Many hospitals around the 
country share this experience.
    In Congress I have made it a priority to uphold consumer 
protections. Unsolicited calls and text messages violate these 
protections, which is why I support the Stopping Bad Robocalls 
Act. This legislation requires consumer consent to receive 
calls and text messages from automated dialing systems, and 
requires those who are sending robocalls to maintain records of 
consent they have received from consumers.
    Consumers will also have the ability to withdraw consent 
from automated texts and calls. This legislation requires phone 
carriers to provide a call authentication technology so 
consumers can trust their caller I. D. again. It is required 
that this technology should not impose an additional line-item 
cost to a consumer's phone bill. There will be also a process 
to help rural carriers implement this call authentication 
technology. Consumers should be able to block harassing spam 
phone calls without being charged extra.
    These harmful phone calls are defrauding our seniors and 
preventing our hospitals from providing timely care. Robocalls 
are a serious, pervasive, and persistent problem that are 
causing serious issues, particularly for our hospitals, 
seniors, and rural populations. These unwanted and unwarranted 
calls are illegal, and it is our responsibility to ensure that 
consumers are protected from these fraudulent calls.
    Illegal robocalls put Americans at risk of scams and fraud. 
It is time that we stop this abuse and do something about 
robocalls.
    I ask my colleagues in the Senate to join us in putting a 
stop to this nuisance to prevent violation of American 
consumers' right to privacy.
    Once again, I want to thank you, Mr. Chairman, and the 
Energy and Commerce Committee, and the full House of 
Representatives for passing H.R. 3375, the Stopping Bad 
Robocalls Act. And thank you for having me here today. And I 
yield back.
    [The prepared statement of Mr. Hern follows:]

                 Prepared Statement of Hon. Kevin Hern

    Thank you, Mr. Chairman and Ranking Member Walden, for 
allowing me to testify before your committee today. I want to 
thank the Energy and Commerce Committee for passing H.R. 3375, 
the Stopping Bad Robocalls Act. This is an important piece of 
legislation that I proudly cosponsor and that the House of 
Representatives passed overwhelmingly yesterday.
    We've all received spam phone calls before. They are 
annoying, harassing, frustrating calls during all hours of the 
day and night. I sometimes get as many as 20 fake phone calls 
per day.
    These robocalls are frequently coming from your own area 
code - a trick that makes us all extra vulnerable to this 
epidemic. Con artists are manipulating the incoming phone 
numbers in order to gain the trust of the American people to 
steal money and personal information from their unsuspecting 
victims. It is criminal and it is long overdue that we do 
something about this breach of trust.
    It is urgent that we shine some light on the pressing and 
increasingly frustrating issue of Robocalls. Currently, 
Robocalls make up about 50% of all phone calls. In 2018, there 
were more than 47 billion robocalls in the U.S., an increase of 
17 billion from the previous year. And this year, according to 
AARP, we are on track to receive a record 60 billion illegal 
Robocalls.
    In my home state of Oklahoma, robocalls are received over 
55 million times per month, about 75,000 calls per hour. That 
is completely absurd.
    Oklahoma's state officials are working tirelessly to solve 
this issue on the local level, but the scope of this abuse 
requires federal intervention. Therefore, I want to thank 
Oklahoma's Attorney General Mike Hunter, who has met with 
Federal Communications Commission Chairman Pai to do his part 
in ending the robocall epidemic in Oklahoma. For rural 
Oklahomans, their phone may very well be their life-line, and 
robocalls block the lines--putting their very lives in danger.
    Additionally, the Robocall epidemic is also a public health 
crisis, as it is plaguing our hospitals and healthcare 
facilities' phone lines. For people with life-threatening 
illness and the elderly, who rely on their phone as their 
lifeline, these phone calls can get in the way of life-saving 
help.
    When a person is trying to contact a hospital, every second 
counts. A blocked phone line due to a spam call can mean life-
or-death to a patient. For example, in the heart of Boston, at 
Tufts Medical Center, administrators registered more than 4,500 
calls within a two-hour window, just last year. Many hospitals 
around the country share this experience.
    In Congress, I have made it a priority to uphold consumer 
protections. Unsolicited calls and text messages violate these 
protections, which is why I support the Stopping Bad Robocalls 
Act.
    This legislation requires consumer consent to receive calls 
and text messages from automated dialing systems and requires 
those who are sending robocalls to maintain records of consent 
they have received from consumers. Consumers will also have the 
ability to withdraw consent for automated texts and calls.
    This legislation also requires phone carriers to provide 
call authentication technology, so consumers can trust their 
caller ID again. It is required that this technology should not 
impose an additional line-item cost to a consumers' phone bill. 
There will also be a process to help rural carriers implement 
this call authentication technology.
    Consumers should be able to block harassing spam phone 
calls without being charged extra. These harmful phone calls 
are defrauding our seniors and preventing our hospitals from 
providing timely care.
    Robocalls are a serious, pervasive, and persistent problem 
that are causing serious issues--particularly for our 
hospitals, seniors, and rural populations. These unwanted and 
unwarranted calls are illegal, and it is our responsibility to 
ensure that consumers are protected from these fraudulent 
calls. Illegal robocalls put Americans at risk of scams and 
fraud. It is time that we stop this abuse and do something 
about robocalls.

    Conclusion:

    I ask my colleagues in the Senate to join us in putting a 
stop to this nuisance and prevent violation of the American 
consumer's right to privacy. Once again, I want to thank the 
Energy and Commerce Committee and the full House of 
Representatives for passing H.R. 3375, the Stopping Bad 
Robocalls Act.
    Thank you for having me here today. I yield back the 
balance of my time.

    Mr. Pallone. Dr. Burgess.
    Mr. Burgess. Thank you, Mr. Hern, for coming and 
reinforcing what has really work for this committee, 
subcommittee, and full committee have been doing this year. As 
you know, we passed the bill yesterday on the floor.
    During the markup in this committee Ms. Dingell and I 
actually had an amendment accepted that addressed the hospital 
portion that you bring up that is critically important. People 
need to know that when their hospital calls it is their 
hospital and not someone spoofing their hospital's number, 
particularly if they are giving out personally sensitive 
information.
    So, I guess the next thing to do is for us all to robocall 
Senators Lankford and Inhofe so that--I mean that it passed so 
overwhelmingly here in the House yesterday, that my hope is 
that, you know, a big vote from the House will sometimes get 
the attention of the people over on the other side of the 
Capitol. But we can't let up the gas, we can't take our foot 
off the gas, we have to keep going. This is what people want us 
to do.
    And it was important work that got done yesterday. May not 
have done everything that you outlined in your remarks. To the 
extent that there needs to be fine tuning, or to the extent 
that there needs to be modification as it goes through the 
rulemaking process at FCC, so be it. But we have to start 
somewhere. This bill yesterday was a good start.
    Mr. Hern. I thank the chairman for the Member Day. And this 
is an opportunity. You know, we, we don't often compliment one 
another across the aisle. I am a new freshman here, and I 
wanted to make sure that the Commerce Committee knew that we 
appreciated this on all sides of the aisle. I think America 
appreciates it.
    And just as my colleague mentioned, we need to maybe put 
all our senators on robocalls and we could irritate them enough 
that they pass it over there.
    Thank you so much.
    Mr. Pallone. Thank you so much. Thank you.
    So, Mr. Delgado, you would normally be next, but Mr. Kilmer 
has asked if he could go before you because he has to chair a 
hearing or a markup of some sort. Is that OK?
    All right. Mr. Kilmer, you are next.
    Ms. Eshoo. Can I just thank,----
    Mr. Pallone. Oh, of course.
    Ms. Eshoo [continuing]. Mr. Hern for being here? I love 
your idea about robocalls to the senators. So, thank you.
    He is walking out, he doesn't know I am saying that.
    Mr. Pallone. I don't think I want to robocall mine.
    Ms. Eshoo. Thank you. Thank you for your wonderful 
testimony.
    Mr. Pallone. You can robocall the New Jersey guy? Is that 
right.
    Mr. Kilmer.

