    [House Hearing, 117 Congress]
    [From the U.S. Government Publishing Office]

                      DEPARTMENTS OF LABOR, HEALTH AND HUMAN
                    SERVICES, EDUCATION, AND RELATED AGENCIES
                             APPROPRIATIONS FOR 2023

    _______________________________________________________________________

                                     HEARINGS

                                     BEFORE A

                               SUBCOMMITTEE OF THE

                           COMMITTEE ON APPROPRIATIONS

                             HOUSE OF REPRESENTATIVES

                         ONE HUNDRED SEVENTEENTH CONGRESS

                                  SECOND SESSION

                                   ____________

        SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
                                RELATED AGENCIES

                       ROSA L. DeLAURO, Connecticut, Chair

      LUCILLE ROYBAL-ALLARD, California            TOM COLE, Oklahoma
      BARBARA LEE, California                      ANDY HARRIS, Maryland
      MARK POCAN, Wisconsin                        CHUCK FLEISCHMANN, Tennessee
      KATHERINE M. CLARK, Massachusetts            JAIME HERRERA BEUTLER, Washington
      LOIS FRANKEL, Florida                        JOHN R. MOOLENAAR, Michigan
      CHERI BUSTOS, Illinois                       BEN CLINE, Virginia
      BONNIE WATSON COLEMAN, New Jersey
      BRENDA L. LAWRENCE, Michigan
      JOSH HARDER, California

        NOTE: Under committee rules, Ms. DeLauro, as chair of the full
    committee, and Ms. Granger, as ranking minority member of the full
    committee, are authorized to sit as members of all subcommittees.

        Stephen Steigleder, Jennifer Cama, Jaclyn Kilroy, Philip Tizzani,
                Laurie Mignone, Rebecca Salay, and Trish Castaneda
                                Subcommittee Staff

                                   ____________

                                      PART 5

                                                                       Page
    Fiscal Year 2023 Budget Request for the Department of Health
      and Human Services ...........................................      1
    Social and Emotional Learning and Whole Child Approaches in
      K-12 Education  ..............................................    141
    Fiscal Year 2023 Budget Request for the Department of Education..   181
    Testimony of Interested Individuals and Organizations............   249

                    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                 _________

              Printed for the use of the Committee on Appropriations

                     U.S. GOVERNMENT PUBLISHING OFFICE

    48-855                   WASHINGTON : 2022

                          COMMITTEE ON APPROPRIATIONS

                                    ----------
                      ROSA L. DeLAURO, Connecticut, Chair

      MARCY KAPTUR, Ohio
      DAVID E. PRICE, North Carolina
      LUCILLE ROYBAL-ALLARD, California
      SANFORD D. BISHOP, Jr., Georgia
      BARBARA LEE, California
      BETTY McCOLLUM, Minnesota
      TIM RYAN, Ohio
      C. A. DUTCH RUPPERSBERGER, Maryland
      DEBBIE WASSERMAN SCHULTZ, Florida
      HENRY CUELLAR, Texas
      CHELLIE PINGREE, Maine
      MIKE QUIGLEY, Illinois
      DEREK KILMER, Washington
      MATT CARTWRIGHT, Pennsylvania
      GRACE MENG, New York
      MARK POCAN, Wisconsin
      KATHERINE M. CLARK, Massachusetts
      PETE AGUILAR, California
      LOIS FRANKEL, Florida
      CHERI BUSTOS, Illinois
      BONNIE WATSON COLEMAN, New Jersey
      BRENDA L. LAWRENCE, Michigan
      NORMA J. TORRES, California
      CHARLIE CRIST, Florida
      ANN KIRKPATRICK, Arizona
      ED CASE, Hawaii
      ADRIANO ESPAILLAT, New York
      JOSH HARDER, California
      JENNIFER WEXTON, Virginia
      DAVID J. TRONE, Maryland
      LAUREN UNDERWOOD, Illinois
      SUSIE LEE, Nevada

      KAY GRANGER, Texas
      HAROLD ROGERS, Kentucky
      ROBERT B. ADERHOLT, Alabama
      MICHAEL K. SIMPSON, Idaho
      JOHN R. CARTER, Texas
      KEN CALVERT, California
      TOM COLE, Oklahoma
      MARIO DIAZ-BALART, Florida
      STEVE WOMACK, Arkansas
      CHUCK FLEISCHMANN, Tennessee
      JAIME HERRERA BEUTLER, Washington
      DAVID P. JOYCE, Ohio
      ANDY HARRIS, Maryland
      MARK E. AMODEI, Nevada
      CHRIS STEWART, Utah
      STEVEN M. PALAZZO, Mississippi
      DAVID G. VALADAO, California
      DAN NEWHOUSE, Washington
      JOHN R. MOOLENAAR, Michigan
      JOHN H. RUTHERFORD, Florida
      BEN CLINE, Virginia
      GUY RESCHENTHALER, Pennsylvania
      MIKE GARCIA, California
      ASHLEY HINSON, Iowa
      TONY GONZALES, Texas
      JULIA LETLOW, Louisiana

                                       (ii)

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                        AGENCIES APPROPRIATIONS FOR 2023

                                  ----------

                                              Thursday, March 31, 2022.

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                                    WITNESS

