[Senate Hearing 116-529]
[From the U.S. Government Publishing Office]




                                                        S. Hrg. 116-529
 
                   THE COVID-19 PANDEMIC AND SENIORS:
                  A LOOK AT RACIAL HEALTH DISPARITIES

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

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                     ONE HUNDRED SIXTEENTH CONGRESS


                             SECOND SESSION

                               __________

                             WASHINGTON, DC

                               __________

                             JULY 21, 2020

                               __________

                           Serial No. 116-21

         Printed for the use of the Special Committee on Aging
         
         
         
         
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]         
         


        Available via the World Wide Web: http://www.govinfo.gov
        
        
        
                           ______                       

              U.S. GOVERNMENT PUBLISHING OFFICE 
 46-842PDF            WASHINGTON : 2022       
        
        
        
        
        
                       SPECIAL COMMITTEE ON AGING

                   SUSAN M. COLLINS, Maine, Chairman

TIM SCOTT, South Carolina            ROBERT P. CASEY, JR., Pennsylvania
RICHARD BURR, North Carolina         KIRSTEN E. GILLIBRAND, New York
MARTHA McSALLY, Arizona              RICHARD BLUMENTHAL, Connecticut
MARCO RUBIO, Florida                 ELIZABETH WARREN, Massachusetts
JOSH HAWLEY, Missouri                DOUG JONES, Alabama
MIKE BRAUN, Indiana                  KYRSTEN SINEMA, Arizona
RICK SCOTT, Florida                  JACKY ROSEN, Nevada
                              ----------                              
              Elizabeth McDonnell, Majority Staff Director
                 Kathryn Mevis, Minority Staff Director
                 
                         C  O  N  T  E  N  T  S

                              ----------                              

                                                                   Page

Opening Statement of Senator Susan M. Collins, Chairman..........     1
Opening Statement of Senator Robert P. Casey, Jr., Ranking Member     3

                           PANEL OF WITNESSES

Dominic H. Mack, MD, MBA, Professor of Family Medicine and 
  Director of the National Center for Primary Care, Morehouse 
  School of Medicine, Atlanta, Georgia...........................     6
Mercedes R. Carnethon, Ph.D., Professor of Epidemiology and Vice 
  Chair of the Department of Preventive Medicine, Northwestern 
  University, Chicago, Illinois..................................     7
Eugene A. Woods, MBA, MHA, FACHE, President and Chief Executive 
  Officer, Atrium Health, Charlotte, North Carolina..............     9
Rodney B. Jones, Sr., Chief Executive Officer, East Liberty 
  Health Center, Pittsburgh, Pennsylvania........................    11

                                APPENDIX
                      Prepared Witness Statements

Dominic H. Mack, MD, MBA, Professor of Family Medicine and 
  Director of the National Center for Primary Care, Morehouse 
  School of Medicine, Atlanta, Georgia...........................    47
Mercedes R. Carnethon, Ph.D., Professor of Epidemiology and Vice 
  Chair of the Department of Preventive Medicine, Northwestern 
  University, Chicago, Illinois..................................    53
Eugene A. Woods, MBA, MHA, FACHE, President and Chief Executive 
  Officer, Atrium Health, Charlotte, North Carolina..............    55
Rodney B. Jones, Sr., Chief Executive Officer, East Liberty 
  Health Center, Pittsburgh, Pennsylvania........................    67

                 Questions and Responses for the Record

Eugene A. Woods, MBA, MHA, FACHE, President and Chief Executive 
  Officer, Atrium Health, Charlotte, North Carolina..............    73
Mercedes R. Carnethon, Ph.D., Professor of Epidemiology and Vice 
  Chair of the Department of Preventive Medicine, Northwestern 
  University, Chicago, Illinois..................................    73
Dominic H. Mack, MD, MBA, Professor of Family Medicine and 
  Director of the National Center for Primary Care, Morehouse 
  School of Medicine, Atlanta, Georgia...........................    73

                  Additional Statements for the Record

AARP Real Possibilities, Statement for the Record................    77
Alzheimer Association AIM, Statement for the Record..............    80
American Psychological Association, Statement for the Record.....    82
Robert Wood Johnson Foundation, Statement for the Record.........    86
Johnson and Johnson Services, Inc., Statement for the Record.....    90


                   THE COVID-19 PANDEMIC AND SENIORS:

                  A LOOK AT RACIAL HEALTH DISPARITIES

                              ----------                              


                         TUESDAY, JULY 21, 2020

                                       U.S. Senate,
                                Special Committee on Aging,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 9:32 a.m., in 
room SD-562, Dirksen Senate Office Building, Hon. Susan M. 
Collins, Chairman of the Committee, presiding.
    Present: Senators Collins, Tim Scott, Burr, McSally, 
Hawley, Braun, Rick Scott, Casey, Blumenthal, Warren, Jones, 
Sinema, and Rosen.

                 OPENING STATEMENT OF SENATOR 
                   SUSAN M. COLLINS, CHAIRMAN

    The Chairman. The Committee will come to order, and we are 
already having some technical problems. There we go. Thank you.
    Before I begin my opening statement this morning, I want to 
acknowledge the loss over the weekend of Congressman John 
Lewis, a Civil Rights icon who changed history at great 
personal sacrifice. In 2015, I was honored to be among those 
who joined him in Selma to commemorate the 50th anniversary of 
the Bloody Sunday March, which he led. I sent my deepest 
condolences to his family and his loved ones.
    Today's hearing comes at a time when our Nation is 
experiencing the confluence of a health crisis and economic 
depression and a series of killings that laid bare the racial 
injustice that still taints our country.
    Our focus today is on COVID-19's disproportionate health 
impact on black and Latino seniors, as well as seniors from 
other racial and ethnic minority communities.
    According to the New York Times analysis, black and Latino 
residents are infected with the virus at three times the rate 
of their white neighbors, and they are nearly twice as likely 
to die from COVID-19.
    The State of Maine has the worst racial disparity in COVID 
cases in the country. Although blacks comprise less than 2 
percent of Maine's population, they account for approximately 
23 percent of all cases. Like many other States, many of 
Maine's outbreaks have occurred in nursing homes and congregate 
care settings.
    Nationwide, 43 percent of black and Latino workers are 
employed in service or production jobs that, for the most part, 
cannot be done remotely, while only about one in four white 
employees hold such jobs. One such field is long-term care, 
where one in four employees is black, according to the Kaiser 
Family Foundation.
    At this Committee's May hearing, Dr. Tamara Konetzka 
recommended routine history of long-term care residents, to 
testing of long-term care residents and employees, a suggestion 
that was echoed at the Senate HELP Committee hearing last month 
with former CDC Director Julie Gerberding. Dr. Gerberding 
described long-term care facilities as, ``intrinsic hot 
spots,'' and suggested that we need to test often and test 
everyone who comes and goes from those centers.
    There is still a great deal that we do not yet know about 
COVID-19, but we do know that individuals with chronic kidney 
disease, serious heart conditions, obesity, sickle cell 
disease, and type 2 diabetes are at increased risk of severe 
illness from COVID-19, and that black Americans experience 
these conditions at disproportionate rates.
    Diabetes provides a clear example. Patients hospitalized 
for COVID who have diabetes account for more than 20 percent of 
individuals admitted to intensive care units according to the 
Journal of Clinical Endocrinology and Metabolism.
    According to a survey conducted by the Centers for Medicare 
and Medicaid, although black Medicare beneficiaries were just 
as likely as white beneficiaries to perform diabetes self-
management activities, they were less likely to have their 
blood sugar well controlled.
    As the founder and co-chair of the Senate Diabetes Caucus, 
I have worked with my co-chair, Senator Jeanne Shaheen, on 
legislation to expand Medicare diabetes self-management 
training as well as a pilot program to test the impact of 
virtual training services.
    We have also introduced legislation to create a special 
task force to eliminate Medicare coverage barriers in accessing 
the latest diabetes treatments.
    We have also worked hard for an extension of the Special 
Diabetes Programs that benefit Native Americans and children 
and adults with type I diabetes.
    Another factor in the disproportionate impact of the virus 
on black Americans appears to be a distrust of the health care 
system. A study from a California health system observed that 
black patients were more likely to have been tested at a 
hospital than in and ambulatory environment and that patients' 
prior negative experiences with the health care system can lead 
to distrust and a decision to seek care only in the most 
extreme circumstances.
    Historical injustices with medical experimentation have 
also left a legacy of mistrust and skepticism among many 
African Americans that we need to work to resolve. Part of the 
solution may be found through community partnerships and 
greater health care workforce diversity.
    Blacks make up 13 percent of the U.S. population, but only 
5 percent of physicians in the United States according to a 
recent report from the Association of American Medical 
Colleges.
    We are so fortunate today to have such a distinguished 
panel of experts with us to help us better understand the 
challenges and, more important, to identify meaningful 
solutions.
    I will introduce our witnesses momentarily, but first, let 
me turn to the Committee's Ranking Member, Senator Casey, for 
his opening remarks, and as I indicated, he is joining us by 
WebEx.

                 OPENING STATEMENT OF SENATOR 
              ROBERT P. CASEY, JR., RANKING MEMBER

    Senator Casey. Chairman Collins, thank you very much for 
this hearing.
    As you noted, as we begin this important work period in the 
Senate, we mourn the passing of United States Representative 
John Lewis. Congressman Lewis was a brave Freedom Rider. He was 
a giant in the Civil Rights movement, who literally shed blood 
for the right to vote. Of course, we know that he served in the 
U.S. House of Representatives for over 33 years. His life was a 
testament to the cause of justice.
    Now as Members of Congress, in the wake of his passing, we 
must ask ourselves at least one major question: What must we 
do--what must we do in the Senate to fulfill our obligation to 
further that cause of justice, especially as it relates to the 
challenges we face right now?
    Our witnesses today will help us answer that basic 
question. They will offer solutions, amid the pandemic and for 
the future, to bring about health equity for older Americans of 
color.
    Older Americans of color, as we know and as the Chairman 
outlined, have spent a life time enduring the structural 
inequities in racism that has plagued our country since its 
inception. We must own up to that simple and shameful truth, 
and we must not only acknowledge these injustices, but we are 
summoned by the example of John Lewis to take action, to do 
something about it, as he so often urged us to do throughout 
his life.
    What are those injustices? Let me just name a few, but they 
are searing in their impact.
    The injustice of a lack of affordable housing. Based upon 
data from 2015, 46 percent of black households spent more than 
one-third of their income on rent compared to 33 percent of 
white households.
    The injustice of food insecurity, right now, black and 
Hispanic households with children are twice as likely--twice as 
likely to struggle with food insecurity as white households, 
number three, the injustice of the education gap. According to 
the Census, 40 percent of white individuals have a college 
degrees or higher, compared to just 26 percent of blacks and 18 
percent of Hispanics.
    The injustice of unemployment itself. In June, the 
unemployment rate for black Americans was 15.4 percent, 
compared to 10.1 percent for whites, a gap that is not unique, 
as we know, to the current crisis.
    Of course, we have been reminded so horrifically lately, 
the injustice of police misconduct against black Americans.
    It is no wonder that older adults of color are diagnosed 
with COVID-19 at higher rates than whites and are dying--dying 
from COVID-19 at higher rates than whites.
    The New York Times recently reported on data from the 
Centers for Disease Control and Prevention that Hispanic and 
black individuals have been three times as likely to become 
infected with the virus and twice as likely to die--twice as 
likely to die as whites, a gap that only widens with age.
    A New York Times analysis of nursing home data from 22 
States found that facilities serving significant numbers of 
black and Hispanic residents are twice as likely to have COVID-
19 infections, even after controlling for facility size, 
location, and quality rating.
    We have a chance right now, in the next 3 weeks, to begin 
to address these injustices, and we hope to put ourselves on 
the road to actually correcting these injustices and thereby to 
advance the cause of justice for communities of color all 
across America and as we focus on older Americans in this 
hearing.
    Now, we have been told that the Senate will finally 
consider additional legislation to respond to the ongoing 
threat of COVID-19. Here is what we need to do in the near 
term. This is just for the near term, the next couple weeks and 
months: 1) we need a national testing strategy; 2) we need more 
funding for personal protective equipment; 3) we need a 
specific plan to keep nursing home residents and workers safe 
and the dollars to make it work so that we do not have another 
56,000 Americans dead in nursing homes; 4) we need an expansion 
of long-term services and supports in the community; 5) 
pandemic premium pay for the heroes on the front lines who are 
helping to care for our aged loved ones; and 6) a guarantee of 
access to quality affordable health care.
    There is more I could say, but we must do all of these, all 
of these, and more to protect older Americans of color from the 
worst public health crisis in a century. However, the actions 
we take in the short run are not a substitute for enacting 
policies to address the injustices that have plagued 
communities of color for generations--not decades but 
generations.
    Taking action on these racial health disparities that we 
are here to talk about today is what the cause of justice 
demands of us in the U.S. Senate.
    Thank you again, Chairman Collins, for convening the 
hearing. I look forward to hearing from our witnesses.
    The Chairman. Thank you, Senator Casey.
    Our first witness today is Dr. Dominic Mack. Dr. Mack is 
director of the Morehouse School of Medicine, National Center 
for Primary Care, the Nation's first congressionally sanctioned 
center to develop programs that strengthen the primary care 
system for health equity and sustainability.
    Last month, the U.S. Department of Health and Human 
Services announced a partnership with the Morehouse School of 
Medicine to fight COVID-19 and racial and ethnic minority, 
rural, and socially vulnerable communities. We look forward to 
learning more about this partnership and how this work will 
translate into better data and best practices to better serve 
seniors in those communities.
    Our next witness will be Dr. Mercedes Carnethon. Dr. 
Carnethon is the Professor of Epidemiology and Vice Chair of 
the Department of Preventive Medicine at the Feinberg School of 
Medicine at Northwestern University. Her research focuses on 
the epidemiology of cardiovascular disease, obesity, diabetes, 
lung health, and cognitive aging in population subgroups 
defined by race and ethnicity, geography, socioeconomic status, 
gender, and sexual orientation and gender identity.
    I am going to turn from introducing the witnesses myself to 
calling on Senator Burr to introduce a witness from his State.
    Senator Burr, thank you for joining us.
    Senator Burr. Thank you, Madam Chairman and Ranking Member 
Casey, for holding this hearing today, and to all of our 
witnesses, welcome.
    It is a distinct honor to be able to introduce Mr. Gene 
Woods from Charlotte, North Carolina.
    In his current role as president and CEO of Atrium Health, 
Mr. Woods is responsible for one of North Carolina's major 
health systems that manages 14 million patient interactions 
each year. Atrium encompasses 26 hospitals, 900 care locations, 
and employs nearly 70,000 people. He spent much of his career 
focused on the issues before the Committee today, decreasing 
health care disparities, and providing high-quality care to all 
members of our communities.
    Mr. Woods has gained over 30 years of experience in health 
care administration. Prior to his move to Atrium, he served as 
president of CHRISTUS Health System and CEO of St. Joseph's 
Health System. He also previously held a leadership role, Madam 
Chairman, of the hospital here in Washington, serving as CEO of 
MedStar Washington Hospital Center.
    He holds an MBA and a master's of health administration as 
well as a bachelor's degree in health planning and 
administration, all from the University of Pennsylvania.
    Gene, I want to thank you for all the important work you 
have done on behalf of North Carolinians and your tireless 
efforts during this pandemic. I look forward to hearing your 
perspective on coronavirus response thus far and what you think 
is around the next corner in our effort to stop the spread of 
COVID-19.
    Thank you, Madam Chairman, and welcome, Gene.
    The Chairman. Thank you very much, Senator Burr. You have 
been a real leader in this area for many years, and I 
appreciate you being with us.
    I would now like to turn to Senator Casey to introduce our 
fourth witness.
    Senator Casey. Thank you, Chairman Collins.
    I am pleased to introduce Mr. Rodney Jones of Pittsburgh, 
Pennsylvania. Rodney serves as the CEO of the East Liberty 
Health Center. East Liberty Health Center provides care to 
underserved populations in the Greater Pittsburgh Area.
    Mr. Jones will share with us the work that the East Liberty 
Health Center is doing to ensure that patients stay safe from 
COVID-19.
    He will also discuss the threat that the pandemic has to 
the overall health and well-being of patients served by the 
health center. As we know, stay-at-home orders and social 
distancing requirements have caused many older adults and 
people with underlying health conditions to fear leaving their 
home to get the care that they need.
    Mr. Jones has been working at various health centers and 
hospitals in Pennsylvania and Ohio for his entire professional 
life.
    Mr. Jones, we want to thank you for testifying today, for 
being with us, for sharing your expertise with this Committee.
    Thank you.
    The Chairman. Thank you, Senator Casey.
    Dr. Mack, we will start with you.