  OPENING STATEMENT OF HON. DEREK KILMER A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF WASHINGTON

    Mr. Kilmer. Thank you, Mr. Chair, and the ranking member, 
and the members of the committee. And I want to thank my 
colleague from New York for letting me jump the queue.
    And thanks for holding this Member Day. It is, I think it 
is really important for members who are not on the committee to 
be able to share some of the challenges our constituents face 
back home.
    I am here to speak with you about something that keeps m up 
at night. Some of you may know I was born and raised in a 
timber town on the Olympic Peninsula. It is a beautiful region 
in Northwest Washington that I now have the honor or 
representing. And though many people think of the sprawling 
metropolis of Seattle when they think of the State of 
Washington, the area I represent is quite different. A majority 
of the land is actually quite rural.
    And, Mr. Chairman, I think a lot of folks on this committee 
know this: rural hospitals are really struggling. A recent 
study found that 97 rural hospitals have closed since 2010. And 
earlier this year, Navigant found that 21 percent of rural 
hospitals are at a high risk of imminent closure. That equates 
to 430 hospitals in 43 states that employ over 150,000 people 
and, most importantly, that care for millions of our friends 
and neighbors.
    And despite the growing problems facing rural hospitals, 
last year the Trump administration put forward a policy called 
Site-Neutral Payments that reduces reimbursement under Medicare 
for hospitals with affiliated clinics or care facilities. Those 
affected clinics and care facilities bring quality healthcare 
closer to folks in rural areas. But this rule cuts 
reimbursement by 30 percent in 2019, and 60 percent going 
forward to those facilities.
    In a time when we should be protecting rural hospitals, 
this policy does exactly the opposite, it punishes hospitals 
for brining medical care closer to the patients. In my 
district, that means Olympic Medical Center, the hospital where 
I was born, could face, could lose $47 million over the next 10 
years. A reduction in reimbursement from Medicare beneficiaries 
would go from $118 to just $47.
    This rule is especially harmful because it impacts many 
hospitals serving health professional shortage areas, as 
designated by the Health Resources and Services Administration. 
Cutting reimbursements actually exacerbates that shortage by 
dramatically reducing the funds available to retain and hire 
healthcare professionals and purchase new medical equipment.
    Earlier this year I went over to visit Olympic Medical 
Center and talked to them about the impacts of this rule. They 
told me that this rule has played a factor in OMC postponing a 
$15 million planned construction project. It may cause 
elimination of some services, while also forcing the hospital 
to change plans to hire eight new primary care providers.
    My district is not the only one impacted. In fact, it is 
not even on the list of the top 30 hospitals across the 
country, including Southwestern Vermont Medical Center, Central 
Vermont Medical Center in Mr. Welch's district, Dartmouth-
Hitchcock in New Hampshire in Ms. Kuster's district, Cox 
Medical Center in Branson, Missouri in Mr. Long's district, all 
in the top 30, impacted worse than Olympic Medical Center.
    Now, in 2018, as CMS was exploring this rule, 138 
bipartisan members signed a letter urging CMS not to adopt this 
rule. But, unfortunately, CMS ignored this request. CMS argues 
that reducing these payments will increase competition with 
private providers. That argument is based entirely on flawed 
logic and faulty assumptions because it assumes that there are 
numerous private providers in every region, and that people who 
go to hospital clinics will be able to get seen by someplace 
else.
    That misses the point that these hospitals tend to care for 
more medically complex cases and will care for every patient, 
even if they can't pay. Private providers have no such 
obligations, which means that as hospitals lose money and 
capacity, access to healthcare will be put in serious jeopardy, 
especially in those areas already suffering from a lack of 
healthcare.
    Not only is this a bad--is this rule bad policy, it also 
exceeds the authority of CMS. Section 603 of the bipartisan 
Budget Act of 2015 affirmed that no existing off-campus 
hospital clinics should have their payment rates reduced. 
Additionally, in 2016, in the 21st Century Cures Act, Congress 
expanded those protections to cover clinics that were in the 
process of being built when that bipartisan Budget Act of 2015 
was passed.
    So, the arbitrary rule actually violates both of these 
laws. It is essential that this Congress acts to ensure that 
legislative intent is upheld in law, and to prevent further 
damage. And out of concern for the damage this rule is doing to 
our hospitals I have introduced bipartisan legislation called 
the Protecting Local Access to Care for Everyone Act, or the 
PLACE Act. The PLACE Act would freeze--it is H.R. 2552--it 
would freeze the site neutral rule until December 31st, 2020, 
direct CMS to reimburse hospitals at the previous Medicare 
reimbursements rates for the money lost under the rule since 
the policy went into effect.
    The American Hospital Association and the Federation of 
American Hospitals have both endorsed this bill.
    I am asking for your help because Olympic Medical Center is 
literally the only game in town in one of the most remote rural 
regions in my district. And if these hospitals and clinics 
close, the next option for care can be hours away. And that is 
just dangerous. This is a really critical issue for the folks I 
represent and for a massive part of the country.
    And I thank you for your attention and I ask for your help.
    [The prepared statement of Mr. Kilmer follows:]