    HON. XAVIER BECERRA, SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES
        The Chair. Let's move forward and to bang the gavel and
    call to order the hearing on fiscal year 2023, the President's
    budget for the Department of Health and Human Services. A
    hybrid hearing, so we need to address a few housekeeping
    matters.
        For the members who are joining virtually, once you start
    speaking, there is a slight delay before you are displayed on
    the main screen. Speaking into the microphone activates the
    camera, displaying the speaker on the main screen. Do not stop
    your remarks if you do not immediately see the screen switch.
    If the screen does not change after several seconds, please
    make sure that you are not muted.
        To minimize background noise and ensure the correct speaker
    is being displayed, we ask that you remain on mute unless you
    have sought recognition. The chair, or an individual designated
    by the chair, may mute participants' microphones when they are
    not under recognition to eliminate inadvertent background
    noise. Members who are virtual are responsible for muting and
    unmuting themselves.
        Finally, the House Rules require me to remind you that we
    have set up an email address to which members can send anything
    they wish to submit in writing at any of our hearings. That
    email address has been provided in advance to your staff.
        With that, I want to acknowledge the ranking member of the
    subcommittee, Congressman Tom Cole, and all of the members of
    the subcommittee who are joining today's hearing, both
    virtually and in person.
        And I would like to welcome my friend and former colleague
    Secretary Xavier Becerra in his first in-person hearing of this
    subcommittee as Secretary of the Department of Health and Human
    Services. So you joined us virtually last year, of course, but
    there is nothing like being in person and being able to
    interact with people. So a very, very, very warm welcome this
    morning.
        Today, I am looking forward to discussing HHS's fiscal year
    2023 budget, which builds on the historic progress we made in
    the fiscal year 2022 appropriations package. In the fiscal year
    2022 omnibus, we increased funding for biomedical research,
    public health, behavioral health, child care and early
    learning, prevention of child abuse and family violence, and
    the list goes on. And through these investments, we are able to
    bring transformational change to millions of hard-working
    American families.
        Let me take a second here before I go on to say a thank you
    to my colleagues on both sides of the dais and those who are
    virtual today and a really heartfelt thanks for our work
    together in passing the 2022 omnibus.
        And Congressman Cole, I want to say a particular thank you
    to you for your good offices in all of this. I think we have a
    bill that we can be enormously proud of. And I would also say
    that there weren't a lot of folks who thought we were going to
    get across the finish line, but we showed them.
        So, and all done by March 8, on the deadline that they kept
    changing on us. So, but thank you all very, very, very much for
    your hard work. And again, a thanks to the staff as well for
    getting us there.
        And we strengthened in the omnibus bill the Centers for
    Disease Control and Prevention by supporting the public health
    workforce, continuing to modernize public health data systems,
    creating a new funding mechanism to support core public health
    activities at the State and local level. We made strong
    transformational investments in maternal health, with increased
    funding for NIH research on maternal mortality through the
    IMPROVE Initiative, for the Health Resources and Services
    Administration's Maternal and Child Health Block Grant and
    Maternal Mental Health Hotline, and for the CDC's Maternal
    Mortality Review Committees, just to name a few.
        We expanded access to behavioral health with investments in
    the 988 National Suicide Prevention Lifeline, the Mental Health
    Block Grant, and in Certified Community Behavioral Health
    Clinics, as well as a new pilot program to support Mental
    Health Crisis Response Teams to ensure that individuals
    experiencing a behavioral health crisis received the medical
    treatment that they need.
        In addition, for the first time in 12 years, we included
    funding for member projects to support hospitals and health
    clinics, mental and behavioral health projects, K-12 and higher
    education programs, and job programs in our home districts. And
    now, with the fiscal year 2023 budget before us, we are
    strengthening these historic investments and ensuring the seeds
    of change that we planted in last year's bill grow deep,
    strong, and sustainable roots.
        I want to be clear. My goal is to pass fiscal year 2023
    appropriations bills on time, which means sending them to the
    President by September 30. We have already had conversations,
    and I plan to work with Ranking Member Granger, Chairman Leahy,
    and Vice Chairman Shelby to reach an agreement on top-line
    spending levels so each subcommittee can move forward with a
    renewed sense of urgency.
        In the immediate term, we need to provide additional
    emergency funding to address the ongoing COVID-19 pandemic, to
    purchase lifesaving vaccines, antivirals, monoclonal
    antibodies, as well as continued support for the uninsured to
    receive vaccination and testing at no cost.
        Surgeon General Admiral Vivek H. Murthy wrote in the New
    York Times on Tuesday, and I quote, ``Now, for the first time,
    we cannot order enough vaccines to provide boosters for all
    Americans if a fourth dose is deemed necessary in the fall. If
    we need variant-specific vaccines, we will not have the funds
    to secure them, deliver them, or administer them. Last week, we
    were forced to cut our shipments of lifesaving monoclonal
    antibodies to States by 35 percent, and we anticipate running
    out of monoclonal antibodies later this spring. We will not be
    able to continue making home tests available, and the critical
    surveillance efforts that help us anticipate new waves and
    variants will be compromised.''
        Let me also add that it is equally critical to support
    global vaccination efforts, both from a humanitarian
    perspective and our own self-interest. Viruses do not stop at
    borders on a map. No amount of domestic preparedness can
    possibly contend with a continuing onslaught of new variants.
        As of today, only 1 in 10 people in low-income countries
    are fully vaccinated. To achieve the goal of vaccinating 70
    percent of each country's population, including health workers
    and the elderly, the United States must take a leadership role.
    It is urgent that we act now to secure more funding to address
    the ongoing pandemic before the money runs out.
        I urge my colleagues on both sides of the aisle to come
    together to save American lives and to save lives across the
    globe. And again, it is urgent that we move in this direction.
        Mr. Secretary, I am pleased to see your long-term plan for
    pandemic preparedness. The President's budget includes
    $82,000,000,000 over 5 years to invest in the Office of the
    Assistant Secretary for Preparedness and Response, ASPR, the
    CDC, the NIH, and the Food and Drug Administration to be able
    to identify new potential pandemics and move quickly to develop
    a vaccine and deploy it within 100 days.
        We also need to tap the potential of the Advanced Research
    Projects Agency for Health, otherwise known as ARPA-H, which we
    created in fiscal year 2022 in the omnibus, to support
    transformative research projects to address debilitating
    diseases like Alzheimer's, diabetes, cancer, ALS, and many
    other health conditions afflicting millions of Americans every
    day.
        ARPA-H has tremendous potential to develop breakthrough
    technologies and advancements while continuing our important
    work to reduce health disparities. However, Mr. Secretary, you
    know my view on this. I must say that the decision to place
    ARPA-H within the NIH I believe is a mistake and will hamper
    the agency's ability to achieve these breakthroughs. I believe
    that ARPA-H would be more successful in its unique mission if
    it were established as an independent agency within HHS.
        And I also believe that the proposed increase of only
    $274,000,000 for the rest of the National Institutes of Health
    is insufficient and threatens the progress this committee has
    made in the past several years through significant, sustained
    investments in biomedical research.
        Beginning in fiscal year 2023, the President proposes to
    reclassify the entire Indian Health Service budget,
    approximately $9,300,000,000, as mandatory. And I look forward
    to hearing more about the need and the rationale for the
    proposal.
        Mr. Secretary, I am happy to see the President's budget
    continues to build on our investments in public health,
    maternal health, behavioral health, including significant
    increases for CDC's core public health capacity, as well as
    increases for SAMHSA's Mental Health Block Grant, Substance Use
    Prevention Block Grant, State Opioid Response Grants, Certified
    Community Behavioral Health Clinics.
        The budget includes targeted increases to improve mental
    health services for children and youth, including increases for
    Project AWARE and the National Child Traumatic Stress Network.
    It includes increased funding for mental and behavioral health
    workforce training, which is critically important.
        These investments will help make quality care more
    accessible for those suffering from mental health disorders, as
    will the July rollout of the new 3-digit number, 988, for the
    National Suicide Prevention Lifeline. This will be a dedicated
    number for individuals in crisis to receive help immediately.
        It is encouraging that this budget expands access to
    healthcare services for low-income woman by providing
    $400,000,000, an increase of nearly 40 percent over the 2021
    enacted level, for the Title X Family Planning Program, which
    will improve overall access to vital reproductive and
    preventive health services and advance gender and health
    equity. I will keep fighting for more money for Title X and
    other reproductive health programs.
        Within ACF, HHS is investing once again in refugee
    resettlement programs. This administration is restoring our
    reputation in the world as a country that welcomes immigrants
    of all colors and faiths, as we did for Afghans in Operation
    Allies Welcome and as I hope this Congress will come together
    to do for Ukrainians as well.
        Let me also tell you, Mr. Secretary that I expect to see
    substantial progress this year in the Unaccompanied Children
    Program. You know my position on this. HHS needs to build a
    sufficient network of State-licensed beds and needs to shutdown
    the emergency intake sites. It needs to fund the services
    necessary to support these children and their sponsors as they
    recover from their traumatic journey and past and as they
    navigate the asylum process and understand their legal rights.
        Mr. Secretary, we thank you for being here today. I look
    forward to working with you over the next year and look forward
    to today's discussion.
        And with that, let me recognize the ranking member,
    Congressman Cole, for any opening remarks.
        Mr. Cole. Well, thank you, Madam Chairman.
        And I am going to start as you did. I am going to be
    outside my prepared remarks for a minute and do a little
    lookback before we look forward. And I want to begin, you were
    nice enough to thank all of us. The reality is all of us should
    be thanking you and Ranking Member Granger for what you did.
        I will point out this committee was ready to go to
    conference at the appropriate time. All 12 bills have passed
    out of this committee last year under your leadership, 9 of
    them across the floor. We were ready before September 30.
        And I am particularly proud of how hard you pushed over and
    over again for demanding the least amount of time. First,
    December and then February. But you were the leader in pushing
    the Congress for getting its job done, and there is no more
    important job than funding the Government across the board at
    every level.
        We know, Mr. Secretary, we hobble you and your colleagues
    when we don't give you a budget on time. It forces you to
    wonder what you are going to be operating with. It slows down a
    lot of things that need to get done in a hurry. But that was
    not the responsibility of this committee at all. It was, again,
    ready to go to work, ready to sit down with the administration.
        Our friends in the Senate I think could learn a little bit
    from you, Madam Chair. As I recall, they didn't get any bills
    across the floor, and they only got three out of committee. I
    know everything is slower in the United States Senate. But
    really? Three bills out of committee? Come on, guys. They need
    to pick up the pace over there.
        But I am proud of this committee. Even when I disagreed,
    and of course, initially, we did. But I am also pleased, as you
    pointed out, for the seventh year in a row, we got to a bill
    that we both could vote for.
        And again, that wouldn't have been possible without your
    leadership and Chairwoman Granger's leadership. And I think we
    certainly have R&D divisions around here, but we have
    institutional divisions as well. And I think our institution
    looked better than our counterpart on the other side of the
    Rotunda, and you bear enormous responsibility for that.
        So I want to associate myself with your goal of making sure
    that we make this done by September 30. My guess is we will do
    a CR and kick it into the end of the calendar year. But it
    needs to get done, and sooner is better. On time is best. If
    not, the calendar year is best. And I think, again, I will
    pledge to work with you as hard as I possibly can to make sure
    that that is our goal.
        It is a mistake to kick it into a new Congress where we
    will have new Members on both sides of the aisle, and they will
    have to vote on something that they have had nothing--very
    little knowledge, no participation in. And they deserve a clean
    start, and frankly, the administration deserves a clean start
    to the third year as well. And so we look forward to working
    with you on that.
        Now let me go to my formal remarks, if I may?
        Mr. Secretary, it is a pleasure to have you here. And as
    the chair said, it is wonderful to be back in the room and have
    the interaction. Particularly good, frankly, interacting with
    you, as you know our world better than any Secretary I have
    dealt with. And I have dealt with some good ones on both sides
    of the aisle, but it is always nice to have another member here
    that understands what are the challenges we have from a
    legislative standpoint, and you do.
        I am glad that, again, our chair chose to hold this meeting
    in our full committee room so that some members could attend in
    person. I wish we could all be together in person for this
    hearing, as I think the dynamic and interaction among members
    is much better when we are all seated together in the same
    place, rather than looking at each other through a computer
    screen.
        Nevertheless, Mr. Secretary, I appreciate your personal
    accessibility to us as members. I have enjoyed the bipartisan
    breakfasts you have been kind enough to host over the past
    years. I appreciate you understanding the challenges of
    legislating and having served this body yourself, and
    particularly your responsiveness on the phone or things like
    that, again to both sides of the aisle, have been greatly
    appreciated.
        Today is our annual hearing to discuss the administration's
    budget proposal for fiscal year 2023. We just completed the
    final funding bill for fiscal year 2022 only 3 weeks ago. So
    thanks for getting us right back to work, Madam Chair.
        I am hopeful it does not take as long to complete the work
    on the budget this year for the coming fiscal year, and I was
    glad to see a return of bipartisanship and compromise in the
    bill recently completed. Although we had strong differences
    going in, we were able to forge a compromise that both the
    chair and I were able to support.
        For more than four decades, the Labor, Health and Human
    Services appropriations bill has carried the so-called Hyde
    Amendment that restricts Federal taxpayer funding for abortion
    under most circumstances. The fiscal year 2022 budget just
    completed was only able to advance because this language was
    again included.
        I thank my chair for seeing the wisdom in continuing this
    decades-old bipartisan compromise, although I know that she
    personally disagrees with it. I am confident that the next
    spending bill we negotiate will continue to include it, as I
    continue to oppose any appropriations bill that seeks to weaken
    pro-life protection.
        Mr. Secretary, I expect under your leadership, HHS will
    continue to enforce these provisions of existing law. But let
    me be very friendly, but firm. No Republican will vote for a
    budget, in the end, that does not have the Hyde protection, and
    in the end, we know it takes a bipartisan majority in both
    chambers to actually move this.
        So the choice is squarely with the administration and the
    majority. We will once again be confronted with a choice,
    either Hyde comes back into the budget or accept a CR. And I
    want to be clear on that. I am not trying to be anything else.
    It is just a political reality.
        Coming on the heels of such bipartisan negotiation, I am
    again disappointed the Biden administration once again is
    putting forward a partisan proposal that seems little more than
    a lengthy liberal wish list in some areas. For example, the
    budget proposes to implement partisan priorities such as
    climate change, gun research, and even a new center for sexual
    orientation and gender identity within the NIH.
        To pay for these partisan initiatives, longstanding shared
    bipartisan priorities are shortchanged. Basic biomedical
    research at the NIH is essentially flat-funded, while the new
    ARPA-H, which was just created this month--and which, by the
    way, I supported--has not even begun to function yet, but is
    proposed an enormous $4,000,000,000 increase.
        I think it is a mistake to shift funding away from basic
    biomedical research into a brand-new program in one year. ARPA-
    H will take time to get up and running and take time to work
    out the many controversial issues I know this new agency will
    face. And I will have some questions about your plans on ARPA-H
    this morning. I appreciate, by the way, your letter that
    clarified some things about it and also made it clear that you
    want to work with Congress.
        This is a very new entity, and we are going to have a lot
    of wrestling with tough questions--I mean this in a very
    bipartisan way--to get to a structure that we all think is
    producing what I know we all want it to produce. And again, I
    say that as somebody that supported the creation of the
    initiative and look forward to continuing to work with you on
    that, Madam Chair.
        Taken as a whole, I disagree strongly with the approach
    taken in the administration's request. To put it simply, it
    spends far too much on domestic programs, far too little on
    defense. Especially now with the current situation in Eastern
    Europe, America cannot afford to stand or cut back our own
    defense spending. At a minimum, we need to see at least a 5
    percent annual increases beyond the rate of inflation for
    defense spending for the next several years. But that is a
    matter for the full committee, not just this subcommittee
    certainly.
        The President's proposal for fiscal year 2023 for this
    subcommittee amounts to a 15 percent effective increase. Coming
    in when the fiscal year is already half way over, another huge
    infusion of spending in these domestic programs in fiscal year
    2023 is just not necessary. And I don't think it can be spent
    prudently and will only serve to increase our already-growing
    inflation problem, which is now near a 40-year high.
        I know we are all hoping that the coronavirus pandemic,
    which began over 2 years ago, may finally be winding down to a
    manageable endemic disease. Despite the many challenges of the
    past 2 years, Congress was able to come together 5 times in
    2020 to pass emergency supplemental appropriations to help us
    through the pandemic. I supported all five of those bills.
        I know we are not out of the woods yet. The administration
    has told us that funding for therapeutics and additional
    booster shots is running low, and we do not know if new
    variants are coming in the summer or the fall. Yet the
    administration has also released documents showing tens of
    billions of dollars, possibly as much as hundreds of billions,
    in previously appropriated COVID dollars remain unobligated and
    available.
        And look, let me just be brutally honest here and use my
    own State as an example. Under the proposed future distribution
    of money, I think we have something like $187,000,000 ticketed
    for Oklahoma. We have a rainy day fund that we added
    $1,000,000,000 to last year. We had a tax cut last year. And I
    can tell you $187,000,000 is unlikely to be spent for corona-
    related purposes. We don't need the money.
        And I think some of the revolt we saw on my friend's side,
    again was more governors that wanted to use the money for other
    purposes. And if I were comfortable they were all going to
    spend it on the priorities that you have laid out in your
    budget, Mr. Secretary that would be one thing. I am not.
        But I am not for just throwing money away when we have got
    hundreds of billions of dollars of money that can be repurposed
    and aligned for this. And I know that is a political discussion
    as well as a policy debate. I recognize that, and I am happy to
    work with my friends on that.
        But again, most of these States are in better financial
    shape, quite frankly, than the United States Government is.
    Most of them have reserve funds. We don't have one. Most of
    them have balanced budgets. We don't have that.
        So the idea of us not taking some of the money that we
    wanted to lay out for coronavirus and say, no, you guys really
    don't need it for other purposes, let us redirect it back, I
    think is a worthy discussion to have.
        Mr. Secretary, again, as I said, I urge you to repurpose
    these existing funds to secure additional doses of monoclonal
    antibodies and other therapies without delay. I urge you to use
    the remaining COVID balances, as well as the increases we
    provided in the bill just passed in the NIH and BARDA accounts,
    to continue to work on the next generation of vaccines. And
    hopefully, a universal coronavirus vaccine or a vaccine that
    targets mucosal membranes can be developed quickly and can not
    only prevent severe disease, as our current vaccines do, but
    can also reduce transmissions and need for additional boosters.
        Finally, I want to take this opportunity to comment on one
    part of your budget, which is not under this subcommittee's
    jurisdiction, but one which I wholeheartedly agree with your
    proposal. And that is your proposal to move the Indian Health
    Service to the mandatory side of the budget ledger. That is a
    move I believe is long overdue, and it will stop the
    competition for scarce resources that currently exist between
    the Indian Health Service and other programs important to
    Indian Country, such as the Department of Interior, the Bureau
    of Indian Schools, payment in lieu of taxes reprogramming,
    other programs that are important in preserving our Nation's
    natural resources.
        I hope this can work together to further this idea this
    year. My colleagues on this subcommittee have had to hear me
    probably more times than they care to since it is not directly
    their jurisdiction. But having sat on Interior, the reality is
    there is just not enough money in the discretionary budget to
    take care of the needs of Indian health, which is already the
    largest single item in the Interior Subcommittee appropriation.
        I think your approach here is a wise one, and sadly, every
    time we have had a Government shutdown or a delay in spending,
    because the Indian Health Service is on the discretionary side
    of the budget instead of the mandatory, we have disrupted
    healthcare in reservations and some very poor communities. I
    think this is a very far-sighted proposal for you. I know you
    are going to get some stiff resistance on both sides of the
    aisle for a whole variety of reasons, but I think you are on
    the right track here.
        And I look forward to working with you, and I appreciate
    very much you advancing this proposal in your budget.
        So, with that, Madam Chair, again, I look forward to
    working with you in the coming year. It has been a delight for
    7 years in a row. It has ended successfully 7 years in a row. I
    hope it ends successfully the eighth time around.
        So, with that, again, yield back to my friend, the chair.
        The Chair. The eighth time is a charm. So there we go.
        Thank you very, very much, Congressman Cole. Thank you for
    your kind words as well. I much appreciate it, and I enjoy so
    much the opportunity to work with you in these areas. As you
    pointed out, we may disagree, but we are never disagreeable
    about it, and we get to a conclusion. And that is really what--
    that is what this job is about. It is about governing.
        So, Mr. Secretary, you know the floor is now yours. Your
    full written testimony will be entered into the record, and you
    are recognized for 5 minutes for an opening statement, and then
    we will move to questions. You know the drill.
        Secretary Becerra. Madam Chair, Ranking Member Cole, and
    members of the subcommittee, thank you for the opportunity to
    discuss the President's fiscal year 2023 budget for the
    Department of Health and Human Services. Pleased to be with you
    today.
        Speaking of today, 255 million Americans have received at
    least one dose of the COVID-19 vaccine. Two-thirds of adults
    over age 65 have gotten their booster shots. We have also
    closed the gap in vaccine rates we usually see fall behind for
    communities in some of our distressed areas.
        It pays dividends to surge resources, including tests and
    treatment, to our hardest-hit and highest-risk communities. We
    think the numbers show that.
        What are those numbers? Three hundred twenty-five million
    free COVID-19 tests have been shipped out to Americans. Two
    hundred seventy million free N95 masks have been made available
    to Americans.
        You all made it possible to have $186,000,000,000 available
    to the Provider Relief Fund. So, so far, we have seen some
    766,000 claims submitted by doctors, hospitals, community
    health centers, pharmacies, labs, nursing homes, long-term care
    facilities. All of them receiving some very critical support at
    a very necessary time. More than 450,000 providers to date have
    submitted requests for reimbursement.
        Real money. Real relief. Real results.
        Beyond COVID-19, today more Americans are insured for their
    healthcare than ever before. That includes a record-breaking
    14.5 million Americans who secure their health insurance
    coverage through the Affordable Care Act.
        In addition, thanks to you, we are now enforcing the new
    law that protects Americans from being blindsided by surprise
    medical bills. We launched Operation Allies Welcome, an HHS-led
    effort that has helped over 68,000 Afghan refugees resettle in
    America. We are coordinating nearly $300,000,000 in nationwide
    support for the launch of the 988 National Suicide Prevention
    Lifeline in July.
        HHS has also made key investments to improve equity in
    areas like maternal health, where we have extended Medicaid
    coverage for postpartum care for a new mother and her baby from
    2 months to 12 months.
        The President's 2023 budget lets us build on that record of
    investment in America's health. It proposes $127,000,000,000 in
    total discretionary budget authority and $1,700,000,000,000 in
    mandatory funding, including newly proposed mandatory funding
    to provide for the Indian Health Service.
        It also asks for $82,000,000,000 for the President's
    pandemic preparedness proposal to get ready for whatever might
    come next after COVID-19. Considering that COVID has cost this
    country more than $4,500,000,000,000 in direct support from the
    Federal Government so far, this is a no-brainer to prepare for
    the next pandemic. The funding we are requesting will be end-
    to-end, for research, development, approvals, deployment, and
    effective response.
        Madam Chair, budgets represent not just dollars and
    investments, but our values and our priorities. This budget
    turns hardship into hope and inclusion into opportunity, and it
    is a commitment to finish the fight against COVID-19 and to
    build a healthier America.
        On that note, I want to acknowledge our collective national
    failure to fund the Indian Health Service at the level needed
    to meet our constitutional treaty and our trust obligations to
    tribal nations in America. But even more so, to point out how
    we failed to meet the elemental level of needed support to
    provide fair and sufficient resources to our families in Indian
    Country.
        I have seen these shortfalls firsthand in my visits to
    Indian Country, where more than 2.7 million patients are served
    by Indian Health Services. The President's fiscal year 2023
    budget takes a historic first step toward finally delivering on
    our long-overdue commitments to tribal nations.
        In my written testimony, I detail our proposal to convert
    the IHS budget to mandatory funding, as Congressman Cole
    mentioned. And we do this not only because it is necessary,
    because we have to do it long term. We are so far behind, it
    bolsters significantly the budgets for IHS over the next 10
    years. This budget is a strong start, but we must continue to
    shine a light and hold ourselves accountable on our promises.
        Madam Chair, I look forward to working with you and all the
    members of this subcommittee to make the President's 2023
    budget a reality and to continue our efforts to improve the
    health and well-being of the American people. Working together,
    I am confident we can give Americans real relief, real results,
    and real peace of mind.
        And with that, I would be happy to answer any questions
    that you may have.
        The Chair. Thank you very, very much, Mr. Secretary. And
    thank you for your written testimony, which was extensive and
    in detail. Much appreciate the information.
        I have got two or three questions, and this is around the
    COVID supplemental, pandemic preparation, public health areas.
    And the administration has told us that more funding is
    necessary to deal with purchasing the COVID vaccines,
    therapeutics, tests, including covering vaccination and testing
    for the uninsured. What is the current status of the COVID-
    related activities that will be reduced or eliminated without
    additional funding? What are the potential consequences of
    failing to maintain these efforts?
        Secretary Becerra. I start by first saying thank you very
    much to what Congress has provided over the last 2 years. As I
    said, $4,500,000,000,000 or so in support overall for all
    aspects of COVID from the Federal Government. That is a major
    investment.
        What we are asking for now is to finish the fight on COVID.
    We are running out of the money in that Provider Relief Fund to
    reimburse claims submitted by all those different types of
    doctors, hospitals, and so forth.
        Just to give you an idea, when we told providers that we
    would have to stop accepting claims about 2 weeks ago, in a
    period of about 8 days, we received over 2 million claims. And
    we know that what we are going to see now is just a rush for
    April 5, when we have announced that we will stop receiving
    claims as well for vaccination.
        The first deadline was for testing and treatment. I think
    that was March 22. The new deadline for vaccination
    reimbursement is April 5. We expect another surge of
    applications to come then.
        I am sorry. I think I said number of claims of 2.3. That is
    what we estimate the number of dollars in claims that we have
    received. That goes with the $2,500,000,000--or $2,000,000,000
    to $2,500,000,000 in existing claims that we are processing as
    well.
        We had to call out these deadlines because we didn't want
    people to think that they were going to be able to get
    reimbursed anymore from the money that was in the Provider
    Relief Fund. The Provider Relief Fund has been a tremendous
    asset to so many, for the doctors, hospitals, community health
    centers throughout the country. We don't think this is a time
    to stop when we are getting real control over COVID.
        The therapeutics, the President had us do something very
    important. He had us buy in advance. And so we not only made
    the commitment up front, but we were first in line because we
    made the commitment up front. We can no longer do that because
    we don't have the monies to make those commitments up front to
    the therapeutics that we know work, that actually if you do get
    COVID, you can be saved. You could be possibly spared going to
    the hospital.
        But those therapeutics, whether it is the antivirals or the
    monoclonal antibody therapies, we need to make sure we are
    purchasing and we don't have to get in the back of the line to
    purchase in the future. That money to do that is running out.
        We get to boosters. As we heard CDC and FDA announce, we
    can do some of the boosting right now, but right now, we are
    talking about those 50 years of age and older. It is going to
    be tough to continue this without the resources. We hope
    Congress will work with us to make sure we have them.
        The Chair. Just a comment on, first of all, with regard to
    CDC, their ability for surveillance and early detection. The
    impact on CDC of what we are talking here about, you know, not
    committing to more resources.
        Secretary Becerra. Yes, well, CDC--by the way, I want to
    make sure we are clear on something in terms of the President's
    budget. The President's budget was essentially shaped before we
    knew if you would pass the omnibus.
        The Chair. Yes.
        Secretary Becerra. We were having to base our projections
    for 2023 on what we knew of the CR, which was funding far lower
    than the omnibus that finally passed. And so when you see the
    funding for CDC, it was based on where we thought we could go
    from the CR funding level. Because the omnibus had funding
    levels vastly better than the CR, we are certainly going to
    work with you all to make sure the CDC is appropriately treated
    when it comes to 2023.
        But CDC has been the closest partner to our State and local
    governments when it has come to addressing COVID. And if they
    don't have the dollars to go out there and do the surveillance,
    to go out there and communicate to communities what we are
    seeing, where we see the next wave coming, it makes it very
    difficult for anyone back home to get ready.
        The Chair. Let me just--I am glad that the President's
    budget talks about preparedness for the next pandemic, and he
    has got new mandatory proposed--that is the $82,000,000,000
    over 5 years. I continue to believe that we underutilize the
    Defense Production Act, and that we should use the DPA to
    increase global vaccine supply in the pandemic worldwide.
        And I would note that only 11.5 percent of individuals in
    low-income countries have been fully vaccinated, and that has
    to--comment on how, in fact, that does hurt us. And under your
    pandemic preparedness plans, how will the administration invoke
    the Defense Production Act? How can this be used more
    aggressively?
        Secretary Becerra. Madam Chair, we have used every tool in
    that toolbox to secure our supply chains, to ensure domestic
    manufacturing. The fact that this country was able to produce a
    vaccine in less than a year is proof of that. The fact that we
    have been able to disperse it to hundreds of millions of
    Americans to date, the fact that we have been the leader when
    it comes to making sure people around the world have access to
    the vaccine, especially in countries that are further behind
    the process, is a testament to the work that we have done using
    the tools we have.
        We have engaged in, oh, couple of dozen DPA or DPA-style
    actions over the course of the past year, whether, as I
    mentioned, the acceleration of COVID-19 vaccination process,
    whether it is getting new tests out. Remember when the
    President took office, there were no at-home tests that were
    available to Americans. Today, we have several that are out
    there, and the President made millions of them available for
    free to Americans to get tested.
        We will continue to do that, working with you as best we
    can.
        The Chair. Thank you. I am going to ask the indulgence of
    my colleagues. I want to just finish this up, if I can? I am
    just going to say instead of asking a question about this, I
    think that there are serious consequences if we cut off support
    for low-income countries. I believe that that is going to hurt
    us at home if we cannot stop COVID across the world.
        And one final comment to ask you about, Mr. Secretary,
    because we have put serious money into modernizing our public
    health data systems and to support the public health workforce.
    How does the budget request reflect the lessons that we have
    been taught about the importance of public health? How does it
    build on public health investments that we made in the omnibus?
        Secretary Becerra. I will thank all of you here because you
    made it possible for us to go to Americans rather than wait
    until Americans came to us to figure out how to attack COVID.
    We want to continue to do that, working closely with our
    partners locally and with our State governments.
        But we need to be able to have the resources to provide
    them something, whether it is the data--and by the way, on the
    data, as much as we need money, we also need authority. There
    are some States that do a great job of providing this data on
    where they stand.
        The Chair. That is interesting.
        Secretary Becerra. Some States don't. And it is tough when
    you have got these gaps. The more authority we have to collect
    this vital information, the better off every American will be
    in every State.
        The Chair. The authority thing is interesting, and I thank
    you again, and I apologize to my colleagues for going over.
        And with that, Mr. Ranking Member, the floor is yours.
        Mr. Cole. Madam Chair, you are the chair. You never have to
    apologize. You take the time you want.
        Just quickly, and I want to make a quick point and then
    get--I am going to talk mostly about--or ask questions mostly
    about ARPA-H.
        But remember on this COVID thing, honestly, our problem is
    a lot of stuff in the American Rescue Plan didn't have much to
    do with COVID. And we see that, at least from our side of the
    aisle, as the number-one difficulty. There is a lot of money
    out there that can be redirected here, and that ought to be one
    of the options in front of Congress.
        But I certainly agree with you, Mr. Secretary. You need to
    have it sooner rather than later, and when we have the progress
    we have had, we need to keep the pedal on the metal, so to
    speak, and keep it up. I don't want to get behind the eight
    ball here. But I also don't want to just say it is okay to send
    money out willy-nilly to States that is supposed to be for
    COVID, and it is not being used that way in many areas.
        Let me ask you about ARPA, and some of these questions, to
    be fair to you, you may not able to ask right now--or answer
    right now, and that is okay. I just want to lay these out and
    get some sense of what your initial thinking is and maybe where
    we are headed.
        Give you an example. I am just going to fire off about
    three or four things here very quickly. Some of the things that
    would come to my mind would be, literally, where is the agency
    staff going to be physically located? What is the timeline for
    coming--who is the Director going to be?
        How will the researchers be recruited for ARPA-H? I know we
    don't want to cannibalize one agency for another. How do you
    envision the grants being made?
        All this is a problem, and I do not blame this on you or
    anybody else. But the authorizing committees didn't do their
    work. Now this was the President's top priority. I agree with
    him on this. But normally, that would be--other committees
    would have wrestled with that. But if we are going to continue
    to fund this, we are going to have to wrestle with this.
        And it is particularly going to be a challenge, given the
    amount of additional resources you have asked for. I just tell
    you up front from my standpoint, I am not prepared to do that,
    even though I am for the agency, when I have no earthly idea
    who the Director is, where it is going to be located, how it is
    going to give out the grants, what it is going to do.
        I know what the NIH does in all those things, and I am
    certainly not going to do it at the expense of literally
    lowering the National Cancer Institute's budget, things like
    that. So just I don't disagree with the kind of spending you
    are talking about, but I do disagree with the division of labor
    between NIH and ARPA-H, which seems to me like it is going to
    have its hands full just getting up and running in the
    remainder of the fiscal year.
        So yield that back to you, Mr. Secretary.
        Secretary Becerra. Congressman, you have essentially asked
    the questions that we are trying to formulate answers to
    ourselves. But I will tell you that we have gone pretty far
    along. In announcing that we will have a Director that is under
    my supervision versus NIH's Director, what we are hoping to do
    is show that there will be autonomy.
        At the same time, because we want it, as you have just
    said, to be able to get up and running, we don't them to worry
    about who is going to run HR, human resources, instead of who
    is going to come up with the next innovation, we wanted to be
    able to pull on those assets, that infrastructure that is
    already in place.
        That is where NIH comes in handy. They don't have to do the
    administrative work. They don't have to do the human relations,
    the payroll work, the general counsel work by standing up all
    those different aspects of a new department or a new agency.
        What we are going to do is house it at NIH, but actually,
    physically, we are looking not to house it within NIH's own
    structures. We are going to have them separate. It is going to
    be a very lean and nimble team. It will be far smaller than
    these agencies or the institutes you are accustomed to.
        There will be program managers and including the Director
    him or herself will likely not be in the job for more than just
    a number of years, 3 to 5 years, because we want to make sure
    that everyone knows there is a clock on what you are doing.
    Unlike NIH, which does that basic research which could take a
    long, long time and who knows when it will be actually
    serviceable, what we are hoping out of ARPA is that these are
    ideas that we could harness right away.
        Again, very similar to what the Department of Defense did
    with DARPA, where the Internet that we know today came out of
    DARPA, those kinds of things. That is what we want our ARPA to
    do. But we need to make sure it is not anchored or tethered to
    doing things an older way.
        The program managers that will be hired will know they are
    on a short timeframe to get their work done, and then they move
    on. And we are going to really have to lean on the private
    sector to be partners in this because it is going to be a lean
    team that really reaches out to folks who are out there doing
    it right now, and we are going to do it with some support that
    you all give us.
        Mr. Cole. Well, I don't have much time left, but I would
    ask that you keep us apprised as you make these decisions. I
    think we all have a tremendous interest in this and want it to
    succeed but look at it with a little bit of skepticism until we
    see the structure and actually experience some success.
        So, again, we communicate well back and forth. You have
    made a priority of that. I appreciate that. I would ask you to
    keep doing that and, as decisions are made, keep us informed.
    And hopefully, Madam Chair, we will get to revisit this issue
    in later hearings.
        With that, Madam Chair, I yield back.
        The Chair. Thank you very much.
        Congresswoman Roybal-Allard.
        Ms. Roybal-Allard. Secretary Becerra, thank you so much for
    being with us today.
        For the nearly three decades I have been in Congress, one
    of my greatest frustrations has been the absence of a Federal
    commitment to improve childbirth outcomes. As the husband of an
    OB/GYN physician, I am sure you are aware that the U.S. spends
    more per capita on childbirth than any industrialized nation,
    with costs estimated to be over $50,000,000,000.
        Yet in spite of this investment, we have some of the worst
    maternal and infant outcomes in the developed world, including
    unacceptably high rates of maternal mortality and morbidity,
    infant mortality, stillbirths, pre-term births, and cesarean
    deliveries. To address these critical issues, in 2015
    Congresswoman Jamie Herrera Beutler and I formed the
    Congressional Caucus on Maternity Care. We, together with
    professional organizations and community activists, have worked
    hard to highlight the challenges of America's maternity care
    system and the need to make safe and effective maternity care a
    national priority for all women and babies.
        I extend to you a huge thank you for the $25,000,000 in
    your HRSA budget to expand and diversify the midwifery
    workforce. This Title VIII funding line closely mirrors one of
    the two provisions in the Midwives for Moms bill that I co-lead
    with Congresswomen Herrera Beutler, Katherine Clark, and Ashley
    Hinson.
        We all strongly believe midwives are a critical part of the
    solution to improving maternity outcomes, lowering costs, and
    addressing the maternity provider shortage. So I look forward
    to working with you to ensure that the final Labor, HHS bill
    will include this funding.
        Mr. Secretary, as you know, the fiscal year 2022 omnibus
    agreement includes $1,000,000 for the Office on Women's Health
    to convene an Interagency Coordinating Committee on the
    Promotion of Optimal Birth Outcomes. This coordinating
    committee is intended to institutionalize the oversight and
    coordination of Federal efforts to improve maternal and infant
    health in America.
        We believe this is the next logical step to build on recent
    Federal efforts such as the 2020 Surgeon General's Call to
    Action to Improve Maternal Health and the 2021 HHS Maternal
    Health Call to Action Summit.
        Mr. Secretary, when do you think the initial meeting of
    this committee will take place, and will you work with
    Congresswoman Herrera Beutler and me to ensure the composition
    of this committee reflects the wide range of maternity care
    programs, issues, initiatives across the Federal Government?
        Secretary Becerra. Congresswoman, first, it is great to see
    you, and thank you for your deep interest in this area. As you
    mentioned, for me, it is also very important.
        I would tell you that probably over the coming few weeks,
    we probably can get back to you on how quickly we will actually
    launch, with whom. We are right now trying to make sure that we
    have put all the correct experts on this committee. It is
    something that goes across many of the different agencies
    within HHS. So we want to make sure that we get those who are