             STATEMENT OF DOMINIC H. MACK, MD, MBA,

           PROFESSOR OF FAMILY MEDICINE AND DIRECTOR

            OF THE NATIONAL CENTER FOR PRIMARY CARE,

         MOREHOUSE SCHOOL OF MEDICINE, ATLANTA, GEORGIA

    Dr. Mack. Chairman Collins, Ranking Member Casey, and 
members of the Special Committee on Aging, thank you for 
convening this important hearing today.
    I am Dr. Dominic Mack and am presenting testimony on behalf 
of Morehouse School of Medicine, one of four historically black 
medical schools in the Nation. I bring greetings to you from 
our president and dean, Dr. Valerie Montgomery Rice.
    At MSM, I serve as a professor of family medicine, director 
of the institution's National Center for Primary Care, and co-
lead on our innovative partnership with the U.S. Department of 
Health and Human Services' Office of Minority Health entitled 
the National COVID-19 Resilience Network: Mitigating the Impact 
of COVID-19 on Vulnerable Populations.
    The daunting news that black Americans in the U.S. are 
disproportionately suffering and dying from the novel 
coronavirus, unfortunately, is not a surprise to those of us at 
Morehouse School of Medicine. We serve on the front lines of 
medically underserved communities and understand the Nation's 
health disparities and overall health status.
    According to the Centers for Disease Control and 
Prevention, as of late June, blacks, Native Americans, Alaska 
Natives, and Hispanics are impacted by the coronavirus at a 
rate reaching five times that of non-minority Americans. In my 
State of Georgia, blacks have accounted for nearly 50 percent 
of coronavirus deaths, and throughout this Nation, seniors 
experienced disproportionate morbidity and mortality across all 
racial and ethnic groups. These facts are a surrogate for the 
glaring lack of health infrastructure in medically underserved 
communities.
    Chairman Collins and Committee members, we are grateful for 
the opportunity to partner with OMH to do the meaningful work 
that will address the disproportionate impact of COVID-19 on 
communities of color.
    The National COVID-19 Resiliency Network, NCRN for short, 
will mitigate the impact of COVID-19 on racial and ethnic 
minorities, rural communities, and other vulnerable 
populations. Related to COVID-19, we will: 1) identify and 
engage vulnerable communities through local, State, territory, 
Tribal, and national partners; 2) establish and active 
information dissemination network; 3) disseminate culturally 
and linguistically appropriate messaging; 4) use technology to 
link communities to health care services, including testing, 
vaccination, and behavioral health counseling; 5) monitor and 
evaluate the success of NCRN services and measure quality 
outcomes; and 6) use broad and comprehensive dissemination 
methods to show lessons learned and best practices among 
vulnerable communities.
    NCRN is a significant step in the right direction, but a 
great need remains in underserved communities. The fundamental 
health needs of vulnerable populations will require 
specifically targeted measures that address the breadth of 
health disparities and the determinants which lie underneath. 
Without significant action as with the past pandemic, COVID-19 
will continue to disparately impact vulnerable populations now 
and long after this pandemic is gone.
    With your leadership, we can realize an equitable policy 
response to the crisis we are now facing. We are calling on 
Congress and the administration to include the following 
measures in the COVID-19 stimulus legislation. One, resolve the 
funding disparity from the CARES Act that short-funded the 
historically black graduate institutions like Morehouse School 
of Medicine. We are on the front line and facing real and 
substantial financial shortfalls. Two, provide robust funding 
for the improvement and development of health care 
infrastructure, including hospitals in medically underserved 
communities. Three, double funding for Title VII health 
professions training programs at HHS's Health Resources and 
Services Administration to increase diversity in the health 
care workforce. Four, invest $100 million in new annual COVID-
19 research funding to NIH's National Institute on Minority 
Health and Health Disparities, specifically targeted at 
minority-serving institutions.
    We stand ready to work with you. If there was ever a time 
to meaningful act to address racial and ethnic health 
disparities and health inequities in the United States, it is 
now.
    Thank you for this opportunity, and I am pleased to respond 
to any questions.
    The Chairman. Thank you very much, Doctor.
    Our next witness is Dr. Carnethon.

           STATEMENT OF MERCEDES R. CARNETHON, Ph.D,

            PROFESSOR OF EPIDEMIOLOGY AND VICE CHAIR

           OF THE DEPARTMENT OF PREVENTIVE MEDICINE,

           NORTHWESTERN UNIVERSITY, CHICAGO, ILLINOIS

    Dr. Carnethon. Am I being heard? Okay, great. Thank you.
    Good morning, Chairman Collins, Ranking Member Casey, and 
other distinguished Senators of the Committee on Aging. Thank 
you for the opportunity to share my observations and 
recommendations to address disparities in COVID-19 among older 
adults in my capacity as a research expert.
    I am an epidemiologist in the Departments of Preventive 
Medicine and Medicine at the Northwestern University Feinberg 
School of Medicine where I have studied the risk factors for 
chronic disease for the previous 18 years.
    My research, which has been funded by the National 
Institutes of Health, the American Heart Association, and the 
American Lung Association, has described an earlier onset and 
more severe course of hypertension, diabetes, heart and lung 
disease among blacks, Latinx, Native American/Pacific 
Islanders, and some Asians subgroups as compared with non-
Hispanic whites. These statistics are borne out in my personal 
experience.
    I never met my maternal grandmother, because when she was 
62 years old, she suffered a stroke followed by a fatal heart 
attack. While I knew and loved my paternal grandmother, she did 
not know me for the last 10 years of her life, because she 
battled vascular dementia following years of high blood 
pressure.
    The relevance of my story is that the vascular diseases 
that affected my grandparents are the same conditions that are 
associated with the worst outcomes from COVID-19.
    Early scientific reports from countries that preceded us in 
the pandemic described the characteristics of individuals with 
COVID-19 who were more likely to be hospitalized and to die. 
Immediately, we realized that non-whites and ethnic minorities 
in the U.S. would be disproportionately affected.
    As States and municipalities began collecting 
sociodemographic data from individuals diagnosed with COVID-19, 
racial and ethnic disparities emerged that were the most acute 
in the younger ages. Although these disparities appear to 
decrease with aging in community dwelling older adults, nursing 
homes with a greater proportion of black or Latinx residents 
have doubled the rate of COVID-19 infections than their 
predominately non-Hispanic white counterparts.
    Against the backdrop of this pandemic, I understand the 
urgency for our country to return to normal. In our research, 
we have described the link between economic factors and health. 
A strong economy that allows for stable housing, access to 
healthy food, and health care access to manage chronic 
conditions is likely to be of even greater benefit to elderly 
vulnerable populations.
    However, we cannot return to normal by prioritizing the 
economy over the people without offering strategies to mitigate 
the impact of COVID-19 on minority older adults, an so I offer 
three recommendations based on my experience as a population 
science researcher.
    First, is to expand the digital infrastructure and training 
available to older adults to support videoconferencing for 
telemedicine. The CARES Act provided provisions to expand 
coverage and offer grants to support broader use of telehealth 
services. However, while this can be carried out by telephone, 
there is likely to be an even greater benefit via 
videoconferencing. Almost half of all older adults have a 
smartphone with video capability, and ownership is similar by 
race and ethnicity.
    Accessibility is one step, but in my experience, 
technology-naive adults require training to maximize these 
technologies. When a patient and provider can see one another, 
patients can maximize the social connection with their 
providers, and providers have more information in the form of 
visual cues to gauge whether in-person visits or other home-
based supports are needed.
    Second, the NIH needs additional financial support to 
address the short-and long-term manifestations of the SARS-COV2 
infection. The majority of the $1 billion infusion of support 
to the NIH through the CARES Act went to the NIAID to 
accelerate study of the virus and vaccine development. We have 
learned since that time that the SARS-COV2 infection damages 
multiple organs, including the heart, lung, blood, kidneys, and 
the brain.
    Further, we know that adults who are obese and have 
diabetes have the worst outcomes, and that underrepresented 
minorities and older adults are overrepresented in those 
populations. As additional financial support is considered, 
other institutes at the NIH need to be on equal footing when it 
comes to the allocation of resources.
    Third and finally, we need to engage the communities who 
have been hardest hit by COVID-19 as we develop strategies for 
prevention and treatment. Progress toward a vaccine to prevent 
COVID-19 is encouraging; however, drawing on parallels from the 
annual flu vaccine, non-white and ethnic minorities are less 
likely to get vaccinated than non-Hispanic whites. Without 
building rapport and trust in these communities, there is no 
guarantee that the highest-risk populations will get the 
vaccine or that they will even want the vaccine.
    Thank you for allowing me the opportunity to offer these 
suggestions today in hopes that we can offer our most 
vulnerable older adults our very best science and medical care.
    The Chairman. Thank you very much.
    Mr. Woods?