                Prepared Statement of Hon. Derek Kilmer

    Site Neutral Testimony

    Mr. Chairman, thank you for having me here today and for 
holding this Member Day hearing--I think it's really important 
that members not on committee have the opportunity to share 
some of the challenges their constituents face back home--and 
their ideas for how to address them--so I applaud you for 
taking advantage of this new opportunity created by Democratic 
leadership in the Rules Package earlier this year.
    I'm here today to speak with you about something that keeps 
me up at night. Some of you may know that I was born and raised 
in a timber town on the Olympic Peninsula, it's a beautiful 
region in northwest Washington that I now have the honor of 
representing. And though many people think of the sprawling 
metropolis of Seattle when they think of Washington State--the 
area I represent is quite different--and a major portion of it 
is largely rural.
    Now I think many of you also represent Districts pretty 
similar to mine--and people are starting to realize what many 
folks across the country already know--rural hospitals are 
struggling.
    A recent study found that 97 rural hospitals have closed 
since 2010--and earlier this year, Navigent found that 21% of 
rural hospitals are at ``high risk of imminent closure.'' This 
equates to 430 hospitals in 43 states that employ over 150,000 
people and most importantly, care for millions of our friends 
and neighbors.
    Despite the growing problems facing rural hospitals, last 
year, the Trump Administration put forward a policy called 
``site neutral payment'' that reduces reimbursement under 
Medicare for hospitals with affiliated clinics or care 
facilities. (CMS-1695-FC).
    These affiliated clinics and care facilities bring quality 
healthcare closer to folks in rural areas.
    But this rule cuts reimbursement by 30% in 2019 and 60% 
going forward to those facilities. At a time when we should be 
protecting our rural hospitals, this policy does exactly the 
opposite--punishes hospitals for bringing medical care closer 
to patients.
    In my district, this means Olympic Medical Center, the 
hospital where I was born, could lose $47 million over the next 
ten years--and a reduction in reimbursement for Medicare 
beneficiaries would go from $118.35 to just $47.34.
    This rule is especially harmful because it impacts many 
hospitals serving Health Professional Shortage Areas, as 
designated by the Health Resources and Services Administration. 
Cutting reimbursements exacerbates this shortage by 
dramatically reducing the funds available to retain and hire 
healthcare professionals and purchase new medical equipment.
    Earlier this year I went over to visit OMC and talk to them 
about the impacts of the rule. And they told me that this rule 
has played a factor in OMC postponing $15 million of planned 
construction projects and may cause the elimination of some 
services--while also forcing the hospital to change plans to 
hire eight new primary and specialty care providers.
    My district is not the only one impacted. In fact, it's not 
even on the list of the top 30. Hospitals across the country, 
including Southwestern Vermont Medical Center (Welch), Central 
Vermont Medical Center (Welch), Dartmouth Hitchcock in New 
Hampshire (Kuster) and Cox Medical Center in Branson, Missouri 
(Long) will all be impacted even worse than Olympic Medical 
Center.
    Now in 2018, as CMS was exploring this rule, 138 bipartisan 
members signed a letter (Roskan/M. Thompson), urging CMS to not 
adopt this rule. But unfortunately, CMS ignored this request.
    CMS argues that reducing these payments will increase 
competition with private providers. This argument is based 
entirely on flawed logic and faulty assumptions because it 
assumes that there are numerous private providers in every 
region and that people who go to hospital clinics would be able 
to get seen by them.
    It misses the point that hospitals tend to care for more 
medically complex cases and will care for every patient, even 
if they cannot pay.
    Private providers have no such obligation, which means that 
as hospitals lose money and capacity, access to healthcare will 
be put in serious jeopardy, especially in those areas already 
suffering from a lack of healthcare.
    Not only is this rule bad policy, it also exceeds the 
authority of CMS. Section 603 of the Bipartisan Budget Act of 
2015 (Public Law 114-74), affirmed that no existing off-campus 
hospital clinics should have their payment rates reduced.
    Additionally, in 2016, Congress passed the 21st Century 
Cures Act (Public Law 114-255), which expanded these 
protections to cover clinics that were in the process of being 
built when the Bipartisan Budget Act of 2015 was passed.
    This arbitrary rule clearly violates both laws.
    It is essential that Congress act to ensure its legislative 
intent is upheld in law and to prevent further damage to 
healthcare access, especially in rural areas.
    Out of concern for the damage this rule is doing to our 
hospitals, I have introduced the bipartisan legislation called 
the Protecting Local Access to Care for Everyone Act--or the 
PLACE Act.
    The PLACE Act (HR 2552) would freeze the Site Neutral rule 
until December 31, 2020 and directs CMS to reimburse hospitals 
at the previous Medicare reimbursement rate and for the money 
lost under the rule since this policy went into effect.
    The American Hospital Association and the Federation of 
American Hospitals have both endorsed this bill.
    I am asking for your help because OMC is literally the only 
game in town in the rural regions of my district. If these 
hospitals and clinics close, the next option for care can be 
hours away--and that's just dangerous.
    Folks, this is a critical issue, not just for the 
constituents I represent, but for a massive part of the 
country--and we must work together to fix it.
    I thank you for your attention to this matter and for your 
willingness to consider my testimony today.
    Thank you.

    Mr. Pallone. Did you want to comment, Ms. Eshoo?
    Ms. Eshoo. I did. Thank you, Mr. Chairman.
    Thank you, Derek, for coming here today and for your 
testimony. To the ranking member of the subcommittee and Mr. 
Pallone, I met with Mr. Kilmer at his request. We have to pay 
attention to this. This is it is not just in his district, this 
is a rural hospital issue.
    I believe, am I recalling this correctly, that you have 
even gone so far as to identify how this would be paid for, or 
am I confusing that with something else?
    Mr. Kilmer. We didn't stipulate that in the bill but, you 
know.
    Ms. Eshoo. But this has bipartisan cosponsorship. This 
really deserves the attention of our committee.
    So, I want to work with you to resolve this.
    Mr. Kilmer. Thank you.
    Ms. Eshoo. It is troubling to me that this was brought 
about by a reversal of policy in the Administration. And but 
whatever it is, we have to contend with it. And I pledge to you 
that I will work with you to resolve this. Because people's 
lives are--you are holding all of these people in the palm of 
your hand. And we have a responsibility to them.
    So, thank you for being here today.
    Mr. Kilmer. Thank you.
    Ms. Eshoo. We will work with you. And let's see what we can 
get going post August recess.
    Mr. Kilmer. Thank you.
    Mr. Pallone. Dr. Burgess.
    Mr. Burgess. I probably need to study the issue again. But 
in the Budget Act of 2015 the concept was that hospitals were 
acquiring medical practices and the reimbursement from CMS to 
the hospitals was three times what the individual doctors had 
been prior to the time their hospital--their practice was 
acquired by the hospital. So it was really driving 
consolidation.
    We had a hearing on consolidation in the last Congress in 
the Oversight and Investigations Subcommittee. And I will have 
to say I don't remember all of the, all of the moving parts 
there. But ones you bring up are important. At the same I would 
just say to the committee there are multiple moving parts here. 
And just like any time you move--this would be an argument for 
not expanding federal footprints in healthcare delivery--but 
any time you move one piece in that big puzzle, a lot of other 
things change. So it needs to be done with some care.
    I don't think it is fair to say it was all on this 
Administration because it was passed back in 2015. I know I 
heard from MD Anderson Hospital, not in my district but just 
outside, because they were concerned that their cancer clinics 
would be affected because they were more than 200 yards from 
the front door of their hospital, which was I think the, if I 
recall correctly, that was the stipulation that was in the 
Budget Act.
    But point made. And we do need to, we do need to take it 
seriously. There are reasons that that was done back in 2015, 
probably reasons the rule was delayed, reasons that you allude 
to. And any time you move one piece in this, a lot of other 
pieces move unintentionally. And we need to be careful with it.
    Thank you for bringing it to our attention.
    Mr. Kilmer. Thank you.
    Mr. Pallone. Mr. Peters.
    Mr. Peters. Thank you, Mr. Chairman. I would like to thank 
Mr. Kilmer for bringing this issue to our attention. It is a 
reminder, as you can see very clearly, as I don't represent a 
rural area, that you can see very clearly how this rule is 
affecting access in his district, and it is a reminder again 
that one size doesn't fit all. What could be a very sensible 
approach in a urban district where there's many providers just 
may not fit at all in an urban area.
    So, I think we should look at this, we should take a look 
at your bill. And I look forward to working with you on this, 
Mr. Kilmer, so we can get it right.
    Mr. Kilmer. Thank you. Thank you, Mr. Peters.
    Mr. Pallone. Thank you, Derek.
    We, you know, we have been saying over and over all the 
time here since 10:00 o'clock that we have to make sure that 
rural areas have access and affordability. And we can't neglect 
them, because too often that has been the case. So we are 
certainly going to take another look at this rule.
    Thank you.
    And I wanted to thank Mr. Delgado for waiting. You are 
next. But we are going to switch chairs here. I am going to ask 
our chairwoman of the Health Subcommittee to replace me.
    Thank you, Anna. Mr. Delgado, you are recognized.