    absolutely interested and committed to this and are the experts
    to be part of this.
        But we are more than committed to work with you and
    Congresswoman Herrera Beutler in making sure that we address
    not just the outcomes issue that we face in America for women,
    but also the fact that we are now trying to take it to the next
    level.
        Ms. Roybal-Allard. Great. Thank you.
        And how will the Office of Women's Health-led coordinating
    committee engage all of the relevant agencies to stay focused
    on concrete policies and actions to address the crises and
    challenges in the maternity care system, and how will you
    ensure this is an HHS priority?
        Secretary Becerra. By having the interagency committee, we
    are guaranteeing that we will have reports on a constant basis
    from all these experts from our different agencies within HHS.
    So we will make sure--and I will be participating as well.
        As you know, the President has made maternal health a major
    priority within his budget and his activities because we
    understand that everyone should have a chance to start on the
    right track, and making sure that both mother and baby have
    that opportunity is critical. And we are going to make major
    investments not just in this area, and by the way, midwifery is
    critical. The doula legislation that we have seen come out of
    Congress as well, all of us understand in a lot of our
    communities, the promotoras are extremely important to help a
    lot of families navigate the healthcare system.
        We are going to make that a priority, and I personally will
    make that a priority.
        Ms. Roybal-Allard. And Mr. Secretary, in order to
    specifically address our Nation's maternal mortality crisis,
    the fiscal year 2022 omnibus also provided increased funding
    for the CDC's perinatal quality collaboratives that would allow
    for their expansion in all 50 States and territories. How can
    PQCs be empowered to address the avoidable harms of cesarean
    rates that have remained appallingly high at about one birthing
    person in three for more than a decade, despite professional
    guidance that this is too high?
        Secretary Becerra. Congresswoman, I know the time has
    expired. So I will be quick and simply say we are going to do
    our part.
        We have, for example, put out a proposal under Medicaid
    that would allow a woman who is about to deliver have
    postpartum care after delivery not just for 2 months under
    Medicaid, but for a full year. Now all we need to do is get the
    States to buy into that. About five States have, but we want to
    see every State go there, and the President would like to see
    that become a permanent program within Medicaid, where every
    woman who delivers a baby under Medicaid would have up to 12
    months postpartum care.
        Ms. Roybal-Allard. Thank you, Mr. Secretary, and I look
    forward to continuing to work with you.
        Secretary Becerra. Thank you.
        The Chair. Congressman Harris.
        Mr. Harris. Thank you.
        And thank you, Mr. Secretary, for being here. And it is
    great to be back in person.
        Secretary Becerra. Yes.
        Mr. Harris. I think that is important for these hearings.
        First of all, just a few comments. I am glad to see the
    Strategic National Stockpile funding, asked for $270,000,000
    additional above this year enacted. As I have said for many
    years, we have plenty of kinetic stockpiles, we better have
    stockpiles for some of the other threats we face, especially
    given what we know about the threats of biological and chemical
    weapons being used.
        Second, I want to echo the ranking member's comments about
    the riders that were left out of the--left out of the
    President's budget. That is just completely unrealistic. These
    budgets will not pass--these appropriations bills will not pass
    through both chambers without those riders in place, and that
    is just a reality check.
        Third, I also want to comment on the ARPA-H. I have some
    concern because tethering it to the NIH administratively
    tethers it to the NIH academically and cerebrally. If we wanted
    to increase the transitional research done at the NIH, we would
    do that. ARPA-H is supposed to be a different concept, and I
    think tethering it to an existing agency might muddy that
    concept.
        The last, my remaining time, I want to take up two issues
    where the Department I think pretty clearly is not following
    either the law or congressional intent. First one is the
    surprise billing issue. This is something that I think before
    the rule came out the beginning of the year, we had some
    discussions with the Department.
        We were assured that all stakeholders were taken into
    account, and then it appears that really only insurance
    companies were taken into account. That the rule that came out,
    found illegal by a Federal court, clearly showed the
    congressional intent was not the rules that came out of the
    agency. So I hope that you are committed on the second go-
    around to actually doing what Congress intended, which is not
    to have the QPA as the basis of the arbitration, which is to
    carefully define QPA not to allow insurance companies to define
    in such ways that will further drive down the number of
    providers.
        And I will tell you in a rural area, it is hard enough to
    find providers. You drive down reasonable compensation by the
    surprise billing rules, you will find great difficulty in
    finding those professionals to practice in those rural areas.
        I want to spend the last half of my time talking about an
    issue that we have spoken about before because the last time
    you were in front of the subcommittee, I think we talked about
    the Conscience and Religious Freedom Division of your agency
    and whether or not you were going to commit the Department to
    protecting conscience.
        Sad to say, despite your assurances to both House and
    Senate, in House and Senate testimony, it is clear that is just
    not true. That urging the Department of Justice to dismiss the
    case against the University of Vermont shows the Department is
    not serious in protecting conscience. It is not serious in
    following the law.
        The Church Amendment is the law of the land. The purpose of
    the executive branch is to execute the law of the land. This
    was an egregious violation of 10 nurses' conscience rights in
    being forced to perform abortions in clear contradiction of the
    law established by Congress, and the Department decided to drop
    the case--to urge the Department of Justice to drop the case.
        And with a commitment that I think that--and I will quote
    directly from your letter in reply, ``to continue to evaluate
    the underlying complaint.'' So, in about 20 seconds, can you
    tell me how the Department is continuing to evaluate the
    underlying University of Vermont complaint?
        Secretary Becerra. I will do best I can.
        Mr. Harris. Well, then I will have to do it as a QFR
    because what I want to say is that in response to that, I filed
    the conscience and religious--the Conscience Protection Act,
    obviously supported by the U.S. Catholic Conference of Bishops
    because we think religious and conscience protection is a very
    important issue.
        I am just going to ask you, is the Conscience and Religious
    Freedom Division funded in this year's budget request?
        Secretary Becerra. Every aspect of the Civil Rights
    Enforcement Section will be funded.
        Mr. Harris. Okay. So it is--so you are asking for funds,
    and then you are just using those funds to urge the Department
    of Justice to dismiss a blatant violation of the Church
    Amendment. Now I want to just reflect that 75 percent of
    Americans believe that healthcare providers should not be
    legally required to perform abortions.
        And I will tell you, in an age--I am worried not only about
    abortions, but in an age where a Supreme Court Justice
    potentially doesn't know the definition of the word ``woman''
    and healthcare providers are going to be asked to perform
    gender mutilation surgery because some people's religious--
    according to some people's conscience, that is what it is. And
    by the way, if you have any question about what a woman is, I
    know you are not a biologist either, give me a call. I will
    tell you. It is not that complicated.
        I am greatly concerned about conscience protection, and I
    question why we are funding a Conscience and Religious Freedom
    Division in a department that is willing to use that against
    the conscience protection of Americans as the University of
    Vermont lawsuit, dropping that lawsuit showed.
        I yield back.
        The Chair. Ms. Lee.
        Ms. Lee. Good morning, Mr. Secretary. I would like to
    respond to Dr. Harris, but I won't.
        I am glad to see you. Thank you, Congresswoman Frankel.
        First of all, thank you for your tremendous leadership, and
    thank you for ensuring that health equity is an important
    cornerstone in all of our HHS efforts.
        With the support of our chairwoman, Congresswoman Pressley,
    Senator Warren, in the fiscal year 2022 omnibus, we included
    language directing HHS to submit a report that involves the
    detailed plan and proposal for the development of a National
    Center on Antiracism and Health Equity within the Department.
    And so following up on that, I would like to know the steps
    that your agency will be taking to comply with this requirement
    for its development.
        And secondly, just with regard to HIV and AIDS, I am really
    encouraged to see that the President's budget requested
    $377,000,000 increase for Ending the HIV Epidemic Initiative
    and $9,800,000,000 over the next 10 years for a PrEP delivery
    program to End the HIV Epidemic in the United States. So just
    wanted to know how you envisioned this program being
    implemented?
        Next, the announcement of the new HHS Task Force on
    Reproductive Health, the announcement, how will that be
    implemented? What steps are being taken?
        And finally, just on poverty. Congresswoman--Chairwoman
    Lucille Roybal-Allard and myself, we put into the fiscal year
    2022 approps bill directing the Secretary, yourself, to convene
    an interagency coordinating council on both child poverty and
    comprehensive supports. So I would like to know, in terms of
    your views, on the development of the implementation of this
    congressional directive with regard to children and the
    interagency council.
        Secretary Becerra. Congresswoman, great to see you, and
    thank you for all the work that you have been doing.
        Let me try to give you a bit of an answer, and please probe
    if you would like to on any of those subjects.
        First, the national center, for us that is a priority
    because we know that bad health outcomes often occur not
    because of just your health, but because of the social
    determinants around you. And so we intend to move on that as
    quickly as we can. We will keep you apprised.
        We have a team that is working on that, but that was one
    that you had us at hello in trying to do that one.
        On--if you could tick off so I----
        Ms. Lee. HIV and AIDS in terms of the HHS implementing the
    program to end the AIDS epidemic by 2030.
        Secretary Becerra. I think you would agree we are that
    close to actually finding a cure, not just keeping people a
    live, but actually finding a cure on AIDS, HIV. And we should
    go the rest of the way.
        And so you see the President's commitment to try to get us
    the rest of the way. We intend to try to fully implement that.
    We have teams at HHS that have been researching this, that have
    been implementing, that have been guiding America for a long
    time. They are anxious to be able to get the resources to let
    that happen.
        Ms. Lee. Great, great. I have a few more questions--I may
    get them to you in writing--under this issue. But on the next
    two questions, in terms of the announcement of the HHS Task
    Force on Reproductive Healthcare, which was announced, how that
    is going and being implemented?
        And finally, the children's interagency council, as relates
    to poverty and comprehensive supports.
        Secretary Becerra. Again, that council, we are in the
    process of setting that up as well. We know we have a lot of
    work to do because we see how throughout the country,
    reproductive healthcare rights of women are being not only
    enjoined, but probably undermined. And so we want to make sure
    that we are out there trying to make sure that we are
    protecting their rights under the law and making sure that
    their health is maintained.
        And so we will aggressively move on that. We will work with
    those who are interested, including those in Congress. But we
    do intend to move on that one as quickly as we can.
        Ms. Lee. Okay, thank you.
        And the final question I had was the implementation of the
    children's interagency council that Congresswoman Lucille
    Roybal-Allard and myself are working on?
        Secretary Becerra. The same there. We were given that
    charge recently, and so we are moving forward to try to make
    sure that we put in place the infrastructure to make it happen.
        Again, I think this is one of those where we have, whether
    it is at the Administration for Children and Families or any of
    our other agencies, HRSA and all those who would have a role in
    that, we are anxious to get going. We will keep you apprised
    and see who is interested in working with us on that.
        Ms. Lee. Great. One more follow-up, I have a minute and 20
    seconds left.
        Going back to HIV and AIDS. Okay, the PrEP program, in
    terms of providing PrEP medication at no cost to people who
    really need PrEP and don't have the resources, and wanted to
    find out how does coverage of PrEP and no cost under Medicaid
    fit into the administration's overall goal for PrEP?
        Secretary Becerra. So I know that--well, what I can tell
    you right now is that we are doing everything we can to do bulk
    purchases because we know for a lot of folks it is
    unaffordable. If we do bulk purchases, we can get those
    treatments for far less cost. We can then make it more
    available to more Americans.
        We also are trying to make sure we focus on those who are
    usually left behind when it comes to these types of therapies
    and treatments, and we are making sure that we reach to them. I
    would have to get back to you on how we would handle this
    within Medicaid because you know that is not a simple process
    of just turning the switch.
        Ms. Lee. Okay. Look forward to hearing from you.
        Okay. And finally, let me just associate myself with what
    the chairwoman mentioned and said with regard to our global
    COVID efforts and, in fact, remind everyone that we have got to
    have the resources for the global COVID response. There are new
    variants on the rise, and I just want to remind everyone that
    this is a very small planet. What affects one affects all. It
    is in our own interests to fund both domestic and global
    immediately.
        Thank you again.
        Secretary Becerra. We concur.
        The Chair. Mr. Fleischmann.
        Mr. Fleischmann. Thank you, Madam Chair.
        Mr. Secretary, good to see you this morning, sir.
        Secretary Becerra. Good to see you.
        Mr. Fleischmann. Mr. Secretary, I have a couple of very
    important questions. So, in all respect, I am going to ask for
    the most brief response in light of the time.
        One of the things that concerns me the most is the
    administration has announced plans to lift Title 42 within the
    next 2 months. That greatly concerns me, not only in my role as
    the ranking member on Homeland Appropriations, but this is
    going to allow tens of thousands of illegal crossings daily on
    our Southern border.
        Do you support the change in this policy, and are you
    concerned with the strain it will place on our healthcare
    system and local hospitals, which are still struggling amid the
    recovery of the COVID-19 pandemic, sir?
        Secretary Becerra. Congressman, appreciate the question.
    Let me try to get right to it.
        A lot of folks probably don't know what Title 42 is, but it
    is a law that allows us, based on public health conditions, to
    impose certain conditions within the country, one of those
    being at the border. Title 42 is based on healthcare
    conditions, and we use Title 42 to make sure we are protecting
    Americans within our country, within our borders.
        Title 42 will remain in place so long as the folks at the
    CDC and others, the scientists give us the facts and the
    science to show that in order to protect public health, we can
    and will use Title 42 to protect Americans. And so what I can
    tell you is that we constantly do an analysis of where we are.
    We will make a determination at some point as to whether or not
    Title 42 should remain in place.
        Mr. Fleischmann. Okay. So, in addition to the national
    security concerns that I would have in regard to that and the
    border crossings, you would understand the implications this
    would have for the burden on the current healthcare system?
        Secretary Becerra. I recognize everything you have said.
    You just have to remember Title 42 is based on healthcare.
        Mr. Fleischmann. Yes, sir. Okay. Thank you, sir.
        Medicare wage index. Over the past decade, well over 100
    hospitals have closed, and over the past 2 years, COVID-19 has
    made healthcare access in this crisis significantly worse. It
    is no coincidence that most of these hospitals have occurred in
    areas with the lowest Medicare wage index rates.
        Now I know you have inherited this, the administration has,
    from administrations past. It is a big problem in my State of
    Tennessee. Do you support, sir, a permanent legislative
    solution to address the problems in the Medicare area wage
    system and prevent future hospital closures, sir?
        Secretary Becerra. Big question, Congressman, but I
    absolutely understand the gist of it. What I will tell you--and
    I will try to be brief because I know you probably have other
    questions. We need to tackle this because we have seen so many
    of our healthcare workforce leave, and we need to make sure
    that they are in place not just for COVID and any pandemic, but
    we have to make sure we have a healthcare system that doesn't
    have gaps.
        And so I will tell you that whether it is Medicare,
    Medicaid, whether it is CHIP, whether it is the Affordable Care
    Act, we have to make sure that we are promoting Americans going
    into our public health workforce.
        Mr. Fleischmann. So then the answer was--my question is do
    you support a permanent legislative solution to this?
        Secretary Becerra. Show me the legislative solution, and I
    will tell you if I support it.
        Mr. Fleischmann. Fair enough. Since national minimums for
    reimbursement formulas seem to be working for the Medicaid
    program and the Children's Health Insurance Program, do you
    agree, sir, that a national minimum for the Medicare wage index
    system is needed?
        Secretary Becerra. Again, you point to a very important
    program in Medicaid. The devil is in the detail, Congressman. I
    would love to work with you on this, but the devil is in the
    detail. We have to make it work not just for us, not just for
    patients, but for taxpayers.
        Mr. Fleischmann. Yes, sir. And for the record, so that you
    know, particularly in my home State of Tennessee, the
    insufficient--respectfully, insufficient reimbursements in this
    are causing undue pressure, particularly on rural hospitals at
    a time when they are really struggling. We have seen many
    closures. So in that regard, I would ask that you and the
    administration work with us to cure this.
        Again, this was a patchwork system from the inception,
    created years and years ago. It was politicized. And if you
    will, it awards or rewards inefficiencies many times to raise
    these indexes in other areas of the country, where fiscal
    restraints and good policies tend to get punished for their
    fiscal responsibility. And that is what we see in our State,
    sir.
        Secretary Becerra. Congressman, what you have said I have
    heard before.
        Mr. Fleischmann. Yes, sir. Thank you.
        Madam Chair, I yield back.
        Secretary Becerra. Thank you.
        The Chair. Mr. Pocan.
        Mr. Pocan. Thank you very much, Madam Chair and Ranking
    Member Cole. Appreciate it.
        And Secretary, thank you so much for being here.
        Just this month, we celebrated the 12th anniversary of the
    Affordable Care Act, and I just wanted to quickly congratulate
    you on that anniversary because I know you were an instrumental
    part of those bills, making sure that got signed into law, and
    even as the California attorney general in defending those
    laws.
        A key piece of the Affordable Care Act was its protections
    from discrimination for the LGBTQ+ community seeking
    healthcare. Can you talk a little bit about how your team at
    HHS is continuing to build on these protections and further
    expanding care for this community?
        And a related question, if I can? As you know, across the
    country, many States are passing laws that harm youth,
    especially transgender youth. I want to thank you for your
    commitment to these kids and ensuring that they receive the
    healthcare they need. What kind of outreach and support is HHS
    providing to stakeholders in States where these attacks on
    LGBTQ+ youth are taking place?
        Secretary Becerra. Congressman, appreciate the question,
    and it sort of goes to the question that Congressman Harris
    asked earlier. I believe you are referencing Section 1557 of
    the Affordable Care Act law, where it provides for protections
    for Americans against any type of discrimination in the
    healthcare setting.
        We are going to do everything we can to make sure we are
    protecting people's rights that they have under law, under the
    Constitution. Whether it is the right of an LGBTQ person or
    whether it is someone who is claiming that there has been a
    violation of their religious freedom, we will do everything we
    can within our Office of Civil Rights to protect those rights
    of Americans.
        We know that there are a number of individuals and families
    that are under attack these days on an LGBTQ basis. We are out
    there trying to inform people of their rights. We are trying to
    make sure providers know of their legal obligations, and we are
    ready to step in. If someone comes forward with a legitimate
    complaint demonstrating facts of violation of the law, we will
    jump on it.
        Mr. Pocan. Great. No, I appreciate that. Thank you.
        Also one thing I think that has really been highlighted
    through COVID is our Nation's mental health. In one area
    specifically, there was a congressional initiative around the
    National Suicide Designation Act, which is going to designate a
    988 number, emergency number, to be rolled out this summer.
        Can you talk a little bit how your agency is looking at
    educating the public on that and how this budget will provide
    funding to have a broad campaign so the public can understand
    this? And again, a related question. In my State of Wisconsin,
    I think 89 percent of the calls are going from local crisis
    centers, about 11 percent get routed to the national, just how
    that support and the importance of those local crisis centers
    fits into this?
        Secretary Becerra. So, Congressman, as you are probably
    aware, suicide is the leading cause of death of young Americans
    and young adults in this country. We are in a crisis. COVID
    exposed just how much mental stress so many of our families are
    going through.
        I believe half of American parents report that their
    children are thinking of suicide. It is a crisis, and
    fortunately, the President has not only decided that it is a
    priority, but he is putting money behind it as well in his
    budget. We have invested over $300,000,000 in trying to help
    States help us patch together what is the existing set of
    suicide prevention centers that are available throughout the
    country.
        We finally--through your good work in Congress, we now have
    the ability to talk about suicide prevention by something akin
    to what we think of in terms of an emergency response. Everyone
    knows 911. If you are in an emergency, you call 911. Well, if
    you are facing a mental health emergency, now you will get to
    call 988.
        And if you call 988, we want to make sure you have got not
    just a supportive hand, but a professional hand ready to assist
    you. And so what we are doing is we are working with States
    throughout the country to make sure everyone is ready. This
    will not be a national, Federal Government-run hotline. It will
    be brought together by the Federal Government with the
    President's support for this.
        And what we are hoping to do is make sure that if you call
    988, you don't find a busy signal or you don't get put on hold.
    That you will actually get assistance. Because if you are
    reaching out at a time when you could have gone the other
    direction and just said I am just going to end this thing, we
    want to make sure that when you reach out, we are there.
        Mr. Pocan. A very important initiative. I don't think in 16
    seconds I can ask another question fairly. So I will submit
    those.
        Madam Chair, I yield back.
        Thank you, Mr. Secretary.
        Secretary Becerra. Thank you.
        The Chair. Thank you. Ms. Herrera Beutler.
        Ms. Herrera Beutler. Thank you, Mr. Secretary, for being
    here.
        And I wanted to bring up just a quick follow-up on my
    colleague's question about Title 42 and rescinding that
    authority. And you made the point that it is a health-related
    decision. And I agree with you, which is one of the reasons I
    would ask you to help us get the administration to reconsider.
        You could do a quick Google search of just drugs flowing in
    from Mexico. And fentanyl, which is a huge problem in
    Washington State and across this country, certainly on the west
    coast. Every major newspaper has stories on how this drug,
    which, as you know, is killing people, and methamphetamine are
    flowing over that border.
        And we can almost tell. I have met with my local law
    enforcement in the middle--I am I-5, Canada to Mexico. You know
    I-5. They can tell within a week of a surge, drug prices for
    fentanyl drop to $3 a pill, and we see increases in overdose
    deaths and hospitalizations.
        So I would argue that it is, in fact, a health crisis as
    well, which would give you the reason to use that Title 42
    authority to gain some more control over the border. So I just
    wanted to put that in your wheelhouse.
        And let me start by saying Congresswoman Lucille Roybal-
    Allard made several really good points about our efforts on
    infant care and maternity care. And you know that the numbers
    for the developed world, the U.S. is not where we should be on
    both of these fronts. So I do want to say I am very grateful
    that you are working to implement an extension of Medicaid for
    women during that first year of life.
        We know that most of the mortality incidents that happen
    happen within that first--happen within that first year, not
    within the first couple of weeks or 6 weeks of giving birth,
    but it is most of them happen after that. So making sure that
    that Medicaid coverage extends to that first year of life for
    the baby and the mother to treat that is incredibly important.
    We have legislation to that effect, but I am glad to see that
    the administration is moving forward with that.
        On the fiscal year 2022 omnibus package, Lucille and I were
    able to secure $750,000 for the first-ever Stillbirth Task
    Force at HHS. More than 22,000 babies are stillborn every year
    in the United States, one of the worst stillbirth rates in the
    developed world.
        Where is HHS in the process of setting up that task force,
    and how can we utilize existing programs like the Safe
    Motherhood Initiative to optimize the work of this task force?
        Secretary Becerra. Congresswoman, first, thank you for all
    the work that you and Congresswoman Roybal-Allard have been
    doing on these subjects. Small investment, big change. And I
    would--we are going to work with you on that. Thank you for
    making it possible. We are going to get to work as quickly as
    we can on some of these things.
        I can't tell you how many stories my wife has told me about
    stillbirths, as an OB/GYN. That is as devastating as it gets.
    And so we will do everything we can. We will include you. We
    are going to try to make sure everyone understands that we have
    an opportunity now to really shine a light on this and focus a
    bit more.
        Ms. Herrera Beutler. Great. Thank you.
        Switching a little bit to telehealth. One of the silver
    linings, I think, if there is that, of the pandemic was that we
    recognized that we can do telehealth and do it well.
        The biggest challenge--and for those of us in more rural
    areas, it has been a godsend. The biggest challenge I have
    heard is it has been great that CMS, there were waivers in
    place to pay for it. Will those be extended?
        And I know that there is a little bit not totally within
    your purview, but I would like to hear you for a moment just
    share what your intentions are with regard to trying to help us
    make that more permanent?
        Secretary Becerra. Well, first, I have to thank you all for
    giving us the extension of another 5 months of the authorities
    on telehealth under this public health emergency. We need more
    help because we only have certain authorities to continue some
    of the telehealth activities that we have engaged with.
        And we are hearing from all sorts of providers and families
    about what happens if they can't use telehealth. So we are
    going to do what we can. We are going to stretch our
    authorities as much as we can under law, but we do need
    Congress to help because the statutes constrain how much we can
    use telehealth. So please help us with that. Thank you for the
    5-month extension.
        Ms. Herrera Beutler. In my area, switching to workforce
    shortages, and very quickly, obviously, we don't have enough of
    anything, right? We don't have enough RNs. We don't have what
    we need. Again, this is another piece where telehealth can
    help.
        But your budget proposes a $2,100,000,000 increase in the
    HRSA workforce program. How can we ensure that we are focusing
    on the entire workforce pipeline? And how can we do this in the
    most expeditious manner possible?
        Secretary Becerra. We have explicitly, specifically
    targeted rural health as well as some of the underserved areas.
    A quick example is on telehealth, you could have someone who
    wants to do telehealth as a provider, as a doctor, but if you
    don't have good broadband, there is a really strong chance you
    are still not going to be able to take advantage of that.
        So the investments in broadband that now have been made
    available, the fact that we are trying to figure out how we
    allow that service to cross State lines as well because there
    are different standards in different States for those medical
    professionals. Not to let the old way of doing business get in
    the way. We are going to try to do all of that, but that is
    where we will need your help to give us the authorities to go
    beyond what we have done before.
        Ms. Herrera Beutler. Thank you. I yield back, Madam Chair.
        The Chair. Congresswoman Clark.
        Ms. Clark. Thank you, Chairwoman.
        And it is so wonderful to be with you, Secretary Becerra.
    And I want to thank you for this budget that puts the American
    family first and is concerned about their health and their
    security, and it is a great piece of work.
        Specifically, I want to ask you about child care. We know
    we are not going to have an economic recovery. We are certainly
    not going to have one that includes women unless we make
    investments in child care, and I am grateful for this
    administration's help with the American Rescue Plan, the
    $40,000,000,000 we were able to secure to stabilize child care.
    And we know we have to go further, and this budget does that.
        But I specifically want to ask you about the workforce
    issues. Child care providers are overwhelmingly women and women
    of color. They make an average of $12 an hour caring for our
    children, leaving too many of them in a position they can't
    care for their own. And they have lost one out of nine jobs in
    this sector.
        So, specifically, how is this budget investing in that
    workforce? Are there other things Congress can do to help
    prioritize?
        And in addition, just yesterday, I was with a healthcare
    leader from my district who was telling me about how linked in
    his hospital the nursing shortage and the shortage of child
    care is. And I specifically want to know if the $324,000,000
    for the Health Workforce Programs address the caregiving needs
    of our healthcare professionals?
        Secretary Becerra. Well, Congresswoman, first here I have
    to thank those of you who supported the American Rescue Plan
    because it made available to us billions of dollars to help a
    lot of those child care workforce participants, but also the
    families. We know that if we are able to get the child care
    proposals in the Build Back Better agenda, that we would have
    the ability to actually meaningfully tackle this, not just try
    to put a band-aid over it.
        It is tremendously important for the tens of millions of
    families who need child care. We saw women lose jobs in numbers
    never seen before because of COVID and the need to be home to
    care for kids, not being able to have a child go to school.
        And so I don't think there is any question that we have to
    make major investments in child care, Head Start. The proposals
    that have been put forward would help us go there. The
    President's budget makes additional investments into child
    care, but to really take this where we have got to go to the
    next plateau, we hope that Congress is able to get across the
    finish line in the child care proposal that is in the
    President's Build Back Better agenda.
        Ms. Clark. Thank you.
        Next, I am also grateful for your leadership in releasing
    through the ARP and the fiscal year 2021 omnibus LIHEAP
    increases, a lifeline for families in Massachusetts and across
    this country. But we know that due to Putin's war, the
    pandemic, corporate greed, prices are still going to continue
    to soar and be out of reach for way too many families.
        There is an increase of $175,000,000, and I just want to
    know how you are preparing for increased volatility in this
    line-item, and are you working with Department of Energy to
    anticipate to the best you can?
        Secretary Becerra. We are hoping to work not just with the
    Department of Energy, but with the Department of Education,
    with the Housing and Urban Development Department so that we
    can coordinate our activities. So that if there is a family in
    need, it might be energy--help with energy bills. It might be
    help with staying housed and not lose your home. Whatever it
    is, we are going to try to make sure that we are working
    together to make sure that we are tackling this.
        No doubt that the dollars that you provided previously and
    the dollars the President is requesting for LIHEAP will take us
    a ways. And the more we are able to see success in this effort
    to keep the leadership in Russia from this crazy war in Ukraine
    will help us. But we are going to meet every need we can with
    the dollars that you have given us because we know it could be
    the difference between life and death for someone who needs
    that heat or someone who has to stay away from the horrid
    temperatures in the summer.
        Ms. Clark. And briefly at the end of my time here, we know
    that overdose deaths have increased by 30 percent, and that not
    the area we want equality. Now black deaths of opioid
    overdose--due to opioid overdose are exceeding those of white
    people. And so I just am urging there is a program that we
    helped create and I led on that helps link student loan
    repayment to encourage and retain people in substance use
    providers.
        You have increased that account by $4,000,000. We are very
    grateful to your attention to this program, but we also know
    that only 8 percent of those 3,000 applicants to this STAR LRP
    program last year were able to be funded. So we hope we can
    continue to work with you to meet this need so we can get
    people the treatment they need and deserve and reduce these
    terrible rates of deaths and overdose.
        Secretary Becerra. We want to give you wind underneath
    those wings to make that happen because getting those
    professionals out there is absolutely important.
        Ms. Clark. Thank you so much.
        Thank you, Madam Chairwoman.
        The Chair. Mr. Moolenaar.
        Mr. Moolenaar. Thank you, Madam Chair.
        Good morning, Mr. Secretary, and thank you for your service
    to our country.
        One of your--within your statutory authority as Secretary
    is not only to declare a public health emergency, but also to
    terminate that decision. One of the questions I have is when do
    you plan to declare an end to this public health emergency?
    What scientific metrics will you use? Is there a specific rate
    of transmission? How will you make that decision?
        Secretary Becerra. And Congressman, I think there are a
    whole bunch of folks waiting to hear this answer. So, great
    question.
        It will be based on the science and the facts that we are
    collecting. And by the way, that goes back to the question
    about data, why it is so important to collect accurately so we
    make the right decisions. It will be based on the science, on
    the conditions we have in the health sector.
        There are a number of issues that we could--that are
    obviously floating around there, but in terms of the health of
    the Nation, where are we, and are we at a point of still an
    emergency? We are in the process over the next couple of weeks
    of getting ready to review again if we should continue the
    public health emergency forward.
        We have also made a commitment because we know providers
    are counting on us, whether it is on the telehealth issues, to
    continue to have authorities to use telehealth or not. A lot of
    providers are relying on our extended authorities to do things.
    And so we have committed to try to give people at least 60
    days' notice if we think we are going to take down that
    emergency declaration.
        Mr. Moolenaar. Okay.
        Secretary Becerra. What I can tell you is in the next
    couple of weeks when we review it, we will assess the facts,
    science, and make a determination. But we do hope to be able to
    give people at least 60-day notice.
        Mr. Moolenaar. Okay, thank you.
        And then, with respect to the mandate, CMS has a mandate on
    vaccines. You had mentioned the workforce issues. Are you aware
    that people are leaving as healthcare workers because of this
    mandate, and shouldn't we be allowing the medical professionals
    to make that decision of how best to protect themselves and
    their patients?
        Secretary Becerra. I think we always want to work with and
    respect what the experts in the medical field are telling us we
    should try to do. We do follow the experts that we have at CDC,
    NIH, FDA, and what they have told us is that keeping people
    safe and especially in a medical setting like a hospital, a
    nursing home, requires us to do--use every precaution we can,
    whether it is a vaccine, whether it is a mask, whether it is
    the social distancing or the sanitary conditions.
        And so when it comes to the provisions that we put out
    there in some cases requiring folks to use masks, requiring
    them to get vaccinated, it is for the protection of the
    American people.
        Mr. Moolenaar. But are you aware that is actually creating
    workforce issues where we are losing healthcare workers, the
    people who have been on the frontlines, heroes, who are
    deciding to leave rather than submit to this mandate?
        Secretary Becerra. Congressman, I have heard some of those
    stories. I would simply say if you are one of those heroes, one
    of the ways you become a hero is by making sure the people you
    are treating are as safe as they can be. And if you are not
    vaccinated and by chance you contract it, even if you show no
    sign of the illness, you might pass it on to somebody.
        Mr. Moolenaar. But that is true even if you are vaccinated.
    Correct?
        Secretary Becerra. Less likely to happen if you are
    vaccinated. Far more likely to happen if you are not.
        Mr. Moolenaar. I recognize your commitment to vaccines,
    vaccination. One of the concerns that has been raised is about
    the level of commitment to therapeutics and making those
    available, approving as many safe possible therapeutics. Are
    you committed to that?
        Secretary Becerra. Absolutely. Can I give you a bit of an
    extended answer? Right now, a vaccine likely costs us about $25
    to $30 to make available to Americans. Those antivirals, those
    alone, those therapeutics probably cost us somewhere between
    $500 to $750 to $1,000 a treatment.
        Those monoclonal antibodies are costing us in the several
    thousand dollars a piece. Thirty dollars versus several hundred
    dollars versus several thousand dollars. One might keep an
    American from contracting COVID. The others are trying to keep
    them from dying from COVID.
        We would rather do the--as we say in Spanish, ``mejor
    prevenir que remediar.'' Better to prevent than to remediate.
    If we spend the $30 to prevent it, rather than pay later, pay
    now $30 than pay later hundreds or thousands of dollars per
    American, we think it is a smart investment.
        But we are going to have the therapeutics available, and
    that is why we need some funding from Congress.
        Mr. Moolenaar. Just so I know, the President recently
    received a booster on television. How often is he going to need
    a booster? How often are you going to recommend that to the
    American people?
        Secretary Becerra. That is up to the scientists and the
    medical professionals. But just as we get vaccinated for flu on
    a constant basis, what we are finding is that COVID is a--it is
    a treacherous animal, and it is hard to control. We will do
    what we can to keep Americans safe, and we will make sure that
    if we give them a medicine, a vaccine or therapy, it will also
    be safe.
        Mr. Moolenaar. Thank you.
        Secretary Becerra. Thank you.
        Mr. Moolenaar. I yield back, Madam Chair.
        The Chair. Ms. Frankel.
        Ms. Frankel. Thank you, Madam Chair.
        First, I want to just thank all my colleagues for the
    bipartisan approach in getting this budget done. With that
    said, I want to just say this, that compromise does not only
    always mean agreement. In my opinion, without any personal
    disrespect to any member, the Hyde Amendment is not wise. I
    think it is unjust and cruel, and I believe it takes away the
    freedom from people to make the most personal decisions that
    they can have, and it hurts the people who have the least
    amount of resources.
        Let me just also just add that no patient should be denied
    the care they need, and I appreciate the administration's
    position on that.
        So let me just add my thanks to your proposed budget. The
    funding for--increased funding for Title X, child care--that is
    reproductive care--to child care, maternal health, mental
    health. And I think it is very important that not only are we
    helping people take care of themselves, but we are reducing the
    costs for people so they can take care of themselves. And I
    would like to just say that I think the best defense for this
    country is to have a strong economy and have people live well.
        I have a couple of questions. Thanks to the--and thank you
    for being here. Thanks to the Affordable Care Act, there is a
    contraceptive coverage requirement really allowed millions of
    people across the country to really to afford contraception,
    but we have been hearing lots of stories that health insurance
    companies are not complying with the law.
        So, for example, they pick a couple of products that a
    consumer can use, a patient can use, and not others. Or they
    are actually requiring payment and cost-sharing. I wanted to
    know what the Department is doing to ensure that every plan
    subject to the ACA's birth control coverage requirement is
    complying with the law.
        Secretary Becerra. Congresswoman, thank you for the
    question.
        I have experience with this not only as the Secretary, but
    as the former attorney general in California, where we moved to
    make sure that women's rights to contraception coverage were
    protected. As the Secretary, we have been working jointly with
    the Department of Treasury as well as the Department of Labor
    to make sure that there is clear guidance to providers on what
    they are obligated to do when it comes to providing healthcare
    services to Americans.
        We will continue to make the case that under the ACA,
    individuals, including women, are entitled to certain
    protections and services, including contraception coverage. And
    if someone points out to us a case where there is a provider
    that is violating the law, we are prepared to take action as
    well.
        Ms. Frankel. Thank you for that.
        And this is an issue that I hope Mr. Cole is going to join
    me in in vigorously tackling. He is smiling. He knows what I am
    going to talk about.
        Each year, there are about 36 million falls reported among
    older adults, and it is amazing what it costs our health
    system. Not only cost to the individuals themselves, just in
    terms of their physical, mental health, and their pocketbook,
    but it costs us over $38,000,000,000 for Medicaid and Medicare,
    and then another $12,000,000 just in private insurance costs or
    out-of-pocket costs.
        I was astonished in researching this that the Federal
    Government only invests a few million--CDC $2,000,000, I think
    it is--in fall prevention programs. I want to thank our
    chairlady because I know we are going to have a hearing on
    this. I was just wondering whether you all are doing any work
    to look at this?
        Secretary Becerra. So we right now have our National
    Institute on Aging, the CDC, which you mentioned, as well as
    our Administration for Community Living, those three agencies
    within HHS have been working on these issues. We work with the
    States and the local health authorities there to figure out how
    we can invest in some of these activities.
        But Congresswoman, as you know, at the Federal level, we
    don't usually try to figure out which program is best and give
    the money to that program. We work with the States to let them
    decide locally which are their best programs. We try to
    support, make investments in those programs, and we have done
    some of the research. We try to provide that to the States, and
    then, working together, we hope that with the resources that
    you made available to us that we make available to them, that
    they will make investments in those types of activities.
        Ms. Frankel. All right. Well, I look forward to further
    discussion on that.
        And Madam Chair, I yield back.
        The Chair. Mr. Cline.
        Mr. Cline. Thank you, Madam Chair.
        Thank you, Mr. Secretary, for joining us. It is good to
    have you with us. It is good to be in this room in person, and
    I am pleased to be a new member of the committee in this room.
        But you talked about facts and science guiding your
    decisions when it comes to Title 42, for example, which I would
    advise we should not repeal. I think it is a policy that is
    necessary to protect the public health, and I would urge you to
    continue to enforce it.
        But I want to talk about a different subagency that you
    have, the CDC, and allowing politics to override policy and
    science. A report of the Select Subcommittee on the Coronavirus
    Crisis revealed that the CDC allowed the American Federation of
    Teachers to rewrite critical portions of the Biden
    administration's school reopening guidance. The CDC initially