         STATEMENT OF EUGENE A. WOODS, MBA, MHA, FACHE,

             PRESIDENT AND CHIEF EXECUTIVE OFFICER,

            ATRIUM HEALTH, CHARLOTTE, NORTH CAROLINA

    Mr. Woods. Yes. Good morning, and, Senator Burr, thank you 
for that kind introduction and for being a friend of Atrium and 
also a champion for the communities we serve in North Carolina, 
both rural and urban.
    Chairman Collins and Ranking Member Casey and members of 
the Senate Special Committee on Aging, my name is Gene Woods, 
and I am president and CEO of Atrium Health. While I have had 
the privilege of meeting Senator Collins during my time as 
chair of the American Hospital Association, it is an honor to 
now present my testimony on behalf of Atrium Health.
    As Senator Burr shared, Atrium Health is headquartered in 
Charlotte, North Carolina. We are one of the largest not-for-
profit health organizations in the Nation and have had the 
privilege of serving our community for more than 80 years. We 
are the largest provider of Medicaid, for example, in North 
Carolina, and further, we provide more than $2 billion in 
community benefit annually to those that we are privileged to 
serve.
    As I reflect back on the past few months of combating 
COVID, we have had to really rethink everything that we do as a 
health system. I will remember the faces of my leadership team 
the first time we reconvened to recognize the dimensions of 
this crisis, serious faces, resolute faces, but I am so proud 
of the team and of our frontline caregivers for the selfless 
dedication in keeping our patients and community safe, and our 
mission to care for all has never shined brighter
    That said, we realized the road ahead is long, and there 
were many challenges that remained. We, for example, can do 
4,000 COVID tests at Atrium every day because we are one of the 
few systems in the Nation that had special in-house lab 
equipment that can process our own testing; however, due to a 
national supply shortage in reagents, we are only doing one-
fifth of our capacity, so opportunities remain to significantly 
expand testing supplies so that we can care for more people, 
especially the elderly, and we stand ready to be part of that 
solution.
    That said, in many other ways, we have taken health care to 
a new impact level and accessibility that will outlast this 
pandemic.
    Take our COVID virtual hospital, for example, which has 
allowed us to care for patients in the comforts of their own 
home while preserving critical capacity inside of our 
hospitals, and to date, our virtual hospital has cared for more 
than 11,000 patients at home and I believe this is a glimpse of 
the future of health care, using technology to increase access, 
including for the most vulnerable among us, closest to where 
they live.
    As another example to help our minority communities, we 
used analytical capabilities to pinpoint geographic hotspots 
where there were disparities in COVID testing and treatment, 
and partnering with local churches and community organizations, 
we deployed our roving health units to the most vulnerable 
underserved areas and I am proud to share that in a matter of 
weeks, we were able to completely eliminate any racial testing 
disparities that existed in the Charlotte region.
    We continue to be deeply troubled by the statistics that 
have been mentioned, the percentage of positive cases and 
deaths among our Hispanic and African American neighbors, so we 
recently launched a public-private partnership to collect and 
distribute 2 million face masks in North Carolina. We at Atrium 
partnered with businesses like Bank of America, the Carolina 
Panthers, Honeywell, Lowe's, Wells Fargo, and others, including 
the health department, and I am proud to say in the past 3 
weeks along, we have already distributed nearly 500,000 masks 
with a specific focus on minority and elderly communities.
    This partnership is an example of how health professionals 
working in concert with businesses and government can help us 
open up our economy as safely as possible.
    We also have focused on another very important vulnerable 
population, our seniors and especially those in nursing homes. 
Atrium Health was one of the first in the Nation to cohort 
elderly COVID-infected patients to a single designated site for 
advanced treatment in care, with half of our patients coming 
from other nursing homes who were not part of a larger system 
like ours and therefore lacked the capacity to provide the 
support needed, including with respect to infection prevention 
resources, respiratory care therapists, and PPE.
    To date, while the national mortality rate for COVID in 
long-term facilities is nearly 40 percent, our skilled nursing 
facility has a mortality rate of 8 percent, and with regards to 
racial demographic mix, we cared for more than 35 percent of 
minority patients, with most being Latinx.
    I would also like to acknowledge and thank Senator Casey 
for his leadership in helping secure more funding through S. 
3768. Senator, that has definitely saved lives.
    Whether through virtual technology, hospital at home, 
roving mobile vans in minority communities, or through our 
skilled nursing facilities that are focused on the vulnerable 
elderly, I am especially proud that we have worked tirelessly 
to care for the most vulnerable among us during these times.
    We certainly cannot do it alone, and that is why we 
appreciate forums like this that continue to explore real 
solutions.
    On behalf of Atrium Health, thank you for the opportunity 
to share our experiences and insights regarding how to mitigate 
the impact of this pandemic and one day, hopefully soon, look 
to eradicate it.
    Thank you.
    The Chairman. Thank you very much, Mr. Woods. I will now 
call on Mr. Jones.