 OPENING STATEMENT OF HON. ANTONIO DELGADO A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF NEW YORK

    Mr. Delgado. All right. Thank you, Chairman Pallone, 
Chairwoman as well of the subcommittee, and Ranking Member 
Burgess. I appreciate the opportunity to come before the 
committee today to talk about an issue that is critically 
important to me, and one I have prioritized from the beginning 
of my commitment to serve New York-19, and that is healthcare.
    It is unacceptable that the United States, the richest 
country in the world, is also the only developed one without a 
universal healthcare system. This is one of the top reasons why 
I came to Congress. And I am proud to be here today to share 
with you a bill I introduced to finally get us to that goal.
    H.R. 2000, the Medicare-X Choice Act establishes a public 
option plan available for purchase on an individual and small 
businesses exchange. I want to thank my colleagues 
Representatives Higgins and Larson for working with me on this 
important legislation.
    The folks I talk to back home want more coverage options at 
lower cost. Importantly, the Medicare-X Choice Act would 
deliver by allowing those who are happy with their employer-
provided insurance to keep it, while giving another more 
affordable coverage option to those who need it. My bill would 
combine the Medicare physician networks and reimbursement rates 
with ACA coverage standards to create a new public option 
available to all Americans.
    The effect of creating a public floor in the private 
marketplace would be to drive down premiums and deductibles for 
everyone.
    Another critical aspect of this legislation addresses the 
urgent priority for New York-19 constituents, and those all 
across the country, and that is the cost of prescription drugs. 
As we all know, currently Medicare is unable to negotiate drug 
prices with the pharmaceutical industry--a travesty. And my 
bill will change this by allowing for such negotiation through 
Medicare Part D, and these prices would carry over to Medicare-
X.
    Lastly, my bill would expand access to premium tax credits 
to those beyond the 400 percent of the federal poverty line, 
the current threshold for premium assistance under the ACA. 
With this bill we are introducing more choice and more 
competition to the marketplace, starting in the places that 
need it most, like rural areas, without provider shortages.
    Our constituents expect us to take on the big issues 
impacting their lives, not shy away from the hard decisions. 
Lowering the cost of healthcare should not be partisan. Taking 
on the skyrocketing costs of prescription drugs should not be a 
divisive issue. I am here to be a part of the solution. I 
encourage my colleagues to cosponsor the Medicare-X Choice Act 
and join me in urging consideration of this bill to achieve 
universal coverage.
    I thank my colleagues again for the opportunity to talk 
about this issue that I care so deeply about; and yield back 
the balance of my time.
    [The prepared statement of Mr. Delgado follows:]

               Prepared Statement of Hon. Antonio Delgado

    First, thank you to Chairwoman Eshoo and Ranking Member 
Burgess for the opportunity to speak about a priority essential 
to my community.
    It's unacceptable that the United States, the richest 
country in the world, is the only developed one without a 
universal healthcare system. This is one of the top reasons I 
came to Congress, and I'm proud to be here today to share with 
you all a bill I introduced to finally get us to that goal.
    H.R. 2000, the Medicare-X Choice Act, establishes a public 
option health plan available for purchase on the individual and 
small business exchanges. I want to thank my colleagues 
Representatives Higgins and Larson for working with me on this 
important legislation.
    The folks I talk to back home want more coverage options at 
lower costs. Importantly, the Medicare-X Choice Act would 
deliver by allowing those who are happy with their employer-
provided insurance to keep it, while giving another, more 
affordable coverage option to those who need it.
    My bill would combine Medicare physician networks and 
reimbursement rates with ACA coverage standards to create a 
new, public option available to all Americans. The effect of 
creating a public floor in the private marketplace would be to 
drive down premiums and deductibles.
    Another critical aspect of this legislation addresses an 
urgent priority for New York's 19th District--cost of 
prescription drugs.
    Currently, Medicare is unable to negotiate drug prices with 
the pharmaceutical industry--a travesty. My bill will change 
this by allowing for such negotiation through Medicare Part D--
and these prices would carry over to Medicare-X.
    Lastly, my bill would expand access to premium tax credits 
to those beyond the 400% of the federal poverty line, the 
current threshold for premium assistance under the ACA.
    With this bill, we're introducing more choice and more 
competition to the marketplace, starting in the places that 
need it most--like rural areas with provider shortages.
    Our constituents expect us to take on the big issues 
impacting their lives--not shy away from the hard decisions.
    Lowering the cost of healthcare should not be partisan. 
Taking on the skyrocketing cost of prescription drugs should 
not be a divisive issue.
    I'm here to be part of the solution. I encourage my 
colleagues to co-sponsor the Medicare-X Choice Act and join me 
in urging consideration of this bill to achieve universal 
coverage.
    I thank my colleagues again for the opportunity to talk 
about a topic I care so deeply about and I yield back the 
balance of my time.

    Ms. Eshoo [presiding]. Thank you. We thank the gentleman 
for making time to be here today. And congratulations on your 
legislation. And today is all about welcoming the ideas that 
members have. So thank you, we will do that.
    Mr. Delgado. Thank you.
    Ms. Eshoo. Your passion for the subject matter is more than 
self-evident.
    Mr. Delgado. Yes.
    Ms. Eshoo. Dr. Burgess.
    Mr. Burgess. May I just ask a question, Mr. Delgado?
    Mr. Delgado. Absolutely.
    Mr. Burgess. What is the geographic distribution of New 
York-19? Where is it?
    Mr. Delgado. Oh, I am happy to talk about my district. It 
is nearly 8,000 square miles about two-and-a-half hours north 
of New York City. It includes the Hudson Valley and the 
Catskills.
    It is the third most rural seat of any Democrat in Congress 
in the eighth in the entire country. It is made up of the best 
collection of small cities and big towns in the country. I 
believe the largest population center is Kingston in Ulster 
County, which is only about 25,000 people. So that is why it is 
one of the more rural seats. A land of plentiful dairy farms, 
fruit and vegetable farms, Delaware River, one of the best 
trout fisheries in the country, along with the Hudson River and 
the beautiful Catskill Mountains.
    Come on by.
    Mr. Burgess. Maybe we ought to do a field hearing.
    Ms. Eshoo. It sounds like we need to travel to your 
district.
    Mr. Delgado. Hey, it is God's country.
    Ms. Eshoo. It is, yes. The whole country is God's country, 
yes.
    Mr. Burgess. You heard Ms. DeLauro talk about her issue, as 
I mentioned, the Medicare for All was just discussed in the 
rules Committee, but I believe we need to have a major hearing 
in this committee and would--I am not the chairman so I can't 
welcome you to come back, but I will bet there would be a 
favorable disposition to hear your ideas and----
    Mr. Delgado. Appreciate that.
    Mr. Burgess [continuing]. Perhaps to have, to have that 
included in the whatever, whatever the healthcare hearing looks 
like when we do get around to doing that in this committee. I 
feel certain we shall, I just don't know when.
    Thank you for bringing those ideas. Again, we would 
probably disagree about a number of things but, nevertheless, 
you deserve, it deserves to be heard. Thank you.
    Mr. Delgado. Much appreciated. Thank you.
    Ms. Eshoo. Thank you, colleagues, Mr. Delgado.
    Now it is a pleasure to recognize and welcome Congressman 
Keller from the great state of Pennsylvania. Welcome.