    planned to issue guidance that would have been more favorable
    toward opening schools but reversed course after consulting
    with teachers union bosses, giving favorable treatment and
    access to teachers unions instead of parents and ignoring
    science and the necessity of opening our schools.
        And we see what that resulted in. Not just lower test
    scores for our children, but also increases in depression
    rates, increases in suicide rates, increases in drug and
    alcohol addiction rates, increases in domestic violence in the
    home.
        So let me ask you first, Mr. Secretary, were you in contact
    with the American Federation of Teachers about these
    guidelines?
        Secretary Becerra. Congressman, I would love to probe what
    you said but----
        Mr. Cline. ``Yes'' or ``no'' would be perfect.
        Secretary Becerra. I have not been in direct touch with any
    particular stakeholder just on those guidelines itself. We have
    done numerous stakeholder meetings with all sorts of
    organizations, individuals, governments on the issues because
    that is what we always do is whether it is CDC or us, we always
    consult with everyone that might be impacted.
        So along the way in formulating any proposal, we speak to
    anyone who might be impacted.
        Mr. Cline. So the answer is ``yes'' to that.
        Secretary Becerra. I didn't say that that was the answer. I
    said we speak to every--if you want to characterize it
    properly, Congressman--and having been in your seat before, I
    would make sure no one gets misquoted.
        Mr. Cline. I would love a ``yes'' or ``no'' answer to that.
        Secretary Becerra. I have--we have sat down with every
    stakeholder who has asked us on those particular issues.
        Mr. Cline. Okay. And that includes the AFT?
        Secretary Becerra. I am pretty sure it has.
        Mr. Cline. Okay. Is it Department policy to keep draft
    guidance confidential?
        Secretary Becerra. Draft guidance is within the internal
    operations of the Department.
        Mr. Cline. Right. And historically in the CDC, draft
    guidance has been kept confidential. Correct?
        Secretary Becerra. Well, it is an internal document. It is
    not something for public consumption because it is not yet
    ready for prime time.
        Mr. Cline. Right. So sharing it, as testified to by the
    Director of the CDC for the Select Coronavirus Crisis Task
    Force, they testified that it was unusual to release that
    guidance to an outside group?
        Secretary Becerra. I am not sure I would characterize what
    happened as you have, but what I will tell you is in consulting
    and meeting with stakeholders, we certainly give them some
    sense of what we are looking at and ask for their guidance. How
    much actually translated into what you have described? That is
    where I think the facts have to answer that question.
        Mr. Cline. Are you aware of other cases in which the CDC or
    any other agencies under HHS have incorporated language from
    outside stakeholders?
        Secretary Becerra. We certainly--as I said, we offer every
    stakeholder an opportunity to comment, whether it is a formal
    rule that we are getting ready to promulgate or whether we are
    looking to have a guidance. We always reach out. Every
    administration has, at least I hope they have, to have those
    who might be impacted to get their input.
        Might their input help us shape the final version of that
    guidance or rule? I would hope so because we are supposed to
    listen to the American people.
        Mr. Cline. Okay. Moving forward, would you commit to citing
    those outside partners who are--who may have been consulted in
    the development of these guidelines?
        Secretary Becerra. Congressman that is all public record.
        Mr. Cline. When you are developing these guidelines, you
    just told me that it is policy to keep draft guidance
    confidential.
        Secretary Becerra. Oh, the draft guidelines, anything that
    is still internal is internal. But when we reach out to
    stakeholders that is publicly available.
        Mr. Cline. Are you committed to listing those stakeholders?
        Secretary Becerra. Again, as I said, it is already publicly
    available. Those meetings are in the public domain.
        Mr. Cline. And citing them in the development of these
    types of official guideline?
        Secretary Becerra. If you take a look at regulations when
    they are issued, they will note the comments that have been
    received, and we usually have--try to be responsive to most of
    the comments that we receive as we are getting ready, for
    example, to promulgate a rule. So, again, that information that
    comes in from the public, when we react to it, you will see it
    in writing.
        Mr. Cline. Well, you didn't cite AFT when you put out those
    guidelines for school reopening. So I would encourage you to be
    more forthcoming.
        Secretary Becerra. You have reached a lot farther along
    than what I am saying we have done.
        Mr. Cline. You are talking about regulations. I am talking
    about guidelines where you neglected to disclose that the AFT
    edited the guidelines, on the orders of the White House, and
    put them forward as CDC guidelines and neglected to release the
    fact that the AFT altered those guidelines.
        And I am asking you if you would commit to publicizing the
    fact that you allow politics to override science when it comes
    to your guidelines?
        Secretary Becerra. Congressman, it would be tough for me to
    respond to that because I don't agree with the premise that you
    have just laid out.
        Mr. Cline. Well, I don't agree with what your CDC did in
    promulgating those guidelines. Children died because of that.
        I yield back.
        The Chair. Mrs. Watson Coleman.
        Mrs. Watson Coleman. Thank you, Chairman.
        Secretary Becerra, it is so good to see you. It is so good
    to hear the good things that are happening, and let me also
    echo that I think our budget is moving--your budget requests
    are moving in the right direction, even though I would like to
    see some more things in some places.
        From a general perspective, I am very interested in all of
    those issues from mental health to suicide to maternal health.
    I am particularly concerned how all of those issues impact
    black women and the black community and black children. Because
    as we all know, unfortunately, in this country, we represent
    the bottom of the heap when it comes to the direness of all of
    these issues.
        So I am going to ask you some questions about that, but
    before I do, I want to ask you about something that is very
    disturbing to me. Recently, the CMS drafted--made a decision
    impacting the access to Alzheimer's disease medication. And
    this decision is delaying the availability of that medicine,
    even though the FDA had already taken it through its procedures
    and had deemed it ready to be more available.
        And so I am wondering is there some miscommunication, is
    there some new authority that CMS has? Does this represent a
    redundancy? Are you at all aware of it, and do you have a
    thought about addressing this issue? Because Alzheimer's
    disease is something that is just so devastating to our various
    communities, and the sooner we can get a handle on it, the
    better.
        Secretary Becerra. Congresswoman, first, I couldn't agree
    with you more. I think all of us believe that in the near
    future, we will probably see medicines and therapies that will
    help us tackle some of these just devastating conditions and
    diseases like Alzheimer's. And we want to be there. I think all
    of us would like to make sure we are there as quickly as we
    can.
        And for that, we have to make sure we have got the science
    coming along with us because we want to make sure that we are
    telling people we are giving them the treatment, the medicine
    that will help either cure them or stabilize them and not harm
    them.
        And so remember that FDA has to operate and does operate
    under a different set of rules than does CMS. FDA has to tell
    us if they think there is a treatment out there that might be
    safe and effective and under what conditions, and FDA gives a
    conditional approval to Aduhelm to provide some treatment for
    some individuals who might be on the stages of--into the early
    stages of Alzheimer's.
        CMS has to make a very different determination. Whether or
    not, now that FDA has moved on a conditional basis, that all
    the 65 or so million Americans who receive Medicare services
    would qualify to receive Aduhelm and have it reimbursed or have
    their doctors and providers get reimbursed for having provided
    it. Two very different things. Two very different analyses.
        One had--FDA had----
        Mrs. Watson Coleman. However----
        Secretary Becerra. I am sorry.
        Mrs. Watson Coleman. Can I interrupt you? Because I have so
    many other questions.
        Secretary Becerra. Yes.
        Mrs. Watson Coleman. It seems to me that the FDA is relying
    on--that we rely upon the FDA on the science, on the efficacy
    of the therapy or the medication, and CMS makes a determination
    as to whether or not it should be covered. The latter is
    important, but the former is the determination in my mind as to
    whether or not that medication should be available.
        My understanding is this is an unusual step for CMS to get
    into after FDA, and I would like to have more information on
    that. I did send you a letter on that. I am looking forward to
    a response on that. Maybe we can't answer it at all today, but
    I get it that there is two lanes. But it looks like there is an
    unnecessary crossover through CMS into a lane that isn't theirs
    to be in in the first place.
        But moving on, I am concerned about an issue that you all
    have been touching upon. We know what is happening with mental
    health issues in all of our communities. I am particularly
    concerned about mental health and suicide and those things that
    affect black youth, black women, black men. Other sort of
    underserved communities.
        I am interested in 988 being made publicly available and
    diverse in who answers that phone, who has the capacity to
    answer those questions, and making sure that everyone--and I
    want to know what you all are doing to make sure that there is
    wide knowledge of it and diversity in it.
        And I also want to know one last thing, and that is that we
    really have experienced an amazing impact on children and
    adults through this pandemic. One thing that I see that I think
    we need to give greater attention to is the children who have
    lost their protector, the person who has taken charge of them,
    who has cared for them, who has paved the way for them up as a
    result of this COVID.
        And I think that we need to be looking at what are the
    long-term needs and how do we pay for those long-term needs so
    that those children have adequate mental health support, as
    well as any other support that they need?
        I see that all the red lights are zero, zero, zero, which
    means that I am out of time. But I have given you kind of a
    flavor of where I am and where my concerns are, and I certainly
    will follow up with some additional questions to you in
    writing.
        Thank you so much.
        I yield back.
        Secretary Becerra. Congresswoman, you have never stopped
    letting me know where you are. So that is good.
        The Chair. Congresswoman Lawrence.
        Mrs. Lawrence. Hello. Thank you so much for being here. So
    good to see you. I have called you a lot of things--colleague,
    and now I call you my Secretary.
        I want to commend the Department for more than
    $250,000,000, including $8,000,000 to Michigan's Department of
    Health and Human Services, to expand and restore access to
    affordable Title X family planning. I just want to thank you
    for that.
        As previously noted, the COVID-19 pandemic has undoubtedly
    had an impact on the mental health of our children across this
    country. I have a unique passion for protecting foster youth,
    which they are no different.
        Earlier this year, I led a bipartisan, bicameral group of
    my colleagues, urging your Department to determine what
    resources States and territories need to ensure that every
    child can have access to timely mental health services in
    foster care. And we know that the CFSRs provide an opportunity
    to review State child welfare systems. This includes assisting
    the States by ensuring children and families achieve positive
    outcomes.
        However, in order to fully understand the work, we need
    updated data to reflect the number of mental health screenings
    and the frequency in which they are conducted. So, Secretary,
    today I am asking if you will commit to reviewing the letter
    from me and my colleagues and the critical information in
    forthcoming CFSRs?
        Secretary Becerra. Congresswoman, first, thank you for your
    devotion to this issue. We are going to make a special emphasis
    within the Department on foster care. Because of the resources
    you all have made available, we can actually try to take States
    to the next level because we know that they are behind on their
    assessments.
        Mrs. Lawrence. Yes.
        Secretary Becerra. They haven't been providing the right
    data. We have talked about how valuable data can be. Bad inputs
    produces bad outputs, and so we are going to try to do as much
    as we can. If you get to the point of getting this Build Back
    Better, I will tell you that we will have an opportunity to do
    far more.
        But we are going to do what we can because we know in the
    foster care system, we are seeing too many of our young people
    age out and then really be in trouble. And so we would love to
    work with you further on this, and thank you for that letter.
        Mrs. Lawrence. Thank you so much.
        Also, the pandemic has worsened America's maternal
    mortality crisis. I am encouraged that the President's budget
    is reflective of putting resources into it. Last year, I
    introduced the Doula for VA Act to create a pilot program at
    the Department of Veterans Affairs providing veterans the
    access to doulas, which they have been denied.
        So, Secretary, can you explain to me how the President's
    budget will grow and diversify the doula workforce as well as
    other proposed maternal health pilot programs?
        Secretary Becerra. And Congresswoman, thank you for the
    question.
        As you have heard in some of the previous responses I have
    given, we are making maternal health a major focus. There is no
    reason why a woman in this country today should die as a result
    of birth of a child. Even worse, of course, for the child as
    well now going without his or her mother.
        And so we are going to do everything we can. We are
    encouraging States to join us. I mentioned the program where we
    are going to expand access to postpartum care to one full year
    instead of just 60 days. But we need States to buy in. So I
    would encourage you to go back home and chat with your folks in
    your State of Michigan.
        Mrs. Lawrence. But I wanted to specifically encourage you
    to incorporate doulas. We know, especially in low-income areas,
    sometime the doulas that are in the community are the only
    support system that can help nurture a woman through her
    pregnancy and post pregnancy.
        So my ask specifically is for please--and continue what you
    are doing--and I am going to continue fighting, but I know how
    important a doula component is to ensuring maternal health.
        Secretary Becerra. You all are moving us in that direction
    through some of the legislation that has been proposed. We
    understand the importance of some of the paraprofessionals. You
    don't need to have an OB/GYN like my wife in order to provide
    good care.
        Mrs. Lawrence. Right.
        Secretary Becerra. In fact, she is one of the first ones
    who will tell you that if you get a person who can give
    guidance to that woman during the 9 months of pregnancy, we are
    all going to be better off.
        Mrs. Lawrence. And I want to just remind while I have these
    2 seconds is that foster children are wards of the court. It is
    on our dime and our responsibility to take care of them. They
    have been through more trauma than most adults, and our
    commitment to them through their mental health is extremely
    important.
        I thank you, and I yield back.
        The Chair. Thank you.
        We have been through with the first round. What I would
    like to do is proceed to a very shortened second round of
    questions. Secretary Becerra has a hard stop at 12:30 p.m.
        So I am just going to say it is your question and allowing
    time for the Secretary to answer, we are talking about within
    the timeframe of about 2 minutes. So if we can. So we want to--
    and thank you. Thank you, Secretary.
        Let me begin by just saying that we have a shift in how we
    respond to behavioral health these days. I think the 988 will
    be able to direct calls to behavioral health and would deal
    with mobile crisis teams and be able to respond to these
    crises. And these teams are being set up around the country.
        We funded these teams in two ways last year. We created a
    new pilot program at SAMHSA. We funded several community
    project requests for members who wanted to support these teams
    in their own communities, and they are composed of people who
    are trained with medical care.
        An individual experiencing behavioral healthcare crisis
    needs that versus law enforcement. We did a hearing here on
    that several months ago, and the result has been they are
    spread all over the country. Now we are going to implement this
    program.
        How does the request--I am concerned about States that do
    not have a robust crisis care and want to be able to follow up
    on how we are going to make sure that this new system in place
    is really working and so forth. And how are we going to ensure
    that the individuals are going to be linked with that care?
        Secretary Becerra. Madam Chair, we just did another
    stakeholder meeting on this. We have done several on this. We
    are doing everything we can to shepherd this within the States.
    I just finished having a conversation when I was in Colorado
    with one of the leaders, executive leaders at the Western
    Governors Association, reminding them that we are ready to work
    with any State and any governor who wants to work with us to
    make sure that they are ready to go.
        We don't want anyone to be at the back of the bus when it
    comes to how you handle this. And so we are doing everything we
    can. We are providing resources.
        I will say to you, and I say this to each and every member.
    Help us make sure that your States are ready. Because we can't
    dictate to them everything. We are trying to use the carrot,
    but the stick comes when some kid calls and ends up with a busy
    signal.
        The Chair. Right, right. Thank you.
        And we need to deal with resources, but we need to deal
    with the oversight to make sure it is happening.
        Secretary Becerra. Absolutely.
        The Chair. With that, I recognize Congressman Cole.
        Mr. Cole. Thanks very much, Madam Chair.
        Mr. Secretary, I want to go back very quickly to this issue
    of additional money for COVID relief because I have very little
    quibble with what the Department is asking for in terms of what
    the purpose is going to be. Do you have a clear understanding--
    because we get all kinds of figures that are hard to nail
    down--about how much unpurposed money there is in specific
    accounts and what have you that could, if we could come to an
    agreement, be diverted to give you the resources that you need
    to tackle the problem as quickly as possible?
        Secretary Becerra. Unpurposed, the numbers are fairly small
    in most cases. The Provider Relief Fund, for example, we have
    reached almost the $186,000,000,000 that was made available.
    There is some still available that is kept to make sure that we
    didn't miss any particular claims, didn't do them right.
        There was some money that was going to be used, for
    example, for testing. We are going to probably have to figure
    out if we can reprogram, but most of that money, as far as I
    can tell, has been purposed.
        Mr. Cole. Is there money--and look, these are never popular
    decisions to be made. I get that. But it is going out the door,
    particularly to State governments. It is not being used for
    COVID. It could be repurposed, quite frankly. And that is a
    political problem for us, but just my understanding is there is
    quite a bit of that there.
        I had very little problem, honestly, with the
    administration proposal or the legislative compromise on the
    COVID package that was stripped out. Fine. Let us take that
    money from these States where I know it is not being used for
    this. This is more important. Let us do this. And I am sorry
    that that honestly wasn't part of our package.
        Moving forward, I think we ought to revisit that, find
    another way legislatively, you know, not to bore everybody with
    this stuff because everybody here knows it. But that came down
    on what is called a rule vote. It wasn't a vote of the
    substance of the policy. We didn't disagree with you on the
    policy.
        So if you could help us at least get a clearer vision of
    what is available, it is our decision, not necessarily yours.
    But I do think this funding issue is going to get in the way of
    letting you do the things that I think you know need to get
    done as a department and that we don't disagree with you. We
    just got to use some of this other money that was not directly
    COVID related that went out the door.
        Secretary Becerra. I appreciate the way you framed it.
        Mr. Cole. Okay, thank you very much.
        Yield back, Madam Chair.
        The Chair. Congresswoman Roybal-Allard.
        Ms. Roybal-Allard. Mr. Secretary, as you know, every year,
    4 million babies are born in the United States, and nearly
    every one of those infants is screened by newborn screening
    programs for certain serious or life-threatening hereditable
    disorders and medical conditions that can be treated. And on
    average, newborn screening saves or improves the lives of more
    than 12,000 babies each year.
        My Newborn Screening Saves Lives Act passed in 2008. It was
    reauthorized in 2014, and we are currently working to get the
    House-passed 2021 reauthorization bill also passed in the
    Senate. The Newborn Screening Saves Lives law established
    national newborn screening guidelines. It ensured the quality
    of laboratory newborn screening tests and established grants to
    help States expand and improve their screening programs. Also
    to enable them to educate parents and healthcare providers and
    improve follow-up care for infants with a condition detected
    through newborn screening.
        The subcommittee has recognized the critical role that both
    the CDC and HRSA programs play in protecting our children and
    has been providing generous increases to them each year,
    including $25,800,000 for the HRSA program and $23,000,000 for
    the CDC quality assurance program in last year's House bill.
        Unfortunately, in the final fiscal year 2022 bill, both of
    these programs received $19,000,000 appropriations for fiscal
    year 2022. While this funding is, in fact, significant, it
    unfortunately falls short of what is needed to meet the needs
    of the CDC and HRSA screening programs.
        I applaud the President's commitment to advancing maternal
    and child heath, but I was disappointed to see that he
    requested $19,000,000 for both the HRSA and $19,000,000 for CDC
    newborn screening programs for fiscal year 2023. I hope that I
    can get your commitment to work with me to ensure the viability
    of these critical screening programs through robust funding in
    the final fiscal year 2023 appropriations bill.
        And my hope is that until this law is authorized, that you
    will ensure that the lifesaving programs continue, and the
    Secretary's Advisory Committee is able to make its critical----
        The Chair. The gentlelady's time has expired.
        Ms. Roybal-Allard. I just need a ``yes'' answer.
    [Laughter.]
        The Chair. I understand that. So got to get to ``yes.''
        Secretary Becerra. Madam Chair, I want to give a straight
    ``yes,'' but what I have to say is that the funding levels that
    we put in, again, as I mentioned before, were based on what we
    thought we were going to have based on the continuing
    resolution.
        So we are absolutely committed to this. The President has
    it in his budget, and CDC is committed to this program.
        Ms. Roybal-Allard. Thank you.
        The Chair. Thank you. Congressman Harris.
        Mr. Harris. Thank you. Thank you very much.
        Briefly, I just want to ask about the expansion of fetal
    tissue research at HHS because this is--I am curious about
    this. Because the Trump administration did not ban fetal tissue
    research from extramural researchers. What they just said is
    you have to come before an ethics advisory board.
        Now, interestingly enough, 13 of the 14 research proposals
    that came before that board actually were found not to pass
    muster at the ethics advisory board. What is the thinking
    behind not requiring--and again, I served on the special
    Investigative Panel on Infant Lives. Some atrocities were being
    committed at clinics with regards to making profit from selling
    baby body parts.
        That is what the panel found. You can read it. Google it,
    read it. What is the thinking behind not requiring an ethics
    advisory board just to review these research projects that
    would use fetal tissue from aborted fetuses?
        Secretary Becerra. Congressman, I am going to be real
    honest with you. That was not one issue I am prepared to
    respond to because I don't know the details of it, but we can
    get back to you.
        Mr. Harris. I would greatly appreciate that. Again, now for
    intramural research, the Trump administration did ban it, and
    one might argue that, well, maybe you should just have an
    ethics advisory board for that, too. But my particular
    question--and I appreciate you getting back to me--is about the
    extramural research.
        Because some of the things that came out of University of
    Pittsburgh, you can read about some of those experiments. I
    just think these should go to ethics advisory boards and let
    the chips fall where they may.
        Thank you very much.
        Secretary Becerra. I appreciate that, and I will get back
    to you. But I know that there are standards and protections in
    place, but let me give you a thorough answer.
        Mr. Harris. Thank you very much. I yield back.
        The Chair. Ms. Lee.
        Ms. Lee. Thank you very much.
        Mr. Secretary, following up on our discussion, and you were
    there with our beloved, the late supervisor Wilma Chan during
    your visit to my district, my colleagues and I sent a letter--
    and this was something we discussed--to HHS to lead the
    National Food as Medicine pilot program using food as medicine
    in a clinical setting to help our healthcare system improve
    health outcomes for the underserved. And our colleague,
    Congresswoman Chellie Pingree, who serves on the Ag Committee,
    along with myself and our chairwoman, has championed the Food
    as Medicine for many, many years.
        So this pilot would be modeled after the work being done in
    my home county, Alameda County, as part of the county's ALL IN
    Recipe4Health initiative. But our intent, though, is that we
    establish a national pilot program that could expand the
    efforts of this program to integrate healthcare, regenerative
    agriculture, economics, and the environment to improve health
    and racial equity and food security.
        And so I would like an update from you on your plans to
    look at this as a national pilot, to develop a national pilot
    for this.
        Secretary Becerra. Congresswoman, first, thank you for
    pushing that. Secretary Vilsack and I have had some
    conversations about how the Department of Ag and HHS can work
    together on this issue because we agree completely that food
    should be considered medicine. And so we will follow up with
    you on some of the details on what we are doing.
        By the way, we hope you will join us in the work we are
    trying to do to reduce sodium in our food products. You can buy
    a bag of potato chips in the U.S., and it is probably twice as
    much sodium in it as it does the same product in Europe. And we
    have to make sure that we are not the place where some of these
    manufacturers try to entice us into getting some of these
    things that aren't good for us.
        So I look forward to working with you because we agree.
        Ms. Lee. And I would like to work with you on that. Thank
    you.
        Secretary Becerra. Yes.
        The Chair. Mr. Fleischmann.
        Mr. Fleischmann. Thank you, Madam Chair.
        Mr. Secretary, just one topic. Last year, Mr. Secretary, we
    discussed at length the issue of safely resettling
    unaccompanied minors who cross our border into ORR facilities.
        Secretary Becerra. Yes.
        Mr. Fleischmann. The safety and well-being of children
    should be of the utmost concern to the administration and to
    members of the subcommittee. In my own district, a contracted
    ORR facility was shut down last year after instances of sexual
    battery were reported to authorities.
        My question, Mr. Secretary, what since the last time we
    spoke has the administration done to better oversight and
    ensure safety net procedures throughout the contracting and
    hiring process of these ORR facilities? And sir, how will the
    President's budget request of $6,300,000,000 be used to remedy
    this issue, sir?
        Thank you.
        Secretary Becerra. Congressman, thank you for that
    question.
        Because, again, we have custody of these children who have
    come unaccompanied during that temporary period that they are
    in the U.S. And I will tell you that we are bending over
    backwards. Any time we receive a report, whether or not--we
    don't try to determine if it is true or not, we report it to
    local law enforcement. We report it to our inspector general's
    office, and we get on it.
        And as quickly as we can because, as you mentioned, most of
    these are contractors that we are working with. We make sure
    that they move to make sure if there is an instance where a
    worker has violated rights and committed some activities that
    is inappropriate, that they move on.
        And so we are doing that as much as we can, and we are
    doing everything we can to make sure we keep the oversight
    going in these places.
        Mr. Fleischmann. Thank you, sir.
        My final request is that perhaps somebody on your staff
    would get with me--your office has been working on a
    constituent issue, and I would just like a little bit of an
    update on that when it is convenient.
        I thank you, sir.
        Secretary Becerra. We will follow up.
        Mr. Fleischmann. And I appreciate your being here today.
        Secretary Becerra. Your staffer's name is--can you give me
    your staffer's name so I know how to tell----
        Mr. Fleischmann. Oh, sure. I would call Daniel Tidwell. I
    will make him famous.
        Secretary Becerra. Daniel. I will make sure my team is
    listening. [Laughter.]
        Mr. Fleischmann. I like him. Good to see you.
        Secretary Becerra. Thank you.
        The Chair. Ms. Frankel.
        Ms. Frankel. Thank you. Thank you again for being here.
        And I will follow up on this, but just for the record, I
    wanted to say that your answer to me on enforcing the
    Affordable Care Act's contraceptive coverage, it really wasn't
    the best answer. So, but I will follow up on that.
        I will ask you another question. Ninety percent of pregnant
    women report taking a medication during their pregnancy, but
    only 1 percent of clinical trials mention the word
    ``pregnancy'' or ``pregnant.'' The Congress did create a task
    force to take a look at that.
        There was a report with recommendations, and then another
    report with implementation recommendations. And I am just--do
    you know where we are with that?
        Secretary Becerra. Congresswoman, I will have to get back
    to you on that.
        Ms. Frankel. Okay. Okay, then you got two things to get
    back to me on now.
        Secretary Becerra. Look forward to it.
        Ms. Frankel. Maybe I will give you an easier question here.
    I know that your budget does have some increases on the home
    care and so forth. Can you tell us what that does and what that
    means?
        Secretary Becerra. We are going all in on home and
    community-based care. We believe that every American, whether
    they are going through an infirmity or whether they are in
    their last days, should be able to be with loved ones through
    that difficult time. And so we are making major investments in
    home and community-based care. We are going to try to increase
    the workforce and recognize that the workforce in those
    settings has to be paid decently so that they will remain in
    there.
        We want to recognize in some cases family members are the
    people who are caring, and just because they are family members
    doesn't mean they don't deserve to be compensated where
    possible. And so we are going to do everything we can to make
    sure if you can be at home, we will let you stay at home.
        You can't be at home, we want it to be in a setting that is
    as close to your home as possible. And we applaud those who are
    providing services in nursing home and other long-term care
    facilities. But to the degree that we can move care to where
    you live and where your loved ones are, that is what we will
    try to do.
        Ms. Frankel. Okay. Thank you very much.
        Yield back, Madam Chair.
        The Chair. Ms. Herrera Beutler.
        Ms. Herrera Beutler. Thank you, Madam Chair.
        I wanted to follow up on the fentanyl conversation a little
    bit. In December, the DEA issued a warning about the alarming
    increase of fake prescription medications obviously being laced
    with fentanyl. And in Lewis County, Washington, the Joint
    Narcotics Enforcement Team seized 106,000 pills suspected to be
    laced with fentanyl as of September of 2021.
        Mr. Secretary, what will you do to ensure that HHS
    continues to work not only on the treatment, but the prevention
    piece?
        And I wanted to make sure you were aware many of the
    traffickers in Mexico are targeting children via social media,
    right? So they can access these fentanyl-laced drugs. I mean,
    that is the whole new--new horrible game. What can HHS do to
    increase awareness to protect our communities?
        Secretary Becerra. Congresswoman, as you are probably
    aware, we have changed direction in terms of our strategy. We
    are not just trying to treat. We are now trying to help
    prevent. And one of the ways we do that, for example, we are
    letting go some of those taboos where forgetting about how
    things were done in the 20th century.
        A fentanyl strip, it used to be thought, well, you don't
    want to give people something that helps them test to see if
    the drug they are about to ingest also has fentanyl because you
    are just helping them take the drug. The problem, of course, is
    that too many Americans think they are taking an illicit drug
    nonetheless, but not going to kill them, and lo and behold, it
    is laced with fentanyl.
        So we are now making--we are now supporting those local
    efforts that have shown that fentanyl strips help save lives.
    And so we are going to try to do what we can to prevent that
    and then follow people through the process as well.
        Ms. Herrera Beutler. I appreciate that. I am just going to
    go out on a limb here because I know everybody in this space is
    saying we need to do things like test the drugs so that someone
    can ingest it safely. But I am not sold on the science behind
    that yet.
        I still--you know, I grew up in the ``don't do drugs.'' And
    man, I can remember the commercials. I remember the message. I
    remember those were the things we talked about, and I believed
    it. Silly me.
        And I feel like now recreational use of--in Washington
    State, by 2023, you can use meth and heroin, not just
    marijuana, in front of cops and not go to jail for it. And my
    concern is the message we are sending to the next generation.
        So I know that this is where a lot of the new talk is about
    going. But that concerns me, and I want to see science on it
    before we move in that direction.
        Secretary Becerra. And so, Congresswoman, I don't want to
    give you the impression that that is only type of prevention
    work we do. We actually devote the majority of our resources to
    actually prevent people from ever using drugs. We are working
    closely to try to keep children, especially in the middle
    schools, from getting to them. That is about the time they
    start using recreationally.
        And so we are doing a lot in that space, but we also don't
    want to forget those who are beginning to use, keep them alive,
    because hopefully we can move them in a different direction.
        The Chair. Mrs. Lawrence.
        Mrs. Lawrence. Thank you.
        I have a question. Because we are experiencing child care
    deserts. I just had a conversation with my lieutenant governor
    where, when we tour the child care facilities in low-income
    areas, there are waiting lists. And so, as we look at
    addressing and complimenting you and the President on the Child
    Care and Development Block Grant and Head Start, we need to do
    something different in those areas where we know we have
    challenges. And so can you talk to me about that?
        In addition to that, what are we doing to ensure that we
    have a workforce that can address the deserts and the shortages
    that are happening in low-income areas?
        Secretary Becerra. Congresswoman, this is where I hope I
    can convince you that my own personal beliefs and upbringing
    mean that we will have equity infused in everything we do. We
    proved that when it came to the Affordable Care Act. A lot of
    black and brown communities were not participating. We raised
    the bar when it came to the participants, and we got the
    numbers of black families and Latino families that signed up
    for health insurance under ACA to levels they have never been
    before.
        When I came into office, the number of black and Latino
    families that were getting vaccinated was well below what we
    saw for white America. Today, they are almost all at the same
    level, and that is because what we are doing is we are going to
    where they are instead of waiting for them to come to us.
        When it comes to child care, it is the same thing. Most of
    the caregivers we know are people, women of color, and so we
    are going to do everything we can to make sure we elevate those
    caregivers and that workforce at the same time we make those
    services available. So if we get the dollars to expand access
    to child care, we are going to work with States to make sure
    that they are also making sure they are providing that extra
    care.
        Mrs. Lawrence. I am going to be reaching out to you. We do
    accelerators for other type of businesses and shortages that we
    see. We need an accelerator to train professionals in child
    care, and I will want your partnership.
        Secretary Becerra. Look forward to it.
        Mrs. Lawrence. Thank you.
        Secretary Becerra. Look forward to talking.
        The Chair. Mr. Cline.
        Mr. Cline. Thank you, Madam Chair.
        And Mr. Secretary, you are committed to upholding them and
    enforcing the laws that are on the books in this country.
    Correct?
        Secretary Becerra. Correct.
        Mr. Cline. Can I get a ``yes''?
        Secretary Becerra. Yes.
        Mr. Cline. Okay. The Title X statute itself says that
    abortion is not a method of family planning, and taxpayer
    dollars should not be used to fund abortion providers. Can you
    tell me how it has come to pass that HHS is awarding $6,600,000
    in Title X funds from the American Rescue Plan to abortion
    providers?
        Secretary Becerra. So, Congressman, as you probably are
    aware, the services that are provided by a number of the family
    planning programs go well beyond just providing contraceptive
    care or abortion services. They provide the full panoply of
    services that you think of in terms of family planning.
        Mr. Cline. You don't view it as a disqualifier, the fact
    that they provide abortions?
        Secretary Becerra. If you are following the rules of the
    law and you qualify, you should be able to receive the funding.
    If you are providing family planning services, you should be
    able to get family planning money.
        Mr. Cline. Okay. I am going to move on to Title 18 of the
    U.S. Code, Section 1531. Last year, you claimed there is no law
    dealing specifically with the term ``partial-birth abortion.''
    This drew a lot of attention and was roundly debunked.
        You voted yourself against this law when it was considered
    by Congress. You repeatedly committed to enforcing these laws,
    as you just said. That extends particularly to laws with which
    you disagree, like the laws that protect the unborn. Will you
    commit to enforcing this law against partial-birth abortion?
        Secretary Becerra. Without question, Congressman, I will
    not only comply with the law, but enforce the law.
        Mr. Cline. Thank you. I yield back.
        The Chair. Thank you. I would now like to yield to
    Congressman Cole for any closing remarks he may have.
        Mr. Cole. Thank you.
        First of all, Madam Chair, thanks for holding the hearing.
    It is good to get back in person, and again, thanks for your
    hard work in getting our last year's bill done and across the
    line.
        Mr. Secretary, thank you. As always, you are forthcoming.
    We don't agree on everything. We are going to disagree very
    strongly on Hyde, and I just want to underline that triple
    fold. I respect the President to submit what budget, but at the
    end of the day, if he wants bipartisan support that is going to
    be an issue we are going to have to confront. And we are just
    not movable on this.
        I am very interested in the ARPA process, and I appreciate
    your commitment to keep in touch with this as these decisions
    are made. Count me as very skeptical that we could hit the
    administration's proposed number because I just think it is
    going to take longer to set this up and organize it than
    perhaps you envision. And I think that money would be better
    redirected toward NIH and traditional biomedical research.
        Finally, I want to reiterate again thank you, thank you,
    thank you for the bold stance that you took with respect to how
    we fund the Indian Health Service. That is a big deal. I know
    that that will actually not be a partisan fight. There will be
    people on both sides against it. I think I respect fiscal
    discipline. I just don't think it needs to come at the expense
    of the healthcare of this population when we have made
    commitments over and over again.
        And your willingness to step out front and offer some bold,
    new thinking. I don't think any other administration that I am
    aware of on either side of the aisle has ever proposed doing
    what you are proposing here. So, to my colleagues, this is a
    really big deal in Indian Country, and the Secretary and the
    administration are to be commended for it.
        So I am hopeful that at the end of the day, because it is
    sort of like the wonderful working relationship I have had over
    the years with the chairwoman, we don't agree on everything,
    but we get to a deal. And we have been able to do it seven
    times in a row, and you are very much part of this deal-making
    process obviously in this particular subcommittee. And the
    administration has to sign anything we produce. So you have as
    a big a seat at the table as anybody else.
        But I appreciate the manner in which negotiations were done
    last time, and I have had several discussions with our good
    mutual friend Shalanda Young, our new OMB Director. We are very
    proud of her, great Appropriations staffer. And frankly, she
    helped me on a number of occasions clarify, okay, this is
    really important to the President.
        And even if I don't agree with the President, what is
    important to him matters. And certainly when we have to come to
    a cooperative deal, and again, we were able to do that.
        But I just end by saying we won't always agree on
    everything, but I appreciate you being here. You have been
    accessible. You have been good to work with. You have been
    fair. You always keep your word.
        And it is a pleasure having the opportunity to work with
    you again. I look forward to it in the coming year.
        Yield back.
        The Chair. Thank you very much.
        And thank you, Mr. Secretary. It is wonderful to be with
    you in person. It was virtual last year, but this is just
    really in person. So I offer congratulations. So delighted you
    are where you are.
        I can recall so many meetings over and over again with the
    two of us, and we are so like-minded on so many issues. And
    oftentimes in our Democratic leadership meetings, we stood
    together. So I really appreciate your remarkable professional
    history and your service here in the Congress and the values
    that you hold, which is what drives you in terms of the public
    policy initiatives that you care about and you put forward.
        And I, too, will say to my colleagues that we did work
    cooperatively. In the end, we got the bill across for 2022, and
    I think we made some very, very important investments in
    biomedical research, public health, behavior health, child
    care, early learning and so many others. And that was after
    years of austerity with regard to some of these efforts.
        And what you have done with this budget is that you have
    now provided the opportunity to build on that success. And
    whether it is through public health and maternal health,
    behavioral health, all these things we talked about today, the
    NIH, ARPA-H, early childhood, et cetera, the range of issues
    that fall within the mission--and it is a mission--at Health
    and Human Services and what you do.
        We need to provide additional emergency funding. I think
    there is a morality about the COVID pandemic and that it is
    about lifesaving vaccines. It is about therapeutics. It is
    about covering the uninsured.
        And I worry about the uninsured and what will happen to
    them if there isn't a funding there. And therefore, we will see
    less people getting the tests and vaccinated, et cetera, which
    is harmful. And I think also I would emphasize our global
    efforts as well. I think we have, again, real moral leadership
    to lead there.
        What is really--this investment with people, and if I might
    just say for a moment that for years Federal resources have
    gone oftentimes to the richest 1/10 of 1 percent of the people
    in this Nation, or a number of the corporations who are the
    biggest corporations who don't pay their fair share of taxes or
    pay taxes at all.
        And for me, looking at the shift in where Federal resources
    have been going and looking at the Rescue Plan, looking at the
    bipartisan infrastructure plan, I know we will get to where we
    are going on some package with regard to Build Back Better that
    will continue this effort of looking at our Federal resources,
    that they are going to children, they are going to families.
    They are going to State and local governments. They are going
    to small businesses, and they are going to where they need with
    allowing people to have the economic opportunity for security
    in their future.
        And the budget you have presented reinforces all of those
    efforts. So look forward to working with you and with my
    colleagues both sides of the aisle as we move forward on what
    we look forward to is a strong spending bill for 2023.
        So thank you for your time. Thank you for your work. And
    thank you for your commitment and devotion to public service.
        Thanks so much. Great to be with you.
        [Answers to questions submitted for the record follow:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                              Wednesday, April 6, 2022.