               STATEMENT OF RODNEY B. JONES, SR.,

             CHIEF EXECUTIVE OFFICER, EAST LIBERTY

            HEALTH CENTER, PITTSBURGH, PENNSYLVANIA

    Mr. Jones. Chairman Collins, Ranking Member, and members of 
the Committee, thank you for this opportunity to testify before 
you today. I am CEO of East Liberty Family Health Care Center, 
which is a Federally Qualified Health Center located in the 
East End of Pittsburgh, Pennsylvania. Federally Qualified 
Health Centers, or FQHCs, are also community health centers in 
which the mission is to enhance primary care services in 
underserved, urban, and rural communities. They provide 
services to all persons, regardless of the ability to pay, and 
charge for services on a community-based, board-approved, 
sliding fee scale that is based on family size and income.
    FQHCs serve as a safety net for patients who are uninsured, 
underinsured, and underserved. Health centers are staples in 
their communities. There are nearly 1,400 health centers across 
the country that approximate 120,000 service delivery sites in 
underserved communities across the country.
    East Liberty Family Health Care Center service area 
encompasses 69 ZIP codes and has a population of over 11,000 
unduplicated patients which yield approximately 40,000 visits 
annually. Of the patients we see, one-third are over the age of 
50, 1,300 are over the age of 65. Approximately 18 percent have 
no insurance, 57 percent are at or below 100 percent of poverty 
guidelines, and 86 percent are at or below 200 percent of 
poverty guidelines. Thirty-nine percent are insured through 
Medicaid, and 13 percent have Medicare. The remainder are 
insured through Managed Care.
    Seventy-seven percent of the patients we treat are part of 
a racial or ethnic minority. Sixty-six percent of the total 
population we serve are black. Ten percent are Latino or 
Hispanic.
    Our data shows that half the patients we treat who are over 
the age of 50 have hypertension. Over 800 patients we treat in 
this age group have diabetes, and nearly 650 patients are 
overweight or obese.
    Research shows that underlying health conditions, like the 
conditions I just mentioned, are more prevalent in minorities 
due to social determinants of health, which are conditions in 
which people are born, grow, live, work, and age. They include 
such factors as socioeconomic status, education, neighborhood 
and physical environment, employment, social support, and 
access to health care and housing.
    These social determinants of health are medical conditions 
they bring about are major factors contributing to the 
disproportionate number of low-income individuals and people of 
color testing positive and dying from COVID-19 along with age.
    The virus has become a flashpoint on racial inequities, 
financial inequities, and social determinants of health. COVID-
19 has exposed our health care system's vulnerabilities and 
revealed our inability to respond effectively to a pandemic. It 
has also highlighted the fact that low-income older adults and 
older adults of color have suffered in significantly greater 
proportion than their white counterparts.
    As a result of the pandemic, ELFHCC providers have seen a 
significant decrease in the patients who are receiving critical 
primary and preventative care as well as treatment for acute 
illnesses.
    In response to this concern, ELFHCC has initiated a 
comprehensive telehealth program. Since March 2020, 
approximately 85 percent of all the patients have been treated 
through telehealth. We also started performing COVID-19 testing 
in March. In addition to the testing, we use this as an 
opportunity to educate patients regarding the importance of 
having a medical home and preventative care, because of the 
ACA, ELFHCC has been able to reach an event larger population, 
including older adults of color, and deliver the care they 
need.
    As of July 2020, more than 780,000 individuals have 
coverage for health care services be cause of Medicaid 
expansion. Pennsylvania's uninsured rates fell from 10.2 
percent in 2010 to 5.5 percent in 2018, the lowest rate on 
record.
    Medicaid expansion is a lifeline for people who otherwise 
would not be able to access quality health care. It is critical 
that health centers continue to receive funding to continue to 
serve our patients.
    Thank you for recognizing the role of health centers and 
making this investment in patients through the CARES Act. 
However, a strong public health system requires a strong 
commitment of community health centers, which include long-term 
stable funding for those community health centers. Community 
health centers will be critical in recovering from COVID-19 
pandemic.
    I look forward to answering any questions from the 
Committee about how to further the goals of health equity, 
including older adults, which is a major goal for ELFHCC to 
strive to achieve each and every day.
    Thank you.
    The Chairman. Thank you, Mr. Jones.
    We will now turn to questions, and I want to explain to 
those who are watching this hearing that we have many members 
who have joined us by WebEx in addition to the members who are 
here physically, as Senator Braun, Senator Burr, and Senator 
Blumenthal. Apparently, if your name begins with ``B,'' you 
come personally to the hearing.
    We will be recognizing members to ask their questions in 
order of seniority. I will turn to alternating between the 
majority and minority.
    If a Senator is not present or logged into WebEx when it is 
his or her turn to ask questions, then that person will go to 
the end of the queue, and we will go to the next person. 
Senators will be given 5 minutes each on this first round.
    I am going to start with my questions, and my first one is 
for Dr. Mack. Dr. Mack, I mentioned in my opening statement 
that Maine has the largest racial disparity in the Nation in 
terms of COVID-19 infection. Many in our State's black 
community are immigrants from Somalia, Congo, and other African 
countries as well as from Haiti. Expanding our State to overall 
testing capacity and reaching these individuals are critically 
important to staying ahead of this virus, and it is imperative 
that those who are most at risk for contracting the coronavirus 
are able to access training.
    I know that your school of medicine has been tapped by the 
U.S. Department of Health and Human Services to start 
collecting and presenting data that will lead to best practices 
for minority populations.
    My question for you is, are you taking a look at recent 
immigrant populations, such as those in Maine, as well as 
African Americans or black Americans who have lived in this 
country their entire lives?
    Dr. Mack. Thank you, Chairman, for the question.
    Yes, we are. Likewise in Georgia, I think there was an 
article in one of the major publications earlier this week that 
the migrant population within Georgia were experiencing 
barriers to being tested and leaving the hospital. Those who 
could access care were leaving the hospital with these major 
bills, so we are suffering some of those same issues among 
vulnerable populations outside of the African American 
population. It is happening all across the country, so not only 
insurance is a barrier, education, training, and as you stated 
in your opening statement, mistrust of the system--and some of 
this mistrust lies on a historical path of issues that happen 
within these communities that have left this mistrust within 
their hearts, so we are looking at that, the importance of 
education, overcoming the stigma of vaccination. We know there 
is a lot of misinformation out there, and this has no 
boundaries with education, however, when you talk about that, 
so, yes, with all populations.
    One part of the program--and I will end with this--is to 
make sure that everything is culturally and linguistically 
appropriate for those audiences. A major part of the effort is 
to have focus groups but also community partners who have what 
we call boots on the ground ability within those populations 
and within those communities to actually work with that 
population, people who live in that population like community 
health workers who actually understand the barriers to testing, 
to care, to vaccinations, et cetera, so we are looking at a 
diverse approach to diverse communities.
    The Chairman. Thank you, and that is a great segue to my 
next question, which I am going to ask the remainder of the 
panel to respond to.
    We just heard Dr. Mack mention the importance of having 
culturally and linguistically appropriate services to reach 
people, particularly in the immigrant community, and this is 
particularly important for contact tracing.
    In Maine, the organization serving our immigrant community 
suggests that contact tracing will be most successful if it is 
accomplished in a culturally and linguistically appropriate way 
by people who are leaders of that community, and we talked with 
one such leader just last evening.
    How do we better activate, recruit, and tap into the 
expertise of these community partners who may not have 
established relationships with traditional public health 
agencies so that we can better reach and target testing and 
followup services to these at-risk communities?
    We will start with Dr. Carnethon.
    Dr. Carnethon. Thank you, Senator Collins, for this 
critical question.
    The need to engage communities is one of the 
recommendations that I highlighted in my statement, and the 
reasons for engaging communities are exactly what you 
described. It is so that when it comes time for contact 
tracing, one of our critical strategies to prevent the spread 
of COVID-19, it is so that we can use individuals from that 
community who are trusted to go around asking questions.
    As you can imagine, in the current climate, suggesting that 
someone from the Government is calling to ask questions about 
where you have been, that can create a lot of anxiety and 
concern, particularly in immigrant communities, and so that if 
we can actually find ways to build partnerships through our 
academic, between our academic institution and community 
leaders, between our health care organizations and community 
leaders, we can bridge that gap and be able to reach people in 
order to promote prevention, and reaching people in their 
language is critical. One of the most challenging features of 
this is that we have got to try to build trust in an urgent 
situation where the very individuals who are experiencing the 
worst outcomes are the most concerned about trust within the 
health care system. I think this can best be done through 
community partnerships.
    The Chairman. Thank you very much.
    My time has expired. I am going to ask the other two 
witnesses to respond in writing with their suggestions and call 
on Senator Casey.
    Senator Casey. Chairman Collins, thanks very much.
    I wanted to start with the issue of health insurance and 
health coverage. We cannot talk about the health disparities 
among seniors and communities of color without talking about 
health insurance coverage.
    We know from many sources, one of them being the 
Commonwealth Fund that indicated that, ``the ACA's coverage 
expansion,'' has led to historic reductions in health 
disparities since 2013.
    Just a couple of examples, the gap between black and white 
adults, uninsured rates dropped by 4.1 percent. The difference 
between Hispanic and white uninsured rates fell by 9.4 percent, 
and third, black adults living in States that expanded Medicaid 
report coverage rates and access to care as good as or better 
than what white adults experience.
    Unfortunately, the pandemic is wiping away some of these 
hard-won gains. With job loss that so many Americans are 
experiencing right now, millions and millions of people that 
have lost their job, we also know that has an impact on health 
care; 5.4 million Americans have lost their health insurance 
just from February to May.
    On top of that, we know the administration is not only 
opposed--or supportive, I should say, of the case in the 
Supreme Court to repeal and, I would argue, destroy the 
Affordable Care Act, but it just filed, the administration did, 
an 82-page brief indicating support for repealing the ACA.
    I think at a time like this, that is unconscionable, and I 
think there are more words that can be used to describe it.
    I have got two bills that I think speak to this. One is a 
bill that would automatically be matching dollars the Federal 
Government pays for help for States with Medicaid, and it would 
match--it would connect, I should say, those dollars to the 
States' unemployment level, so that Federal aid would be 
adjusted based upon the State's economic condition and protect 
coverage, and it has wide support.
    Mr. Jones, I will start with you, not only because you are 
a Pittsburgher, but that certainly helps.
    Can you explain, Mr. Jones, in your experience, the work 
you have done in Pittsburgh and in Ohio? Can you explain the 
role that Medicaid and the Affordable Care Act has played in 
insuring that people, including older adults of color, that 
they have the care that they need? That is question one.
    Question two is, What would be the implication for 
communities of color if these programs were in jeopardy?
    Mr. Jones. First of all, thank you for the question, 
Senator Casey.
    Medicaid is critical. Before COVID times, 20 percent of 
Pennsylvanians received coverage through Medicaid. However, 
that is not all who benefit from Medicaid. One in three 
children in our State also benefited. Two-thirds of all nursing 
home residents in Pennsylvania benefit from Medicaid, and two 
in five people with disabilities depend on Medicaid in our 
State.
    I mentioned in my testimony that at my own organization, 57 
percent of our patients are at or below 100 percent of poverty, 
and 86 percent of our patients are at or below 200 percent of 
poverty. Nearly every patient we treat, 77 percent of whom are 
people of color, is eligible for Medicaid or subsidies to the 
marketplace to help with coverage.
    Back during the recession, people lost their coverage 
through their employer. Medicaid was there to help, and that is 
the reason we have it.
    In 2008 and 2009, what we saw then is going to be 
reflecting of what we see now if things do not change. I do not 
think it should take an act of Congress to make sure that 
States that can respond to the need. I do not think that States 
should be allowed to cut Medicaid just when we need it.
    I would like to thank you for introducing legislation that 
will protect Medicaid coverage for individuals and families and 
ensure Pennsylvania by extension, community health centers like 
East Liberty Family Health Care Center continue to have 
resources to meet the need.
    As far as the Affordable Care Act is concerned, that 
expanded Medicaid has given people the opportunity to seek 
health care as a preventative measure, not just when there is 
an acute condition. People forget about the fact that an ounce 
of prevention is worth a pound of cure, and we do not focus as 
much on prevention as we should.
    The group of people that are overrepresented in this area 
are blacks and Hispanics. Expanded Medicaid also produces 
economic benefits for both the individuals and cover society as 
a whole, but what are the implications if this were to go away?
    You know, let me just say human lives matter. The 
implications are that human beings will not be able to get 
affordable health care, and from a business perspective or 
economic perspective, that is going to be a significant cost. 
There is a significant human cost and a significant financial 
cost.
    Senator Casey. Thank you.
    Thank you, Chairman Collins.
    The Chairman. Thank you.
    Senator Burr?
    Senator Burr. Thank you, Madam Chairman.
    This first question is for Gene Woods. Gene, your success 
in Charlotte is, in large part, your health system's reliance 
on the data helping in real time to direct the care provided 
both to patients and to the broader Charlotte community. What 
are some of the key metrics that provided early warning signs 
of the disproportionate impact of the pandemic on minority 
populations in Charlotte?
    Mr. Woods. Thank you, Senator, for the question, because of 
the nature of our organization, we have our own internal 
scientists and data specialists, and early on, we were trying 
to make sense of where exactly this disease was growing.
    What we have, geospatial hotspotting analytics that allowed 
us to really focus on mostly the six ZIP codes in Charlotte 
that we were finding out that had disproportionate incidence of 
COVID, and also, we realized early on that they did not have 
adequate testing, so that went to my opening statement.
    In a matter of three days when we saw that data, because it 
is about action, not just about data, we had two roving vans, 
and we went directly to those communities.
    To the earlier comment, the reason where we knew where to 
go is really working with the faith community and working with 
community leaders. We worked, engaged with the Hispanic 
community on an initiative called ``Para Tu Salud,'' for Your 
Health, and so we engaged people in the community to really 
help us with that.
    Some of the data early on was a bit noisy, and we were 
trying to get data from all kinds of sources initially and we 
realized we have to do that internally. We refined our ability 
not just to pinpoint what communities need our care, but also 
this data was important to analyze our staffing needs, our PPE 
needs, and so forth, so this analytical capability also we 
provided to the public health department here in Charlotte. One 
of the recommendations we would have is there is organizations 
like ours that have the capabilities and the expertise to do 
this by ourselves, but there are many communities throughout 
the country that do not have that, so we would encourage an 
investment in public health with respect to analytical 
capabilities. As I said, we were providing that data to public 
health versus the other way around, but it is critical to be 
able to manage this going forward, to have that type of 
capability to really respond to communities in need.
    Senator Burr. Thank you, Gene.
    My second question is to Ms. Carnethon. North Carolina has 
been reporting facility-level COVID-19 data for nursing homes 
and other congregate living facilities throughout the whole in 
coronavirus responses. What information or metrics would be 
most useful for researchers to study the impact of the outbreak 
in nursing homes and other congregate settings?
    Dr. Carnethon. Thank you for that question.
    The burden of COVID-19 in nursing homes emerged very early 
on as a significant problem that we are facing. As I described 
in my testimony, we know that nursing homes with a higher 
proportion of black and Latinx residents have higher death 
rates.
    However, there is not universal reporting of the race and 
ethnicity of those individuals within nursing homes who have 
been affected by COVID, and that presents for us a significant 
challenge when it comes to targeting resources in order to 
prevent the transmission of COVID, because when COVID-19 enters 
a nursing home, it is because somebody has brought it in, a 