  OPENING STATEMENT OF HON. FRED KELLER, A REPRESENTATIVE IN 
         CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA

    Mr. Keller. Thank you, Chairwoman. And thank you, Ranking 
Member. I would also like to thank the members of the committee 
for allowing me to testify about the importance of 
Pennsylvania's natural gas industry.
    Pennsylvania's natural gas has far-reaching economic and 
geopolitical benefits, both to the Commonwealth of Pennsylvania 
and the United States. The record is clear, domestic natural 
gas production strengthens our communities and makes our 
country safer. Pennsylvania's natural gas industry supports 
more than 300,000 jobs, contributes $45 billion to the 
commonwealth's economy, and saves the average household $1,100 
per year in energy costs. This means more financial security 
for families, making day to day life more affordable.
    The success of natural gas in Pennsylvania and across the 
United States has completely shifted long-term thinking about 
American energy policy and our role in the global energy 
marketplace. Not long ago the United States was an energy--was 
energy dependent, relying on foreign adversaries to meet our 
energy goals. That's no longer the case.
    Thanks in large part to our nation's robust supply of 
natural gas, paired with a strong economy, American energy 
production has significant implications for our national 
security and our relationships abroad. For the first time in 
six decades, the United States is a net natural gas exporter. 
We can now use our energy exports as leverage in our foreign 
policy, giving our allies flexibility while diminishing the 
influence of unfriendly nations.
    Natural gas production is also environmentally sound. 
Natural gas is the cleanest and lowest carbon-emitting fossil 
fuel and has helped the United States to reduce carbon 
emissions by more than any other country. Pennsylvania has 
reduced carbon emissions by 30 percent in the last 10 years, 
mostly because of increased use of natural gas fired electric 
generation.
    We have a great opportunity to create some good-paying 
jobs, lower energy costs, and expand America's role as a global 
economic leader. To continue with this success, we must do more 
at the federal level. I am committed to supporting policies 
that allow the natural gas industry to grow and expand into new 
markets. Unfortunately, some states are abusing the state 
environmental permitting costs to stop critical pipeline 
infrastructure.
    Just last year, New England imported natural gas from 
Russia because infrastructure cannot pass through New York. It 
is absurd that an individual state can threaten our national 
security and interfere with interstate commerce. I look forward 
to working to stop these abuses, allow companies to transport 
gas to market, and strengthen our national security.
    Again, I would like to thank the chairman, the ranking 
member, and the members of this committee for allowing me to 
speak about the importance of natural gas for our nation's 
economy, the environment, and our national security.
    Thank you. I yield back.
    [The prepared statement of Mr. Keller follows:]

                 Prepared Statement of Hon. Fred Keller

    Good afternoon and thank you for the opportunity to speak 
about the importance of Pennsylvania's natural gas industry.
    Pennsylvania's natural gas industry has far-reaching 
economic and geo-political benefits, both to the Commonwealth 
of Pennsylvania and the United States as a whole.
    The record is clear: Domestic natural gas production 
strengthens our communities and makes our country safer.
    In Pennsylvania, the natural gas industry supports more 
than 300,000 jobs, contributes $45 billion to the 
commonwealth's economy, and saves the average household $1,100 
every year in energy costs.
    This means more financial security for families, making 
day-day life more affordable.
    The success of the natural gas industry in Pennsylvania and 
across the United States has completely shifted long-term 
thinking about American energy policy and our role in the 
global energy marketplace.
    Not long ago, the United States was energy dependent, 
relying on foreign adversaries to meet our energy needs.
    That's no longer the case, thanks in large part to our 
nation's robust supply of natural gas.
    Paired with a strong economy, American energy production 
has significant implications for our national security and our 
relationships abroad.
    For the first time in six decades, the United States is a 
net natural gas exporter.
    We can now use our energy exports as leverage in our 
foreign policy, giving our allies flexibility, while 
diminishing the influence of unfriendly nations.
    Natural gas production is also environmentally sound.
    Natural gas is the cleanest and lowest carbon emitting 
fossil fuel and has helped the United States to reduce carbon 
emissions by more than any other country.
    Pennsylvania has reduced carbon emissions by 30 percent in 
the last 10 years, mostly because of increase use of natural 
gas fired electric generation.
    We have a great opportunity to create more good-paying 
jobs, lower energy costs, and expand America's role as a global 
economic leader.
    To continue with this success, we must do more at the 
federal level.
    I am committed to supporting policies that allow the 
natural gas industry to grow and expand into new markets.
    Unfortunately, some rogue states are abusing state 
environmental permitting processes to stop critical pipeline 
infrastructure.
    Just last year, New England imported natural gas from 
Russia because infrastructure cannot pass through New York.
    It is absurd that individual states can threaten our 
national security and interfere with interstate commerce.
    I look forward to working to stop these abuses, allow 
companies to transport gas to market, and strengthen our 
national security.
    Again, thank you to Chairman Pallone, Ranking Member 
Walden, and the members of this committee for allowing me to 
speak about the importance of natural gas for our nation's 
economy and national security.

    Ms. Eshoo. Thank you, Mr. Keller, for your excellent 
testimony.
    What part of the overall energy portfolio of your state is 
represented by natural gas? Do you know?
    Mr. Keller. The natural gas, we actually have our energy 
portfolio standards. And currently right now there is probably 
up to 20 percent that is renewables. Up to that. That is by 
2025.
    Actually, in Pennsylvania I did do some legislation to help 
solar energy production in Pennsylvania, so that, that is one 
thing I worked at at the state level. Natural gas is probably I 
am going to say 35 percent or between 35 and probably 45 
percent, just off the top of my head, as I remember it. Nuclear 
energy is big in Pennsylvania. We are one of the states that 
has--largest states for nuclear production also.
    Ms. Eshoo. Thank you very much.
    Dr. Burgess.
    Mr. Burgess. Thank you. And thanks for your testimony. When 
I first started on this committee in 2005, we had hearings 
about how America was running out of natural gas and the crisis 
that was developing because of that. So the fertilizer people 
were saying we don't have the feed stock to create the 
fertilizer that we need to have the harms to grow the corn that 
we need to provide the ethanol.
    And then it all changed with horizontal drilling, hydraulic 
fracturing, as you know well. And we have now become a net 
energy exporter. And there are geopolitical implications. A 
country that used to be entirely dependent upon the former 
Soviet Union for their energy now have another source for that, 
and that would be the more friendly United States of America.
    So it really has been just in the brief time that I've been 
on this committee the world literally has changed, and it has 
changed because of the ability to produce and, as you point 
out, move natural gas from the point of its origin to the point 
where it is consumed.
    It is an important part of our energy infrastructure. It is 
an important part of our economy. And you are correct to be 
focused on it. And we need to maintain that focus as well.
    So thank you.
    Mr. Keller. I appreciate that concern. You know, when you 
look at, when you look at natural gas, it lowers energy costs 
for families. So, families that are lower income families, it 
helps them.
    It has also helped the Commonwealth of Pennsylvania. They 
had an $800 million surplus in the past budget cycle. So it has 
helped the Commonwealth of Pennsylvania, and I think it can 
help our nation just as well as it helped the commonwealth. 
Thank you.
    Mr. Burgess. I think Representative DeLauro spent that on 
her healthcare.
    Mr. Keller. Excuse me?
    Mr. Burgess. I am just kidding. I am just kidding. I said I 
think she spent your surplus.
    Mr. Keller. OK. Well, I think we can spend it ourselves in 
Pennsylvania pretty well. Thank you.
    Ms. Eshoo. Thank you. It is a pleasure to welcome and 
recognize our colleague from Texas, the Honorable Vicente 
Gonzalez.
    Mr. Gonzalez. Thank you.
    Ms. Eshoo. And who just, I just want my colleagues to know, 
a week ago--it was a week ago. Oh, it is almost----
    Mr. Gonzalez. Right.
    Mr. Gonzalez [continuing]. Two weeks ago now. Hosted a 
congressional delegation in his district in Texas. And we 
appreciate what you did for us.
    Mr. Gonzalez. Thank you.
    Ms. Eshoo. It was more than an eye-opener. And your 
hospitality is so gracious, warm and welcoming. Thank you.
    So, you are recognized.
    Mr. Gonzalez. It was a pleasure having you.
    Ms. Eshoo. You have 5 minutes----
    Mr. Gonzalez Thank you.
    Ms. Eshoo [continuing]. To present your ideas to us.
    Mr. Gonzalez. Thank you. And I am here on a different 
issue. But as a Texan and as chairman of the Oil and Gas Caucus 
for the Democratic party, I agree with everything Congressman 
Keller had to say.
    Ms. Eshoo. I saw you nodding.
    Mr. Gonzalez. It is shameful to see----
    Ms. Eshoo. I noticed that you were nodding, yes.
    Mr. Gonzalez. It is shameful to see a Russian vessel 
plugged into a terminal in New England selling us Russian gas.
    Ms. Eshoo. Oh my God.