       SOCIAL AND EMOTIONAL LEARNING AND WHOLE CHILD APPROACHES IN K-12
                                   EDUCATION

                                   WITNESSES

    PAMELA CANTOR, FOUNDER AND SENIOR SCIENCE ADVISER, TURNAROUND FOR
        CHILDREN
    LINDA DARLING-HAMMOND, PRESIDENT AND CEO, LEARNING POLICY INSTITUTE
    MAX EDEN, RESEARCH FELLOW, AMERICAN ENTERPRISE INSTITUTE
    TIM SHRIVER, COFOUNDER AND BOARD CHAIR, COLLABORATIVE FOR ACADEMIC,
        SOCIAL, AND EMOTIONAL LEARNING
        The Chair. The hearing is fully virtual this morning, so we
    do have a few housekeeping matters.
        For today's meeting, the chair, or staff designated by the
    chair, may mute participants' microphones when they are not
    under recognition for the purposes of eliminating inadvertent
    background noise. Members are responsible for muting and
    unmuting themselves.
        If I notice when you are recognized that you haven't
    unmuted yourself, I will ask the staff to send you a request to
    unmute yourself. Please then accept that request so you are no
    longer muted.
        I remind all members and witnesses that the 5-minute clock
    still applies. If there is a technology issue, we will move to
    the next member until the issue is resolved, and you will
    retain the balance of your time.
        You will notice a clock on your screen that will show how
    much time is remaining. At 1 minute remaining, the clock will
    turn yellow. With 30 seconds remaining, I will gently tap the
    gavel to remind members that their time is almost expired. When
    your time has expired, the clock will turn red, and I will
    begin to recognize the next member.
        In terms of speaking order, we will begin with the chair
    and ranking member, then members who are present at the time
    the hearing is called to order. They will be recognized in
    order of seniority. And finally, members not present at the
    time the hearing is called to order.
        Finally, the House Rules require me to remind you that we
    have set up an email address to which members can send anything
    they wish to submit in writing at any of our hearings or
    markups. That email address has been provided in advance to
    your staff.
        My gosh, there are so many rules and regulations here, as
    we move forward.
        I really want to welcome everyone this morning and want to
    acknowledge Ranking Member Cole and all of my colleagues for
    joining.
        And a particular thank you to our witnesses for testifying.
    Very, very excited about all of you this morning--Dr. Pamela
    Cantor, Dr. Linda Darling-Hammond, Mr. Max Eden, and Dr.
    Timothy Shriver. I will provide a more fulsome introduction
    before their testimony, but so delighted that you could all
    join us this morning for this hearing.
        American author, social critic, and educator Neil Postman
    once said, and I quote, ``Children are the living messages we
    send to a time we will not see.'' They are quite literally the
    legacy we leave behind--the legacy we leave behind us and the
    surety that everything we do continues onward, making the world
    a better place when we are gone.
        Which is why it is not only incumbent on parents and
    educators to ensure our Nation's children are primed to meet
    the challenges of the future, it is also incumbent on all of
    us, especially legislators, to ensure they are sufficiently
    prepared not only intellectually, but emotionally and socially
    as well.
        Decades of adolescent development research have shown that
    all aspects of a child's well-being must be supported if we are
    to ensure their success. The Learning Policy Institute, which
    states that, and I quote, ``A whole child approach to education
    is premised on the fact that children's learning depends on a
    combination of instructional, relational, and environmental
    factors the child experiences, along with the cognitive,
    social, and emotional approaches that influence one another as
    they shape the child's growth and development.''
        Fortunately, there are a variety of strategies that
    instructional and school leaders can employ to support the
    whole child, including social and emotional learning
    interventions. The evidence base behind these interventions is
    overwhelming. High-quality SEL programs that support students'
    social, emotional, and cognitive development result in lasting
    positive academic and life outcomes.
        Four meta-analyses conducted by CASEL and researchers over
    the past decade found that students participating in SEL
    programs showed significantly more positive outcomes related to
    academic performance and cognitive behavior. A 2021 evidence
    review by the Early Intervention Foundation found that SEL
    interventions are effective at enhancing students' social and
    emotional skills while reducing symptoms of depression and
    anxiety.
        And RAND Corporation found that there are at least 60 SEL
    interventions that have been evaluated that meet the evidence
    requirements for the Every Student Succeeds Act, ESSA, the
    elementary and secondary education law we authorized in 2015.
        In fact, the evidence in support of these interventions is
    so strong that a 2015 bipartisan report from American
    Enterprise Institute and Brookings concluded that, and I quote,
    ``The Federal Government should provide resources for State and
    local education authorities to implement and scale evidence-
    based social and emotional learning practices and policies.''
        I could not agree more. For too long, education
    policymakers at the Federal level have been slow to focus
    necessary attention and resources on approaches that adequately
    address the holistic needs of students to drive stronger
    achievement in school and beyond. And in light of the extreme
    stress and hardship our country's most vulnerable students have
    faced during the COVID-19 pandemic, these effective strategies
    are needed more than ever.
        Which is why in the first year of chairing this
    subcommittee, in fiscal year 2020, we created an initiative in
    the Labor-H bill on SEL and whole child approaches in K through
    12 education. In the recently passed bipartisan fiscal year
    2022 omnibus appropriations package, this includes $82,000,000
    for evidence-based, field-initiated SEL grants that address
    students' social, emotional, and cognitive needs within the
    Education Innovation and Research Program. It includes
    $85,000,000 for the Supporting Effective Educator Development
    Program, with a priority for professional development and
    pathways into teaching and school leadership that provide a
    strong foundation in implementing SEL and the whole child
    strategy.
        And further, $100,000,000 in set-asides for school-based
    mental health professional training to help local education
    agencies directly increase the number of mental health
    professionals in schools. And finally, there is $75,000,000 for
    full-service community schools, providing comprehensive
    services and expanding evidence-based models that meet the
    holistic needs of children, families, and communities.
        The subcommittee's work is a direct response to what has
    been recommended strategies and approaches that are championed
    by our witnesses today and was significantly influence by the
    landmark National Commission on Social, Emotional, and Academic
    Development report. We started from nearly zero for these SEL
    and whole child approaches just a couple of years ago, and we
    now have secured resources which have been, as I said, a long
    time in coming.
        And I am so pleased to have been able to work with Ranking
    Member Cole, my colleagues in the House and Senate, to be able
    to get this done. And so many of these efforts about promoting
    social and emotional learning have come from members of this
    subcommittee.
        Appropriations legislation requires negotiations and
    agreements from both parties in the chambers of Congress. So I
    am proud that our bipartisan legislation has included the SEL
    and whole child approaches initiative for the past 2 years.
        The initiative was inspired by Dr. James Comer, a
    psychiatrist at Yale Child Study Center, who worked with New
    Haven Public Schools starting in 1968. His model for child
    learning demonstrates focusing on positive school environment
    and students' social and emotional needs as necessary to
    promote their cognitive development and academic success.
        I hope that in this hearing today, we can learn more about
    the overwhelming body of evidence in support of these programs
    and the Federal support that is needed. Especially eager to ask
    our witnesses where it is that we need to go and where the
    resources are best used.
        But before we turn to our witnesses, let me yield to my
    colleague, the ranking member of the subcommittee, Congressman
    Cole, for any opening remarks that he may have.
        Congressman Cole.
        Mr. Cole. Thank you very much, Madam Chair.
        And just for the purposes of housekeeping before I get into
    my prepared remarks, I need to let you and the committee know I
    have to leave by about 11:00 a.m. or a little before. We have a
    Rules Committee meeting so we can get some stuff on the floor
    and, hopefully, get home reasonably--at a reasonable time this
    week. So I am sure you would rather me be there than here
    anyway.
        So, again, good morning, members of the subcommittee and
    certainly to our testifying witnesses. I want to thank you for
    being here today and look forward, as always, to our
    discussion.
        I will admit up front that I don't know a great deal about
    the topic being discussed today. From what I have learned,
    social and emotional learning is a curriculum or teaching
    methodology that is intended to help students to better
    comprehend their emotions and demonstrate empathy for others.
    That sounds like a good thing, indeed.
        But I also have a concern as to whether or not the Federal
    Government or this committee has any role to play in
    encouraging specific curriculum or teaching methodologies. In
    fact, the U.S. Department of Education is explicitly prohibited
    from dictating local school curriculum in its underlying
    statutes.
        And I think that is a wise decision, regardless of where
    one falls on the political spectrum. Decisions about what to
    teach and how to teach should be made at the State and local
    level by professional educators and parents who know the
    children in their communities personally, not by bureaucrats in
    Washington, DC, or by advocates outside the classroom with a
    political agenda to advance.
        Parents and children across the country are still reeling
    from what I believe was one of the biggest policy missteps of
    this pandemic. That is the decision of many, if not most, of
    our Nation's public schools to close for nearly 2 years.
        The school closures hit the most vulnerable children the
    hardest--those with disabilities, those without access to
    technology, or parents who could not help them in a virtual
    environment. Children in minority communities and those who
    have a difficult time learning through a computer screen also
    suffered. The lasting impact of the pandemic on these children
    has been profound.
        Now we have also seen concerning rates of mental health
    issues, missed preventive care, self-harm, and ongoing lack of
    engagement, not to mention lost academic and study skills. I am
    glad that the importance of in-person learning is now being
    recognized, and I am glad to see children back in the
    classroom. Perhaps this focus on social and emotional learning
    can help these children regain ground and develop a love of
    learning again.
        So, to that point, I am interested in learning from our
    witnesses today exactly what is meant, more specifically what
    social and emotional learning activities in the classroom look
    like. Because from what I have been reading, there are some
    critics of this particular approach.
        I have read the concerns that social and emotional learning
    is being used as a way to advance radical ideas about race,
    gender, and sexuality that may not be welcomed by all parents.
    And that even if some of the material is not objectionable,
    some parents continue to raise concerns about the amount of
    time that discussing feelings and current social issues as
    contrasted with the time spent focused on academic subjects and
    recovering lost ground.
        Again, I do not believe the Federal Government should be
    involved in these decisions. They properly belong with parents,
    teachers, and local school boards. But as we have this hearing
    today, I am interested in learning more about it from our
    witnesses and seeing what role the Federal Government can
    appropriately play.
        I want to thank all of our witnesses for coming before us
    today, sharing their time and expertise.
        Thank you, Madam Chair, and I yield back the balance of my
    time.
        The Chair. Thank you very much, Congressman Cole.
        And with that, I am delighted to welcome and introduce our
    witnesses.
        Dr. Pamela Cantor, founder and senior science adviser of
    Turnaround for Children. And I will just make a quick comment
    here. I have worked with Dr. Cantor in the past, and I can
    recall, if I have got this right, Dr. Cantor, you were tasked
    with taking a look at the mental health issues with regard to
    children after 9/11.
        And the work that you did--and while 9/11 certainly had
    impact on the children, but what you found, and I think the
    term you used when we spoke at that time was that it was about
    grinding poverty that had much more an effect on our children
    than almost anything else.
        So thank you for being here.
        Dr. Linda Darling-Hammond, who is president and CEO of the
    Learning Policy Institute, thank you. Thank you for your body
    of work in this area.
        Mr. Max Eden, research fellow at the American Enterprise
    Institute, and welcome to you, Mr. Eden.
        And Dr. Timothy Shriver, cofounder and board chair of the
    Collaborative for Academic, Social, and Emotional Learning.
        And I will just also say I have years and years of a
    friendship with Dr. Shriver from his days in New Haven, CT, and
    he could almost be regarded as a ``townie,'' he spent so much
    time there and working with Dr. Comer and devoted on his career
    to dealing with educating our children.
        So thank you very much for being here.
        I am going to remind our witnesses that the entirety of
    their written testimony will be entered into the record.
        And our first witness for today will be Dr. Cantor, and
    again, your full written testimony will be included, and you
    are now recognized for 5 minutes for your opening statement.
        Dr. Cantor. Thank you, Chairman DeLauro.
        If I were to ask any teacher today, ``What are the biggest
    challenges you are facing?'' the answer might be lost learning
    time or the physical and emotional wellness of your students.
    Or that you are just exhausted from the pandemic.
        What is being asked of us today are solutions to more than
    one of these challenges at the same time. Not a choice between
    them, which would be a false choice. Our education system was
    not designed to meet this moment.
        One lecture in medical school forever changed the way that
    I looked at human beings, especially children. I was taught
    that there are 20,000 genes in the human genome, yet in our
    lifetime, fewer than 10 percent will ever be expressed. Well,
    what determines what is in that 10 percent? It is context--the
    environments, experiences, and relationships in our lives.
    Context determines who we become, how and what we learn, and
    even the expression of our genes.
        The risks and opportunities in development sit inside this
    one profoundly important point, that there is no separation of
    nature and nurture, biology and environment, or brain and
    behavior, only a collaboration between them. This is why
    developmental and learning science paints an optimistic story
    of what is possible.
        Children's brains and bodies and abilities are malleable to
    experience because the human brain is a dynamic living
    structure made up of tissue that is the most susceptible to
    change from experience in the entire human body. The brain is
    also malleable over time. Most of its growth happens after we
    are born. So there are multiple opportunities to catch up along
    the way.
        The message in the science is clear. We need a new design
    for our schools mapped to the way the brain grows and children
    learn, a design that recognizes children as whole people,
    values their assets, and supports them to master critical
    knowledge and skills and to excel in many different ways.
        Whole child design combines five things--positive
    developmental relationships, environments filled with safety
    and belonging, rich learning experiences so that students
    discover what they are capable of, the intentional development
    of the 21st century skills, mindsets, and habits that all
    successful learners have, and integrated supports.
        But when we use each of these five components together in
    reinforcing in integrated ways, whole child design will
    accelerate recovery from the pandemic, but also promote growth,
    learning, and wellness for each and every child at the same
    time. This is a context for learning that is greater than the
    sum of its parts, personalized, empowering, affirming, and
    transformative for each student.
        Let us take this idea into the classroom. If educators
    teach a math skill like long division, just a skill, some
    children will learn it. But if they teach to the whole child,
    educators can support students to understand it, be curious to
    learn more, and be able to apply it to new situations. Students
    will build analytic skills and even discover parts of
    themselves they didn't know they had, like maybe I am a math
    person after all.
        When we ask the question, what can we do that will work
    optimally for this child in this context, that question gets
    you to fundamentally different answers about the way our
    schools and our education system of the future needs to be
    designed. This vision constitutes a transformational shift in
    the purpose and potential of our learning systems and a shift
    in the policies and laws that would constrain this vision.
        To conclude, the message in the science and in this
    testimony is optimistic. Context shapes the expression of our
    development and our genetic attributes. This is the biologic
    truth. And schools designed using this knowledge will be able
    to see and unleash talent and potential and ensure that each
    and every young person can thrive.
        Thank you so much for allowing me to talk to you today.
        The Chair. Thank you so much, Dr. Cantor, for your
    testimony.
        And our next witness is Dr. Linda Darling-Hammond. And
    again, your full written testimony will be included in the
    record, and you are now recognized for 5 minutes for an opening
    statement.
        Ms. Darling-Hammond. Thank you very much, Chair DeLauro,
    Ranking Member Cole, members of the subcommittee, for your
    invitation to participate in this hearing. I am honored to be
    here today to discuss the Federal role in supporting whole
    child practices that can support children's learning.
        As Dr. Cantor noted, the latest research for neuroscience
    and other disciplines shows that emotions and relationships
    influence learning. Positive emotions, such as interest,
    excitement, and trust in a teacher, facilitate learning.
    Negative emotions, such as caused by trauma, anxiety, or self-
    doubt, reduce the capacity of the brain to process information
    and to learn.
        Students' interpersonal skills, their ability to interact
    positively with peers and adults, resolve conflicts, and work
    in teams, all contribute to effective learning and lifelong
    behaviors.
        The Collaborative for Academic, Social, and Emotional
    Learning identifies five main areas of social-emotional
    competence--self-awareness, self-management, social awareness,
    relationship skills, and responsible decision-making. In
    addition, traits such as a growth mindset that allow us to
    understand that we can improve our work with effort and that we
    should not give up when we experience setbacks create
    perseverance and resilience. These are skills that employers
    say are among the most important for success in work and that
    research demonstrates are important for success in life.
        As Chair DeLauro noted, and as I describe in my written
    testimony, among the hundreds of studies on this topic are
    several meta-analyses that show the benefits of social-
    emotional learning for students' behavior, school safety,
    attitudes, grades, and test scores.
        Social-emotional learning is not a specific curriculum.
    Just as teachers focus on adding and subtracting in math,
    regardless of what curriculum they use, they can focus on
    helping students learn to work well with others and manage
    themselves in many different ways from many different
    curricular starting points.
        A recent study from the Fordham Foundation also shows that
    parents, regardless of their party affiliation, recognize the
    importance of these skills. They want their children to learn
    how to set and achieve goals, navigate social situations,
    empathize with others, respond ethically, and manage their
    emotions. The study concluded that when such programs are
    described without jargon, support soars on both sides of the
    aisle.
        Because of this broad support, all 50 States and DC have
    social-emotional learning standards for preschool students, and
    at least 18 have standards for K-12 students. Teaching these
    skills does not detract from academics but supports it. They
    can be folded into all aspects of school, including how
    conflicts are resolved on the playground, how students learn to
    take a deep breath and calm themselves when something
    disturbing has happened, how students develop a growth mindset
    as they revise their essays in English class, and how they
    learn to collaborate effectively in their science
    investigations.
        Research also shows that in order to thrive and learn,
    children need stability in their lives, good nutrition,
    healthcare, and supports when they have trauma, which creates a
    toxic stress reaction that affects brain development, physical
    health, learning, and behavior.
        Even before the pandemic, 46 million children were exposed
    each year to violence, crime, abuse, homelessness, or food
    insecurity. These experiences, of course, have been exacerbated
    by the pandemic, but many States and districts are,
    fortunately, investing in community school approaches,
    including California, Maryland, New Mexico, New York, Vermont.
        These initiatives integrate education and health, mental
    health, and social welfare supports. They offer expanded and
    enriched learning time. They involve parents and community
    organizations and wrapping around children and their needs. A
    recent review of more than 140 studies found that well-
    implemented community schools support improved attendance,
    achievement, and attainment.
        As Chair DeLauro has already noted, Congress has reported
    many aspects of a whole child framework in its last annual
    spending bills. To build on these foundations, I will mention
    four things the Congress can do.
        First, continue efforts to support States and districts
    implementing social-emotional learning and whole child
    approaches to education by expanding funding for the School
    Safety and National Activities Program and creating competitive
    grants to redesign schools around the principles that Dr.
    Cantor outlined.
        Second, catalyze the expansion of community school
    initiatives to sustain increases in additional funding under
    ESSA Titles I and IV, among other sources.
        Third, increase investments in preparation and ongoing
    professional development for educators under Title II of ESSA
    and HEA so they can support safe, inclusive, and positive
    learning environments.
        And finally, promote alignment and interagency coordination
    of Federal funds across the 10 departments and hundreds of
    programs that are currently administered in a fragmented
    manner.
        Thank you for your focus on this issue and for the
    opportunity to share ideas for a path forward. I am happy to
    answer any questions that the members of the subcommittee have.
        The Chair. Thank you very, very much, Dr. Hammond.
        And our next witness is Mr. Max Eden, research fellow, and
    your full testimony will be included in the record. You are now
    recognized for 5 minutes for your opening statement.
        Thank you, Mr. Eden, for being here.
        Mr. Eden. Yes, thank you. Good morning, and thank you all
    so much for the opportunity to address this very important
    issue.
        Social-emotional learning is a burgeoning education
    industry. From November 2019 to April 2021, SEL spending
    increased by 45 percent to $765,000,000. If it isn't already,
    it will likely soon become a $1,000,000,000 education
    subsector.
        Advocates claim that SEL holds great promise, and on its
    face, it sounds like a very sensible idea. But my research has
    led me to be more alarmed than optimistic. For four reasons, I
    fear that the costs of SEL may substantially outweigh the
    benefits.
        The first reason, the evidence of the benefits has been
    substantially exaggerated. Advocates promote claims like $1 of
    SEL spending yields $11 in return. This would be astonishing if
    true, but is it really?
        A clear-eyed view of the evidence suggests perhaps not. The
    2017 RAND Corporation study, which examined the evidence base
    for SEL, separated it by tiers of evidence. Within the top tier
    for rigorous evidence, no studies demonstrated academic
    benefits--academic achievement benefits.
        Now, to be sure, there are plenty of less rigorously
    designed studies that show positive results. Researchers can
    and have retroactively attached the label of SEL onto these
    studies, regardless of whether these studies involved what we
    now know as SEL implementations and practices.
        The merits of these studies can be debated. We can talk
    about what conclusions we can and can't draw from them, but
    they certainly do not rise to the level of a settled social
    science that provides reliable predictive value.
        Furthermore, the relevance of this literature may be
    categorically questionable because of the rise of what is
    called ``transformative SEL,'' and this leads us to the second
    cause for concern. The concern is that SEL has become an
    ideologically charged enterprise. In 2018 and 2019, SEL was
    bipartisan. The notion that schools should help kids develop
    competencies like self-awareness and self-management sounded
    good to folks on both sides of the aisle.
        Back then, however, I was somewhat skeptical of the
    sustainability of what seemed to be an effort at values-free,
    immoral education. But in 2019 and 2020, the Collaborative for
    Academic, Social, and Emotional Learning embraced
    transformative SEL, infusing the project with values. Values
    derived from the left academic canon, commonly referred to as
    critical race theory.
        Self-awareness now involves intersectionality. Self-
    management now involves resistance. CASEL's documents and its
    leaders have openly embraced antiracism. As commonly defined,
    antiracism amounts to an essentially totalizing ideological
    commitment.
        A recent Washington Post article is titled, ``In SEL, the
    Right Sees Critical Race Theory'' and pointed to transformative
    SEL as the cause. The reason parents see it there is because
    they read it there.
        Now it is, of course, an open question to what extent those
    words and those statements really do filter down into classroom
    practice, and it is very hard to draw an immediate
    generalization. But parents have a plain facial reason for
    concern that what is being called social and emotional could
    prove in practice to be political and ideological.
        Another big concern for parents is data security. SEL
    implementation is frequently accompanied by school surveys that
    ask psychological and personal questions relating to students'
    mood, family life, and even their sexuality. The more extensive
    and sensitive this data becomes, the more valuable it becomes
    to potential hackers.
        Last month, 820,000 students in New York City learned that
    their data was hacked. We should expect more of this as a
    matter of structural inevitability, given the increasing value
    of the data collected.
        Now even if we could perfectly guarantee data security and
    also guarantee that no vestiges of political ideology seep into
    classroom practice around SEL, there remains a fourth and
    probably insuperable concern, and that concern is that SEL in
    practice can tend to resemble the practice of unlicensed
    therapy. My colleague Robert Pondiscio has addressed this
    concern at length in an excellent report, titled ``The
    Unexamined Rise of Therapeutic Education.''
        Although it may not always be explicit within training
    materials, in practice, it does invite teachers to play the
    armchair psychologist, identifying root causes of trauma,
    providing students with a schema to understand themselves, and
    explaining how best to relate to others. In theory and in
    practice, it also tends to blend seamlessly with a rising
    emphasis on school-based mental health provision.
        And while we certainly want students to be mentally
    healthy, there are very good reasons why medical ethics
    prohibits the practice of unlicensed therapy. Untrained adults
    trying to do good can do a great deal of damage. And this is my
    overriding concern with the entire SEL enterprise, that when
    schools, which are still struggling to effectively teach
    reading and math, extend their ambition to embrace the whole
    child, they may end up doing more harm than good.
        The Chair. Thank you, Mr. Eden.
        And now let me ask Dr. Timothy Shriver. And just once
    again, your written testimony, your full written testimony is
    included in the record, and you are recognized now for 5
    minutes for an opening statement.
        Mr. Shriver. Thank you, Madam Chair, and thank you, Ranking
    Member Cole, both of you, and all the members here.
        And Congresswoman DeLauro, I am including in my background
    today a picture from your home district from the New Haven
    Public Schools taken some 30 years ago with Dr. James Comer in
    it because he is my mentor and, in some ways, the founder of
    this field.
        And then, Congressman Cole, I want you to know that your
    questions and concerns are valid, but these faces behind me are
    the ones we, I hope, will see most in this hearing today.
        I want to thank you, Madam Chair, for your longtime support
    for broad, bipartisan education initiatives. Head Start, to
    name one, in some ways was a precursor to the field of social
    and emotional learning we are hearing about today. Parent
    engagement, supports for early childhood development, social
    and emotional and academic integration in these early childhood
    centers.
        In some ways, we are 40, 50 years of trying to figure out
    how to capitalize on the broad bipartisan consensus that
    emerged way back in the 1960s, and Dr. Comer himself was a
    pioneer, and many others, in showing us that children develop
    through these malleable interlocking systems that Dr. Cantor
    and Dr. Darling-Hammond mentioned that we do not have a choice
    between whether or not to support the social and emotional
    development and the cognitive development. There is no
    ``either/or.''
        Notwithstanding Mr. Eden's comments about insuperability
    and the separation of these things, children--no brain ever
    came to school without a body. No mind ever came to school
    without wanting to matter. No search for knowledge was ever
    disconnected from the search for meaning or importance or a
    relevance in the world. There is no such thing as a child that
    learns purely cognitively or acquires only information.
        The only question we have before us and the only question I
    dare say you have before you is how well we will support the
    social and emotional development of children? Because it is
    foundational, as Dr. Cantor has said and Dr. Darling-Hammond,
    the brain science, the learning science, and to common sense.
        We know this as human beings. I have seen Representative
    Beutler's child there. There is no question--hi--that that
    child, like all of us learns in an integrated way.
        So the science is not settled. There is no question about
    that. This is an early days issue. There is lots of research to
    be done. There is every indication that social and emotional
    learning is promising, if not effective. Mr. Eden's comments
    are fine as far as they go in challenging us to make the
    research more effective, but the idea that we have a choice to
    turn our back on the work because we have more research to do
    is, in my view, unsustainable.
        In some ways, all of this comes down to how we support the
    day-to-day experiences of children. Congresswoman DeLauro, we
    have thought at times, I have talked about maybe we need social
    and emotional learning in Congress because what we teach our
    children when they have stress is we teach them how to turtle.
    We say, you know, put your arms across your shoulders and drop
    down into your shell and take three deep breaths, and
    experience some positive self-talk and don't react too quickly.
        And but you do, when you find it, you can teach this to a
    first grader, how to turtle, how to manage stress. And you find
    your responses are much more effective. We teach lessons on--
    and you learn more, to Mr. Eden's point, and you are more
    capable of paying attention, and your brain is more locked in
    and your relationships are stronger.
        Same thing, Congressman Cole, you brought up these very
    important questions about whether this belongs. But when we
    think about what it actually is, one of the lessons, for
    instance, we teach to high school children is how to disagree
    without being disagreeable, which is, in my understanding at
    least, an extraordinarily important skill in Congress, right?
        How do we disagree in a productive, meaningful way? The
    citizens of this country are asking these questions of the
    adults in our communities, not just of children. They are
    asking it of all of us, not just of our fourth or sixth or
    eighth graders.
        The last focus group I did with young people about a year
    ago, one of the kids said to me, you know, Mr. Shriver, we have
    gotten so much better at bullying in our school, but adults are
    still bullies. And so, in some ways, this field is seeding not
    just the supports for children and learning, but the shifting
    of the system that surrounds children and learning so that they
    can be attentive to this great consensus that exists in
    America.
        After the pandemic, I dare say we have a very robust
    consensus on the need to support the social and emotional and
    mental health of our children. Parents are starving. They are
    desperate. They are exhausted, and they are searching. ``Can
    anyone help me support my kid? I don't know what to do next.''
        Our chance is to answer that affirmatively.
        Thank you, Madam Chair.
        The Chair. I am on mute. Okay, there we go.
        Thank you very, very much for all of your testimony.
    Appreciate it, and we will get started with the questioning,
    and I will kick it off.
        And Dr. Shriver, you made a couple of points in this
    direction that I want to ask Dr. Darling-Hammond and yourself,
    and in his written testimony, Mr. Eden claims that the evidence
    base for SEL has been ``vastly oversold.'' Specifically, he
    called into question the validity of research supporting SEL.
        Can you both respond to his assertion and speak to the
    evidence base supporting social, emotional, and cognitive
    learning? Dr. Hammond?
        Ms. Darling-Hammond. Well, there is a substantial evidence
    base, and the way we think about evidence in research is the
    accrual of triangulated evidence that comes from many
    difference sources that points in the same direction.
        You mentioned in your earlier remarks the relatively famous
    meta-analysis of 213 studies that represent 270,000 students
    from urban, suburban, and rural schools that was done some
    years ago, that found that students who participated in social-
    emotional learning programs, that teach those things like self-
    management and collaborating with others, showed greater
    improvements than comparison students in their social-emotional
    skills, their attitudes about themselves and others and school,
    social and classroom behavior, school grades and test scores.
        On average, across all those studies, averaging those that
    measured achievement, an average 11 percentile gain in
    achievement scores. But equally important is the fact that in
    their school, there was more safety, more affirmation, less
    bullying, which all of which also support the desire to go to
    school, the capacity to learn well there.
        After that, there was another meta-analysis that found that
    benefits were sustained in the long term, showing how the
    learned skills and attitudes can endure and serve as a
    protective factor, both supporting academic success, but also
    protecting students from mental health difficulties.
        Even more recently, there was a meta-analysis of 54 studies
    of classroom management programs that found that all of the
    approaches have positive effects, but the most positive, the
    most substantial were the interventions that focused on social-
    emotional development of students, helping them learn how to be
    responsible citizens of the classroom so that that could carry
    over into all of their other exchanges.
        You can manage a classroom by saying if you do this, you
    get punished, and if you do the other thing, you will get
    rewarded. And you can also manage a classroom by teaching
    students how to be knowledgeable about themselves, aware of
    other people, responsible citizens of the classroom. And the
    second of those is what lasts into one's life and future.
        Mr. Eden noted that the RAND Corporation study did not find
    as much evidence of academic achievement, but I want to note
    that in that study, they explicitly excluded interventions that
    were focused on promoting academic achievement in disciplines
    such as reading and math. They intentionally focused on those
    that measured social-emotional learning outcomes.
        So most of the studies they chose to review did not measure
    academic achievement, but they did find that all 60 studies
    improved outcomes in social-emotional learning competencies and
    also improved safety climate and civil engagement and academic
    achievement and attainment in about a quarter of those studies.
        And ultimately, the authors of that study were confident
    that there were several reasons that schools and educators
    should view social and emotional learning as a priority based
    on the evidence that they reviewed. So I think that there is
    always more research to be done. As a researcher, I will always
    say that that is true, but there is a quite substantial
    evidence base already that points us in a direction that we can
    act on.
        The Chair. I don't know, Dr. Shriver, if you want to make a
    comment about it? I also would like to try to get in a question
    for also Dr. Cantor.
        Mr. Shriver. Yes, maybe just very briefly, Madam Chair.
    Just very briefly.
        Just let me just also point out, because many members of
    this committee have also been big supporters of the Special
    Olympics movement and the work that Special Olympics does in
    schools. Special Olympics has designed, if you will, an
    intervention using social and emotional learning foundational
    principles--empathy, perspective taking, moral courage,
    universal values. The numbers are off the charts when you
    invite children into these experiences.
        So the kinds of interventions that are using these
    strategies--Congressman Cole has been very supportive of this
    work--they are common sense American values. I mean, we teach
    Jefferson and the creativity of Franklin, and we teach the
    resilience of Tubman and the search for justice of Cesar
    Chavez. We ought to not just be teaching about those people,
    but teaching children to be those people and to have the skills
    and qualities and values that enable them to grow and develop
    and to be citizens of the country. These are citizenship skills
    as much as they are affective skills.
        So I would just say that the data is very prominent, Madam
    Chair, not just in the core research areas that are being
    discussed here because that has all been mentioned here, but
    also in the related programs in youth-serving organizations