care provider, a loved one, and really what it is telling us, 
that if those nursing homes are following the same safety 
procedures of restricting visitors, of ensuring that providers 
have clean PPE every time they are coming in, then we should 
not see these disparities; however, we do, and the likelihood 
that leads to disparities in rates of COVID infections within 
nursing homes are going to occur are going to be even higher in 
communities with a higher burden of COVID-19.
    What we are seeing in the nursing homes is really a 
snapshot of what is going on in a community, and so we really 
need the data coming out of the nursing homes on who, on the 
sociodemographic characteristics of who is contracting COVID in 
order for us to stop this transmission and prevent these 
disparities.
    Senator Burr. Just to clarify, have the disparity in 
congregate setting outbreaks been similar or different from 
what you are seeing in the broader population?
    Dr. Carnethon. The disparities in congregate care settings 
are quite similar to what we are seeing in the broader 
population; however, I will offer the caveat that at community-
dwelling older adults, the disparities tend to be smaller than 
they are younger ages, and the disparities that we see in 
younger ages are likely due to a higher burden of earlier onset 
cardiovascular diseases, kidney diseases, and diabetes.
    By the time we have older adults living in communities, 
those rates tend to even out a little bit more; however, the 
intensity of the disparity is still significantly higher in 
congregate care settings, two to five times higher for black 
and Latinx residents than for white congregate care residents.
    Senator Burr. Thank you.
    Thank you, Mr. Chairman.
    The Chairman. Thank you.
    Senator Blumenthal?
    Senator Blumenthal. Thank you, Chairman Collins. Thank you, 
Senator Casey, to both of you, for having this hearing on such 
a critically important topic, and it could not be more timely.
    Like many of my colleagues, over the last few weeks in 
Connecticut, I have been to a number of demonstrations, 
peaceful and passionate, and more than seventeen myself all 
across the State. I have been so inspired and impressed by the 
cries for justice not only in policing but also in housing, 
education, health care, maternal mortality, addressing the 
disparity that exists in so many areas of health care.
    In Connecticut, black and Latinx residents are more than 
three times as likely to have tested positive for COVID-19 as 
white people, and black residents are more than two and a half 
times as likely to have died from the disease as white people. 
Latinx people are more than one and a half times as likely, and 
just one last statistic, almost 60 to 70 percent of all our 
deaths from this insidious disease have occurred in nursing 
homes, so if you are older and you are black or Latinx, this 
disease has a target on your back, not one that you have 
created, but one that has results from lack of proper health 
care, housing, maybe education, and that is a kind of injustice 
that this Nation must overcome.
    I thank all of the witnesses for your testimony, and I want 
to begin by asking Dr. Carnethon. You mentioned in your 
testimony the lack of trust and rapport that must be overcome 
if vaccines are to be effective. What specifically would you 
recommend doing to overcome lack of trust and rapport?
    Dr. Carnethon. Yes. There is an historic lack of trust in 
the health care system going back to the days of the Tuskegee 
syphilis experiment, which is cited most often, and even more 
recently, there is evidence to suggest that non-white 
minorities are not receiving the same evidence-based care in 
certain settings as non-Hispanic whites, so building trust, 
what my colleagues who are working most heavily in this space--
and I believe Dr. Mack can likely speak to this as well--
building trust involves spending time with the community, 
ensuring that we are explaining the why along with the how of 
what we are doing to community members, and most of all, 
spending time to listen to members of the community so that we 
are addressing their needs as well as our own.
    What we really need to do is put ourselves in the shoes of 
community members to try to understand what those barriers are 
to wanting to engage in preventive health behaviors, to wanting 
to accept these vaccines.
    Senator Blumenthal. Thank you.
    I want to focus, Dr. Jones, on an issue that I think is 
tremendously important to our Federally Qualified Health 
Centers.
    I visited with our seventeen Federally Qualified Health 
Centers in a call on Friday, and I have visited physically 
almost all of them over the last couple of years, and I know 
how critical they are.
    In fact, you mentioned that 77 percent of the patients you 
care for are from racial or ethnic minorities. In Connecticut, 
we have 17 of those kinds of centers, and the numbers are 
almost the same. Nearly 75 percent of Connecticut community 
health center patients are from racial or ethnic minority.
    The HEROES Act was passed by the House not that long ago, 
with an additional $7.6 billion in emergency funding for 
community health centers. It is month later, but we still have 
not voted on it. It is a critical bill.
    Can you tell us how those additional resources would be 
used by your health centers and others?
    Mr. Jones. Sure. Thank you for the question.
    I hear people talking about building trust and how do we 
reach people. I am proud to represent over 1,400 FQHCs across 
120,000 sites across the country. That is who we are, and that 
is what we do. The trust is there.
    Our focus is just a safety net for the uninsured, 
underinsured, and underserved. I think that FQHCs need to be 
more involved with getting people into the community. We have 
relationships with community leaders, churches, businesses, 
etc.
    The funding should be set up in such a way that there are 
resources available, so that people can have access to care, 
there is resources available so that everyone has PPE, there is 
resources available so that people can be tested; and there is 
also resources available so that people can find medical homes 
and get preventative care, so the money that we have received 
thus far has been used to keep our staff employed so that we 
can treat this vulnerable population. Without that money, a lot 
of my peers across the country would have had to downsize, and 
the amount of care that we would have been able to deliver 
would have been significantly less.
    Senator Blumenthal. Thank you, Mr. Jones.
    Mr. Jones. One last thing, people respond to people that 
look like them, and the idea of being comfortable with people 
that look like me and understand me is significant.
    Thank you.
    Senator Blumenthal. Thank you very much.
    Thank you, Madam Chair.
    The Chairman. Thank you.
    I am uncertain whether Tim Scott has returned yet, and it 
looks like he has been a bit delayed. We will next call on Josh 
Hawley.
    Senator Hawley. Thank you. Thank you, Madam Chair, and 
thank you for holding this hearing today. I also want to thank 
the Ranking Member for his participation and help in setting 
this hearing up. Thanks to all of the witnesses here for your 
testimonies.
    Like other regions, my home State of Missouri has seen and 
continues to seen disproportionate rates of infection and death 
among our seniors and also among communities of color, and this 
is a tragic reality that merits attention by Congress and 
action by Congress, and so I want to thank again Madam 
Chairwoman and the Ranking Member for holding this hearing.
    Mr. Jones, I would just like to come back to a question 
that Senator Blumenthal was just asking you a moment ago about 
community health centers. The CARES Act provided--I believe it 
is $127 billion supplemental funding for public health and 
social services emergencies, including funding for community 
health centers.
    In April, I asked Secretary Azar at HHS to prioritize 
funding for community health centers in my home State of 
Missouri, and I did this after speaking with representatives of 
the health care community, pastors, and others who emphasized 
to me the vitally important role that community health centers 
can play in meeting the needs of underserved communities that 
are being disproportionately affected by this virus.
    I just wanted to give you the opportunity to expand on the 
line of answers that you started with Senator Blumenthal a 
moment ago. Could you just tell us more about why community 
health centers play such a important role and what they can do 
in helping to address some of the needs that we are seeing 
here, some of the unique needs faced by older Americans and 
historically underserved communities?
    Go ahead.
    Mr. Jones. Thank you for the question.
    It centers around social determinants of health. We have 
been plagued as a race, as human beings, with this overall 
arching concept, and what it simply means is that people are at 
a disadvantage based on housing, education, where they live, 
the environment by which they matriculate.
    The way the funding has helped is the fact that we have 
been able to reduce the barriers by which people can seek 
health care. Most of the health care centers across the country 
run about a 30 to 40 percent no-show, meaning that people are 
scheduled for appointment. They do not call. They do not count. 
They just do not show. More often than not, it is because of 
things they cannot control, also, the other issue that people 
need to think about, people are focusing on living, no life. 
Health care is important, but it is not important if you do not 
have a way to put a roof over your head or to feed your family.
    The thing that has been really important for FQHCs is that 
we have moved from a culture or process of seeing people in our 
health centers to telehealth. Telehealth has been significant 
in this way that we are trying to address the disparities and 
primary health care. We are now able to see people in their own 
homes, able to remove the barriers that have been in place that 
would stop them from seeking health care, so the funding not 
only provides ways to break down the barriers associated with 
social determinants of health, but it allows us to provide 
health care in an environment by which we were not able to do 
before. It also gives us the funding to get into our mobile 
vans and get out into the community and provide the care that 
we need.
    As I said before, let us not forget the fact that this 
pandemic has--and I say this in my testimony. It is a 
flashpoint on the health inequities and also the inequities of 
our overall health care system, that there needs to be a way 
that everyone has access to care, and again, the funding will 
allow us to broaden our scope and to deepen our resources to 
provide the care for people that need it.
    Senator Hawley. Thank you very much for that.
    Let me pick up on the telehealth points that you mentioned 
just now and that you also mentioned in your written testimony 
and about how vital that can be, telehealth can be, to 
expanding health care access during the pandemic, this 
pandemic, and in general.
    Of course, one of the things we know, however, is that many 
elderly, low-income, communities of color, rural communities 
have significant barriers to accessing telehealth, and this is 
certainly true in my own State where we have a very significant 
rural population and where all of those things are true.
    Tell me a little bit about how you have addressed concerns 
related to technology access and what more you think we can do 
to improve that so we can improve this vital tool.
    Mr. Jones. Sure. Back when I was a young child, I used to 
laugh because our doctor used to carry a little black bag and 
actually walk up and down our street and see people in their 
homes.
    We have a division in our organization called Homebound 
Outreach. Our Homebound Outreach, we have nurses that we send 
into the community, and they see people who for whatever reason 
cannot come into our health center, and also they are the eyes 
and ears of our providers, so one of the things we have done to 
those people that do not have the technology, we send the nurse 
into the home, and we use the technology of our laptops to 
communicate with our providers in the office.
    I know at our particular health center and I know my peers 
in western Pennsylvania, we have applied for funding so we can 
get technology into the home of the aged and the feeble, so 
they have the opportunity to turn on a computer to be able to 
see what is going on. That is only half the battle because the 
technology is still a challenge, so there needs to be staffing. 
There needs to be community Ambassadors. They do not have to be 
medical people. They have the ability to get into the community 
and get into the homes with people that need care. It could be 
a very inexpensive proposition. They are not the highest-paid 
people, and they can be the ears and eyes of providers to 
provide timely care, which again we are doing that on a small 
scale at our health center. We plan to expand that as we 
continue to identify the needs.
    Senator Hawley. Well, thank you very much, Mr. Jones. 
Thanks for the tremendous work you are doing. Thanks to the 
other witnesses for being here, and I will have a few questions 
for you in the record.
    Thank you, Madam Chair.
    The Chairman. Thank you.
    Senator Warren?
    Senator Warren. Thank you very much, Madam Chair, and t 
hank you very much for putting together this hearing. Seniors 
are bearing the brunt of the COVID-19 pandemic. People over 65 
account for just 18 percent of coronavirus infections, but they 
make up 80 percent of the deaths.
    Nursing homes, where 1.3 million seniors live, have emerged 
as hotspots of infection, and systemic racism has put seniors 
of color at even greater risk of catching and dying from COVID-
19. We are nowhere near controlling this pandemic.
    Public health officials are reporting tens of thousands of 
new cases and hundreds of deaths every day. Congress must act 
fast, really fast, to protect our seniors and contain this 
virus. We need to ramp up testing. We need to create a national 
contact tracing program. We need to stabilize our supply chain, 
and we need better data to ensure that communities of color are 
getting the COVID-19 resources that they need.
    Let me start with you, Mr. Woods. In your testimony, you 
talk about how Atrium Health developed a COVID-19 dashboard to 
track cases and deaths in real time. All of this data was 
stratified by race and ethnicity as well as additional factors 
like geography, so, Mr. Woods, what did the data reveal about 
how communities of color were experiencing the COVID-19 
pandemic?
    Mr. Woods. Thank you for the question, Senator, and for 
your leadership in this regard.
    I think, quickly, we realize--and some of what the 
testimony of some of the other panelists is those social 
determinants of health have--the cracks have been laid bare. 
The issues of lack of access to food, lack of access to health 
care, all of those in these communities, we found that they 
were magnified during this COVID pandemic, so I think what we 
are realizing is that it is years of lack of investment in core 
communities, the things we have talked about, affordable 
housing. We have invested $10 million in affordable housing 
before this pandemic because we knew if you do not have a warm 
place and a warm home, you are not going to be healthy.
    We have fed about 10,000 kids through our Kids Eat Free 
program because we realize that if you do not have food, you 
cannot be healthy, so I think it has just magnified the social 
and economic and health care disparities that we have known for 
a long time, and we have been fortunate to have been part of a 
coalition to help address that straight on.
    Senator Warren. I really do appreciate your work in this, 
and what I am hearing you say is the demographic data you 
collected showed that communities of color face barriers and 
accessing COVID-19 resources and then the responses, so let me 
just followup with this, though, Mr. Woods. It is one thing to 
detect disparities, but it is another to actually tackle them. 
Did the data allow you to actually reduce racial inequity in 
your coronavirus response?
    Mr. Woods. We did, and as I mentioned in my testimony, 
because we have the unique ability to run our own internal 
COVID tests, we were able to launch very quickly when we saw 
this data and the six different ZIP codes in Charlotte area. We 
were able to work with the churches, work with Hispanic 
community, and we said rather than you come to us, we have nine 
fixed testing sites. Let us go to you, but we do not want to 
assume we know where to go, so please tell us where it is, so 
we were in church parking lots. We were at YMCA parking lots, 
and we also--it was mentioned earlier. The one thing I want to 
focus on as much as anything, we have invested this past year, 
$7 million just on interpretive and language services. We know 
that, for example, that is a really important part of reaching 
this community, so it is not just taking the data, going to 
where the communities or needs are, but really making sure we 
had the language to be able to speak to people on their terms.
    Senator Warren. Right, so in other words, by collecting 
detailed demographic data, you could develop a targeted data-
driven response to COVID-19 and send resources where they were 
most needed and send the appropriate kind of resources to those 
places, so from the outset of this pandemic, the Trump 
administration should have collected demographic data to guide 
its COVID-19 response, but it did not, so instead, my 
colleagues and I have spent months pushing HHS to publicly 
report race and ethnicity data, and in the end, we had to force 
HHS to issue a report on COVID-19 racial disparities.
    Still, only 55 percent of cases reported to CDC to date 
include information on race and ethnicity, so let me ask it a 
different way, Mr. Woods. Without up-to-date, comprehensive 
demographic data about COVID-19, do you believe that the 
Federal Government will be able to craft a pandemic response 
that provides communities of color with the resources that they 
need?
    Mr. Woods. What I can do is speak from our experience. 
Without the data that we had to respond to this community in 
real time--our data is updated actually every 2 hours. We know 
exactly where the disparities are, where the incidents of 
COVID. We have a map that I look at every single day in terms 
of how it is spreading, so from our experience, without that 
data, without that real-time data, it is really difficult to 
contain and ultimately eliminate the COVID.
    Senator Warren. That is really important, so it is part of 
the reason why I am still fighting for comprehensive 
coronavirus data.
    Just last week, Ranking Member Casey and I asked HHS to 
report demographic data on residents and workers in nursing 
homes to better track COVID-19 infections and better track 
deaths among seniors. We need to put the public health impacts 
of systemic racism at the very heart of the CDC's work--and I 
am working on legislation to do this--in this pandemic and 
beyond.