OPENING STATEMENT OF HON. VICENTE GONZALEZ A REPRESENTATIVE IN 
                CONGRESS FROM THE STATE OF TEXAS

    Mr. Gonzalez. But thank you, Chairwoman, and thank you, 
Ranking Member, for having us and allowing me to testify before 
you about the importance of including direct and indirect 
remuneration, or DIR fee reform in your discussion on how to 
best lower prescription drug prices. These price concessions 
are imposed on community pharmacists serving Medicare Part D 
patients by plan sponsors and their pharmacy benefit managers, 
or PBMs.
    Rather than including these concessions at the point of 
sale, these retroactive fees are taken back from pharmacies 
months after the sale has taken place, exploiting patients, the 
government, and our community pharmacies. I can't think of any 
other business in the world that, that would require, would be 
required to sell a product to a consumer without knowing what 
it costs themselves.
    These unpredictable fees increase patient cost sharing for 
drugs, pushing them into coverage gaps, better known as the 
donut hole, and accelerating their approach to the catastrophic 
phase, increasing Medicare spending at the expense of 
taxpayers. These fees are costing taxpayers, patients and small 
business money, and are, most importantly, not contributing to 
improved patient outcome.
    I think we can all agree that without prices that make 
these lifesaving drugs accessible, innovation for the sake of 
innovation is not why we were sent to Congress. I am thankful 
for this committee's promises to lowering prescription drug 
prices. I think the American people are reliant on you. I 
commend you all for your bipartisan consideration and the 
passage of H.R. 2296, the More Efficient Tools to Realize 
Information for Consumers Act, or the METRIC Act, which 
requires for price concessions to include DIR fees to be 
reported to the Secretary of HHS, along with other pricing 
documentation.
    Given your consideration of H.R. 2296, I ask that the 
committee consider H.R. 1034, the Fair Pricing Act of 2019, 
introduced by myself and Congressman Doug Collins of Georgia. 
Mr. Collins and I have worked with Mr. Welch, Mr. Carter, and 
Mr. Griffith to ensure that DIR fee reform is included in 
efforts to lower the costs of prescription drugs.
    The Fair Pricing Act seeks to reduce prescription drug 
costs by--for seniors by bringing all negotiated price 
concessions at the point of sale. I can't think of anything 
that makes more sense. Ensuring savings are passed on to 
patients, that our community pharmacists--and that our 
community pharmacists are not taken advantage of through DIR 
fees or indirect remuneration.
    The Fair Pricing Act also defines standard quality measures 
and sets criteria by which they are developed and applied to 
pharmacies. Addressing these fees would not only refocus an 
important part of our drug supply chain to improve patient 
health, but combat the financial uncertainty that these small 
businesses face, enabling them to continue serving Medicare 
beneficiaries.
    I look forward to working with this committee, the Centers 
for Medicare and Medicaid Services, our Senate colleagues, and 
the President to address these fees that are hurting our 
seniors, our small businesses, and our taxpayers. We are seeing 
our community pharmacies across the country disappear.
    Again, I thank you for all your leadership in lowering the 
costs of prescription drugs and ensuring that these policies 
address the role of PBMs that they are playing increasing costs 
of medications that our seniors are taking or that the American 
people are taking. I thank you for taking this issue up in such 
an important fashion, and I thank you for your time.
    I yield back.
    [The prepared statement of Mr. Gonzalez follows:]

              Prepared Statement of Hon. Vicente Gonzalez

    Chairman Pallone, Ranking Member Walden, and members of the 
committee
    Thank you for allowing me to testify before you about the 
importance of including direct and indirect remuneration, or 
DIR fee reform, in your discussion on how to best lower 
prescription drug prices.
    These price concessions are imposed on community pharmacies 
serving Medicare Part D patients by plan sponsors and their 
Pharmacy Benefit Managers, or PBMs.
    Rather than including these concessions at the point of 
sale, these retroactive fees are taken back from pharmacies 
months after the sale has taken place, exploiting patients, the 
government, and community pharmacies.
    These unpredictable fees increase patient cost sharing for 
drugs, pushing them into the coverage gap, better known as the 
donut hole, and accelerating their approach to the catastrophic 
phase--increasing Medicare spending at the expense of 
taxpayers.
    These fees are costing taxpayer, patients, and small 
businesses money and are, most importantly, not contributing to 
improved patient outcomes.
    I think we can all agree than without prices that make 
these lifesaving drugs accessible, innovation for the sake of 
innovation is not why we were sent to Congress.
    I am thankful for this committee's promise to lowering 
prescription drug prices.
    I commend you all for your bipartisan consideration, and 
passage of H.R. 2296, the``More Efficient Tools to Realize 
Information for Consumers Act,'' or the ``METRIC Act,'' which 
requires for price concessions, including DIR fees to be 
reported to the Secretary of HHS along with other pricing 
documentation.
    Given your consideration of H.R. 2296, I ask that the 
Committee consider H.R. 1034, the PHAIR Pricing Act of 2019, 
introduced by myself and Congressman Doug Collins of Georgia.
    Mr. Collins and I have worked with Mr. Welch, Mr. Carter, 
and Mr. Griffith to ensure that DIR fee reform is included in 
efforts to lower the cost of prescription drugs.
    The Phair Pricing Act seeks to reduce prescription drug 
costs for seniors by bring all negotiated price concessions to 
the point of sale--ensuring savings are passed on to patients 
and that our community pharmacists are not taken advantage of 
through Direct and Indirect Remuneration (DIR) Fees.
    The Phair Pricing Act also defines standard quality 
measures and sets criteria by which they are developed applied 
to pharmacies.
    Addressing these fees would not only refocus an important 
part of our drug supply chain to improve patient health, but 
combat the financial uncertainty these small businesses face, 
enabling them to continue serving Medicare beneficiaries.
    I look forward to working with this committee, the Centers 
for Medicare and Medicaid Services, our Senate colleagues, and 
the President to address these fees that are hurting our senior 
citizens, small businesses, and our taxpayers.
    Again, I thank you all for your leadership in lowering the 
cost of prescription drugs and ensuring that future policies 
address the role PBMs play in increasing costs.
    Thank you for this time.