    that are using these principles for very positive outcomes.
        The Chair. Thank you both. And what I will do because my
    time has expired, I will move--when we move to a second round,
    I want to engage with Dr. Cantor as well.
        And with that, let me yield to my colleague Congressman
    Cole.
        Mr. Cole. Thank you, Madam Chair.
        Let me just--and I would ask this of each of you, and we
    will just move right down the line. Just to help me get a
    better understanding, can you provide some examples of the
    types of exercises, what they would look like in classrooms to
    help students with social and emotional skills? What are some
    specific examples of techniques that an instructor would use
    with a student?
        And I will start with you, if I may, Dr. Cantor, and we
    will just sort of move down the line. I think you are on mute.
        The Chair. There we go.
        Dr. Cantor. So imagine that you give a student a
    challenging project, academic project, and they take a look at
    this project, and they have this feeling, ``I can't do it.''
    And let us say even that they shut down because they are
    nervous that they are not going to be able to do it or not
    going to be able to do it well. What does the teacher do in
    that moment that inspires that child to believe that they can
    not only do the project, but do it well?
        So the pedagogical techniques of a teacher in that moment
    are to recognize how a student is struggling and to be able to
    do the thing at that moment that enables that student to
    persevere through it. Now you wouldn't call that necessarily by
    the label social and emotional learning, but you would
    recognize that you are teaching at that moment a student to
    have a growth mindset, ``I believe in myself,'' to stick with
    it, perseverance; to be able to transfer the knowledge of this
    project that you have just succeeded at to other projects. So
    your confidence builds that you can do other things.
        I think right now the labels could be getting in our way
    because I think the universals here are what do we want every
    single child to believe about themselves and to be able to do?
    I think that is what Tim Shriver said just a few minutes ago.
        Mr. Cole. Okay. And if I can keep going, Dr. Darling-
    Hammond, what would be, again, some of the techniques that in a
    practical sense somebody would use in a classroom?
        Ms. Darling-Hammond. Well, one of the things that a lot of
    teachers use in a classroom is group work. Students get
    together, and they have a project or an activity or an inquiry
    that they are going into. And to do that effectively, there are
    specific ways to engage in that group work that allow students
    to take roles that will allow them to figure out who is doing
    what, to be respectful to one another. So it would teach
    specific ways to listen and to respond to each other, to be
    sure people are included.
        Those--all of those skills of group work and collaboration
    are the social-emotional learning skills that teachers will
    teach in the context of helping kids do the academic work much
    more effectively. We have probably all had experiences of bad
    group work and good group work, and the difference is whether
    those skills were taught in the process.
        Another one would be conflict resolution. Things come up.
    Somebody took somebody's pencil, or something happened on the
    playground. So teaching students ways to stop, listen to each
    other, express their feelings or their views, and come to a
    resolution--and there are some specific strategies that people
    have used across schools to do that--is another example of
    teaching those skills that will go on through the classroom and
    into life with those students.
        Mr. Cole. Well, to Dr. Shriver's point, we have plenty of
    examples of bad and good group work in Congress. [Laughter.]
        The Chair. Amen, amen.
        Mr. Cole. And I would say our recent omnibus was good group
    work. So, thank you, Madam Chair.
        I don't have a lot of time left. Let me go quickly to you,
    Dr. Shriver, and then to you, Mr. Eden.
        Mr. Shriver. Yes, well, first of all, thanks, Congressman
    Cole.
        I mean, look, again some of this is common sense. I will
    just give you one good example on the conflict side of things.
        So being able to disagree without being disagreeable
    assumes a series of skills that kids can learn. One of them is
    how to presume positive intent.
        So Mr. Eden and I currently don't necessarily agree on all
    of these things, right? But we have spent the last 5 to 7 years
    as progressive and conservative-leaning educators, trying to
    learn how to presume positive intent. So that as I listen to
    him, I feel like I am trying to train my ear and my mind to
    identify what about his intent I can see is really in the
    interest of children.
        I am just using this current example because it is right in
    front of us, right? So presuming positive intent is very
    powerful for kids, and it is a lifelong skill. And you can
    teach it.
        Sorry, I am over time.
        Mr. Cole. Madam Chairwoman, can I----
        The Chair. That is okay.
        Mr. Cole. Is it okay just to give Mr. Eden a quick chance
    to add?
        Mr. Eden. Yes, very quickly. I mean, one common technique
    is the technique of role-playing for conflict resolution,
    conflict management. The question of what is being played with
    in these roles is an important question. And just from this
    week talking to some educators, I came across an example of a
    school counselor doing role playing with middle school students
    on how to break up with a boyfriend or girlfriend.
        This raises many questions about kind of the appropriate
    role for adults vis-a-vis students in guiding romantic
    relationships and is part and parcel of what I fear, with very
    good intent, Dr. Shriver, could be an encroaching and then
    passing over a boundary that parents would not want adults
    speaking to their students about, would not want adults
    training them with positive intent in for fear that what will
    be trained would not align with their values.
        Mr. Cole. Thank you very much.
        Thank you for the indulgence, Madam Chair. I yield back.
        The Chair. Sure. Thank you. Thank you.
        Mr. Pocan? And let me mention this, Mr. Pocan. I am going
    to jump off to do something in Mil-Con, which is meeting at the
    same time, and get back on. So asking you to take the gavel and
    to chair.
        So, Congressman Pocan.
        Mr. Pocan [presiding]. Absolutely, Madam Chair. Thank you,
    and thanks to our witnesses.
        Especially good to see Dr. Shriver. Obviously, you know I
    am a big fan of Special Olympics and all the work you have done
    there. So, thank you.
        Mr. Shriver. Yes, sir. Thank you.
        Mr. Pocan. I think my biggest question, you have talked a
    lot about the effect on students, and one of the problems that
    I am hearing, you know it is a national problem in our
    districts, is teacher retention. Between some public policy
    attacks, the last couple years under COVID, a number of
    factors, we are having a hard time keeping teachers. We have
    had very good applicants for some open positions, including in
    the biggest city in my district, in Madison, Wisconsin.
        I am just wondering how teachers look at this and if this
    could be perhaps something to help stop the slide of decline
    that we are having on teacher retention. So maybe for the three
    doctors if you could each----
        Mr. Shriver. I think Dr. Darling-Hammond is--oh, sorry.
        Ms. Darling-Hammond. Maybe I will kick off because it is an
    area I have spent a lot of time on.
        Mr. Pocan. Thank you.
        Ms. Darling-Hammond. Yes. The use of social-emotional
    learning strategies actually has been found to support teacher
    retention in work that has been done on that because as the
    classroom and the school become more calm, more safe, more
    organized, and managed through the use of those programs,
    teachers get the benefit of a class that is easier to teach.
        They also learn strategies that help their social and
    emotional learning and confidence, which makes them more
    efficacious in their work, and they can benefit themselves by
    developing those strategies to maintain calm and to be able to
    focus their attention in the right ways. So it is a very
    helpful piece of the puzzle with respect to teacher retention.
        Right now, a lot of kids are coming back to school having
    experienced trauma with dysregulated behavior that is a result
    of that, and it is especially important for what teachers and
    other educators are experiencing right now to have these
    supports.
        Dr. Cantor. Another example that I could add to this is a
    district that I happened to be visiting yesterday. It is
    outside of San Diego, El Cajon, and what was described to me
    was that this is a district with a waiting list of teachers who
    want to work there.
        So when you dig into why, why does this district have a
    waiting list of people who want to work there? Underneath all
    of that is the culture, the culture that is district wide that
    is modeled by the adults and, therefore, also modeled by the
    kids.
        So there is a very, very powerful effect, and we know this
    in other fields. The connection between culture and the
    satisfaction of employees and their retention.
        Mr. Pocan. Thank you.
        Mr. Shriver. And Mr. Pocan, I will just one slightly, well,
    related point. The great longitudinal study that some of you
    may be familiar with, the Grant Study, which studied what leads
    to happiness in life, you know? Now I think we are in the 80th
    year of the study.
        The current principal investigator, in fact, Robert
    Waldinger, concludes that after millions of pages of data, they
    can conclude one thing, that the quality of the relationships
    is the only thing that matters to quality of life.
        This work is designed to strengthen the relationships not
    just for kids, but for teachers. Most of us went into teaching
    because we care so deeply about children. Yes, some of us love
    the Civil War or Shakespeare or poetry or language arts or
    whatever, the periodic table. But most of us went into it
    because we wanted to connect with kids.
        And when those relationships are broken and tense and
    fractured and angry and hostile, burnout is inevitable. And
    then when you add to that the layers of political conflict and
    aggression from outside forces, it is overwhelming. All right?
    You just can't survive it.
        But when the relationships are strong, my goodness, you
    know, you find what you came there for, if you will. So just at
    a very basic level, if you can imagine work that helps teachers
    strengthen the quality of their relationships with children is
    almost directly related to the quality of their capacity to
    want to stay in the profession.
        Mr. Pocan. Great. Thank you.
        And I have 35 seconds, I don't know if one person could
    answer, and I know this is a longer question. But is there any
    kind of one type of student that benefits most? I know I can
    clearly see benefits for every type of student, but is there a
    type of student that benefits the most?
        Ms. Darling-Hammond. Well, I would just----
        Mr. Shriver. I will take that one. Oh.
        Ms. Darling-Hammond [continuing]. Go ahead, Tim.
        Mr. Shriver. I would just say the answer is this is about
    every child. This is, yes, there are children who benefit in
    outsized ways, but this is just good child development. It is
    for every child and, therefore, really for all of us.
        Mr. Pocan. Gotcha. Great. Thank you, and we got it down to
    the perfect timing. Appreciate it.
        Next up, I have Representative Harris. You are recognized
    for 5 minutes.
        Mr. Harris. Thank you very much.
        And Mr. Eden, I would like to delve a little bit into your
    testimony because it is interesting. You know, as a physician,
    we always look at the quality, these internal and external
    validations, the quality of the study and then whether it is
    actually appropriate to what we are thinking about. And when we
    do Preventive Services Task Force, you rate things good, fair,
    poor, and then you base your recommendations on that.
        So, first, it is very concerning to me that none of the
    studies that have shown a benefit are highly rated. That is,
    and we learned during COVID that we know the quality of
    scientific information is very important. So as we approach a
    $1,000,000,000 industry, it is very concerning that there are
    no high-quality studies, apparently, that show a benefit.
        So is that--basically, is that what your testimony
    suggests?
        Mr. Eden. My testimony suggests that the kind of randomized
    control trial, the gold standard, what physicians recognize as
    proof-of-concept, are far fewer. They are fewer and farther
    between than what we are being presented, which is meta-
    analytical results, right?
        Mr. Harris. Sure.
        Mr. Eden. This meta-analysis that is frequently referenced
    that has I think 215, 213 studies----
        Mr. Harris. Absolutely. And again, I understand, and it
    appears that the vast majority of those, if not all of them,
    are not the highest quality. And then you are making
    conclusions based on relatively poor data, and this is the
    whole--again, the whole purpose behind the U.S. Preventive
    Services Task Force is to look at quality of data, sir.
        Now of particular concern is the external validity, which
    is to say that in a medical treatment if you actually change
    the type of treatment or slightly modify the drug, then looking
    at past studies of the past therapies and then trying to
    extrapolate into the new version is absolutely scientifically
    invalid. I mean, it is just, look, it might be true, but it is
    scientifically invalid to extrapolate.
        So your observation, which I think is borne out with what
    is going on at the school level, of a radical change in what
    SEL was all about occurring in the last 3 years is very
    worrisome.
        For instance, we have a--and this is from my State because
    you actually mentioned the Parents Defending Education, I guess
    the name of the organization. You go to their website, and this
    is in my State, a third grade elementary school instruction
    team leader and Rainbow representative in that school system
    sent an email to colleagues full of excitement about plans to
    incorporate LGBTQ within our elementary curriculum, explicitly
    stating this would be integrated during SEL time. Well, now the
    Florida law looks more important when you have a third grader
    being taught LGBTQ during SEL time.
        So this is kind of the camel's nose under the tent. I
    understand CRT. I didn't understand its extrapolation and other
    things into SEL, which is something we have to be very cautious
    about because, of course, the North Harford Public School
    System, again Parents Defending Education website, has gender
    literacy embedded in their SEL elementary school curriculum.
        Like, I am sorry, we need to--and last, but not least, I
    want you to comment on this idea that we are urging--and an
    important part of this is to urge students to be community
    activists. Because in my district, we had a major problem a
    couple years ago when one of our school superintendents urged
    her students in the system to attend Black Lives Matter
    rallies--now, remember Black Lives Matter is a--was an
    institution founded on Marxist principles. To somehow, without
    putting it in full context, urged students to attend Black
    Lives Matter rallies.
        Now is that the kind of community activism that you see
    creeping into the new definition of SEL that CASEL is
    promulgating?
        Mr. Eden. It certainly can be. When you look at CASEL
    documents, they say that they want a commitment to antiracism,
    which, as I said, is an ideological doctrine. They said they
    want justice-oriented citizens, which obviously begs the
    question that we know what justice is.
        And I would like to just briefly draw attention to
    something Dr. Shriver said, which I think was offered with the
    best intent, but falls on other ears is very alarming, right?
    The question of meaning and the question of whether schools
    should be in the business of providing students with meaning.
    And then the question of, well, what meaning will the school
    tell students their lives have?
        And these concepts blend very, very subtly, right? You have
    a buzzword like SEL. You have studies of various quality that
    you use to validate it. You fill the buzzword with any given
    concept, and you don't know. It is very hard to tell how
    widespread is it that SEL is being used as a Trojan horse, but
    the vector by which it can be is clear, and there are examples
    of it. And it is not--it is not--it is not of a piece with the
    rest of what we are hearing in this testimony from other
    witnesses.
        Mr. Harris. Thank you very much. We just got to get back to
    reading, writing, and arithmetic.
        Thank you. I yield back.
        Mr. Pocan. Thank you, Representative Harris.
        Representative Frankel, you are recognized for 5 minutes of
    questioning.
        Ms. Frankel. Yes, thank you. Good morning. Thank you to the
    panelists.
        Well, I want to say I am glad there has been a lot of
    research on this, but I will just tell you, my common sense, as
    a mother and a grandmother--and I have been around lots of
    little kids my entire life and so forth. I can just say there
    is no question about the importance of a healthy emotional
    development.
        And right now in Broward County, which is just south of me,
    there is the death penalty phase of someone who killed dozens
    and dozens of people in the Parkland shooting, the perfect
    example of a young man who did not have good emotional
    development. Now that is an extreme case, but I want to talk
    about my home State of Florida because, I am telling you, we
    are in a race with Texas for the craziest governor in
    legislature, in my opinion.
        And so let us see what they did this year. Just to let you
    know, affordable housing has gone up. Flood insurance has gone
    up. But that wasn't dealt with. But they did do this. They
    enacted the ``Don't Say Gay'' bill and banning critical race
    theory.
        And I--even there is no such thing as teaching critical
    race theory, but what the ban on--the ``Don't Say Gay'' bill
    bans any classroom discussion on gender, gender identity, and
    sexual orientation in grades K through 3, if there is any
    discussion that any parent might find inappropriate in grades K
    through 12, or the teachers are just all gagged up now in
    Florida. I would like to have any of the panelists, if you
    wanted to comment on this in terms of what that--is the
    potential threat for our children?
        Dr. Cantor. I would like to comment on that. One of the
    things that we know from many, many, many studies on positive
    youth development is that kids will struggle to learn and focus
    if they do not feel safe physically, safe emotionally, and
    frankly identity safe. When kids are ``othered,'' you are
    setting in motion a process by which bullying can be promoted,
    where kids will walk into school and be afraid that they and
    their identities and their cultures are not welcomed and not
    affirmed.
        So there are a couple of problems with that. One, it
    produces fear and anxiety walking in the school door. Second,
    when kids are anxious and fearful, they can't concentrate. And
    then, on top of that, you are not giving the classroom a
    language for tolerance, for being able to know how to behave
    around people that are different than you.
        So citizenship, something that we prize in this country,
    has a great deal to do with experiences with people that are
    different than us.
        Mr. Eden. Yes, I can----
        Ms. Frankel. Yes, go ahead.
        Mr. Eden [continuing]. I can make a couple of comments on
    it.
        I mean, that obviously was not the name of the bill at all.
    It was the Parental Rights in Education bill, and I have seen
    polling that suggests that the majority of Florida Democrats
    agree with it. They agree that it is not appropriate to teach
    sexuality, gender, gender orientation, and sexual orientation
    to 5- to 9-year-olds.
        This is not something that we have historically done. And
    frankly, the best argument against the bill was this is not
    something that we are doing, but as Mr. Harris and I were
    discussing, this is something that can start to happen under
    the guise of SEL and raises profound questions about how
    developmentally appropriate it is to be teaching about gender
    identity to kids who believe the tooth fairy is real? Do we
    really know that this will help?
        Do we have any studies whatsoever to suggest that this is
    in their best interest over the long term? I would be very
    interested in reading them. I don't believe it has. This is a
    very novel development.
        And I think when you have most Democrats supporting the
    bill, I----
        Ms. Frankel. But, Max, I would like to--listen, most
    Democrats do not support it. Most normal people, if would they
    understand and then be able to have discussion other than a 10-
    second poll.
        But I would like to see if any of the other panelists would
    like to respond to your comments? And I thank you, Mr. Eden. I
    do appreciate your point of view. I don't agree with it. But
    would any of the panelists like to respond to that?
        [No response.]
        Ms. Frankel. Okay. They have given up. But anyway, thank
    you very much. It was an interesting discussion.
        Be careful when you go to Florida. You know what not to
    say.
        I yield back.
        The Chair [presiding]. Okay, thank you.
        Let me thank Congressman Pocan for stepping in. I really
    appreciate it.
        And let me now recognize Congresswoman Herrera Beutler. And
    who is our little friend here?
        Ms. Herrera Beutler. Oh, I was begging my husband to lock
    them all out.
        The Chair. Oh, God, no. No, no, no.
        Ms. Herrera Beutler. They are driving me batty. I love
    them, but----
        The Chair. What is his name?
        Ms. Herrera Beutler. That one was Ethan. Ethan that is my
    5-year-old.
        The Chair. Okay, lovely. That is great.
        Ms. Herrera Beutler. Thank you. I appreciate that.
        I can so relate with parents and pandemics and academics
    and social and emotional well-being because in our house as it
    implodes on a daily basis. So I find this a really interesting
    conversation, and I have some questions.
        Although just if I put--take my lawmaker hat off and I put
    my mom hat on, I will tell you one of the reasons I think
    parents are so attuned to these conversations and what
    policymakers are discussing is because even just the, I don't
    know, I feel like lack of just comity or graciousness with
    which we are addressing some of these things causes me to say
    ``gosh.'' And these are--I mean, look, we are doctors and
    Members of Congress and chairs of--right? These, in theory, are
    the highest levels of attainment in our society, and yet we are
    having major disagreements. And if we disagree, rather than
    disagreeing, we are like digging at each other.
        And so, when I look at that, I think how in the world could
    I expect an educator with a ton of kids in her classroom, and
    all those kids are like my kid, who I am like ``Just sit still.
    Just, for the love of God, sit still.'' I just think that is
    part of why I do have a lot of questions about whether there
    is--so even if everybody agreed on what the curriculum or the
    teaching here was, whether there is the infrastructure to do it
    in the way that it is being proposed. So there is just a lot
    of--this raises a lot of question.
        I mean, obviously, my observation is we are all striving
    for the same thing. We want our children to be poured into, to
    be nurtured, to learn how to do--the rigor of academia, to be
    able to compete on a global stage, right? They are not
    competing against kids down the street like I was. They are
    competing with kids in China and India who are hungry for
    achievement, and our kids are dealing with parents who can't
    decide what the classroom structure should be.
        And I really wonder--I think we are wanting to do the right
    things, but sometimes I question whether we are going to--
    whether we are going to put aside our personal feelings about
    some of this and do what is in the best interest of kids, which
    is why I know all of you, as you have gotten into this line of
    work, why you have done it, because that is your heart.
        I wanted to ask--I was really--and maybe this is for Dr.
    Cantor. And Mr. Eden, I think you probably also will have some
    thoughts on this--about the ability of teachers within the
    classroom to address the mental health issues that we know are
    there. When I talk with my educational--my directors, my school
    boards, they will tell you the number-one thing to worry about
    right now is the mental health of their kids. They can't even
    get to the academics because the mental health is in a pretty
    crisis state.
        One of the concerns I have is how do we get them into
    mental health services, and do we think teachers really can be
    trained to do this? And do we want them doing it? I have
    educators who would tell me they don't.
        And maybe for both of you? I would like to hear both of
    your comments on that. Dr. Cantor, could we start with you?
        Dr. Cantor. Sure. One of the questions that I was often
    asked when I was practicing as a child psychiatrist, which I
    did for about 20 years, what is the active ingredient of a
    therapy? Okay, is it all the things I studied in medical
    school, or is it the experience I am having with the child in
    the moment in my office as I build trust with them, as I build
    a relationship with them?
        So if I were to say to you what can a teacher do on behalf
    of the emotional well-being of every student, it is to support
    knowing them, caring about them, and really having a classroom
    in which every child feels known, loved, and connected with.
        Now you can do that in different ways because I have also
    had teachers say, ``How can I have a relationship with 30
    kids?'' Well, okay. Very, very challenging. But there are
    advisories, there are structures that can be put in place.
    There is even group work that Linda was talking about where a
    student can feel known, cared for, and loved.
        Relationships are the greatest preventive mental health
    intervention that there is, and they are also great for
    learning. So that is the no-brainer here. That is what I would
    say is in the province of teachers.
        Ms. Herrera Beutler. Thank you, Doctor. Mr. Eden?
        Mr. Eden. Yes, I think the distance between the studies
    that we have of programs that may or may not have been reliably
    evaluated and what really happens, as you said, is huge.
    Frequently, what happens when I talk to teachers is, oh, we are
    supposed to do SEL? Okay, let us go to Google. Let us go to
    Pinterest. Let us find some things that are labeled SEL, and
    let us try them.
        Vast difference between whatever we might have validated
    and what is actually happening under the skies, and I have also
    talked to a lot of teachers who have said, ``I just want to
    teach. I don't want this burden on my shoulders. I am not
    trained to do this.''
        Suicide prevention. That is not--what if it goes wrong?
    What if we are acclimating them to these thoughts?
        I think that there is a large sentiment in teachers that
    just let us teach. Don't make us do more than we are already
    doing.
        Ms. Herrera Beutler. Thank you all very much. Appreciate
    it.
        Yield back, Madam Chair.
        The Chair. Thank you. Congresswoman Watson Coleman.
        Mrs. Watson Coleman. Thank you very much, Chairman and
    Ranking Member Cole. Thank you for this. It is really
    interesting. I am learning a lot, and I know I don't know a
    lot.
        Dr. Shriver, let me just tell you, you said something that
    really stirred me, and that was presuming a positive intent
    and, therefore, presuming a positive outcome.
        I am really--I want to know, first of all--first of all, I
    kind of agree that this is more of an approach of a teacher,
    how you teach, how you interact, and how you help students
    develop than it is actually being a thing that you set aside an
    hour a day and work on.
        I want to know, are students who are being taught to be
    teachers now being taught this as a sort of a method of
    teaching, an approach to teaching? Dr. Shriver, do you know?
        Mr. Shriver. Yes. Yes, well, I will yield to Dr. Darling-
    Hammond, whose scholarship and work in the field of teacher
    education is legendary around the world.
        Mrs. Watson Coleman. Okay.
        Mr. Shriver. I will just say that when I was training to
    teach, the answer was no. I had in three degrees in education
    one class in child development, which is backwards, right? It
    is indicative of a system that doesn't see the child as the
    primary goal. It sees information as the primary goal. You
    don't, as I said earlier, have to choose.
        The next generation of teachers we believe the essential
    reform effort, if we can call it that, will be to equip
    teachers with intensive understanding of child development not
    so that they can get embroiled in political disputes, but so
    then they can adapt behavior--as Dr. Cantor said earlier--to
    the situations, context, the pedagogy, the skills necessary to
    help a child go from A to B in terms of their learning.
        Dr. Darling-Hammond, I go to you.
        Mrs. Watson Coleman. I am watching the clock. Thank you.
    Thank you.
        Ms. Darling-Hammond, do you have anything you want to add
    to that?
        Ms. Darling-Hammond. I would simply say that there is a lot
    of work going on right now to infuse this kind of knowledge
    base in teacher education and in leader preparation. Those are
    equally important, and those are areas where congressional
    investment could be helpful.
        Mrs. Watson Coleman. Are we investing in current teachers
    to sort of bring them up to date in this sort of holistic
    emotional and, what do you call it, social and emotional
    learning sort of paradigm into their--the way they teach? Are
    we supporting that sufficiently? Do we need greater investment
    in it?
        Ms. Darling-Hammond. We invest very little in educator
    preparation programs in this country from the Federal level,
    and there is a need to kind of move the curriculum of teacher
    and leader preparation programs to accommodate the science that
    has been developed around how people learn and ensure that that
    knowledge base gets to them, just in the same way as we do in
    medicine and that we do in other professions.
        Mrs. Watson Coleman. So I talk to you as a grandmother of a
    beautiful black 9-year-old, and I want to talk to you as a
    black person. The one thing I want is for children,
    irrespective of their race, their color, or whatever, to feel
    equally valued, to believe that they are as great and as
    accomplishable as anybody else. I also want those that are not
    black or of color or different to embrace the differences that
    they see as opportunities and not as a negative.
        And so I am wondering, and Dr. Shriver, maybe in my few
    seconds left, you could tell me how we approach SEL to ensure
    that there is this equity, this appreciation that we overcome
    this sort of over-disciplining of black kids in schools, that
    we help them all to determine the outcome of disagreements in
    less disagreeable ways, how we can minimize the bullying, et
    cetera.
        I am very concerned about what is happening in our schools
    and the kind of political pawns schools are being made under
    these false pretenses of teaching CRT or whatever. It is
    ridiculous. It is sickening, and I want to know how we overcome
    that with approaching the SEL.
        Dr. Shriver.
        Mr. Shriver. Thank you. Thank you. I am not sure I am the
    best to comment on it, but I will just mention very briefly
    that you mentioned discipline practices that have been
    disproportionately punitive toward children of color.
        But discipline practices, again, this is back to the
    earlier question, that have been not so successful for any kid.
    We put too many kids out of school. We suspend kindergartners.
    I mean, these are not good strategies for promoting
    development.
        So we have got things, strategies we call restorative
    practices. Some people don't like them as much as others
    because they think they are too lenient. But we can create
    discipline strategies that are not designed to segregate and
    eliminate children from the system, but rather to keep them in
    the system and help them heal.
        Mrs. Watson Coleman. Thank you.
        Madam Chairwoman, thank you for the indulgence. I do hope
    to get a second reading opportunity here because I want to
    explore this beyond just the issue of discipline.
        So, thank you. Thank you, Dr. Shriver.
        I yield back.
        The Chair. Thank you. Thank you very much.
        Congressman Cline.
        Mr. Cline. Thank you, Madam Chair. I want to thank our
    witnesses for being with us and for the interesting
    conversations that we have had.
        I have learned a lot as well, and I want to reflect the
    comments of Congresswoman Watson Coleman. I found it really
    interesting. I am learning a lot and don't know a lot. And that
    is why Members of Congress are probably in the least
    appropriate place to be making decisions about the allocation
    of hundreds of millions of taxpayer dollars for educational
    purposes.
        I was in the State of Virginia House of Delegates for 16
    years, and we were much more involved in making educational
    decisions about the content, about the standards of learning in
    our schools, about the standards of quality in Virginia
    schools. But recognizing that much of what was taught and much
    of what was decided was best left to the local level, local
    school boards, and to parents, ultimately, as they make the
    decisions.
        As I was in the State House for 16 years, I remember when
    No Child Left Behind was passed, and the negative reaction not
    just on the part of State legislators at the infringement over
    the prerogatives of States to decide how best children should
    learn in their States, but with parents who were upset about
    teaching of Common Core and different concepts that were being
    pushed down on localities and on parents by an overarching
    Federal education bureaucracy being run out of Washington, DC.
        And so I associate myself with the comments of many
    colleagues on my side who are questioning the role of the
    Federal Government in this process, and quite frankly, I am
    falling back on my old Ronald Reagan line, ``Here we go
    again.'' Because this is a perfect example of what happens when
    the Washington bureaucracy creates a means by which you can
    hijack local instruction and use it to push overtly political
    social and emotional engineering down on students on a national
    level.
        So I will ask Mr. Eden, at the very least, with this
    radical ideological being taught more regularly in schools, do
    you believe that if there is more transparency and if these
    topics are being discussed, that parents can be made aware of
    what is being taught and should be made aware of what is being
    taught in their child's schools?
        Mr. Eden. I think they can, should, and must, right? I
    mean, structurally, what SEL can do is come down as a mandate
    that you kind of fill these categories of instruction, ways of
    approaching children. That could be filled with
    unobjectionable, positive things or could be filled with things
    that many parents would object to.
        And parents have a right to kind of know what is coming in.
    If it is objectionable, they should be able to speak from an
    informed perspective to what they object to. And if it is not,
    they should be put at ease that, hey, actually in my district,
    SEL doesn't do all these things. SEL is still kind of what it
    primarily involved 5 to 10 years ago.
        But parents can't know that unless they know that. And
    local government doesn't work unless parents know what is going
    on at their schools.
        Mr. Cline. Well, I know that in one county in Virginia,
    Loudon County, they were requiring parents to sign
    nondisclosure agreements before they could review curriculum in
    those Loudon County schools. And there has been an earthquake
    in Virginia politics over the last year, and it has been
    centered around parental rights.
        Our new Governor, Glenn Youngkin, has put that at the
    forefront of his administration and is pushing for more
    transparency in our schools. I would look to Ohio, where they
    have a Parents Right to Know Act that provides for full
    parental curricular review and opt-in by the parents, not opt-
    out.
        So I think there are opportunities there, but they should
    be taken at the State level. They shouldn't be mandated at the
    Federal level unless you are talking about openness and making
    sure that parents are ultimately the ones who have the control,
    who have the responsibility, and not, again, a bureaucracy from
    DC pushing a certain mandate down on localities.
        Mr. Eden, can you speak to how social and emotional
    learning may infringe on the privacy of students and families?
        Mr. Eden. Yes, I mean, the story that you gave from Loudon
    County, if I recall correctly, it was about access to a school
    survey, in addition to curriculum. What questions are kids
    being asked? Asking questions is not an inherently neutral act.
    What is being done with the question that is being asked might
    not be neutral.
        When you ask students very personal questions to find out
    things in order to affect them, that is an invasion of privacy
    technically, and I think there is a role the Federal Government
    could play in shoring up parental notification, kind of shoring
    up the People's Protections Rights Act so that parents don't
    have a situation where they don't know what their kids are
    being asked and don't know what is being done with what they
    are being asked.
        Mr. Cline. Thank you. I yield back.
        The Chair. Thank you. And I would hope at some point, our
    other witnesses will get an opportunity to speak to the issue
    of what is being done at the local level in a variety of
    States, which is under their own jurisdiction and the efforts
    that are being made that is not a Federal mandate.
        Let me recognize Congressman--I have to move on to
    recognize Congresswoman Bustos, but we will get to your point.
    Congresswoman Bustos.
        Mrs. Bustos. Thank you very much, Chair DeLauro, and thanks
    for holding this hearing today.
        And I am going to get hyper local here, okay? So, Dr.
    Darling-Hammond, I am going to address my first question to
    you, but let me have a little bit of a lead-in, okay?
        I held a series of economic roundtables throughout the
    district that I serve in Central and Northwestern Illinois. I
    have done this for a number of years, and the more recent ones,
    you know what I heard about at every single one of them? It was
    about teacher shortages, okay? Hyper, hyper local here.
        So, so what I did, then I made a decision to bring together
    teachers, teachers aides, administrators, so we could drill
    down and have a deeper conversation on this issue. And you know
    what came up at every single one of them at the local level?
    Social-emotional learning.
        All right? So there you go. It is local.
        So, but part of it, I am going to drill down then even
    further about teachers, specifically. Do you know what happens
    when we don't pay teachers enough or if we don't provide a
    supportive environment? People don't become teachers.
        Or if they do become teachers and we are not supportive or
    they are overworked and underpaid, they leave. And when they
    leave, we are losing staff members, and we are losing this
    experience. And that all takes a toll on our kids. So, again,
    drilling down further, that takes a toll on our kids.
        So our schools really, as I see it, aren't equipped to
    provide our students the whole learning environment that they
    need. And as a result, students suffer.
        So teacher shortages were worsening pre-pandemic. We knew
    that. We have all seen that. And they have been made even worse
    by the pandemic.
        So, again, Dr. Darling-Hammond, can you please talk about
    the measurable impact of teacher shortages on the academic,
    social, and emotional development of children? And touch on how
    the pandemic has affected these issues as well.
        Ms. Darling-Hammond. Well, we know that teacher shortages
    result in several things. They result in several things. They
    result in courses getting canceled. They result in larger class
    sizes because you can't hire enough teachers. Or they result in