    If the Trump administration does not start taking this 
virus seriously, tens of thousands more Americans will die, and 
a disproportionate number of those seniors will be people of 
color. That outcome is unacceptable. Congress must act.
    Thank you, Madam Chair.
    The Chairman. Thank you.
    Senator Braun?
    Senator Braun. Thank you, Madam Chair.
    This is just another topic regarding health care. I have 
spent so much time on the issue prior to becoming a Senator, 
and social determinants, underlying issues with chronic 
conditions as well as how minorities are being treated through 
an epidemic like this, to me, still begs the question of what 
is wrong with our health care system before we got to this 
junction.
    In my opinion--I am going to ask the question of Mr. Woods 
and Mr. Jones. Our issue with health care when it comes to 
access, to covering preexisting conditions, no caps on 
coverage, all the things, 80 Senators weighed in prior to COVID 
coming along are still there, and to me, the number one issue--
it has been referred to as the ``tapeworm on our economy''--is 
the high cost of health care. Eighteen to 19 percent of our GDP 
here in this country and, of course, nearly half that in 20 to 
25 other countries with results that are as good as ours, so, 
to me, in my own business in trying to tackle this 12 years 
ago, until I engaged the individual in his or her own well-
being and tried to provide transparency, so you could see what 
things cost, whatever we decide to do here, whatever we can 
accomplish through the Federal Government to maybe look at 
disparities, we still get back to the same old system. It is 
dysfunctional. It is run increasingly by large corporations 
that have no interest in fixing the system.
    I want to ask you this. Transparency. President Trump, by 
the way, has been the most aggressive individual in trying to 
reform certain dysfunctional parts of our health care system. 
Every time it occurs, it lands up in the courts because the 
industry takes him to court.
    We here as Senators, I think, tiptoe around the industry 
too often.
    What about basic reforms to actually not only address 
issues like we are talking about here, like transparency? What 
value would transparency give us?
    The hospitals recently took the President to Court on a 
directive to where he wanted to make the charge masters 
transparent. Now I think it has been overturned by a judge. 
Thank goodness, we are making headway.
    The question is directed to Mr. Woods. Do you believe 
transparency would be the tool to not only fixing health care 
in general, but also to help us better navigate through a 
disaster like a microorganism that is confronting us now?
    Mr. Woods. Thank you, Senator, for the question.
    I think transparency is certainly one of the solutions, and 
we are like other health systems that have provided charges 
online, so I think that is one avenue, but I think, 
fundamentally, the issues that we deal with, at least in our 
communities as a safety net provider, go back to some of the 
things that were alluded to earlier. We are the safety net 
provide for the entire State of North Carolina. We see more 
Medicaid, more compensated than anyone else in the State, and 
so I think we still--there is a lot of opportunities to 
continue to fix health care and through the health system lens.
    We have got to come together to deal with some of these, 
which was referred to earlier, some of the social determinants 
of health that really are being magnified in this crisis. The 
lack of affordable housing, that is fundamental to dealing with 
the health care cost and crisis in this community, because 
ultimately, these patients are showing up in our facilities, so 
I think it is a multifactorial equation that we have to solve. 
Transparency is certainly part of it, but there is a lot of 
other pieces, I think, that needs to be addressed and the one 
thing that I would just suggest is that these things can only 
be addressed through private-public partnerships, such as the 
one that I just mentioned earlier; for example, for masking, 
where we have big business and also health systems working 
together and I think working together with the health 
department, so I think it is a complex equation. The President 
said health care is complicated. I certainly agree with him. 
Transparency is one of many ways to help address those.
    Senator Braun. Imagine the dividend we would get from 
saving that we could invest in some of the other things you 
were talking about.
    Mr. Jones, would you briefly comment on it as well? My time 
is about up, but please tell me what you think.
    Mr. Jones. Sure. Transparency is only part of it.
    It is under the broad umbrella of socioeconomic status. As 
I mentioned before, this pandemic has served as a flashpoint, 
but the bigger picture is we have to get fundamentally into the 
situation of why is there disparity. It all has to do with 
education, neighborhood, housing, social supports, access to 
health care.
    The broader picture is we need to take care of this 
pandemic. It needs to be a Federal global approach, but once we 
get on the other side of this, we need to peel it all the way 
back and get to the root of what the issues are and, again, it 
is about people not having equity and equality in accessing 
jobs, education, and health care.
    Senator Braun. Thank you so much.
    The Chairman. Thank you, Senator.
    Senator Jones?
    Senator Jones. Thank you, Madam Chairman, and thank you, 
Ranking Member Casey, for holding this really important 
hearing. This is especially, I think, significant in all of our 
States, but I have been acutely aware of the problems in 
Alabama.
    You know, Mr. Woods, I would like to kind of followup with 
you initially about some--Senator Casey made some comments 
about Medicaid.
    You practice. You have got hospitals, I think, in both 
North Carolina and Georgia, and like Alabama, those States did 
not expand Medicaid. You are one of the largest providers of 
Medicaid services.
    Every study that I have seen has indicated that health 
outcomes are raised in States that have expanded Medicaid, but 
yet we still seem to have a great deal of political pushback on 
Medicaid expansion, not only in our States, but also in the 
Congress. We have got billions of Federal dollars that we are 
putting into every State right now that deal with this 
pandemic, and it only makes sense to me that we try to do that 
in a way to give States the incentives to expand Medicaid.
    We have made a lot of strides. The Commonwealth Foundation 
indicated that black working-age adults across the country have 
greatly benefited from Medicaid expansion, and there is a huge 
proportion of those folks that reside in our State, so I would 
like to ask you about Medicaid expansion and the benefit that 
the population that you serve, how it would benefit, how it 
would improve your hospitals if we can go forward and try to 
get something in this next package to give States the 
incentives to expand Medicaid.
    Mr. Woods. Thank you for the question, Senator Jones.
    One real live example of what we are seeing, especially 
during this COVID, is one out of five Americans have behavioral 
health issues, dealing with mental health issues, and we are 
seeing our outreach, especially right now with behavioral 
health, has magnified significantly.
    One of the things that Medicaid expansion would do is 
provide additional funding for care of mentally ill patients. I 
think that is just one example that were we to have that 
coverage now, we would be able to expand our efforts 
significantly.
    The other thing I would just say, as a safety net provider, 
as I alluded to earlier, if you look at we never turn anyone 
away, irrespective of ability to pay, right now we probably 
cover about 2 cents for every dollar of cost that we have for 
someone who is uninsured. Medicaid expansion would probably 
increase that to about 11 or 12 cents, and what do we do with 
those additional funding as we continue to reinvest in the 
community through skilled nursing facilities, through outreach 
to minority communities, etc.
    It is important, I think, to continue to explore Medicaid 
expansion in States like ours because I think it will help the 
community be healthy.
    Senator Jones. Great. Well, thank you very much. I 
completely agree with you about the mental health aspect of 
this. I think folks often forget as we focus so much on this 
virus right now that I think a lot of the mental health 
outcomes or mental health issues are going to be with us for a 
long time based on this virus.
    Dr. Mack, let me ask you a little bit about Morehouse. 
Since coming to the Senate, I have been a pretty strong 
advocate for additional funds for HBCUs. We got additional 
funds for the first 2 years, and then we were able to get some 
permanent funding.
    In the CARES package, we had a billion dollars that went to 
HBCUs, and recently, I have joined a letter with my colleagues, 
Senator Harris and Senator Booker, to try to encourage an 
additional $6.5 billion to HBCUs and particularly graduate 
institutions like yours.
    If we could get only a portion of that, how would that 
benefit colleges like Morehouse? How would you use additional 
funds in the middle of this pandemic to help us get out, and 
how would it benefit the college and the communities that you 
serve?
    Dr. Mack. Thank you, sir.
    As I stated earlier, we are on the front lines with these 
communities not only from the experience aspect, but what we 
are doing today with the testing, also with the treatment, and 
also with the push to give vaccinations. If we would have that 
additional funding, it could help us educate and train 
providers and MDs who actually work within the underserved 
communities.
    At Morehouse School of Medicine, almost 50 percent of our 
graduates actually work in the State of Georgia. The State of 
Georgia is mostly a rural place, so our graduates actually go 
into these underserved communities of multi-cultures and 
actually work in those communities.
    I think it would benefit from a training perspective, 
benefits when it comes to scholarships, to provide training for 
the students, but also the care that we provide on the 
frontline.
    As you stated, quickly, I would like to say about the 
insurance around COVID today. The lines are longer in those 
communities that are uninsured or underinsured, and also the 
testing sites happen not to be in those underserved 
communities, so it is really affecting us today when it comes 
to access to care, so it could help us in many ways.
    Senator Jones. Great. Well, thank you all for being here 
with us today. Thank you for the work you are doing in all of 
this.
    Thank you, Madam Chair, for this hearing, the important 
hearing today. Thank you.
    The Chairman. Thank you.
    Senator Tim Scott?
    Senator Tim Scott. Good morning, Chairwoman, and thank you 
for all your hard work and dedication on so many of these 
issues that are important to the Nation. Frankly, you have been 
the leading voice in our Congress and, I mean, either the House 
or the Senate, so in our Congress for issues around disparity 
and around taking care of people who simply need help. You have 
been the type of chair who looks only at Americans, not at 
parties, not at color, but at people in need, so thank you for 
being that kind of chairman, and I really appreciate your 
leadership.
    Let me just say this. As we have looked at the numbers in 
South Carolina, 27 percent of the population happens to be 
black. About 43 percent of the fatalities are African American. 
Thirty-two percent of the diagnoses are. Those numbers were 
alarming to me initially, and as I looked around the country, I 
found that 14 percent of Michiganders are African American, but 
41 percent of the mortality were black.
    I started realizing that there seems to be a racial impact, 
and I asked HHS to step up and start giving us more information 
broken down by racial categories, and they did that. I asked my 
Governor to do the same thing, and he did that, so we were able 
to then start targeting more of our energy and our focus on 
these health care outcomes and disparities, number one. Number 
two, as I spoke with NIH, Dr. Collins started talking about the 
importance of programs like the RADx, so we could put more 
resources, more testing in communities.
    Frankly, I pushed my Governor and our health care apparatus 
in South Carolina. I am so thankful that they responded so 
constructively and positively. We have had pop-up sites for 
testing at churches and at schools in minority communities. 
These are really important.
    One of the things that I see as headwinds is that even with 
all of the new ground that we are making up--and there is a 
whole lot of ground to make up--that when you look at the 
confidence within our communities, particularly the communities 
of color, as it relates to taking a vaccine, 25 percent of 
African Americans say they are willing to take the vaccine, 37 
percent of Hispanics.
    To the panel, what can we do to increase those numbers?
    Mr. Jones. I would like to take a stab at that, Senator.
    Senator Tim Scott. Thank you, Mr. Jones.
    Mr. Jones. Again, the issue has to do with trust, and you 
do not start trust during a pandemic. The trust starts way 
before then, and I needs to give a shout out to FQHCs. That is 
who we are; that is what we do. We are in the communities. 
People trust us. People come see us. They are treated with 
dignity and respect. It does not matter if they have insurance 
or they do not have insurance, so the way we can do that is 
identify agencies, organizations, and churches that people 
trust. Once you get the trust, then you can start the 
conversation of convincing people the value of getting the 
things that they need to have.
    Senator Tim Scott. Thank you, Mr. Jones.
    Dr. Carnethon. I would like to follow with that. This is 
Dr. Carnethon.
    We right now are working through a cross-NIH initiative led 
by NHLDI as well as NIMHD, minority health and health 
disparities, because we understand. Certainly, as Dr. Jones has 
stated, it would have been ideal to start sooner; however, we 
have to start now and we have to get out there. We have got to 
build these bridges, and I think what is going to be critical 
is to communicate the urgency and also to really empower 
community members to understand that they have to be the ones 
to step up to help us stop the impact that we are having on 
minority communities, so what I would really like to do with 
our messaging is really promote this partnership that we have 
to step up in order to help ourselves.
    Senator Tim Scott. Let me just make this comment before I 
hear from other panelists.
    On the Paycheck Protection Program, one of the things that 
I saw as a small business owner or at least a previous small 
business owner was the importance of having a marketing 
mechanism in place, so I went to the Minority Business 
Development Agency, the MBDA, and said, ``I am going to put $10 
million in the MBDA so that we have the type of marketing that 
reaches specifically into communities of color and targets the 
outcomes that we are looking for,'' which is higher utilization 
of the PPP.
    What I hear, I would say that I hear the need for something 
similar, and if that is true, where is that similar 
organization? Certainly the churches. I know the HBCUs. I have 
worked with them, and frankly, our office led the charge to get 
more resources for the HBCU in the CARES Act, and frankly, 
according to the UNCF, we have record-breaking dollars coming 
in during the last 3 years, so how do we find those one or two 
organizations that penetrate so deeply that we can have that 
kind of focus?
    Mr. Woods. Senator, this is Gene Woods.
    One thing, I think we just got to recognize that part of 
the issue is after 3 million cases of COVID and 140,000 deaths, 
we still have a fundamental--just a general in the country--50 
percent of people still do not want to get vaccinated.
    If you look at even during flu season, last flu season, we 
had 40 percent of the population that said, ``We are not going 
to get a flu shot.''
    I think the messaging has to occur on multiple levels. 
There should be a national strategy right now, a PR campaign, 
as you mentioned, that touts the benefits of vaccination. I 
think that is layer one, and then with respect to your 
suggestion, what we have done here and in the communities we 
serve is we have partnered with media outlets that specifically 
focus on minority communities. I think there could be a 
national strategy, but there has to be a local strategy as well 
because different outlets have different insights into the 
particular community. I think it has got to be a multi-
factorial type of campaign, but that begins that vaccinations 
are important as part of containing COVID but also influenza.
    Senator Tim Scott. I would love to talk to you after this 
is over if you have time, 1 day this week. I would love to 
continue this conversation.
    Mr. Woods. Absolutely.
    Senator Tim Scott. Yes, sir.
    Dr. Mack. Senator, if I could say one thing quickly. I 
think we have to stop funding the usual suspects all the time. 
We have to look for new organizations that have deep tentacles 
within the community, and that is the initiative we are doing 
now.
    There are organizations that the community respects as 
leaders. I think we have to partner with those organizations, 
as we have said earlier, and make sure some of the resources 
empower those organizations to do the work and be the lead for 
that work within the community.
    Senator Tim Scott. Thank you, sir.
    I look forward to reaching out to some of the panelists, if 
you all are interested in engaging in this conversation further 
when we are not limited to 5 minutes of questions and answers. 
I read through your backgrounds, and frankly, an incredibly 
impressive group of folks who are dedicating a lot of your life 
to making a difference. I would love to just partner with those 
who may be interested in doing so.
    Thank you.
    The Chairman. Thank you very much, Senator Scott.
    Senator Rosen?
    Senator Rosen. Well, good morning, everyone. Thank you, 
Senator Collins, Ranking Member Casey, for holding this 
important hearing, and of course, like Senator Scott said, for 
the impressive group of panelists. You have spent so much of 
you life and efforts on health care in so many areas and 
particularly this one.
    I want to address the racial health disparities and how we 
can work through education, training, and resources to make 
things better, because racial and ethnic health disparities, 
they persist because of longstanding inequities and working, 
living, health, and social conditions.
    You see the manifestations of such disparities everywhere. 
For example, during COVID-19, data from my home State, the 
Southern Nevada House District, shows that Latinos are dying at 
a higher rate than any other group in the region. In Northern 
Nevada, the Latino population has the highest number of COVID-
19 patients in Washoe County, even though the Latinos only make 
up a quarter of the county's total population, so, of course, 
we know too often, inadequate access to care, underlying 