    Ms. Eshoo. I thank the gentleman. We did, we have taken up 
some legislation that tracks some of the elements of your 
legislation relative to manufacturers, PBMs, the discounts that 
are negotiated. And they say that those discounts move on to 
the providers, and that the patients win because their premiums 
are lowered.
    I don't think the committee really went for that, that 
notion. But that is really the outcome.
    Mr. Gonzalez of Texas. I am glad they didn't.
    Ms. Eshoo. And so, what you have is one of the, you know, 
the basic values of your legislation I think on a bipartisan 
basis the committee agrees with. Yours very directly goes to 
Part D, and that is where the money is.
    Mr. Gonzalez of Texas. Right. Our pharmacies----
    Ms. Eshoo. And so I think that----
    Mr. Gonzalez of Texas [continuing]. Need to have certainty 
that whatever they are selling----
    Ms. Eshoo. They do.
    Mr. Gonzalez of Texas [continuing]. They know what it costs 
them themselves. And right now we don't have that.
    Ms. Eshoo. And we are very fortunate, because the only 
pharmacist in the entire House of Representatives is the 
gentleman from Georgia, Mr. Carter.
    Did you want to say something? Yes, you are recognized.
    Mr. Carter. Mr. Gonzalez, thank you, Representative. I 
appreciate this very much. And you are spot on. And I just want 
to thank you for bringing this to the committee's attention.
    And, Madam Chair, I wanted to ask, Congressman Doug 
Collins, who is one of the primary sponsors of the FAIR Act is 
unable to be here, but I wanted to ask unanimous consent to 
submit his letter for to be included in the record.
    Ms. Eshoo. Without objection.
    [The information appears at the conclusion of the hearing.]
    Mr. Carter. And also, earlier this year the CMS had 
proposed a rule about DIR fees that, unfortunately, did not, 
was not finalized. And we, along with Representative Gonzalez, 
Peter Welch and Morgan Griffith, members of our committee and, 
in fact, there were 20 members of the Energy and Commerce 
Committee as well as over 100 other Members of Congress who 
signed this letter to the President expressing our 
disappointment.
    And I wanted to add that as part of the record and ask 
unanimous consent.
    Ms. Eshoo. Without objection.
    [The information appears at the conclusion of the hearing.]
    Mr. Carter. Thank you. And thank you again, Representative.
    Mr. Gonzalez of Texas. Thank you.
    Ms. Eshoo. Dr. Burgess.
    Mr. Burgess. I'm smart enough to not get between Buddy 
Carter and DIR fees.
    Mr. Gonzalez of Texas. It is some slippery stuff, which is 
part of the problem; right?
    Mr. Burgess. So, I just, and I agree with what Mr. Carter 
said, but I also wanted to point out I have visited your 
district a number of times over the years, a lovely district. 
And the doctors at Renaissance Hospital is certainly one of the 
gems of the medical delivery model in this country. So----
    Mr. Gonzalez of Texas. They are. Thank you.
    Mr. Burgess [continuing]. H.R. 3062, which would allow for 
continuation and expansion of physician-held hospitals is a 
cause that I now carry with the retirement of Sam Johnson from 
our state.
    Mr. Gonzalez of Texas. Thank you. And I support you on 
that.
    Mr. Burgess. It is, it is an important concept. They do a 
great job down there. Always enjoy it every time I get to visit 
their campus. And they do a lot of work on the border health 
problem.
    Mr. Gonzalez of Texas. Would love to have you back.
    Mr. Burgess. Again, I am not a frequent flyer, but still I 
have been, I have been through McAllen Airport enough times 
that I know, I know where the best restaurants are.
    Mr. Gonzalez of Texas. Yes.
    Mr. Burgess. Well, there is only one. But anyway.
    Mr. Gonzalez of Texas. Thank you.
    Mr. Burgess. Thank you for your, for your presentation 
today.
    Mr. Gonzalez of Texas. A pleasure.
    Ms. Eshoo. And he hosted us at one. So, it was wonderful. I 
am still full.
    Thank you. Thank you. We will work with you.
    Now we have the pleasure of recognizing the Honorable 
Stacey Plaskett, the delegate from the Virgin Islands. You have 
5 minutes. And this is the second time we are meeting today, 
the two of us.

 OPENING STATEMENT OF HON. STACEY PLASKETT A REPRESENTATIVE IN 
       CONGRESS FROM THE TERRITORY OF THE VIRGIN ISLANDS

    Ms. Plaskett. Yes.
    Ms. Eshoo. And I think that you are going to raise some of 
the issues that we spoke to. And look forward to your 
testimony. Welcome and thank you.
    Ms. Plaskett. Thank you, Madam Chairwoman Eshoo. And Mr. 
Burgess, thank you as well, and to the committee for allowing 
many of the members the opportunity to present brief statements 
about our views on some of the areas that this committee deals 
with.
    I would like to use this time in particular to speak about 
healthcare concerns on the island territories in the United 
States. You know that we all need significant investment in 
healthcare in this section. Even before the severe natural 
disasters of the last two years the healthcare systems in the 
territories were under great distress.
    Specifically regarding Medicaid, the arbitrarily high local 
match required of territories under Medicaid impose severe and 
unsustainable financial demands on the territories. Each of us 
have tried to resolve these very differently and has had little 
success in doing so up until now.
    Up to 30 percent of the population of my district could 
lose access to healthcare unless Congress takes action to 
eliminate the fiscal cliff that we know we are facing due to 
Medicaid. And Congress must act to prevent this potentially 
calamity before September 30th.
    I am so grateful that this committee has really taken on 
that task and has taken action to address that cliff by moving 
legislation, H.R. 2328, the REACH Act, which includes the 
language of Mr. Soto's bill, the Territories Health Care 
Improvement Act, to provide an additional stream of Medicaid 
funds for the Virgin Islands and other territories from fiscal 
year 2020 to fiscal 2025.
    Under this bill, for my district, the Virgin Islands, the 
Medicaid cap would be increased by an overall $756 million over 
six years. The rate of federal matching funds for Medicaid in 
the Virgin Islands would also be raised temporarily at 100 
percent for fiscal year 2020, 83 percent for fiscal years 2021 
through 2024, and 76 percent in fiscal year 2025. Without this 
additional funding stream and at least another year of waiver 
for any local match required for Medicaid, the resulting 
Medicaid cuts would put healthcare delivery at risk not only 
for Medicaid recipients on our islands, but actually for the 
population at large.
    Due to the large amount of individuals on Medicaid, our 
hospitals and other systems are solely dependent on Medicaid 
revenue, which help us to understand how lost Medicaid revenues 
would hurt healthcare providers in private practice as well.
    And I have to say that I am so appreciative of this 
legislation. I would respectfully request, however, that the 
Virgin Islands have the ability to carry over any unspent 
funding provided in any given fiscal year to a later fiscal 
year in order to improve the flexibility in the way dollars are 
able to flow, and to better ensure that the beneficiaries will 
see the services they need in full, for the full entirety of 
the bill's 6-year period.
    Lastly, I would also like to highlight healthcare needs of 
the territories that fall outside of the Medicaid funding 
cliff.
    Even before the 2017 hurricane, the Virgin Islands' two 
hospitals, publicly owned, have been excluded from the Medicaid 
disproportional share for hospitals, or DISH program, in spite 
of disproportionate amount of care provided to low-income 
patients. The exclusion of all of the territories from Medicaid 
DISH, and the small territories from Medicare DISH--Puerto Rico 
receives a Medicare DISH--had major health issues in the 
territories for many years, resulting in significant 
uncompensated care costs, burdens on providers, hospitals, 
local government across the islands.
    If you talk with the hospitals, this in many ways 
necessitated the reason why we had the type of destruction we 
did within our hospitals, where a hospital provides, the 
hospital had to make a decision are we going to pay our doctors 
or are we going to get a new roof put on our hospitals? We lost 
both of our public hospitals in the storm in 2017, and are 
awaiting modulars now while we are primarily doing triage care 
and having people medevaced out for any long-term care in the 
Virgin Islands.
    We have two emergency rooms on each island that are 
operational, which is very, very precarious situation to be in.
    I have sponsored legislation, joined by my colleagues from 
the territories, and others, to correct inequities we face 
under all of the federal health programs. By eliminating the 
Medicaid cap, providing for fair inclusion of the territories 
in Medicaid and Medicare, as well as other issues. It also 
tries to address Medicare Part D low-income subsidy programs, 
and address exclusion from the healthcare insurance exchange 
program under the Affordable Care Act.
    I recognize that my time is over. That is under legislation 
in this session, H.R. 1354, the Territories Health Equity Act 
of 2019. We confront difficulty, difficult reality living in 
the territories. U.S. citizens have been neglected and allowed 
to fall behind. I trust that this committee sees the importance 
of this and is willing to work with us to resolve these issues.
    Thank you.
    [The prepared statement of Ms. Plaskett follows:]