    people being hired into the classrooms who don't have training
    to teach, and that happens at a large level. It happens
    disproportionately in higher-need settings.
        But I will say, for example, in California, about half the
    people coming in to teaching in the last few years have been
    coming in without preparation. And that means that they are
    coming in not knowing how to teach math and science and
    reading. It also means that they don't have the tools to
    understand child development. And quite often, the
    disproportionate disciplinary actions and problems like
    managing a classroom also bubble up.
        So children are underserved when there are teacher
    shortages in substantial ways. And just to kind of loop it back
    around to the questions we have been talking about, one of the
    things that we need to keep teachers in the classroom and to
    give them that support is the set of wraparound supports that
    community schools and other whole child education strategies
    can offer, which a number of districts and States are looking
    into and that Congress has begun to support.
        When you have health and mental health services there in
    the school, when you have the social services to help kids,
    then teachers can create a much more positive environment, and
    they can help kids get what they need.
        Teachers burn out also when they can't help kids, when they
    can't meet all of the needs that they see their students
    presenting because they want--that is why they are there. And
    if we wrap around the teachers and the students with these
    kinds of supports, you will see a much better result with
    respect to teacher retention and student learning.
        Mrs. Bustos. Very good. Thank you.
        I am going to try to squeeze in a last question here in the
    last minute.
        Dr. Cantor and Dr. Shriver, if we have time for this, this
    will be addressed to you. We have seen this siloed approach to
    addressing certain elements of childhood development. So the
    whole child approach obviously is important towards breaking
    down these silos. With developing children's physical, mental,
    social support all together, we are able to create a more
    supportive learning environment and be able to address these
    social disparities that we talked about today.
        But the approach of breaking down the silos and addressing
    disparities is really we see it as central to addressing social
    determinants of health, and I know Chair DeLauro knew I would
    try to squeeze this in. She has been incredibly supportive, as
    has Ranking Member Cole, in a bill that I have called the
    Social Determinants Accelerator Act.
        We have got grants in that that look to empower communities
    to tailor their approach to addressing these local disparities,
    which may include better incorporating educational initiatives
    like the whole child program.
        I am out of time now. I guess I plugged my Social
    Determinants Accelerator Act, and I guess I just want to make
    sure that our panelists know about this, and we will have to
    talk about this offline at another time.
        Thank you, Chair DeLauro, for all of your support of such
    an important measure, and thanks for holding the hearing today.
        I yield back.
        The Chair. Thank you. Is Congresswoman Lee on?
        [No response.]
        The Chair. Okay. I guess not. And then what we will do is
    to move to a second round. And I don't know if--Congresswoman
    Bustos, and thank you for getting in the social determinants. I
    knew you would, but I would also like to have people respond to
    you because these are really experts in the field.
        Let me, I think, as Mr. Cole has had to go to the Rules
    Committee, so let me ask about community schools. This is an
    issue that you have some familiarity with. You had one of the
    first in the Nation in New Haven, the Dr. Harry Conte Community
    School, which I spent a lot of time working at and
    volunteering, really volunteering time there.
        So, and I wanted to ask you, Dr. Cantor, Dr. Darling-
    Hammond, and Dr. Shriver, I want to ask you the question about
    how the community school model can play a role in really
    disrupting the effects of poverty so that our most vulnerable
    kids can learn and they can thrive. And if you will, let you
    talk about, Dr. Cantor, the positive environment in which kids
    can thrive in community schools in this space. So let me ask
    the three of you to respond.
        Dr. Cantor. Thank you for giving me the opportunity to talk
    about this. I am actually on the current task force for
    community schools and in this next generation.
        First, it emphasizes the point that Congresswoman Bustos
    just mentioned, and that is that health and mental health and
    well-being are essential determinants about kids and their
    ability to learn in school. And we have known this forever.
        And in the first generation of community schools, the big
    focus was access. Have the services in school and have those
    services easily available to parents, particularly parents who
    work, and to take the stigma out of many of those services,
    particularly mental health services.
        But now community schools is doing something more. Okay, I
    spoke about whole child learning and the fact that integrated
    supports are an essential component of the five components of
    whole child learning. So the new focus of community schools is
    actually to connect the activities in support of kids, whether
    they are health and mental health, and learning, engagement in
    learning, in enhancing motivation, enhancing energy, and
    putting kids into a position where they can feel the full power
    of their capacities to learn and engage.
        So the new generation of community schools is not even just
    about supports. It is about supports in service to powerful
    learning for each and every child.
        The Chair. Dr. Darling-Hammond.
        Ms. Darling-Hammond. I will just piggyback on that. I will
    just say California has just invested almost $3,000,000,000 in
    getting community schools launched in our highest-poverty
    schools. And about a third of our schools have more than 80
    percent of students who live in poverty.
        And what does that mean? It means to us that in these
    schools, we will have health clinics and mental health supports
    and mental health professionals. The health clinics will be
    sure that kids get the kind of healthcare that many of them
    don't get, that they get vision testing and hearing testing and
    all of the other supports.
        But it will also mean that they get expanded learning time,
    that there will be tutoring after school, that there will be
    support for after school homework, for mentoring and a variety
    of other recreation and enrichment activities for students.
        It will mean that they will be able to get support from
    social service providers. If a family is about to be evicted,
    we have a high homelessness rate all across the country for
    children, but certainly in my State. And the facilities to help
    families in those regards will be there. All of these things
    remove obstacles to learning.
        And then we need inside the school for teachers to have
    enough knowledge base about how to recognize the needs that
    children have to connect them to those services that will be
    readily available, and that can be transformative to the
    teaching and learning process and for the retention of
    teachers, as I mentioned.
        The Chair. Dr. Shriver, I am going to go over my time
    because I want you to have the opportunity to talk about some
    of these schools because I think we have similar experiences.
        Mr. Shriver. Yes. Well, having also worked at Conte school,
    Congresswoman DeLauro, I think we know--again, I think there is
    not a really controversial issue here. I mean, there has been a
    lot of discussion on this hearing about Federal versus local.
    This is a movement that started as a local movement. It is not
    a top-down movement.
        I mean, I don't want to disillusion Members of Congress,
    but this is a movement that has been built by parents and
    teachers and educators for the last 30, 40 years by communities
    that wanted to add tutorial services, that wanted to support.
    So I think we have like much more agreement here than we
    realize.
        Parental engagement. Absolutely. The picture, again, behind
    me, Dr. Comer. First pillar of this work is parental
    engagement. I would agree with all the members of this
    committee and all the witnesses in saying that parents are
    completely critical and need to be in community schools and
    need to be valued and listened to and disclosed to in community
    schools.
        The resources that children need are at the community
    level. They are not at the Federal level. So I mean, maybe
    there is a specter of a Federal takeover, but count me as a
    person not in favor of it. I am completely in favor of
    empowering parents and local communities to be at the center of
    all this work.
        So I will stop there.
        The Chair. Before we go on, let me just mention this. Just
    piggyback on what you said, Dr. Shriver.
        It was--I am just trying to think--it was in the 1960s at
    the Dr. Harry Conte Community School, and I had just finished a
    graduate degree at Columbia University. It may have been 1965,
    1966, and I didn't have a job. So I went to volunteer my time
    at the Conte school. It is a community school.
        And by the way, the initiation of community school and that
    concept came from Dr. Gerald Tirozzi, who wrote his doctoral
    dissertation in Ann Arbor about the role of community schools
    and locally what community schools could mean. That school was
    open from 6:00 in the morning until 9:00 or 10:00 at night.
    Everyone was in the school--mothers, fathers, grandparents.
    There were sports with older kids.
        Tutorial services, health services, the whole 9 yards. And
    the benefit was really extraordinary. All locally based. No one
    was dictating what was taught, what extracurricular activities
    were, what the after school programs were, et cetera. It was
    all based on local efforts.
        It was almost--well, we really went backwards in terms of
    education when we stopped dealing with community schools, which
    is why that we are now moving to looking to the future with
    community--understand the word ``community''--schools and their
    ability to help to make and create a positive, a positive
    environment for children and for families and for parents, and
    for parents to engage with their kids and with one another and
    to be able to create that overall positive relationship there.
        And I am going to--Congressman Harris, Congresswoman Lee is
    here. I am going to give her--I am going to recognize
    Congresswoman Lee. I tried to get her in the first round. But
    then we will move forward, Dr. Harris.
        So, Congresswoman Barbara Lee? You are on mute. Barbara,
    you are on mute.
        Ms. Lee. Yes, I apologize for being late, but I was
    chairing my own subcommittee. So I am so glad to be able to
    just be with you for a few minutes.
        And I want to thank all of our witnesses. This is such an
    important, important meeting, hearing to really secure the
    future for our young people in the country. And I wanted to
    just--forgive me if this is a redundant question on trauma.
        Just wanted to find out how the schools, how you see the
    trauma that many of our young people now are experiencing as a
    result of, say, gun violence in many of our communities, as a
    result of being unsheltered, as a result of COVID. All of the
    trauma of just living--and many communities living poor, living
    as a black person, as a black-brown person, black and brown
    children.
        And also how can--my background is psychiatric social work,
    and so I have always wanted more social workers and
    psychologists in our schools and defining their roles so that
    they are servicing schools and school districts, and with
    teacher turnover so high and staff changing, we wanted to find
    out how the Federal Government, what you think the Federal
    Government should do to intervene to make sure that we sustain
    levels of training that we need in our schools, as well as what
    we can do to address trauma-related factors that children now
    are experiencing?
        Dr. Cantor. Trauma is my specialty. This is--this is the
    work that I have dedicated my life to as a mental health
    professional. But we have--we have a lot, a lot of kids that
    have been impacted by the pandemic. So we can't say to
    ourselves that the solution is every child will have a
    therapist because that is unlikely to be something that we can
    provide.
        But one of the things that we can provide is for all of the
    environments, whether they are schools or community-based
    organizations, after school programs, the whole principle of
    whole child design is that every single environment in which
    children grow and learn can be set up to address the things
    that trauma does to kids.
        Trauma is about stress and stress' affect on the brain and
    on learning and on kids' emotional development. You have kids
    walking into environments every day that are going to be
    healing places, places that reduce stress, places that provide
    relationships, and places that connect kids to sources of
    support. That is the response that is required today because of
    the impact, the traumatic impact of the pandemic on development
    and learning.
        Ms. Lee. And let me ask you--I have a couple minutes left--
    anyone who could answer this question, in terms of any Federal
    guidelines that provide guidelines for expulsions and
    disciplinary action. I, for many years, when I was in the
    legislature, tried to tighten up the California code to have
    some criteria for expulsions, especially of black and brown
    young kids like in kindergarten, and never could get that done
    for a lot of reasons.
        And so I am wondering do we have new guidelines? Because we
    want alternatives to suspension and disciplinary actions that
    would allow--that would force kids out of school. So what are
    the Federal guidelines, or are there any Federal initiatives
    that would make sure that kids have alternatives and that
    expulsions have some kind of criteria? If a kid is going to be
    expelled, it is going to be for the right reason, which I
    can't, for the life of me, determine what the right reason
    would be to expel a child.
        Ms. Darling-Hammond. Yes, I would love to speak to that
    from both the California and Federal perspectives. The
    Department of Education is right now revising and getting ready
    to issue guidelines on disciplinary actions and disparities and
    how they will be involved in investigating disparities as well
    as guidelines for the sort of practices that involve kids in
    community circles and in supports that teach them conflict
    resolution and a variety of things.
        In California, the zero-tolerance policies that were in
    place have been eliminated. The use of suspension and expulsion
    for things like sort of discretionary behaviors like willful
    defiance and----
        Ms. Lee. Right. Or wear hair like I wear my hair.
        Ms. Darling-Hammond. Yes. Have been eliminated. The State
    now looks at exclusionary discipline in its accountability
    system. We have got licensing standards that require teachers
    and principals to learn strategies that work to support
    children in learning behavior and staying in school.
        So there is a lot that both the Federal guidance can do in
    this regard and that States can be picking up and can be
    encouraged to pick up as ways to keep kids in school. We see
    higher graduation rates. We see stronger achievement as a
    result of those kinds of actions.
        Ms. Lee. Thank you very much. Thank you, Madam Chair.
        The Chair. Got it. Okay, Dr. Harris.
        Mr. Harris. Thank you very, very much.
        And Mr. Eden, I want to follow up with you because if you
    read--if you go to CASEL's website and you read about things,
    and I am going to read from it, it says, ``CASEL is refining a
    specific form of SEL implementation that concentrates SEL
    practice on transforming inequitable settings and systems and
    promoting justice-oriented civic engagement, which we are
    calling transformative SEL.''
        So SEL is being changed. So is there any academic evidence
    that transformative SEL, this new kind of SEL actually improves
    academic performance? Because I mean that is, hopefully, what
    the school system is all about. Because families can do a lot
    of social-emotional learning and teaching. Schools have to
    concentrate on academic performance.
        Is there any evidence that transformative SEL improves
    academic performance in a highly rated study?
        Mr. Eden. Well, yes. Well, before answering that question,
    I kind of would like to pose a question, which is that if we
    know that SEL works from all these studies that we say that
    prove that it works, well, why transform it?
        As for what we know about the outcomes of transformative
    SEL, given that it is based on a paper that was written in 2019
    or 2018, I believe, and then adopted within about a year by the
    organization, and it takes a totally different moral,
    political, ideological spin to the enterprise, I would be
    shocked to find that there are studies, short term or long
    term, about SEL as it is now defined.
        Mr. Harris. Sure, and that is totally--totally
    understandable because it is brand new, and I imagine your
    question was rhetorical because I think we know why. It is
    because we want to change this into a--because CRT is no longer
    very popular to use, people shy away from it.
        By the way, Mr. Shriver, I am glad to hear that you don't
    want a top-down involvement because what we learned from
    COVID--and there are very few silver linings--is that parents
    finally figured out what is being taught in their schools, and
    they didn't like it. Parental involvement is absolutely
    essential, but they didn't like what they were seeing in
    schools.
        Then when they tried to get information, they had to sign,
    as the gentleman from Virginia said, nondisclosure agreements
    to look at curriculum, something that should never, ever occur
    in our public school system, but it is going on.
        Anyway, so, Mr. Eden, let me talk a little bit because I
    want to follow up on what my colleague from Washington State
    asked about, which is this idea that you kind of are turning
    teachers into therapists a little bit? Yes, with their mental
    health issues, I get it. You know, I am a physician.
        To actually deal with mental health issues, we have
    complete residencies that take years and years. Teachers are
    not equipped to do this, and yet they may be asked to do it,
    and you suggest that things could go horribly wrong in a
    variety of ways.
        How, why do you say that? I mean, I believe that is
    probably true. When you have undertrained individuals delving
    into very, very serious issues, why do you say that things
    could go horribly wrong?
        Mr. Eden. Yes, I will go straight to the scariest thing
    that scares me, which is the implementation of suicide
    awareness and prevention programs, right? Now, to my knowledge,
    I haven't looked at it deeply, I believe that it is possible to
    implement these programs well. It would stand to reason that it
    would be. But also there is a risk that that could terribly
    wrong because you might normalize the thought of suicide if you
    ask students repeatedly, year after year, possibly semester
    after semester, in surveys or interventions, are you thinking
    about hurting yourself? Are you thinking about killing
    yourself? You risk normalizing those thoughts.
        You risk potentially increasing the overall number of
    suicides in an effort to address it. The scariest thing for me
    is if that happens, will the system double down on the
    intervention that might be engendering it? Will it say, oh,
    wow, we have this increase in student tragedies, let us double
    down in suicide prevention awareness?
        I mean, that is the worst thing that can happen. But other
    things is when students are kind of asking questions about who
    they are, those are questions maybe best left to a therapist or
    to a psychiatrist. When it reaches levels of kind of gender
    dysphoria, reaches levels of extreme stress, those are things
    that teachers just aren't trained and really can't be
    effectively trained with anything except for pop psychology,
    which frequently carries an ideological valence to it, even if
    it is not intended to.
        You can feed all sorts of counterproductive not--not good
    thoughts into students while you are trying to help them.
        Mr. Harris. Yes, it is the cart before the horse. I mean,
    we can agree that that might be important, but then we have to
    educate our educators to actually be therapists.
        Finally, just one last thing is the privacy issue, a huge
    again. This was in the State of Maryland, where they were
    passing around these surveys and specifically not releasing the
    surveys to parents, the questions on the surveys. Very
    disturbing when it is dealing with early elementary school
    children.
        Anyway, I yield back, Madam Chair.
        The Chair. Thank you. If I might, since CASEL was
    referenced, and Dr. Shriver, you are on the board, chairman of
    the board of CASEL, I wanted to give you an opportunity to
    respond to the issue of transformative SEL.
        Mr. Shriver. Thanks, Congresswoman. Thank you, Congressman
    Harris. Yes, thank you.
        So I appreciate the concern about transformative SEL. It
    was a paper written, and as you pointed out, Mr. Eden, it
    suggests that there are forms of SEL for certain districts
    where local communities are particularly interested in the
    issues that you describe. It is not a reform of the basic
    science. It is a paper that describes ways to integrate certain
    strategies when communities are interested in that form of SEL.
        It has become very popular in many districts. It is not
    inflammatory. Maybe some of the language sounds to some people
    that it is triggering or in some ways of concern. But it has
    been very well received as a form. Again, I just want to point
    out all of these decisions are made at the local level. CASEL
    is not impose--CASEL doesn't have a curriculum.
        CASEL reviews and evaluates and creates knowledge of
    learning systems for teachers and superintendents and parents
    and others who want to look at curriculum and want to decide on
    what works in their community, but CASEL is not telling people
    what to teach. It is getting people guidelines about where the
    evidence is, as good as the evidence is, and where the evidence
    isn't.
        So we are trying to create an open forum here that inspires
    people to experiment and challenge and try things. The studies
    that you referred to as not being about transformative SEL are
    not about transformative SEL. They are about other forms of SEL
    where you can look at the curricula that were in the meta-
    analyses, and those are the ones that are being evaluated.
    There is no secrets here. It is really--I mean, at some level,
    I think, Dr. Harris, you know, your point about the comparison
    to medicine I think is really important.
        My mentor, Dr. James Comer, always used to say that in
    medicine every doctor has a basic science. It is the human
    anatomy. In education, we need a basic science, which is child
    development. It is not to say that you know on all moments how
    to apply the science. It is just to say we need the basic
    understanding of human development as educators in order to be
    able to teach math and science and reading and so on better.
        So what we are trying to do is underpin the field, if you
    will, the profession. Teachers should not be therapists.
    Absolutely, lesson one. I mean, I learned this, again, 30
    years. When problems arise--and they are in the classroom
    already. I mean, we can hope that these problems aren't in the
    classroom, but they are there.
        What we have tried to enforce and emphasize to teachers is
    when problems surface, make sure you have the capacity to
    recognize them and refer the children out. Help the children to
    recognize what we call help-seeking skills.
        When I was a kid, when I was in trouble, I had no skills to
    look for help. I didn't know how. I was embarrassed. I was
    ashamed--if I was lonely, if I was angry, if I was confused, if
    my peers were using drugs. What we try to do in these programs
    is help children recognize when they need help. We call it
    help-seeking skills.
        And we try to help teachers realize when children need help
    how to refer them out. We call it multi-tier systems of
    support. Classrooms are not therapeutic settings, but they can
    be very powerful settings for supporting development across an
    array of local environments.
        The Chair. Congresswoman Frankel.
        Ms. Frankel. Thank you. Thank you again, everyone.
        Okay. So I have with me a calculator. Now if I ask this
    calculator, I don't ask it, but if I put in what is 2 plus 2,
    it tells me 4. It is uneventful. If I ask my grandchild that,
    depending upon his mood, I might get an answer.
        So I just said a lot of this is just common sense. Of
    course, a child's emotional development is important to his
    education, his well-being, and to everybody else. That is not
    to say, and look, I believe that parents are the most important
    part of children's life or can be or should be. Unfortunately,
    some children are not blessed with the love and nurturing of
    parents.
        But the fact of the matter is I just looked this up. The
    average child spends between 3 to 6 hours a day in school,
    depending upon the age. So by the time they are done with
    school, it is over 14,000 hours. Hello? These children are not
    robots. We better be paying attention to all aspects of their
    life.
        And so I don't want rant and rave all day about my
    horrifying and embarrassing law in Florida, the ``Don't Say
    Gay.'' Okay, I am going to go past that because we are
    mourning, we are still mourning in Florida the carnage of
    Parkland. The trial is going on this week. Seventeen children
    and teachers killed, 17 more injured.
        And not to make an excuse for the killer, but it appears
    from his background that he was very--that he was bullied, that
    he had a lot of what I would say emotional problems. That is
    not an excuse. But it would have been nice if there had been
    some intervention because it may have saved so many lives.
        And that is what I really wanted to ask--I am going to
    start with Dr. Cantor. If you could, just explain how this type
    of by recognizing the child's emotional development, how can
    this help at least point out to the powers that be that there
    may be a child in trouble?
        Dr. Cantor. So one of the things that Tim Shriver said a
    minute ago around this idea of what is knowledge that we have,
    and what is basic science? So one really crucial element of
    basic science is the impact of stress on development and
    learning. All of us, when we experience stress, have a biologic
    reaction to it that is mediated by a hormone, a hormone that
    travels to the brain and can create that fight-flight feeling.
        When kids are bullied, when kids are othered, when they
    don't feel safe in the environment in which they go to school,
    these stress mechanisms are set off. And they will impact how a
    child behaves, whether they can concentrate and learn, and
    whether they are going to be able to thrive in a setting.
        Now this is knowledge. This is not theory. I learned it in
    the 1980s in med school. Okay? So there is nothing about this
    that is new.
        I also learned that the most powerful force that can
    mitigate, okay, that can address this feeling of stress is
    another hormone that is released because of positive
    relationships that kids have. That hormone is oxytocin. So in
    our bodies, we have one that raises stress and one that takes
    it away.
        So what do we know that releases that helpful hormone that
    helps kids learn and helps them feel safe? Okay, it is an
    environment in which they feel safe, have positive
    relationships, know that they belong. You are actually
    impacting the biology of a child and making that child able to
    learn and thrive.
        Okay, this is not theory. This is knowledge.
        Mr. Eden. Ms. Frankel, if you don't mind?
        Ms. Frankel. Thank you very much. And I yield back.
        Oh, I am sorry. Did you----
        Mr. Eden. Just a quick comment because I----
        Ms. Frankel. Sir, no comment. I am out of time. I yield
    back. Sorry.
        Mr. Eden. Yes, ma'am.
        The Chair. Congresswoman Watson Coleman.
        Mrs. Watson Coleman. I thank you, Dr. Cantor. That was a
    very interesting discussion.
        So we know that we had all these problems in the schools
    anyway--the bullying, the racism, the homophobic behavior even
    at a very young age. Now we have kids coming back to school
    from the pandemic, from the isolation, from the insecurities
    that they experience at home. I even have concern about
    children who have lost their caretakers, their providers during
    this pandemic, and now we are bringing them back into what we
    consider to be their normal routine of going to school.
        What are some of the things that we need to be looking at
    and doing and are we doing to address the kind of sort of
    emotional condition that a child is coming back to school?
        Dr. Cantor. I think that the work on whole child learning,
    this was a collaboration where we sought, Linda Darling-Hammond
    and I and a team of scientists, to answer the question, what do
    we know from the science of learning and development that says
    how should a learning environment be designed so that children
    walking in the door are going to experience the conditions that
    optimally support their ability to engage and perform in
    school?
        So those five factors in whole child design--relationships,
    belonging, rich instruction, supports, and building 21st
    century skills--all of that came directly out of the science of
    learning and development and pointed the way toward the design
    of these comprehensive environments.
        We now have a playbook that can help districts implement
    toward that kind of comprehensive design. We have to stop
    binary solutions. We have to stop siloed solutions. You can't
    do whole child design with your left hand and have harsh,
    exclusionary discipline with your right hand. Okay?
        These things are antithetical to each other. And we need to
    build holistic design in which we solve many problems at the
    same time for kids.
        Mrs. Watson Coleman. Thank you. Ms. Darling-Hammond, could
    you just quickly address where are we in our--in schools having
    access to this sort of learning paradigm and their readiness
    and willingness to engage in this approach to educating and
    addressing the needs of our children?
        Ms. Darling-Hammond. Yes. I think that where we started in
    the beginning of the hearing around the social-emotional
    learning programs that have been developed and vetted and are
    accessible to schools is a part of that. About a third of the
    districts that have used the American Rescue Plan Act money and
    the ESSA funding have used it to put in place these kinds of
    supports that enable teachers to help students process their
    emotions, talk about their experiences, learn coping strategies
    that allow them to work through some of what they have
    experienced.
        The community schools component of it, which, again, many
    districts are using those funds for, are also accessing the
    mental health professionals and supports that then can help
    students deal with the trauma that they have experienced. But
    there is a lot of effort going in, and the Federal funding has
    been extremely valuable for this to help schools create this
    kind of a whole child design in the curriculum and in the
    support systems around them.
        There is more to be done, to be sure, but we do see much
    better outcomes in the places that are putting those supports
    in place for students so that they can recalibrate and feel
    that the school is a welcoming place where they can get the
    necessary supports that they can't get otherwise.
        Mrs. Watson Coleman. Thank you. Can I say that I am so
    supportive of the community school design? I believe that we
    could co-locate services not only for students, but for even
    families.
        Ms. Darling-Hammond. Yes.
        Mrs. Watson Coleman. I mean, I had a visionary Governor who
    believed decades ago that we could have healthcare there. We
    could have job seeking there. We could have housing seeking
    there.
        I also believe very much that we could keep children in
    school doing both academic and athletic and social involvement
    after the traditional school hours, keep them off the streets.
    I mean, there is just so much that we are not doing that we
    should be doing in public education.
        So I love hearing this. Thank you, Madam Chair, for this
    opportunity, and I just look forward----
        The Chair. Okay. Let me just--there is a couple points, and
    then I am assuming, Dr. Harris, that in the absence of Mr.
    Cole, I will yield to you for closing remarks. But I wanted to
    make a couple points.
        And Mr. Eden, I appreciate really--very, very much
    appreciate your concerns about low-quality SEL investment.
    Which is why with the committee, with the grants that we have
    dealt with, they are included in what is a rigorous tiered
    evidence program, the Education Innovation and Research. So to
    do whatever we can to make sure that the quality of the program
    is as intended, you know, and not--I would just say about
    mental health issues, I would overall love to have an
    overwhelming support on both sides of the aisle. I believe we
    ought to have a mental health professional in every one of our
    schools.
        That would be a goal to have a trained mental health
    professional, and one of the things we do most recently in the
    Labor-H bill is to include funding for mental health
    professionals. But I think particularly given what has happened
    with the pandemic and the aftermath of that, I think it would
    be a real investment in--a serious investment in how we would
    like to see our children be able to get past the absolutely
    tragedy of the last couple of years and to put mental health
    professionals in every single school.
        And yes, and that is something that we ought to fund to be
    able to do. It would serve us well.
        A last point before I recognize Mr. Harris is that this is
    the issue of the local effort, and I think we are looking at
    the creation of social and emotional learning that is in a
    nonpartisan way. It is in a safe--it is in rural, urban,
    suburban settings. And I just would mention to you the various
    States that are engaged and involved. There is Georgia, Kansas,
    Kentucky, Missouri, Oklahoma, Tennessee, North Carolina, North
    Dakota. And these are efforts that are being made that are
    grounded in what the need is on a local basis.
        That is the genesis of this. At its core, it is about
    what--and I think about this issue of parents and school
    boards. As far as I know, and I have started to look into this,
    local school boards are parents. The local school boards all
    over the country include parents, and who have a vested
    interest, obviously, in what happens to their kids and have
    input into what is happening to their kids.
        Now let me recognize Dr. Harris for closing remarks.
        Mr. Harris. Thank you very much, Madam Chair.
        And look, I want to thank all the panelists for your
    interest in making sure that our children get educated. That is
    the bottom line. That is incredibly important because, I think,
    as someone pointed out that is the future. I mean, our children
    are the future.
        I am a grandfather of 10, father of 6. Clearly, I am very
    concerned with our ability to educate the next generation.
        Look, I am going to concur with the chair. We are probably
    not going to agree on how to fund the mental health
    professional in every school because I think that is a State
    and local responsibility, but we should urge that to occur.
    Because unfortunately, over the past several decades, the
    schools have come to replace the families as places where
    social, emotional, moral learning and teaching goes on.
        Now, look, that is the hand of cards we are dealt. We could
    try to put the family back in charge of some of that. But
    again, that may or may not be able to occur, and until that
    happens, we have to recognize that this now--and it is
    different from 50 years ago and 60 years ago--that schools are
    going to have to take up some of this.
        I would urge us don't put the cart before the horse. We
    should do some rigorous research, see what works, what doesn't,
    and then train the next generation of educators for that.
    Because I am afraid a lot of the educators, you know, it is
    hard to teach an old dog new tricks. And a lot of educators I
    think look at some of this and say this is not what I was
    trained to do, and they are probably right.
        So it is important to look at it, as long as we keep our
    eye on the same goal, which is to make sure that our children
    get educated, that their academic performance, their social,
    their ability to fit in socially is achievable within our
    society. That is our goal.
        So I appreciate, Madam Chair, I appreciate bringing
    together the panel. I always appreciate when you bring together
    panels of people who are interested in just improving the lives
    of our children and how our children turn out.
        So, with that, I want to thank you all, and I yield back.
        The Chair. Thank you.
        And just in closing, I want to end where I began with the
    Neil Postman quote. ``Children are the living messages we send
    to a time we will not see.'' They are literally the legacy we
    leave behind us, and we know that everything we do needs to be
    making sure that--whether it is parents or educators, we need
    to make sure that our kids can meet the challenges of the
    future.
        So it is incumbent on all of us, especially legislators, to
    ensure that they are prepared. And that is not only
    intellectually. That is emotionally and socially as well.
        And I just might add I hear a lot about research and more
    evidence, well, there is substantial, substantial evidence
    behind, it is scientific. We are standing on very solid
    scientific ground here that the interventions and the science
    behind the interventions is overwhelming and that high-quality
    SEL programs that support these efforts result in absolutely
    positive and academic life outcomes.
        And it is about the future of our children and,
    particularly now, of the stress and the hardship of our most
    vulnerable kids that they have faced in this pandemic.
        And I was interested in, Congresswoman Watson Coleman, and
    I don't have the number at my fingertips, but the number of
    children who have lost their parents to COVID. What is
    happening to these children, and what are we doing to address
    this issue? So we are looking at the strategies that are
    effective strategies, as we know, that are needed now more than
    ever.
        And which is why what we try to do is to engage through the
    Labor, Health and Human Services, and Education Subcommittee in
    addressing these issues and based on the science because we can
    look at study after study after study, and we know--and we have
    study after study telling us about how children learn, at what
    age they are learning, et cetera. It is now for us to put into
    practice the information that we know and to act on it. That is
    the moral obligation that we have in this effort.
        I just want to say a thank you to our witnesses today.
        I wanted to thank you for not only for your testimony
    today, but I want to say thanks for the years and years in your
    professional lives of devoting just to looking at the science,
    developing--helping to develop the science, taking the interest
    to understand how we need to--the most significant impact we
    can make on children is their education and where those
    educational opportunities will lead them.
        And it is just so critically important. It is probably the
    most where we should have the greatest Federal involvement in
    supporting what local government is doing and what the research
    tells us are the ways in which we can transform the lives of
    our kids through education and making them feel that they have
    the environment, the cognitive ability, and have the social
    skills to be able to succeed. And thank you for devoting your
    lives to making that happen.
        And with that, I am going to adjourn this hearing. Thank
    you very, very, very much for your testimony this morning. It
    is very appreciated. Thank you.