biases, both ethnic and racial minorities, and especially 
seniors of color at greater risk of complications due to COVID-
19 and other diseases as well, so research also suggests that 
provider actions could be influenced by implicit biases, which 
impact the delivery of over all medical care, sometimes without 
medical providers even realizing it.
    I am glad to see that the University of Nevada Reno's 
Sanford Center for Aging is taking the steps to combat the 
impact of implicit racial bias by requiring staff to attend 
trainings on the subject. The Sanford Center is also taking 
steps to review all of its internal policies and the 
gerontology academic program curriculum overall to ensure that 
they include economic, social, and policy content that address 
the impact of racial disparities.
    To Dr. Mack and Dr. Carnethon, as both researchers and 
educators, how can we best train our medical students and, in 
fact, all of our medical professionals to identify and 
understand their own implicit biases, so that they can 
recognize how this contributes to their decisionmaking and 
delivery of care? What types of practices do you think are 
worth us investing in to make the most success?
    Let us start with Dr. Mack, and then we can go to Dr. 
Carnethon, please.
    Dr. Mack. Thank you.
    Well, when we consider the practicing, we have always 
focused on the importance of primary care and the behavioral 
health component that it actually highlights within primary 
care, and that is what we are talking about.
    There is a larger aspect to the training which should 
provide the sensitivity of the student to the total patient and 
the health care of the patient. We realize that only 20 to 25 
percent is contributing to health care, so it is very important 
that we take in consideration those socioeconomic determinants, 
and that includes the bias of physicians, the bias of the 
health system when it comes to treating patients, so that has 
to be put into the curriculum. It has to be expressed and to 
train, whether it is in the ambulatory setting or it is in the 
hospital, and some of that training means we have to train the 
trainers. Educators have to be aware of the biases, and while 
there, the student that is shadowing them, they have to also 
make sure that they are addressing that.
    I think we have to make sure it is in the curriculum, it is 
taught on the wards, but also that the academicians, including 
myself, professors and associates, etc, are aware and are 
properly trained to train the students properly to be aware of 
those biases.
    Senator Rosen. Thank you.
    Dr. Carnethon?
    Dr. Carnethon. Thank you for this opportunity. These are 
discussions that we are actively having right now at our 
medical school about how best to incorporate these critical 
skills and the ways in which we teach our clinicians to treat 
patients and how to interact with them.
    My experience in the educational field suggests that 
experiential learning is one way to really cement the lessons 
that are out there. I think that the ability for medical 
students and training to actually hear directly from patients, 
the ability to hold panels or even invite community members to 
share their experiences, providing recordings so that health 
care providers can hear the very subtle languages, language 
that they may use that does seem to imply that the problem lies 
with the patient.
    Consider the example of managing somebody with diabetes to 
say, ``You need to eat more fresh fruits and vegetables.'' To 
hear directly from a community member about how difficult it is 
for them to access those fresh fruits and vegetables in the 
neighborhoods where they live may help to guide the ways in 
which they hold conversations with patients, so I think this 
content, it should be required, and I think experiential 
learning is an excellent technique in order to train medical 
providers on how to best pay attention to these factors.
    Senator Rosen. Well, thank you. I appreciate that. I do 
agree. The way that we listen and respond and the way that we 
offer advice, all of us can learn from those kinds of 
conversations. I appreciate that.
    Thank you, Senator Collins.
    The Chairman. Thank you.
    Senator Rick Scott?
    Senator Rick Scott. Well, first, I want to thank Senator 
Collins and Ranking Member Casey for holding the hearing. I 
want to thank all the witnesses for being here today.
    This is an unprecedented time in our country. One of my 
concerns has been all along that we do not have enough testing, 
and I have also heard that health insurers are limiting or 
denying coronavirus testing coverage for some of their 
enrollees, which that is clearly unacceptable and dangerous.
    I introduced a bill, the Affordable Coronavirus Testing 
Act, that will make sure every American could have access 
because I think it is going to be hard to get back to a normal 
life if we cannot make sure everybody can get a test that feels 
that need to get a test, and I hope we can get something like 
that done to make sure that happens.
    Mr. Jones, can you talk about how the business of our 
Federally Qualified Health Centers have changed since the 
coronavirus started back in, really, I guess February, but 
early March?
    Mr. Jones. Absolutely. In a word, we went from seeing 
people in our health center to doing telehealth. In my own 
health center, we were seeing, starting in the middle of March, 
about 85 percent of the people we saw was through telehealth, 
and as I mentioned in my statement, it was because we knew the 
practice of social distancing need to protect our patients, 
need to protect our staff, so the best way for us to do that 
was doing it remotely.
    The other way out of this change that we have included in 
our scope of practice testing every day. In addition to 
treating patients the way we normally do--and incidentally, 
when a patient--when a lot of patients come to our health 
center, oftentimes they are coming way beyond the acute stage. 
It is not unusual for a typical patient to have three to five 
comorbidities. They come into the health center for high blood 
pressure, and you find other things.
    That being said, in addition to doing that, we are doing 
our testing, and we are trying to make sure that we get the 
testing back in a reasonable amount of time, so that when you 
start looking at contact tracing, you can figure something out, 
so our whole model has changed significantly. Even though our 
staffs are working, a lot are working remotely because it is 
changed significantly, so we have gone into a space that we are 
not comfortable with, but we have adapted very quickly, and 
amidst to all of this, we have people that are afraid to come 
out of the house. We have people that are afraid to actually 
get tested and people that are still trying to wonder how do I 
get back to normalcy.
    Senator Rick Scott. Have your overall volumes gone down or 
gone up?
    Mr. Jones. They have gone down. There are more in my 
presentation I had to take out because of 5 minutes, but we 
have gone down by approximately 33 percent on the medical side. 
The dental side is nonexistent, because of all of the CDC 
guidelines our dental team is helping doing the testing. They 
are not really seeing patients because it is really unsafe. 
They are only doing emergent cases and a little bit of denture, 
so our volume has gone significantly.
    The PPP has enabled us to keep going and not lose the level 
of care that we have had, so without that funding, we would 
have had a very difficult time having a viable organization to 
address this problem.
    Senator Rick Scott. How are you doing on getting your 
protective gear?
    Mr. Jones. We are fortunate in the western part of the 
State. We partner with various vendors. We collaborate as FQHCs 
in the western part, so we have not had a lot of difficulty 
getting PPEs and really have not had a lot of difficulty 
getting the testing.
    Our difficulty has come in getting the test results. In 
some situations, it has taken 7 to 10 days, so we are working 
feverishly trying to find tests. If we can get the results a 
lot quicker, then we can actually communicate that to people so 
that they will know what to do in order to protect themselves.
    Senator Rick Scott. So you have not had access to any of 
the rapid tests that may not----
    Mr. Jones. It is interesting. I just received an email this 
morning from my supply department saying, ``we are going to be 
getting those tests in like the next week,'' so prior or that, 
we did not have them available to us, no.
    Senator Rick Scott. All right. Well, thank you for what you 
do. In Florida, we have a lot of great Federally Qualified 
Health Centers in Florida, and I know they are a safety net for 
a lot of communities, so thank you for what you do.
    Mr. Woods, can you talk about how you are doing with regard 
to getting protective equipment and gear and how you are doing 
with regard to testing at your facilities?
    Mr. Woods. Thank you for the question, Senator.
    You know, back in March because we were looking at peak, we 
had canceled all of our electives. We actually did it before 
there was any requirement to do so, so, actually, we took that 
time to really reinforce our PPE.
    For the most part, we are in a much better situation than 
obviously we were several months ago. With isolated challenges, 
we have a predominantly female workforce. We need more small 
N95 masks, so that is something. There are some supply items we 
have months of supply for, but that is something that on a 
weekly basis, we make sure that we focus on.
    On testing, I shared earlier we do have our special lab 
equipment, so we can run our own tests. We could probably do 
four times the amount of tests and have close to the same-day 
turnaround. The challenge is reagents, and so some of the--and 
still, in some respects, swabs, so I think we really need to 
continue to beef up the supplies of reagents so that we can 
expedite the testing. That would be our request.
    The other thing--and there has been some conversation on 
testing about a national registry and how that testing and 
those reagents are distributed to hotspots, so I think that is 
something that we are having some conversation, about 
opportunities to do that as well.
    Senator Rick Scott. Hopefully, this will pass, right? What 
will you do differently from the standpoint of making sure you 
have whether it is the issues you are dealing with now, the 
protective equipment, the reagents, the swabs? What are you 
going to do differently in the future to make sure you do not 
have the same problem again?
    Mr. Woods. Yes. Well, we certainly have significantly 
expanded our sources of supplies. A lot of times, you are 
buying in bulk to get savings. Organizations like ours, you do 
that and you get a lot of savings, but we realized that we need 
to have a good diversified supply line, so we have vendors that 
we might have never had before, before COVID, and obviously our 
par levels are where might have been several months now, in 
some respects, extended to a year or beyond, so we have 
invested probably about $45 million or so just to make sure we 
have stockpiles of PPE, because this thing could be with us for 
a while, so those are some of the things that we have been 
focused on.
    Senator Rick Scott. Is your elective surgery coming back?
    Mr. Woods. It is. Probably right now, it is about 85 
percent on some of the elective surgeries. Our inpatient 
surgeries are pretty much pre-COVID levels.
    Where we are seeing some challenges mostly is on the 
emergency room, probably about 70 percent. That concerns us 
because a lot of people that are in their homes, there is a lot 
of studies, as you know, that people are having heart attacks 
at home, and they are afraid of coming into the emergency room. 
We are really focused on our own campaign. We call it our 
COVID-Safe Campaign. We are sharing with the community exactly 
what we are doing to keep people safe.
    The other thing we have, we are doing rapid cycle surveys 
of patients, and so when they come in, so far 95 percent of 
patients have said they felt safe when they come in and for the 
5 percent that have questions, what we do is we take that data 
and rapid cycle improvements to make sure that people feel more 
comfortable, but right now, we are seeing it coming back. Now, 
we will see what happens in the fall when influenza comes, how 
the trends continue then, but right now our focus, our main 
concern is emergency room
    Senator Rick Scott. Well, thank you, each of you, for being 
here, and thank you for what you are doing to take care of 
patients.
    Thank you, Chairman Collins, for putting this together.
    The Chairman. Thank you.
    Senator McSally?
    Senator McSally. Thank you, Chairwoman Collins. Thanks to 
all of you for your expertise during this very unprecedented 
time.
    I first want to echo I am a cosponsor of Rick Scott's bill 
that is focused on testing and ensuring that people can get 
free testing during this once-in-a-century pandemic, and 
insurance companies are not denying that to people where there 
is a financial burden. Hopefully, that is something that 
everybody can agree upon, and we need to get that passed. We 
should just not have finances be a barrier for people getting 
tested.
    I want to talk about the impact of the coronavirus on 
Native American communities. As you have all mentioned, 
underlying health conditions such as diabetes, we know is one 
of the strongest risk factors for COVID-19.
    We also know diabetes is far more prevalent in minority 
communities, and we have 22 Native American Tribes in Arizona. 
They have a greater chance of having type 2 diabetes than any 
other population.
    In fact, in Arizona, the Gila River Indian Community has 
the highest rate of type 2 diabetes in the world, so we have 
established, Congress has established the Special Diabetes 
Program for Indians, the SDPI, in 1997 to provide funds for 
diabetes prevention and treatment services. Through the SDPI 
grant programs, Tribal communities have been able to develop 
much needed diabetes programs and increase access to quality 
diabetic care.
    While this is very popular and effective, it suffered from 
short-term reauthorizations and stagnant funding, which is why 
I introduced legislation along with my colleague from Arizona, 
Senator Sinema, to reauthorize the Special Diabetes Program for 
Indians for an additional 5 years and increase the funding to 
$200 million per year.
    Dr. Carnethon, in the midst of a pandemic where there is a 
multitude of, obviously, health care funding priorities, can 
you talk about the importance of maintaining focus and 
treatment for underlying conditions like diabetes and the 
importance of programs like the SDPI?
    Dr. Carnethon. Absolutely. Thank you so much for bringing 
up this important point.
    Pre-COVID, I spent most of my time on diabetes, 
cardiovascular disease, and lung disease, and these conditions 
are not going away and are the conditions that are leading to 
these adverse health outcomes from COVID-19 exposures.
    One thing that is not going to happen is that COVID is not 
going to magically go away. We are going to be living with 
COVID for a long period of time, and there is no indication 
that the underlying health conditions are going to become less 
problematic for people who are exposed to COVID.
    Using that rationale, we need to continue to support 
research that prevents the development of chronic diseases such 
as diabetes, hypertension, chronic kidney disease, heart 
disease that are predisposing to worse outcomes. We need to 
provide strategies for managing those conditions.
    In my testimony, I mentioned the use of telehealth and 
telemedicine, particularly via video. I think this is critical 
because older adults may find themselves skipping their 
maintenance visits, and the opportunity to be on a call or, 
better yet, a video call with their physicians to make sure 
that they are managing their chronic conditions is going to be 
critical throughout this so that we can protect them from 
developing the worst outcomes, so I think the work that you 
have done so far to provide support for these resources, 
particularly in Native communities who are suffering mightily, 
definitely needs to continue.
    Senator McSally. Thanks, Dr. Carnethon. That actually 
brings up a follow-on for me.
    I have legislation with Senator Doug Jones, also on this 
Committee, about medical monitoring, especially for rural 
communities, so it is not just the telehealth It is the actual 
medical monitoring. If you have continuous glucose monitoring 
and things like that, you can transmit that information without 
having to take transportation long distances to get to the 
doctor, so how important is the medical monitoring as well as 
the telehealth?
    Dr. Carnethon. I think the medical monitoring is critical, 
and you bring this up at a time when we are working to adapt 
our research programs to use Bluetooth-enabled devices, so that 
we can have blood pressure measurements sent regularly to a 
physicians, glucose monitors sent regularly to treating 
physicians and clinicians, so that we can monitor. I mean, it 
has always been a wonderful strategy for those in rural areas 
who are far away from health care providers to be able to track 
more regularly, and these are critical things that need to 
happen, but in addition to making the technology available, 
``If you build it, they will come,'' is not enough. We need to 
leverage people who can go out and teach our older adults to 
use it. I have gotten a number of Zoom explanation with my 
family members, and I know that people need help with these 
technologies and even how to set them up, but all of that is 
really critical to making sure that we can keep the population 
as healthy as possible.
    Senator McSally. Great. Thanks.
    Madam Chair, before I forget, the Navajo Nation has 
submitted a statement on the COVID-19 impacts for Navajo elders 
in particular. I would like to submit this to the record.
    The Chairman. Without objection. Thank you.
    Senator McSally. Thank you.
    I want to shift to Arizona that has a growing Hispanic 
population. According to the American Psychological Association 
and National Survey looked at people 70 years and older. Forty-
four percent of Latinos received home-based family caregivers 
compared to 25 percent of non-Hispanic whites, and epic 
differences were found among those with regard to the care 
recipient. Among those age 70 and older who required care, 
whites are more likely to receive help from spouses compared to 
Hispanics more likely to receive help from their adult 
children.
    The instance of the adult children being caregivers for 
more likely for the Hispanic population, we know anyone who is 
a caregiver, you are also taking time off from your job to care 
for your loved one. That impacts your livelihood and support 
for your own family.
    Dr. Mack, can you talk about just these issues with 
caregivers specifically? What other challenges to minority 
caregivers face and preventative measures we can take to ensure 
the protection of both the caregivers and the elderly?
    Dr. Mack. Yes. Thank you.
    Minority caregivers tend to, of course, have less 