               Prepared Statement of Hon. Stacey Paskett

    Thank you to the chair and ranking member, and members of 
the committee, for allowing me the opportunity to present a 
brief statement of my views on the work of this committee in 
the 116th Congress. I would like to use my time to speak in 
particular about healthcare concerns of the island territories 
in the United States.
    The territories will need significant investments in 
healthcare in this session. Even before the severe natural 
disasters of the last two years, the healthcare systems in the 
territories were under great stress.
    Specifically, regarding Medicaid, the arbitrarily high 
local match required of U.S. territories under Medicaid imposes 
severe and unsustainable financial demands on the territories. 
Each of the territories have tried to resolve this very 
differently and have had little success in doing so up until 
now.
    In addition, while overall federal Medicaid funding to the 
States and the District of Columbia is open-ended, Medicaid in 
the territories is subject to annual federal funding caps. Once 
the cap is reached, the territory must assume the full cost of 
Medicaid services.
    While the capped federal funding has been supplemented by 
additional Affordable Care Act block grants since 2011, the 
Virgin Islands and all other territories face the so-called 
fiscal cliff on September 30th of this year when these 
Affordable Care Act allotments expire.
    Up to 30 percent of my district could lose access to 
healthcare unless Congress takes action to eliminate the 
Medicaid fiscal cliff. Congress must act to prevent to this 
potential calamity before September 30th.
    I am grateful that this committee has taken action to 
address the Medicaid cliff by moving legislation, H.R. 2328, 
the REACH Act, which includes the language of Mr. Soto's bill, 
the Territories Health Care Improvement Act, to provide an 
additional stream of Medicaid funds for the Virgin Islands and 
the other territories from fiscal year 2020 through fiscal year 
2025.
    Under this bill, for my district, the Virgin Islands, the 
Medicaid cap would be increased by an overall $756 million over 
six years ($126 million in each of fiscal years 2020 through 
2025). The rate of federal matching funds for Medicaid in the 
Virgin Islands would also be raised, temporarily, to 100% for 
fiscal 2020, 83% from fiscal 2021 to 2024, and 76% in fiscal 
2025.
    Without this additional funding stream, and at least 
another year of a waiver for any local match required under 
Medicaid, the resulting Medicaid cuts would put healthcare 
delivery at risk; not only for Medicaid recipients on our 
islands, but also for the population at large. Due to the 
relatively large number of individuals on Medicaid, our 
hospitals and other systems depend on Medicaid revenue. 
Therefore, the loss of Medicaid revenue resulting from the 
fiscal cliff would hurt healthcare providers in private 
practice as well. Using 2018 data for the Virgin Islands, 
Medicaid funding would go from roughly $70 million to just $18 
million. The islands cannot suffer cuts like that and continue 
to deliver services. Significantly more funding is needed, and 
at a far more equitable matching rate.
    While I am very appreciative of the committee's approval of 
the Territories Health Care Improvement Act, I respectfully 
request that the Virgin Islands have the ability to carry over 
any unspent funds provided in any given fiscal year to a later 
fiscal year in order to improve flexibility in the way dollars 
are able to flow, and to better ensure that the beneficiaries 
will see the services they need for the full entirety of the 
bill's six-year period.
    Lastly, I would like to highlight healthcare needs of the 
territories that fall outside of the Medicaid funding cliff.
    Even before the 2017 hurricanes, the Virgin Islands' two 
hospitals, publicly owned, have been excluded from the 
disproportional share hospital (or ``DSH'') program, despite 
the disproportionate amount of care provided to low income 
patients. The exclusion of all of the territories from Medicaid 
DSH, and the small territories from Medicare DSH (Puerto Rico 
receives Medicare DSH), has been a major health issue in the 
territories for many years; resulting in significant 
uncompensated care cost burdens on providers, hospitals, and 
local government finances across all of the islands.
    These uncompensated care costs, in many ways, were a major 
reason why the hospitals experienced the extent of their 
destruction in the event of disaster. For a very long time, the 
hospitals have been forced to make choices like whether to pay 
doctors and nurses or to fix a roof. The hospitals in the 
Virgin Islands are still waiting for modular structures to come 
online, while primarily doing triage care, and having people 
evacuated out for any long-term care. The hospital on St. Croix 
has only one operating room. Both hospitals remain in a very 
precarious situation nearly two years after the 2017 
hurricanes.
    I have sponsored legislation, H.R.1354, the Territories 
Health Equity Act of 2019, joined by my colleagues from the 
territories, and others, to correct the inequities faced by the 
territories across all of the federal health programs. The bill 
eliminates the Medicaid funding caps and provides for fair 
inclusion of the territories in Medicaid and Medicare DSH. It 
also improves the treatment of the territories in the Medicare 
Part D low income subsidy program, and addresses their 
exclusion from the health insurance exchange program under the 
Affordable Care Act.
    Regarding the Affordable Care Act, I have long been 
dismayed that it was underinclusive of U.S. territories. My 
bill would allow residents of the territories (where there are 
no Affordable Care Act insurance marketplaces) who lack 
employer-provided healthcare to access marketplace insurance 
plans offered to Members of Congress and congressional staff.
    We must confront the difficult reality that Americans 
living in the territories are U.S. citizens that have been 
neglected and allowed to fall behind. I trust that this 
committee sees the importance of this and is willing to work 
with us to resolve these issues. Thank you.

    Ms. Eshoo. Well, I thank you, Stacey, very much. I think on 
the first issue that you raised relative to rolling over of the 
funds, I already spoke to Mr. Pallone about that. And we look 
to be helpful to you. And I don't see any reason why funds 
can't be, unused funds from one fiscal year can't be rolled 
into another.
    The DISH issue, as I said to you today earlier, is a larger 
one. But we appreciate what you said about the work that we 
have done together. I think that there is a sense of pride here 
on the committee on both sides of the aisle, and we saw an 
expansion of the commitment to the territories. We will keep 
working together and before the legislation goes to the full 
House post August recess.
    So thank you. Dr. Burgess?
    Ms. Plaskett. Thank you. We love that there is an August 
recess.
    Ms. Eshoo. Yes. Yes.
    Ms. Plaskett. We get to work on this. Thank you so much.
    Ms. Eshoo. For many reasons, right. Thank you, and have a 
good one. And thank you for being here today. I am glad that I 
mentioned it to you, yes, and that you took us up on it.
    The Chair requests unanimous consent to enter the following 
into the record: Joint testimony of Mr. Cummings and Mr. 
Ruppersberger of Maryland; joint testimony of Mr. Kelly of 
Pennsylvania and Ms. Kaptur of Ohio on behalf of the House 
Congressional Auto Caucus; testimony of Mr. Raskin of Maryland; 
testimony of Mr. Engel of New York; testimony of Mr. Gomez of 
California; testimony of Ms. Moore of Wisconsin; testimony of 
Mr. Payne, New Jersey; testimony of Mr. Briggs of Arizona; 
testimony of Mr. Swalwell of California; testimony of Mr. Smith 
of New Jersey, and; testimony of Mr. Cisneros of California.
    Without objection, so ordered.
    [The information appears at the conclusion of the hearing.]
    Ms. Eshoo. And is there anything that you would like, Dr. 
Burgess?
    Mr. Burgess. We will do it again real soon.
    Ms. Eshoo. OK. I want to thank the Members, most especially 
Dr. Burgess here for the participation in today's hearing, 
Members Day--Member Day. I think that we learned a lot, have 
much to appreciate in what they brought forward, and even more 
work to do with the committee to help meet the needs that they 
have in their congressional districts. So, we are grateful to 
all.
    And at this time, the committee is adjourned.
    [Whereupon, at 3:51 p.m., the committee was adjourned.]
    [Material submitted for inclusion in the record follows:]
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