resources, as you know, Unemployment is usually high in those 
communities, less time to take off work, and oftentimes the 
kids are engaged. Sometimes the children are actually missing 
school.
    I think those goes into more resources to not only care for 
the populations in a preventative manner to make sure that they 
do not get sick, but also have those too such as telehealth, 
etc, but also those social programs that help support families, 
whether it is around meals or whether it is around caregivers.
    As you know, today if you are elderly and ability to 
actually go into a nursing home--I have people in my family 
that have Alzheimer's disease. People had to retire early, and 
they are looking for resources because the insurance does not 
pay or we do not have any way to pay for them to put them in a 
personal care home.
    I think, again, we talked about those social determinants. 
The health care system itself cannot take care of those. We 
have to put resources in those areas of prevention but that are 
outside the walls of the facility to support these and not only 
health care services but also social services that the kids can 
continue to be educated, and etc.
    Let me just say this, The Wi-Fi gap, we call it the 
``homework gap.'' It is also the telehealth gap, so the same 
folks who cannot get the homework, especially during this time, 
they are going to fall behind, so education is an indicator of 
health.
    Senator McSally. Wonderful. Thank you.
    Thank you, Madam Chair, for having this hearing.
    The Chairman. Thank you.
    Senator Sinema?
    Senator Sinema. Well, thank you, Madam Chair and Ranking 
Member, and I want to thank our witnesses for being with us 
today for this critical coronavirus hearing.
    Arizona is currently experiencing one of the worst 
outbreaks in the Nation. Our State is also home to many 
communities are that in high-risk groups. We think they are 
more likely to become severely ill should they contract the 
virus.
    In Arizona, many of our communities of color have been 
disproportionately impacted by the virus, both from a public 
health perspective and an economic one.
    Arizona is home to many groups that are considered high 
risk, including seniors and our Hispanic and Latino communities 
and amongst our Tribal populations. It is clear that 
policymakers must address the existing disparities that exist 
in different communities if we are to effectively combat this 
pandemic.
    My first question is for Dr. Mack, but I welcome everyone's 
thoughts.
    Dr. Mack, I was struck by the part of your testimony that 
called for increased investment in our health care 
infrastructure. Native Americans face increased risk relative 
to COVID-19 and other illnesses in part because some 
communities do not have access to running water for sanitation 
and other basic needs.
    Tribes in Arizona have been particularly hard hit by this 
pandemic. The Navajo Nation at one point had the highest rate 
of coronavirus rates in the country, and nearly 1 in 10 
residents of the White Mountain Apache Tribe have tested 
positive for the virus. These health care challenges exist in 
other underserved communities as well.
    Could you elaborate on how a lack of access to basic 
services like running water and other resources can impact 
public health during a pandemic, especially for vulnerable 
seniors?
    Dr. Mack. Yes. Thank you.
    That is entailed in the conversation about what happens 
outside of the walls of the health facility. That is a 
significant impact to health, and that is why prevention is so 
important and resources for prevention that extend into the 
homes of the Native Americans and other underserved 
populations.
    How much can we save if we provided that water, we provided 
the food assets, if we provided equitable living for those 
communities? That in and of itself--and education and those 
things--improves the health of the population. It has been 
proven. It has been studied, so that is an extension of the 
health system. That is what the health system is called upon to 
do.
    To your point, it is not only testing. It is very 
important, the testing, but the uninsured and those who are on 
Medicaid are standing in longer lines. They are sleeping 
overnight to get tested, and then the test results are coming 
delayed, so, to sum it up, we have to consider to extend health 
into the home and health care into the home and more around 
preventative services in addressing the social determinants of 
the health as opposed to waiting until people get sick before 
we start to take care of them.
    Senator Sinema. Thank you.
    Would any other members of the panel like to respond?
    Mr. Woods. Senator, what I would add is, also, because in 
many of these Native communities, access to basic health 
services is also a big challenge and having to travel. I think 
it does speak to continuing to invest and fund telehealth 
services well beyond this pandemic so that we can reach those 
communities with respect that they are getting the right 
physicians and caregivers into those communities without them 
having to travel sometimes for basic care, so I think that is 
another part of the solution to help those in need in many of 
these Tribal communities.
    Senator Sinema. Thank you.
    Actually, my next question is for you, Mr. Woods. Your 
testimony mentioned different strategies to help break down 
barriers to testing information amongst our communities of 
color. One recommendation was to ensure the availability of 
culturally relevant information and access to language 
interpretation services. I can see how this would be important 
not just for public health information, but also to help 
seniors access other social services or avoid coronavirus-
related scams.
    That is why I have made it a priority to have my press 
releases and other resources that we share in my office 
translated into Spanish and to work for local community 
organizations to reach more people.
    When it comes to our aging populations, how important is it 
to design coronavirus information services that are both 
culturally relevant and specific to their needs as a member of 
a high-risk population?
    Second, how can culturally relevant information access to 
language services help combat the socialized isolation that 
many seniors in high-risk populations are experiencing when 
they are unable to see family and friends due to the pandemic?
    Mr. Woods. Yes, it is absolutely essential.
    One of the things you mentioned, actually what we are 
finding out, that it is--and I am half Spanish and half African 
American, and what we are finding out is it is actually a 
problem sometimes to translate both English to Spanish, so 
really, when we are writing out our PR and our public service 
communications and speaking, we are really doing it in the 
Native language, so that is one thing I would just add.
    The other thing is class or culturally linguistically 
appropriate services has been a requirement for about 10 years. 
We only have 10 States that provide Medicaid support for that. 
Medicare does not.
    I mentioned earlier we have invested about $7 million this 
past year just on translation and interpretative services.
    Then when we have gone out to these minority communities 
with testing, it was very, very important to have on our mobile 
vans, people that can speak the language.
    I think one of the panelists mentioned that people are 
sometimes more comfortable with others that are caring for them 
that look like them also speak like them is really important.
    I think this is an essential fundamental way of addressing 
this, and I do think providing funding, Medicare and Medicaid 
funding for interpreters and translators, could go a long ways, 
not just for this pandemic, but for dealing with some of the 
things that you brought up, including social determinants of 
health that extend beyond this pandemic in vulnerable 
communities.
    Senator Sinema. Thank you.
    Thank you, Madam Chairman.
    The Chairman. Thank you, Senator.
    We are about to start some votes, but I am hopeful that the 
Ranking Member and I can ask just a couple more quick questions 
before we adjourn the hearing.
    My first one is for Mr. Woods. I have had many health care 
providers in Maine tell me that they are very concerned that 
the delayed and deferred health care screenings and elective 
procedures, which while they are called elective are still 
necessary, will produce downstream effects where people will 
have increased cancers, heart disease, strokes, undiagnosed 
diabetes as a result of the delay of health care during this 
pandemic and it is interesting because researchers found that 
after Hurricane Maria hit Puerto Rico, the leading cause of 
death was due to that interrupted access to health care.
    Similarly, after Hurricane Sandy shutdown the Veterans 
Affairs hospital in Manhattan for 6 months, veterans had worse 
blood pressure control for at least 2 years after reopening 
compared to veterans in Connecticut, whose access was 
uninterrupted.
    For those who are already struggling within equitable 
access to health care in general, how can we ensure that the 
actions taken to defer routine health care do not create a 
second health care crisis downstream?
    Mr. Woods. Senator, thanks for that question, and that 
really is keeping many of the people in my seat awake at night.
    I mean, the lockdown, for example, that we have had in 
different areas has had a large impact on routine screenings, 
mammographies, colonoscopies, and there was a story of a 
senior, a patient who had actually needed hip surgery, put it 
out for 4 months, and the pain that she experienced until she 
was able to get in and be taken care of, so I think it is a 
real concern.
    I think part of the solution comes in inspiring confidence 
both at the health system level, as I alluded earlier, that we 
are doing everything possible to really keep a patient safe 
when they come into our facilities. We are testing staff. We 
are giving PPE to patients as they come in. We are temperature 
checking, and we are doing all the things with cleaning between 
rooms that are taking two and three times longer than we would 
otherwise do, but we are really sharing with the community that 
we are doing everything we can to keep them safe.
    I think also there is an opportunity for policymakers for 
some of the conversations we have had today of testing and 
contact tracing and so forth to give a measure of confidence to 
the communities that we are also doing everything we can to 
keep them safe.
    We share that concern. Every day, we see the manifestations 
of delayed care, and as you indicated, at one time, it might 
have been called ``elective.'' It goes quickly to urgent, then 
to emergent, so we are reaching out to the community through 
many, many different forums to say, ``If you think you have 
elective care needs, come to us. We will help guide you,'' but 
it is that sense of confidence that is important that we 
provide the communities and we are doing everything possible to 
keep them and their loved ones safe.
    The Chairman. Thank you so much.
    My final question is for Dr. Carnethon, and it has to do 
with clinical trials. Making clinical trials more inclusive of 
women and minority groups has been an issue that Senator Warren 
and I worked on and became part of the 21st Century Cures Act, 
but we know that many older black Americans are reticent to 
participate, given past medical exploitations such as the 
misappropriation of cancer cells belonging to Henrietta Lacks, 
for example.
    My question to you, Doctor, is, what recommendations do you 
have to help ensure that clinical trials are more 
representative of those who face the highest risk of COVID-19?
    Dr. Carnethon. Thank you so much for pointing out that 
significant challenge that we face when it comes to making sure 
that the therapies that we develop work for everybody.
    There are cases through our history where we have shown 
that not including women in clinical trials left us with a gap 
in understanding about the biological mechanisms of action of a 
given drug.
    I think we are in a similar--we face the risk of being in a 
similar position here when we talk about vaccine trials for 
managing and preventing the infection, and the ways that we 
have worked to try to engage communities to participate in 
observational research are the partnership strategies that I 
described earlier. I think we need to start that now so that we 
can prime communities to be ready to partner with the medical 
and research establishment so that we can test strategies that 
will protect us.
    I think messaging around a shared sense of responsibility 
to protect ourselves may help to motivate individuals who may 
be reticent to join.
    I think putting forth spaces that the community trusts, the 
faith-based spaces that Dr. Jones mentioned, engaging Federally 
Qualified Health Centers, as well as HBCUs can help to lend a 
bit of understanding and trust.
    Finally, really seeing the investigators behind this work, 
we do have a diverse biomedical workforce. It is not as diverse 
as we would certainly like to have, but there are key 
individuals out there who represent the very communities who 
are the hardest hit.
    I think putting these individuals at the forefront of 
messaging, the shared responsibility that we have to 
participate in science, will help us achieve our goals of 
developing therapies that work for all
    The Chairman. Thank you so much.
    Senator Casey?
    Senator Casey. Thank you, Chairman Collins.
    I just had a quick question for Dr. Carnethon. I know you 
just had a question. I just have one more, and then I know we 
have to wrap up.
    It is on home-and community-based services. We have 
referred to all of the deaths in long-term care settings. Part 
of the answer to getting those deaths down is to have care 
settings that are not congregate, and one of the ways to do 
that, of course, is home-and community-based services.
    I wanted to ask you, Doctor, about explaining how 
additional Medicaid dollars for these home-and community-based 
benefits would be critical for older adults.
    Dr. Carnethon. Yes. I really appreciate that, especially 
your efforts on behalf of shoring up the financial resources 
for these home-and community-based workers because, as you 
point out, keeping seniors in their home can be safer. 
Providing them with opportunities to receive the care that they 
need and maintain their independence is critical.
    I think there are two key issues here. One is the need to 
protect the home care workers. Essentially, they need to have 
the same level of protective equipment that we are providing 
for our health care providers within health care settings. They 
are going from home to home. The last thing we want is for 
those individuals to be transmitting disease from home to home.
    While many professionals within health care settings have 
protection about their income if they happen to be sick or 
unable to work, a number of home-and community-based workers do 
not have those protections, and so their incentive to be 
conservative about symptoms is lowered when if they do not go 
to work, they do not get the care that they need.
    I think those are critical ways in which money can be used 
to protect those individuals.
    Senator Casey. Thank you.
    Thank you, Madam Chair.
    The Chairman. Thank you very much, Senator Casey.
    I want to thank all of our witnesses for joining us today 
and sharing your extraordinary dedication and expertise. I 
particularly appreciated that each of you focus so much on 
recommendations, on practical solutions that we can pursue in 
order to lessen the disparity, the racial disparity in the 
COVID infections and also in general in our health care system.
    This week, the overall death toll in the United States from 
COVID-19 now stands at more than 140,000 deaths. More than 3.7 
million have been infected. Nearly one in three black Americans 
knows someone personally who has died from the coronavirus, far 
exceeding their white counterparts.
    As I have mentioned, it is appalling to me that my State of 
Maine has the worst rate of COVID racial disparities in the 
Nation, and I know that is of concern to the people of Maine 
and to health care providers as well as to the Governor. We 
face many of the same core challenges and risk factors that are 
present throughout the country, how to drive down COVID 
infections among populations where many hold jobs as frontline 
or essential workers who may not be able to easily engage in 
the same level of social distancing as some of their white 
neighbors due to transportation or housing arrangements and 
those who may have cultural or linguistic barriers, 
particularly among our immigrant population.
    I particularly appreciate the suggestions for how to ensure 
that Federal dollars committed to prevent or mitigate COVID 
actually reach all members of our communities as we intend.
    Support for translation and interpreter services, direct 
engagement of trusted community partners, telehealth services 
which we heard a lot about today can enhance that response. For 
seniors who are at the highest risk of severe complications or 
even death, the value of these interventions is even greater.
    I hope that our Committee will continue to work together on 
policies that not only can help change the trajectory of this 
current pandemic but also solve some of the disparities that 
have become so evident during the COVID pandemic.
    Senator Casey, I would like to turn to you for any closing 
remarks.
    Senator Casey. Chairman Collins, thank you for this 
important hearing, and I want to thank, of course, our 
witnesses for their testimonies and the ideas they gave us for 
solutions.
    We know that over the next several weeks, the Senate will 
negotiate legislation to provide help, a measure of help to 
tens of millions of Americans who are suffering from the COVID-
19 disease and the job crisis. This legislation is an 
opportunity to advance the cause of justice for older Americans 
and communities of color as well as many other Americans.
    This bill should include policies to save the lives of 
nursing home residents and nursing home workers. The bill 
should also guarantee access to affordable quality health care. 
The bill should also recognize and pay the heroes on the front 
lines.
    I hope that we will pass this test that our national 
challenges have presented to us and that we will also pass the 
bill that strives to achieve a measure of justice for our 
seniors in communities of color.
    Thank you.
    The Chairman. Thank you.
    Again, my thanks to all of our witnesses, to the many 
Committee members who participated in today's hearing, and to 
our staff which worked so hard to bring these witnesses to us 
and to put this hearing together.
    Committee members have until Friday, July 31st, to submit 
any additional questions for the record.
    Again, my thanks, and this concludes our hearing. We are 
adjourned.
    [Whereupon, at 11:55 a.m., the Committee was adjourned.]



      
      
      
      
      
      
      
      
      
      
      
      
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