                                              Thursday, April 28, 2022.

                            DEPARTMENT OF EDUCATION

                                    WITNESS

    HON. MIGUEL CARDONA, SECRETARY, DEPARTMENT OF EDUCATION
        The Chair. I now call to order the hearing on the fiscal
    year 2023 President's budget for the Department of Education.
        This is a hybrid hearing, so we need to address a few
    housekeeping matters.
        For members joining virtually, once you start speaking,
    there is a slight delay before you are displayed on the main
    screen. Speaking into the microphone activates the camera,
    displaying the speaker on the main screen. Do not start your
    remarks if you do not immediately see the screen switch. If the
    screen does not change after several seconds, please make sure
    that you are not muted.
        To minimize background noise and ensure the correct speaker
    is being displayed, we ask that you remain on mute unless you
    have sought recognition. The chair or an individual designated
    by the chair may mute participants' microphones when they are
    not under recognition to eliminate inadvertent background
    noise. Members who are virtual are responsible for muting and
    unmuting themselves.
        Finally, House rules require me to remind you that we have
    set up an email address to which members can send anything they
    wish to submit in writing at any of our hearings. That email
    address has been provided in advance to your staff.
        Before I move into my remarks, I just want to acknowledge
    that today is the birthday of our ranking member, Congressman
    Cole. So we want to wish you all a very, very happy birthday,
    Congressman Cole. We are not going to ask you anything about
    age or any of those things, but we wish you a wonderful,
    wonderful day.
        Mr. Cole. [Inaudible.]
        The Chair. And I hope there is bourbon and cigars somewhere
    in the day.
        Mr. Cole. Multiple times.
        The Chair. Okay. This is great.
        I also want to say--and I think Josh Harder may be, you
    know, virtual--we want to welcome Josh back, who has been, as
    he explained to me yesterday, changing diapers and staying up
    late and taking on his responsibilities as a dad. So welcome
    back, Josh.
        So let me acknowledge the ranking member of the
    subcommittee, Tom Cole, and all of the members who are joining
    today's hearing both virtually and in person.
        And I would very much like to welcome Secretary Miguel
    Cardona to his first in-person hearing in the subcommittee as
    Secretary of the Department of Education. You were with us
    virtually last year, but there is nothing like being in person,
    so a very, very warm welcome.
        Secretary Cardona. Thank you.
        The Chair. There is little more critical to our growth and
    progress as a Nation than support for the educational success
    of our students. If the last 2 years have proven anything, it
    is that as we struggle to overcome moments of so much change,
    we have a moral responsibility to ensure that our students and
    the families and teachers that support them every day have the
    resources to succeed and to flourish.
        Schools and learning provide consistency. As educator
    Horace Mann said, and I quote, ``Education, beyond all other
    divides of human origin, is a great equalizer.'' And, I would
    add, is a great constant in the constantly changing world.
        Secretary Cardona, you have proven over the last year and
    throughout your career as a Connecticut educator to be a
    fighter for the programs and policies that give our students
    and our teachers the certainty that they need for success.
        Next week is Teacher Appreciation Week, a moment to
    celebrate and to recognize you, Mr. Secretary, and the millions
    of teachers around the country who dedicate their lives to
    educating our students. And you and I both know the incredible
    sacrifice that being an educator entails, which is why the work
    that you do to support our teachers as they transform students'
    lives is so crucial.
        I also want to acknowledge our parents, who have struggled
    to get their kids educated throughout the pandemic. And we
    agree they should have a big role and a big say in their
    children's education. There are some today who are trying to
    divide parents and teachers, but by design, our public school
    systems require significant input from local communities and
    parents.
        Nationwide there are 13,500 school districts with about
    90,000 school board members. Around 90 percent of these school
    board members are directly elected by their communities. One-
    third of school board members are parents of students in
    schools or preschools, with over 90 percent of those students
    attending schools in the districts that their parents
    represent.
        I also get troubled by broader efforts to ban content. That
    is divisive. The banning of books from public schools and
    libraries, restricting free speech and access to books is
    divisive, and it impedes the development of our children. That
    also must hold at universities and in university libraries
    where freedom of expression is under attack. This too limits
    the growth and development of the next generation.
        And we should not ally critical race theory with students
    learning about our history. America has a complicated history,
    but America is exceptional. American freedoms grew out of our
    history dealing with Native Americans, immigration, and
    slavery, and somehow we keep bending the arc toward progress
    and greater equality.
        Strengthening our educational system and our students'
    learning begins with a strong Department of Education. So I
    thank you, Mr. Secretary, for joining us to discuss the
    Department's fiscal year 2023 budget. It builds on the
    transformative investments we have made over the past year.
    Under your and President Biden's leadership, historic progress
    has already begun to improve the lives of our Nation's
    students, educators, and their families.
        This work began with $170,000,000,000 in the American
    Rescue Plan fund that were secured by congressional Democrats
    and President Biden, who moved quickly to reopen public
    schools, provide emergency grants directly to students, and
    assist colleges and universities in giving support to students
    in need.
        The Biden administration has also taken swift action to
    ensure student borrowers are not denied the benefits that they
    are entitled to. With improvements to the Public Service Loan
    Forgiveness Program, $6,800,000,000 in loan debt has been
    canceled for more than 113,000 public servants, and the
    administration's new waiver for borrowers and income-driven
    repayment will bring another 3.6 million Americans closer to
    loan forgiveness.
        And the days of the fox guarding the henhouse at the
    Department are over. You have advanced strong proposed
    regulations that will protect students and taxpayers from
    predatory for-profit colleges, providing relief to the student
    borrowers that they have defrauded. And despite bad-faith
    arguments by some, you have proposed reasonable measures that
    will increase accountability and transparency in the Charter
    School Program.
        Mr. Secretary, I applaud you and the President for your
    unprecedented support of our students, public schools,
    colleges, and universities. We have so much more to do as we
    continue reversing decades of underinvestment in our Federal
    education system, which is why I am so proud that Congress, led
    by this committee, passed in a bipartisan way the 2022
    government funding Omnibus bill last month, which included
    historic funding, including an increase of $2,900,000,000 for
    programs under the Department of Education.
        I am especially proud of the $1,000,000,000 increase
    included for Title I to support low-income students in our
    Nation's public schools, the largest increase in over a decade
    and, again, on a bipartisan basis. No child in this country
    should be denied a quality of education because of where they
    were born, their family's income, or their race or ethnicity.
        And with an increase of $448,000,000 for special education
    programs, we are also recommitting ourselves to improving the
    lives of babies, children, and young adults with disabilities.
        As chair of this subcommittee, I was excited as we created
    an initiative on Social and Emotional Learning and whole child
    approaches, which we funded now for the third year in a row. We
    have included $82,000,000 for evidence-based SEL grants;
    $85,000,000 for teacher and school leader development that
    prioritizes SEL training; $111,000,000 for school-based mental
    health professional grants; and an increase of $90,000,000 and
    $75,000,000 for full-service community schools, an increase of
    $45,000,000.
        These programs support students' social, emotional, and
    cognitive development and positively impact their academic
    performance and well-being.
        Earlier this year, we held a hearing on these strategies
    where we examined the overwhelming evidence, the evidence based
    behind these interventions, and we heard how these effective
    strategies are needed now more than ever, considering the
    extreme stress and hardship our country's most vulnerable
    students have faced during the COVID-19 pandemic.
        And to make higher education accessible to even more
    students, we were proud to fight for and deliver the largest
    increase in over a decade to the maximum Pell grant, a $400
    increase. We delivered $96,000,000 to historically Black
    colleges and universities and minority-serving institutions. We
    are proud of these critical investments which will make college
    more affordable for historically underserved students and their
    families.
        Alongside the Department of Education programs, for the
    first time in 12 years, we included member funding for projects
    to directly support students and educators in our home
    districts. We were able to meet the needs of communities all
    across our Nation through district-specific funding for
    programs that support students with intellectual and
    developmental disabilities, mentorship, tutoring initiatives,
    college success, and learning loss programs for underserved
    students.
        In my own district, $2,000,000 will help the New Haven
    public schools as they expand job development opportunities for
    high school students interested in a career in the
    manufacturing sector with a new manufacturing education and
    pathways program.
        As we begin the 2023 budget process, we need to build on
    these critical investments to help even more students and
    families to achieve that American dream, and I am pleased to
    see such a strong budget request to do just that.
        The President's 2023 request includes $88,300,000,000 for
    the Department of Education. It is an increase of
    $11,900,000,000, 16 percent above the 2022 level. It would
    continue to build on the historic investments we have made in
    Title I, the cornerstone of our Federal support for public
    education. It provides an additional $3,000,000,000
    discretionary increase to support our students and those
    schools that are most in need.
        The request also prioritizes support for our students with
    disabilities with a $2,900,000,000 increase to IDEA Part B
    grants to States for special education services, and a critical
    $436,000,000 increase for IDEA grants for infants and families,
    for early intervention services available to children with
    disabilities age birth through two and their families. And it
    supports English learners and immigrant students with a
    $244,000,000 increase for English language acquisition program.
    A transformative $393,000,000 increase for community schools
    will provide critical comprehensive services and expand
    evidence-based models that meet the holistic needs of children,
    families, and communities.
        Your budget recognizes the immense value of higher
    education by providing key investments to make college more
    affordable and accessible for low-income and minority students.
    I am pleased to see a $500 increase to the discretionary Pell
    grant maximum award, an additional $249,000,000 for HBCUs,
    MSIs, and other underresourced institutions. We will continue
    to meet the needs of low-income, first-generation students and
    narrow our Nation's racial wealth gap and expand access to
    employment.
        Mr. Secretary, the work that you do and the rest of the
    administration do day in and day out touches the lives of every
    single student and educator. The investments in this budget
    request and our support for our students and our teachers
    ensure that our government will get one step closer to leveling
    the playing field so that every child and every student has a
    fair shot that allows for their God-given talent to help the
    opportunities that are created where they can flourish in our
    society today.
        I look forward to working with you over the next year,
    looking forward to our discussion this morning. And thank you
    for being here today.
        And, with that, let me recognize our ranking member,
    Congressman Cole, who has a very strong commitment to public
    education and the opportunities that it opens up and provides
    for our children. And I would like to yield to the ranking
    member for his opening remarks.
        Mr. Cole. Well, thank you very much, Madam Chair. And you
    have been so kind to wish me a happy birthday, but this is a
    much more important day than my birthday. It is the first
    meeting of the big four.
        The Chair. That is right. That is later today.
        Mr. Cole. So I wish you well later today as you sit down--
    --
        The Chair. Thank you.
        Mr. Cole [continuing]. And I want to take----
        The Chair. What do we think about bourbon and cigars for
    that meeting?
        Mr. Cole. I tell you what, it would go a lot better. I
    would be happy to send you in with all you need if you think
    that would loosen them up.
        But I want to, again, take a minute before I get to my
    prepared remarks and just thank you, again, for getting us
    through the last process. You and Ranking Member Granger
    working together I think were critical to that. I think this
    committee took the leadership role, quite frankly, in pushing
    the process forward, and nobody did that more than you. And I
    am glad to see it is starting a little bit earlier this year
    and everybody has worked together.
        So I will make a commitment to, once again, try to work
    with you and make sure that we get this budget done hopefully
    within the fiscal year but, if not, certainly within the
    calendar year. I think it would be a huge mistake for this
    budget to go into next year. And that is something we should
    all want to avoid.
        That is not fair to the administration. It slows them up in
    terms of making important decisions. It is not fair to the next
    Congress. They shouldn't have to vote on appropriations bills
    that they were not here to be part of.
        So I take considerable pride in the fact that for 7 years
    in a row you and I have managed to get this bill across the
    line. It didn't matter who was chairman, didn't matter who was
    ranking member, didn't matter which party controlled Congress.
    It didn't matter what the administration was. We've gotten it
    done under every conceivable scenario, and I would certainly
    like to make it eight in a row.
        And I want to thank you for being such a good negotiating
    partner and such a good leader for this full committee in terms
    of us forcing our sometimes slower-moving Senate colleagues to
    actually do the work that they were elected to do.
        Mr. Secretary, it is very good to see you this morning. And
    we don't always agree, but I always find you agreeable and
    professional and particularly accessible to this committee, and
    I appreciate that very much. You know, COVID has been a
    difficult time, but you have always made time anytime we have
    had questions or comments or whatever, and I appreciate the
    spirit in which you approach your job.
        And, again, welcome. As the chairwoman said, it is great to
    get to deal with you in person and as many of our members as
    can be here in person.
        I will start by, once again, expressing concern regarding
    the total level of spending proposed by the administration. I
    have been a longtime supporter of helping achieve better
    outcomes for our students, but I fear the proposed 15 percent
    increase for the Department of Education will leave the next
    generation saddled with the highest national debt our Nation
    has ever seen.
        The fiscal year 2022 budget was just completed last month.
    We know it will take some time to get those funds out the door.
    A more moderate approach, in my view, is called for, especially
    in this time of runaway inflation.
        I would like to turn next to the topic of which I believe
    is one of the greatest failures of the Federal response to the
    COVID pandemic, and that is the closing of many of our Nation's
    public schools for almost 2 years, and the subsequent lost
    student learning and mental health issues that are flowing from
    these bad decisions.
        Your budget proposes increases in mental health and
    counseling to help with these issues, and I appreciate that.
    But the sad truth is we can never give those children back
    those years of their lives, and some of these wounds may never
    heal. In many cases, a growing level of learning in an
    adolescent, progress a student with a disability was making, or
    basic skills that were beginning to be solidified by a young
    student may have been lost forever.
        A recent survey conducted by the Government Accountability
    Office highlighted just how widespread and profound these
    losses are. Their survey discovered that nearly half of public
    school teachers had students who were registered for class but
    literally never showed up online. Even more disturbing,
    students who never showed up came mostly from majority non-
    White urban schools. These are the very students that our
    Federal programs are in place to support, and I think our
    country will be seeing the negative consequences from school
    closures for years and years to come.
        So, I certainly hope it is an experience--I know we all
    share this hope--that we don't have to go through again.
        I will also ask some questions this morning on what I
    believe to be executive overreach on the charter schools
    policy. One of the greatest benefits of the charter school
    movement has been the fact that these schools are locally
    developed, authorized, and operated. The Federal role in
    charter schools has been one of providing limited financial
    support to secure physical infrastructure and some startup
    grant funding, but the Department of Education is not a
    national school board or a national chartering authority.
        I agree with the 18 Republican Governors who have recently
    called for your department to pull back proposed regulations
    that would, as they say, quote, impose a top-down, one-size-
    fits-all approach and undermine the authority of parents to
    choose the educational options best suited for their child,
    unquote.
        I would like to ask unanimous consent to submit for the
    record a letter from our former colleague, now Governor Jared
    Polis, which outlines very well his objections and concerns to
    administration actions.
        Is that all right?
        The Chair. Yes, so ordered.
        Mr. Cole. Thank you very much, Madam Chair.
        My own State of Oklahoma has a long history in the charter
    school movement, and I believe that States, not the U.S.
    Department of Education, should continue to be responsible for
    what charters they do or do not authorize to operate within
    their jurisdiction.
        I would also like to touch today on another area of
    executive overreach, and that is the President's recent
    decision to extend the student loan repayment pause to August
    31. Not only is this inflationary, but there are also people
    making literally hundreds of thousands of dollars a year who
    aren't being asked to repay their student loans. I think that
    is unfair. And I have introduced legislation called the, quote,
    ``can't Cancel Your Own Debt Act,'' to prohibit Members of
    Congress from voting to forgive their own student loans. These
    folks are making $174,000 a year. Even if a Member favored debt
    cancellation for most people, we should not support this policy
    for people making this type of salary at the expense of our
    taxpayers and constituents.
        Finally, I hope to discuss today another area which greatly
    concerns me, and that is the politicization of programs like
    civics education with controversial priorities and grant
    announcements. Programs like civics education should be used to
    bring our country together and focus on our own commonalities
    while teaching respect for our differences. Sadly, I fear that
    recent announcements put out by the administration have only
    fanned the flames of controversy and division rather than heal
    them. That is a disappointment.
        In closing, I would like to say that as a longtime member
    of this subcommittee, I understand the important role played by
    domestic programs, and I certainly support increases for these
    critical programs.
        I was pleased to see support for special education in your
    budget. We know the Federal Government has not upheld its fair
    share of responsibility for ensuring education is provided for
    students with a disability, and I hope we can see achieving
    support for sustained increases for special education as a
    bipartisan goal.
        I also believe in strong support for Pell grant recipients
    and the TRIO and GEAR UP Programs. Pell grants and
    participation in TRIO and GEAR UP help first-generation college
    students chart a course to a better future into the middle
    class.
        We need to continue to help these students not only enroll,
    but also graduate and find good-paying jobs. Unfortunately, our
    double-digit inflation is eating away at the salaries of these
    recent graduates and making it more difficult for them to
    establish themselves in their careers.
        I also believe that we should do more to help underserved
    populations and underperforming schools. I support programs to
    strengthen our teachers and school leaders, and I support the
    Title I program. But I also question whether simply dumping
    billions of dollars into the program without careful planning
    is the best way to help undo the damage caused by 2 years of
    school closure.
        I want to again thank you, Mr. Secretary. Again, as I said,
    while we don't always agree, I do enjoy working with you, and I
    do appreciate the manner in which you approach your job and
    which you represent the Department.
        I yield back the balance of my time, Madam Chair.
        The Chair. I thank the ranking member.
        And, Mr. Secretary, let me recognize you, and your full
    written testimony will be entered into the record. You are
    recognized for 5 minutes for your opening statement.
        Thank you.
        Secretary Cardona. Thank you.
        Thank you, Chairwoman DeLauro, Ranking Member Cole, members
    of this distinguished subcommittee. Good morning and thank you.
        And, Mr. Cole, I would sing happy birthday, but the clock
    is running and I have 5 minutes.
        Today's hearing is about more than the President's budget
    and proposed investments for the fiscal year 2023. It is about
    the needs of our students and how we can meet them if we work
    together.
        The priorities in the budget reflect what I have learned in
    my visits to 32 States across America this past year. I visited
    schools in small towns, in affluent suburbs, urban and rural
    communities, including Tribal communities. And I know that
    addressing opportunity and achievement gaps is more important
    now than ever. I met with parents in Nevada worried about their
    kids catching up in the classroom. The gaps in underserved
    communities are so much greater now.
        Let's close those opportunity gaps by boldly investing in
    our Title I schools. This is our best tool for reducing
    inequities between underfunded schools and their wealthier
    counterparts.
        Let's also invest in full-service community schools, which
    provide high-poverty communities with easier access to
    services, like health and nutrition, enrichment, adult
    education, and more.
        Last week in New Mexico, I met with students struggling
    with anxiety. They had depression, trauma from losing parents
    amid the pandemic. Our children are hurting. Anxiety and
    depression have doubled among youth. Teen suicide rates are up.
    It is heartbreaking.
        Let's do something about it. Let's invest a billion dollars
    in hiring staff and building their skill set to support
    students' mental health needs so they can be their best in the
    classroom.
        I met with superintendents and principals in red States and
    in blue States trying to fill vacancies so that teachers could
    spend more time providing that individualized attention that
    our students need now. The teaching profession is in crisis,
    and we have a solution.
        Let's support and grow our educator workforce. We are
    proposing a half billion dollars for education, innovation, and
    research grants, including $350,000,000 for recruiting and
    retaining teachers. Remember what it was like when we couldn't
    open our schools because of teachers and sub shortages. Let's
    not go back to that.
        Let's invest in teacher quality partnership grants so more
    States can stand up innovative teacher residencies and Grow
    Your Own programs that prepare new and diverse candidates, like
    the programs I saw in Tennessee.
        What I haven't heard is an appetite from parents for sowing
    division in our schools, or using our schools for culture wars,
    or telling students what they can or can't read or can't learn,
    or telling teachers what they can't teach, or telling any
    person what they can or can't be.
        I know there are some that would rather distract and divide
    and spread misinformation to undermine our public schools and
    gain attention, but that is not what the parents that I have
    spoken to told me they want. That is not what I want.
        Based on a recent survey, the overwhelming majority of
    parents, teachers, principals are on the same page about what
    children need in our schools. Our parents need their children
    to learn.
        The American Rescue Plan got us this far. Today our schools
    are open for in-person learning, and our teachers are deep in
    the work of recovery. Now is our opportunity to reimagine what
    education can be. With your investments, let's build more
    inclusive, affordable pathways to higher education and
    rewarding careers for all of our students.
        College enrollment has fallen by nearly a million students.
    We can't afford this. Let's invest in community colleges,
    historically Black colleges and universities, Hispanic-serving
    institutions, Tribal colleges, and other inclusive
    institutions, and let's build on the $400 Pell grant increase
    you included in fiscal year 2022. We could double the Pell
    grant by 2029 if we start with another bold increase of $1,775
    for this upcoming year.
        We know that these days a high school diploma is no longer
    a ticket to the middle class. We shouldn't let any student walk
    off the graduation stage without an onramp to a good-paying
    job.
        Therefore, we are proposing $200,000,000 for career-
    connected learning so more underserved students graduate high
    school with industry credentials and college credits. This is
    good not only for the students but for the economy.
        Look, education gave me the tools to achieve the American
    dream. I grew up in a low-income community. I only had what the
    public schools offered me at that time. I attended a Title I
    school, and I graduated from a technical high school. I became
    a first-generation college student. I am a bilingual certified
    educator who benefited from quality teacher preparation and
    professional development. I am a product of the investments in
    this budget. Education brought the promise of the American
    dream alive for me. We must renew that promise for today's
    students and those to come.
        This last year we fought hard against COVID. Together, this
    up-coming year, let's fight complacency. Let's not accept the
    culture of low expectations. Let's not return to the systems
    that weren't working for all students. Who here in this room
    hasn't wished for a reset button in education, a chance to take
    stock of our system and reimagine what it can be?
        Well, our country is at a point of inflexion. Let's use it
    to reimagine education, to show the American people we can come
    together, red and blue. We can come together to fight for what
    is right for our students. This budget is a chance to do that.
    So together, let's seize the opportunity.
        Thank you.
        The Chair. Thank you very much, Mr. Secretary.
        And I know you have been a proponent of keeping our schools
    open, and I am happy to say that it was the American Rescue
    Plan that accelerated the opening of our schools nationwide.
        Mr. Secretary, I strongly support the Department's modest--
    what I believe are modest, good government proposals for the
    2022 Charter School Program competitions. However, the National
    Alliance for Public Charter Schools has been spreading wild
    exaggerations and misrepresentations in opposition. This kind
    of information campaign is a familiar tactic for the trade
    organization. It does represent charter schools that are run by
    risky, low-quality, for-profit education management
    organizations.
        And I would just cite a couple of the examples of the
    recent expansion grants awards that were made to something
    like--you know, the Torchlight Academy Charter School in North
    Carolina now being shut down. Capital Collegiate Preparatory
    Academy in Ohio has been passed from one for-profit operator to
    another. A New York school, they have oversized fees for its
    services.
        So as I point out, the modest--what I believe are modest,
    good government proposals for your charter school reform, what
    I would like to do is to ask you, what are the new proposed
    requirements in the Charter School Program and why are they
    necessary?
        Secretary Cardona. Thank you for the question. I appreciate
    an opportunity to speak to this, because there have been some
    misunderstandings and, quite frankly, some myths being spread.
        I support all high-quality schools, including public
    charter schools. The budget continues the Charter School
    Program investment of $440,000,000. I think the proposals are
    reasonable. And what they ask for is greater accountability,
    transparency, and fiscal responsibility. Again, they are
    proposals at this point.
        And it is absolutely accurate that we do not authorize
    charter schools. If anything, when using Federal dollars, we do
    want there to be reasonable expectations around accountability,
    transparency, and fiscal responsibility.
        The Chair. Let me just--I also, to move in a similar
    direction, am concerned by the proliferation of contracts
    between universities and online program management companies,
    OPMs. We had a Wall Street Journal investigation expose how the
    University of Southern California, in a for-profit OPM known as
    2U, recruited thousands of students to an expensive online
    graduate program, which left student borrowers with a median
    debt of $112,000 and median earnings of $52,000 2 years later.
    And by the way, they received 60 percent of the program's total
    revenue, because they shoulder the cost of setting up the
    program by an exchange for getting a cut of the tuition. And
    calculated, USC could have been generating about $142,000,000
    for their for-profit company in 2021.
        What will the Department do to protect students from the
    OPM cost escalation and recruiting abuses? And The Wall Street
    Journal did a very fine piece on this issue.
        Secretary Cardona. Thank you for raising that issue. It is
    really important that we maintain positive support for
    students, and that we, in all the decisions we make, are
    protecting our students, protecting our borrowers. We worked
    really hard this last year to move forward with policies and
    practices that keep our borrowers first, including borrower
    defense.
        But one specific thing that I want to talk to regarding
    that is we reinstated our Office of Enforcement and the FSA
    Office. This office was disbanded, and we brought it back to
    make sure that things like that are not happening and making
    sure that we are protecting our students.
        We are also in communication with college presidents to
    monitor situations like this because students aren't
    benefiting. We are going to continue with our borrower defense,
    but we are also going to make sure we are having communication
    with universities so these things are not happening.
        Thank you.
        The Chair. I would just say with regard to that, this is
    about harming student borrowers, but it is also about ripping
    off Federal taxpayers.
        Secretary Cardona. Right.
        The Chair. Because the issue is with the--what is being
    proposed are--the Federal grad plus program that exists there.
    It lets students borrow as much as colleges charge, has
    provided a valuable revenue stream for universities, and that
    leaves students in debt and a greater proportion of revenue for
    the university.
        So, again, I would just like to say to you and ask the
    Department to take that lead in protecting students from these
    agreements, and protecting the integrity of the student loan
    program for Federal taxpayers. It is about students and the
    Federal dollars that we are expending, and happy to do if they
    are going to good causes in that effort. So, I thank you.
        Secretary Cardona. Thank you.
        The Chair. And, with that, I am going to yield to my
    colleague, the ranking member. And also ask my colleague, I
    have to dash to the Ag subcommittee for a few minutes and I'll
    be back, so I am going to ask Congresswoman Roybal-Allard to
    continue to chair the meeting.
        Thank you.
        Ms. Roybal-Allard [presiding]. Mr. Cole.
        Mr. Cole. Thank you very much, Madam Chair.
        Mr. Secretary, 18 Governors sent you a letter this month
    outlining their concerns with new regulations altering the
    Charter School Program. Quite frankly, the regulations, in our
    view, would dismantle, you know, frankly, a successful Federal,
    State, and local partnership that really has enabled millions
    of children to have a public education but in a setting that,
    in their view and their parents' view, best fits their needs.
        Will you extend the comment period for these regulations to
    reflect the magnitude of the changes and to allow more time for
    public input?
        Secretary Cardona. Thank you, Ranking Member Cole. As I
    said before, I do support high-quality public charter schools,
    and I have seen examples of their effectiveness. We have had
    the public comment period, and we are reviewing the comments
    now. We have received the letters. So, we do have a process for
    reviewing comments that have been submitted.
        Mr. Cole. And I recognize that, but I would hope you would
    extend that. I think, again, when you are hearing from nearly
    20 Governors--and, frankly, not all Republicans. Obviously, our
    friend, Mr. Polis, is not a Republican Governor, but he
    certainly was a very able member of this body, very respected
    Governor. So, I would ask you to at least consider that.
        And, you know, I would like to know what your attitudes are
    in terms of regulations that limit local control, including the
    new requirement for community impact analysis, which would
    mandate school districts be overenrolled, if I understand it
    correctly. And, you know, why would we do that? Why wouldn't we
    just let local people make their own decisions as to what is
    best for their kids?
        Secretary Cardona. We do agree. And I can tell you
    personally I do agree, as a former district person, that local
    decisions should be the ones that are driving, and I certainly
    continue to support that.
        What I do think we have are reasonable expectations around
    getting an understanding of what the needs are in the community
    as a proposal to make sure that there is interest and make sure
    that the schools stay open. We want to make sure that these
    schools stay open.
        Mr. Cole. And I would like you to at least consider
    delaying changes to the program--these are pretty major
    changes--until next fiscal year, so that we can continue to
    operate this year under a system everybody understands. I know
    there is never a convenient time to make a change, if that is
    the decision that is ultimately made, but I think it takes a
    lot of time to adjust to that. And whether or not we could
    implement--and, frankly, I hope we don't because, obviously, I
    don't agree with a lot of these proposals--in a timely way and
    give administrators and students, local school officials, an
    opportunity to adjust, I think, in the timeframe is something
    worth considering.
        Is that something you have concerns about?
        Secretary Cardona. Thank you, Mr. Cole. We will take that
    into consideration and make sure that we are providing adequate
    technical assistance to all of the folks we serve.
        Mr. Cole. Let me ask you something that caught my eye,
    because this is a very robust budget, but in two areas you
    actually reduce spending, I think, by about $3,000,000 in
    Indian education, about $16,000,000 in Impact Aid.
        I will tell you, I have district concerns in both those
    areas. We have, as you know, a large Native population in
    Oklahoma; and, second, my district has two huge military
    facilities that, frankly, draw a lot of kids into local
    schools, but, obviously those facilities don't pay any State or
    local taxes. We get that. We are very proud to have them, but
    we certainly appreciate impact aid to help us offset the cost
    of those students that come with the service families that are
    located there or even the civilian workforce.
        Secretary Cardona. Thank you for that, and I couldn't agree
    with you more. I was able to visit Knob Noster High School
    recently. A hundred percent of the students were military-
    connected families, and let me tell you, I heard from students
    directly. We need to increase Impact Aid. And that was a
    community that did a great job--it was in Missouri--did a great
    job using Impact Aid.
        And I last week was in New Mexico in the Pueblo of Jemez
    Tribal Nation, and I know the importance of funding there.
        I think--well, I know the reason why it looks like a cut--
    it is an artificial cut--is because the submission was done
    after the 2022 allotment. So it looks like it is a cut, but it
    is not. We were using 2021 numbers because the Omnibus hadn't
    been passed.
        Mr. Cole. Well, I certainly recognize that, because we
    weren't quite as speedy as I know we all would like to be in
    getting you numbers, and I just want to flag that for you
    because I will be trying to work with you to get a more
    appropriate number. Those are areas that have been underfunded.
        Secretary Cardona. Thank you.
        Mr. Cole. And, again, I appreciate the technical
    difficulties that you had to face putting together your budget
    before, frankly, we had finished our deliberation. So that is a
    fair point.
        I am close to the end of my time, Madam Chair, so let me
    yield back.
        Ms. Roybal-Allard. Mr. Secretary, welcome.
        Secretary Cardona. Hi.
        Ms. Roybal-Allard. As you know, many of our students in
    higher education are facing the burden of college tuition and
    rising costs of living, including food, housing, and child
    care. This is especially true for the 4 million parenting
    students who are pursuing a college degree or credential while
    taking care of a dependent child.
        According to research from The Hope Center at Temple
    University, parenting students are much more likely to struggle
    to find and afford enough to eat for themselves or their
    families and maintain stable housing. Without proper support,
    these students are at risk of dropping out of college.
        And I am happy that the administration is requesting an
    increase in the CCAMPIS program. Can you speak to how the
    CCAMPIS program helps parenting students and how it can be used
    also to help connect struggling students to more resources of
    financial support, as well as programs such as SNAP, WIC, and
    TANF?
        Secretary Cardona. Right. Thank you for that question. The
    Child Care Access Means Parents in School, or CCAMPIS, is
    something that I was able to see firsthand. And I think we have
    an opportunity, when I talk about reimagining education. We
    must look at this as an opportunity to attract students who may
    not be traditional students. There are many people during the
    pandemic that had an epiphany and wanted to change their
    trajectory in life, and they want to go back to school. And the
    CCAMPIS program is one of those programs that I saw firsthand
    allows parents to go back to college, pursue their degree,
    chase that dream.
        I will speak to a situation that I was able to witness
    firsthand in Bergen County Community College where CCAMPIS was
    being used to allow parents to attend while their children had
    childcare on campus. I spoke to a young lady, Kezia, who
    attended that college, and she and her husband were there, and
    their twins were down the hall in a childcare center being
    cared for while she was studying. And she said: This CCAMPIS,
    these funds are not only allowing me to change the trajectory
    of my life but that of my children, her two twins.
        So I--for Kezia, she wouldn't be able to go to school if it
    weren't for CCAMPIS.
        I remember visiting Nevada and talking to students there in
    a community college who were homeless, and the community
    college was trying to help them find housing, so they were
    making connections.
        We have an opportunity to embrace students who
    traditionally didn't think of themselves as college students in
    this new wave now, and I really want to take advantage of it.
    Programs like CCAMPIS make that possible.
        Ms. Roybal-Allard. Now, the fiscal year 2022 Omnibus
    actually lifted the cap on CCAMPIS grants, which limited an
    institution to receiving only 1 percent of its Pell grant
    receipts. By removing the cap, the Department of Education can
    now set a higher limit of support for CCAMPIS.
        How much of an increase can schools expect to receive, and
    will there be any changes to the eligibility criteria?
        Secretary Cardona. We are requesting $95,000,000 and we
    want to make that available for as many schools as possible. I
    can share more information about the criteria for that, but the
    goal really is to make sure it is available to more students
    across the country so more can have access to higher education.
        Ms. Roybal-Allard. This year, we--you know what, I am also
    very close to ending, so I won't take the prerogative of the
    chair to go over my time, and I will now call on Mr.
    Fleischmann.
        Mr. Fleischmann. Thank you, Madam Chair, Ranking Member
    Cole.
        Mr. Secretary, good morning, sir.
        Secretary Cardona. Good morning.
        Mr. Fleischmann. Thank you for being with us in person
    today. Really appreciate this.
        I think we can all agree that we are glad to be back in
    person, and especially to have our students back, sir, in the
    classroom for in-person learning.
        Secretary Cardona, the most recent data shows that 3.5
    million STEM-related jobs will need to be filled by 2025 in
    order to maintain a stable workforce. It is imperative that we
    continue to support public-private partnerships to close the
    skills gap and cultivate a diverse workforce.
        Last week, I was privileged to visit the Middle Valley
    Elementary School located in Hixson, Tennessee, in my district,
    to observe their public-private partnership with Amazon, a
    program that supports almost 175 schools with computer science
    curriculum, robotics clubs, and other learning opportunities.
    Actually, it was quite inspirational, very uplifting.
        What is the administration doing to encourage more public-
    private partnerships in STEM and computer science literacy?
        Thank you, sir.
        Secretary Cardona. Thank you for that question, Mr.
    Fleischmann. I couldn't agree more with you that we need to do
    much more. We are not doing enough currently. We need to make
    sure that our students are connected to great STEM programming
    within our schools, that are connected to the regional
    workforce needs, connected to the 2-year programs, the 4-year
    programs. I am really excited about the priority of redesigning
    high schools and providing better career pathways.
        We have asked in the budget for $200,000,000 for career-
    connected high schools, new competitive awards that reinforce
    districts like the one you visited and give them funding to
    make those programs consistent and grow those programs.
        We have an opportunity now to reimagine what career
    pathways look like. Those are one of my priorities at the
    Department of Education. Not only do we want to address
    achievement disparities, we want to make sure we are connecting
    our high schoolers, our college students to careers that exist
    today in the STEM fields.
        Mr. Fleischmann. Thank you sir.
        A followup. How can we provide continued professional
    development in STEM and computer science literacy for our
    teachers specifically, sir?
        Secretary Cardona. Right. Thank you for that. We have to
    make sure that, as we are doing these public-private
    partnerships, they include providing support for our educators,
    giving them real-life experiences to see what the jobs look
    like today, right? So I can envision having one of our teachers
    partnering with one of these regional workforce partners and
    having trips for the teacher to see what the site looks like
    and gain skills there, or something where it is co-taught or an
    after-school program for professional development for our
    teachers.
        Mr. Fleischmann. Thank you, sir.
        And the final question for this first one here is, how
    important is early exposure to STEM and computer science
    curriculum to get students exposed to that early, sir?
        Secretary Cardona. Yeah. It is really important that we
    start early. We have to start in elementary school, and we have
    to make sure that we are connecting it to real world
    experiences, real world jobs. And by the time they get to
    middle and high school, students should be exposed to the
    different careers that there are in STEM, and there are many
    and they are growing.
        Mr. Fleischmann. And, Mr. Secretary, I would like to put
    something on your radar, if I may, and for our other members. I
    would like to encourage members on this subcommittee to
    consider cosponsoring H.R. 3602, the Computer Science for All
    Act. This is something that actually our distinguished
    colleague, Ms. Barbara Lee, from the majority, is working with
    me on. She is the lead Democrat; I am the lead Republican. The
    Computer Science for All Act, which provides new grant
    opportunities that would make computer science education more
    accessible for all students, pre-K through 12th grade.
        So, Mr. Secretary, thank you. I would like you to take a
    look at that legislation, and I would appreciate members of our
    subcommittee to take a look at that as well.
        Thank you.
        Secretary Cardona. Thank you.
        Ms. Roybal-Allard. Ms. Clark.
        Ms. Clark. Thank you, Madam Chair.
        And welcome, Mr. Secretary. We are delighted to have you
    here.
        I can't thank you enough for prioritizing the mental health
    and well-being of our students. In a recent survey out of
    Massachusetts, 60 percent of the parents and caregivers
    responded, reported at least one death in their family, 60
    percent, and we know what a crisis this is. It is a compounding
    crisis to one we were already facing, and I appreciate the
    resources that you are putting into this.
        Secretary Cardona. Thank you.
        Ms. Clark. I want to specifically ask, as we are facing a
    dual crisis of retaining and recruiting educators, how is your
    budget also addressing the mental health needs of those
    educators as you are doing so well with our students?
        Secretary Cardona. Yeah. I appreciate your acknowledgment
    of the crisis that we are having in mental health.
        I had a lunch with Dr. Xia yesterday. We were talking about
    how the crisis went from counting cases to thinking about the
    impact of mental health on our students, on our staff, on our
    community in general, and how we must continue to put energy
    toward addressing them.
        I am really proud that with ESSER--thank you for the
    support of ESSER--there is a 65 percent increase already in
    social workers in our schools, 17 percent increase in
    counselors, but we have got a ways to go.
        What we want to do is make sure that we are not just adding
    one or two more counselors; that we are giving students an
    opportunity to have mental health support not only during the
    school day but outside of the school, parents having access to
    mental health support or being able to access support through
    connections with the school.
        We are proposing funds in the fiscal year 2023 to really
    make it more foundational in our schools. I will tell you,
    Representative Clark, we had mental health issues in our
    schools that were unaddressed before the pandemic. They were
    just made worse. But we have a moment now to really make sure
    it is a foundational support that we provide our students, and
    I look forward to leading that.
        Ms. Clark. Are we also going to be able to provide that to
    our educators? Is that part of the plan you are working on?
        Secretary Cardona. Without question. You know, we cannot
    act as if only our students suffered during the pandemic. I
    have spoken to teachers in all of my visits, who are doing
    everything they can for their students, but are also struggling
    with changes in their family or loss in their family. So making
    it more accessible to our staff is going to be critical if we
    expect them to be there for our students.
        Ms. Clark. And speaking of staff, we know we have lost
    almost 117,000 early education jobs, and I know that we have
    spoken about this privately before.
        Secretary Cardona. Yes.
        Ms. Clark. But what strategies have you considered, are you
    working on, to build a pipeline of students who are pursuing
    early childhood credentials and training that are going to be
    so necessary for our childcare needs of the future?
        Secretary Cardona. This is an area of opportunity. Much
    like Mr. Fleischmann's questions with STEM, we must really
    reinvent Grow Your Own programs in our schools. I speak to
    Tennessee's program. They have a program in their high schools
    where students are going toward teaching, and there is a
    relationship between the high school and the college.
        In the budget, the request is $514,000,000, a $288,000,000
    increase over the 2022 enacted level, to develop Grow Your Own
    programs, to invest in these teacher preparation programs.
        The shortages are real. They are going to get worse if we
    don't invest in them. And as I said in my opening remarks, in
    January, we dealt with school closures not because of Omicron,
    but because we didn't have the staff, and we can't afford that
    in this country.
        Ms. Clark. In my brief 1 minute, we know how much LGBTQ
    students are facing attacks that are compounding this mental
    health crisis that we have been talking about. Can you tell me
    about how the increased funding for your Office for Civil
    Rights, what that funding will go to, and what is the level of
    need and cases being reported to the OCR that you are seeing?
        Secretary Cardona. A recent study by GLSEN found that LGBTQ
    students are bullied 42 percent compared to 15 percent of non-
    LGBTQ students. It is an issue that we are taking very
    seriously. Supporting the Office for Civil Rights will help us
    be more expedient in the investigations, and ensure that all
    students are going to school in an inclusive environment that
    sees them, respects them, and welcomes them.
        Ms. Clark. Thank you.
        I yield back, Madam Chair.
        Ms. Roybal-Allard. Ms. Herrera Beutler.
        [Audio malfunction.]
        Ms. Herrera Beutler. Thank you so much, Mr. Secretary. So I
    have just been--there is so many different things I wanted to
    talk with you about. I am going to start--I think I am going to
    start with this--let's see, I am going to start, actually, with
    the proprietary schools issue because, you know, I am a huge
    fan of Pell. I am a big supporter of Pell. I think it helps
    nontraditional students. And I am--you know, a year-around Pell
    increasing it, I think it just gives a lot of flexibility.
        And one of the things that has been brought to my attention
    is that there seems to be a real anti-proprietary school
    ideology within the administration. And I know that there have
    been bad actors, but I also know there have been really bad
    actors in public, you know, school systems on the secondary
    level too. So I think apples to apples, there are similar
    challenges.
        But when I think about the population that do take
    advantage of proprietary schools, it is primarily women. It is
    a lot of 40-year-old women. Maybe I am looking for a job.
    Oftentimes, it can mean people of color or people who are
    looking for a second career or who maybe only have a high
    school degree but want to earn something more than minimum
    wage. And to tell that whole block of people, Well, you don't
    fit the 4-year liberal arts academics, when the 4-year schools
    right now, especially the top--you know, not even the top
    schools. You know, middle schools--you know, middle range
    schools are not accepting--I mean, they are 50 percent
    acceptance rates, and that is a good acceptance rate. It seems
    to me you are cutting out a whole class of trade workers by
    refusing to support their desire to attend a proprietary
    school.
        Could you speak to that?
        Secretary Cardona. Sure. Thank you. Thank you for that.
        And I agree with you. We have to create stronger career
    pathways. I am really looking forward to making sure that all
    schools, high schools and 2-year schools, do more there.
        There are many great short-term programs that deliver great
    value to students. Last week, I was at D.C. Central Kitchen----
        Ms. Herrera Beutler. I am going to--I am so sorry. I am
    going to cut into that really quickly just because I am going
    to be cognizant of my time.
        Secretary Cardona. Okay.
        Ms. Herrera Beutler. Specifically, I am aware of current
    rulemaking at the Department of Education, surrounding
    eligibility requirements for programs authorized by Title IV,
    and I have heard that cosmetology schools in my district feel
    like their opinions haven't been considered in this process and
    it could threaten their ability to provide financial aid to
    their students.
        So I guess more specifically, as that rulemaking process
    moves forward, can you commit to actively at least engage with
    these schools and hear from them as you are making the rules
    about it?
        Secretary Cardona. Certainly. We definitely will, and I
    appreciate your advocacy, and we can provide a more detailed
    written response also.
        Ms. Herrera Beutler. I would love that.
        Secretary Cardona. Happy to work with you on this.
        Ms. Herrera Beutler. Thank you.
        Secretary Cardona. Thank you.
        Ms. Herrera Beutler. Thank you so much.
        I just think the nontraditional route needs to be just as
    valued. I have brothers in the trade that didn't go to a 4-year
    school, and I just think it is the way we need to look at
    higher education.
        Another piece along that line--and I guess I am going to
    switch over to the K-12 system. I received an email from some
    of my--from parents in my district who said that, due to a
    Federal law, they needed to submit their child's demographic
    information to the school. This was a public high school. It
    was my public high school district that I went to.
        I know that the Office for Civil Rights has taken steps to
    increase data collection on students and update definitions,
    but as you can understand--I mean, this basically says, We are
    getting this message--this is from the school to the parent--
    because you haven't updated ethnicity information for your
    student. Due to new Federal laws, yada yada, we need to keep
    all this information. Of course, we are going to forward it on
    to the State, but we won't put your kid's name in there, which
    every parent has concerns about that privacy issue.
        Could these updated data collection requirements create an
    additional administrative burden for schools, and how do you
    plan to keep that information private?
        Secretary Cardona. Thank you. Thank you for that question.
        You know, student privacy, as a father of two high
    schoolers myself, I certainly want to make sure that they are
    protected and their information is private and it is not
    everywhere else. I believe you are referring to the CRDC
    report, Civil Rights----
        Ms. Herrera Beutler. I don't know. The parent didn't know.
        Secretary Cardona. And I would be happy to have a followup
    with you and even the school, if necessary, to make sure that
    it is clear for that parent what they are asking for.
        For us, ensuring that schools are providing students with
    opportunities to succeed, all students, regardless of race,
    gender, is critically important. So I believe it is referring
    to the CRDC report. Happy to follow up with you to get more on
    that.
        Ms. Herrera Beutler. Okay. And I have more questions. Some
    of them have to do with mental health, which I know we are
    going to talk about. Hopefully, we will get a second round of
    questions maybe?
        Ms. Roybal-Allard. Yes.
        Ms. Herrera Beutler. Okay. With that then, I will yield
    back. Thank you.
        Ms. Roybal-Allard. Ms. Frankel [inaudible]
        Ms. Frankel.
        Ms. Frankel. Oh, yeah. Hello. Yeah. Thank you.
        Thank you to Mr. Secretary. I want to ask you just a
    question on title IX. I know that you are working on some new
    rules. Can you give us a progress report on that?
        Secretary Cardona. Sure. We are working on the new rules,
    and we are expecting next month that they are released in May.
    So I can't really get into specifics now, but at the end of the
    day, the goal is to make sure we have equal access, protect
    students against discrimination, and protect students against
    sexual violence.
        Ms. Frankel. Okay. Thank you very much.
        Just another title IX question. According to the research
    for the Women's Sports Foundation and the National Women's Law
    Center, girls of color have not benefited from title IX the
    same way as White girls. And so Black girls face disadvantages
    both based on race and gender and have lacked access to
    participation in schools, sports, and other activities that are
    available to boys. Any comment on that? Any efforts that your
    department is going to make to remedy that?
        Secretary Cardona. Thank you for the question. You know, it
    is put in--title IX was put in to ensure equal access, and we
    still have a ways to go. The question that I had before you--
    you asked the question was about the reporting that was done,
    the CRDC report. That helps us get information to ensure that,
    regardless of race or place, students are getting a high-
    quality education with equal access to extracurricular
    activities to high-level courses. And that is why we collect
    those data, to ensure that we are supporting districts,
    supporting States that are maybe inadvertently creating gaps in
    opportunities for students.
        This is our responsibility to make sure all students in the
    country have access. And looking at those data really makes
    us--reinforces the important work that we are doing to collect
    those data but, more importantly, to provide support to our
    States and districts and make sure all students, regardless of
    race, socioeconomic status, have access to high-quality
    learning and high-quality after-school activities.
        Ms. Frankel. So let me just do a follow-up, because I am a
    big advocate for sports and children playing sports. It is not
    just fun, but they learn so much----
        Secretary Cardona. Right.
        Ms. Frankel [continuing]. About themselves, about being
    part of a team. So this year marks the 50th anniversary of
    Title IX. Wow, that is unbelievable. And I know we have made a
    lot of progress. Still, I think there is--research shows that
    the majority of high school administrators still don't know who
    their title IX coordinator is, and that 83 percent of college
    coaches say they have never received formal title IX training.
        So it is hard--when people are ignorant of the law,
    sometimes it makes it harder to enforce it and may be partially
    the reason why we still have this discrimination or lack of
    activities for--especially for girls of color.
        Does your department have designated funding for training
    title IX coordinators, and do you have any kind of plan of
    action on this effort?
        Secretary Cardona. Yes. Thank you for that question. I
    agree with you wholeheartedly. Cocurricular activities--and I
    don't like to call them extracurricular, because they are not
    extra, they are cocurricular activities--must be a part of the
    experience for our students. In fact, due to the American
    Rescue Plan, I put a challenge out there for every high school
    student to be connected in at least one cocurricular activity,
    whether it is theater, athletics, clubs. We should make sure
    that every student feels connected.
        And, yes, the Department of Education, as we celebrate the
    50th anniversary, have several events planned. We have had
    webinars. It is unfortunate those data that you shared with me
    regarding the lack of understanding. We will be amplifying the
    importance of it, making sure that we can reverse those data
    that you shared. All athletic directors, all school leaders,
    all district leaders should make it very clear who the Title IX
    coordinator is but, more importantly, the purpose of Title IX
    and the importance of having access for all students.
        Ms. Frankel. So I--yes, I agree with you on that latter
    point. So--but do you have plans to follow up to make sure that
    that happens?
        Secretary Cardona. Yes, we do.
        Ms. Frankel. You do, okay.
        Secretary Cardona. Yeah.
        Ms. Frankel. I don't know--I lost you off the screen. I
    don't know what happened to you.
        But I will yield back. I do have another, I think,
    important question, but I will yield back, if we have another
    round.
        Thank you so much, Mr. Secretary.
        Secretary Cardona. Thank you.
        The Chair [presiding]. Mr. Moolenaar, and we are following
    each other at the various hearings, so--and my apologies again
    to the committee. There wound up being two subcommittees that I
    had to be at.
        So Mr. Moolenaar.
        Mr. Moolenaar. Thank you, Madam Chair. Appreciate it.
        And, Mr. Secretary, good to see you again. I want to follow
    up with you on some of the questions Mr. Cole had raised
    regarding the charter school. And, I guess, you know, when I
    read some of the comments from previous Presidents, President
    Obama once said that charter schools serve as incubators of
    innovation and give educators the freedom to cultivate new
    teaching models and develop creative methods to meet students'
    needs.
        And then when you think of President Clinton when he
    celebrated the passage in the Senate, the first charter
    school's legislation, he said that it puts the Federal
    Government squarely on the side of public school choice and
    innovative charter schools.
        And, you know, when I heard you speaking earlier about
    transparency, accountability, fiscal responsibility, I think
    everybody would be in agreement that that is important in
    public education.
        What I am concerned about is the proposed rule really seems
    like kind of a radical departure from this idea of allowing
    innovation, encouraging innovation, and specifically this
    community impact analysis at the expense of people trying to
    start a charter school.
        My experience with charter schools is they form in a
    variety of ways, but often it is parents, teachers coming
    together, seeing a need that is not being met, an opportunity,
    a tremendous amount of work and cost to start something up. And
    by putting sort of a one-size-fits-all Federal rule that
    discourages that and creates more burdens, more costs, you are
    actually--whereas you may be, you know, an advocate for high-
    quality charter schools, and I don't--you know, I take you at
    your word on that, but what you are doing is, by this new rule,
    discouraging new innovation, discouraging people to take the
    risk to jump in and be part of this.
        Like Mr. Cole, you know, I think that the comment period is
    pretty tight. And I would just encourage you to consider
    extending that, really look through to see what can be done to
    encourage some of the things that you are talking about in
    terms of transparency, but at the same time, not put a burden
    on people who are trying to do something innovative in a
    community because there is a need that is not being met. So I
    would just ask you if you would consider that, think through
    that, and any feedback you have on that.
        Secretary Cardona. I appreciate that, Mr. Moolenaar. And,
    you know, I agree that they--and I have seen great examples of
    that, where people in the community come together. And we
    certainly don't want to discourage innovation or interest in
    this, and we do believe it is reasonable.
        What we are trying to protect is against closures,
    premature closures, because, you know, the need or maybe there
    wasn't enough analysis done around the community need. But
    without question, we do know that charter schools can serve
    unique needs, and they are often incubators of innovation and
    we want to continue to encourage that.
        Mr. Moolenaar. But when you say premature closures, are you
    talking about traditional schools or charter schools that would
    open and then close?
        Secretary Cardona. Correct.
        Mr. Moolenaar. Okay.
        Secretary Cardona. Underenrollment or it seemed like there
    was an interest and then a year or 2 later they are closing
    because there wasn't enough interest.
        Mr. Moolenaar. Okay. Well, my experience would be, you
    know, I think the flexibility that is there between authorizers
    and, you know they certainly have the ability to start up. And
    if there is not a market there or there is not a need, then you
    kind of learn about that and you close. I understand that is
    disruptive. But at the same time, in the cases where it could
    be tremendously impactful, innovative, and really a good thing
    in the long term for a community, you just don't want those
    barriers to getting started.
        Secretary Cardona. I understand. Thank you.
        Mr. Moolenaar. Thank you. I yield back.
        The Chair. If I could just take one second because I think
    you asked an interesting question, Mr. Moolenaar. And I would
    recommend an article, and I will get it to you. There was an
    interesting statistic in it that more than one in four parents
    who walked their kindergartner into a new charter school have
    to find another school for their children by the time they
    reach the fifth grade. That is about the alarming closure rate
    of those schools. Over one in four closes during the first 5
    years; by year 10, 40 percent are gone. Between 1999 and 2017,
    nearly 1 million children were displaced due to the closure of
    their schools.
        So an interesting thing to follow up on to see what the
    issue is, but I will share that with you.
        Congresswoman Lawrence.
        Mrs. Lawrence. Thank you, Madam Chair.
        And thank you, Secretary for being here.
        I have a question. It is a follow-up on a response you gave
    on--I am very excited about the career connected learning. We
    all know we have a staffing crisis, but the issue is the crisis
    is present. The connected learning, what is the expectation we
    can have for when we will have a trained workforce that will be
    able to let us get parity with our need and with our workforce?
        Secretary Cardona. Thank you for the question, Mrs.
    Lawrence. I have to go back to my visit. I went to Henry Ford
    Community College----
        Mrs. Lawrence. Yes.
        Secretary Cardona [continuing]. In Michigan, and let me
    tell you, like, if there was a model I could lift up, they get
    it. They understand that high schools can feed into 2-year
    schools, and then the workforce partner is waiting.
        I visited Groton with Congressman Courtney, and the Groton
    submarine base was waiting for the graduates of those schools
    who were learning how to weld with the same machines they use
    on the sub base, because the partnership was there.
    Unfortunately, across the country, we have pockets of
    excellence. It hasn't been systematized.
        So what we are trying to do is make it so that every
    school--and not just technical high schools, which I am a proud
    graduate of--not just technical high schools but all
    comprehensive high schools have career options that are
    responsive to the community needs, to the regional needs.
        And I want to go a step further to say, we would expect
    that districts and States have models of workforce partnership
    boards with our 2-year college representatives, our 4-year
    college representatives, our workforce partner representatives,
    and our K-12 system so that the program feeds.
        Now, students should graduate with options. Unfortunately,
    in our country today, they don't. We have to do better. So the
    funding for the career-connected high schools is $200 million
    in new competitive awards to systematize it, so that when a
    superintendent leaves, she doesn't leave with those great ideas
    and the system stays there. We really have to lift--raise the
    bar there across the country.
        That is how we are going to become competitive. That is how
    our students are going to be able to get high-paying, high-
    skilled jobs earlier. They can continue with their college. In
    many cases, these workforce partners are paying for the
    college. So we have an opportunity here and I really want to
    seize it.
        Mrs. Lawrence. So my next question goes to the mental
    health of our schools and our teachers, as has been mentioned.
    I just visited with my governor a school that has partnered
    with a community-based healthcare system that supports the
    school's mental health needs.
        Now, I saw that program being very, very effective, because
    when we talk about putting enough staffing for mental health,
    and you talk about a pocket of excellence, I really want to
    encourage you to have a systematic plan to support these mental
    health providers in the community, because the mental health
    provider didn't have the restrictions or the normal part. They
    were just there, and those--and it was referrals that were able
    to be made by the school staff, nurse and social worker, and
    they were in the schools and it was seamless. We--our needs for
    our teachers and our parents.
        And the one thing that was brought to my attention during
    this meeting is that when you see the connection between mental
    health of our children, the crisis there, and the crisis of the
    parent, if we don't recognize that and do what we can to
    support the resources as needed, it is going to become
    generational.
        So do you have any planning for that?
        Secretary Cardona. Three things I want to accomplish as
    Secretary of Education: close achievement gaps, improve career-
    connected pathways, and address the mental health needs of our
    students.
        In Santa Fe High School, last week or 2 weeks ago in New
    Mexico, I saw a program that really could be replicated where
    our community partners, mental health partners were in the
    school. They had space in the school, and they were connected
    to a university a research university, so that is taking it to
    that next level.
        But what we can do, kind of going to your first question,
    is not only connect our health centers to our schools and give
    them space there where even parents can come in and access it
    but also create a throughway for our high school students to
    learn about fields in the healthcare industry and maybe even
    take some courses there or learn from the health experts that
    are in the building. That is another example where, as you
    mentioned, pockets of excellence are not going to get us where
    we need to go.
        We have to systematize it. The funding request that we have
    here will move that along much quicker.
        Mrs. Lawrence. Okay. Thank you.
        Secretary Cardona. Thank you.
        Mrs. Lawrence. And I will yield back.
        The Chair. Congressman Cline.
        Mr. Cline. Thank you, Madam Chair.
        Thank you Mr. Secretary, for joining us today. I don't know
    if you saw the news this morning that the U.S. economy saw a
    1.4 percent decline in Q1 GDP growth of this year. Definitely
    supply chain issues and inflation are the primary drivers of
    the decline that we have seen, but the pandemic policies of
    this administration that include massive trillion dollar
    spending packages and economic restrictions, like the ones we
    saw in my home State of Virginia under Democratic-led
    administrations, started this ball rolling.
        $190,000,000,000 in COVID relief funds has been distributed
    by your department to be spent on preparedness and learning
    loss. We have all seen the stories of how some of these funds
    have been spent. For example, in a Whitewater, Wisconsin school
    district, the board voted to allocate almost 80 percent of
    their $2,000,000 to build synthetic turf fields for the
    football team.
        An Iowa school district spent $100,000 of COVID relief
    money to renovate the weight room and add new floors, and now
    the district has recently reported more students interested in
    football. That is great. But the East Lyme, Connecticut school
    district spent $175,000 to address drainage problems on the
    baseball field. A Pulaski County, Kentucky, school district
    spent $1,000,000 in COVID relief dollars on resurfacing two
    outdoor tracks.
        In March 2021, the Government Accountability Office
    reported that the U.S. Department of Education system for
    tracking data was inadequate. Can you report on how you provide
    oversight for these Federal investments to avoid this type of
    waste? And how many school districts are truly prepared for the
    future? What percent of funding was spent on learning loss of
    students, because we saw that across the Nation? And how is
    your agency using data to help understand the impact of these
    harmful school closures that we saw?
        Secretary Cardona. Thank you, Mr. Cline, for the question.
    And I agree wholeheartedly with you that we must ensure that
    these dollars are being used to address learning loss and
    mental health needs, and it is something that we take very
    seriously at the Department.
        As a matter of fact, the GAO report that you referenced, we
    instituted new protocols for oversight because we felt that the
    data collection was poor, and we have to fix that mess. There
    were several messes we had to fix.
        With regard to ARP accountability, I have visited more than
    100 sites, and the first question that I ask is, how is the ARP
    money being used. We are trying to lift best practices. We have
    had dozens of webinars with State chiefs, superintendents. I
    have spoken to hundreds of superintendents, visited their sites
    to make sure that we are very clear, learning--addressing
    learning loss or missed instruction is critical, mental health
    needs of our students is critical, and making sure that our
    schools could be safely reopened. We are doing that. We are
    going to continue to do that.
        And a recent report from FutureEd reported that the
    projections of spending will go $30,000,000,000 toward academic
    recovery, which is exactly what you were asking for;
    $26,000,000,000 of the $130,000,000,000 in the K-12 space would
    go towards staffing, which include mental health support;
    $26,000,000,000 for infrastructure.
        And I have to say, some of the examples of what I have seen
    in my visits include deferred maintenance in buildings where
    air quality was really poor or the--so infrastructure is being
    fixed during--with the use of the American Rescue Plan.
        Schools are open today. We went from 46 percent of the
    schools open when President Biden took office, 99 percent open
    today because of the American Rescue Plan and their ability to
    get their schools open safely.
        Mr. Cline. I think that one of the things that the American
    Rescue Plan also resulted in was the inflation that we are
    seeing today. The Department just announced steps to further
    exacerbate this problem by dealing with student loan
    forgiveness.
        The Federal Student Aid estimates that the changes you are
    proposing will result in an immediate debt cancellation for at
    least 40,000 borrowers under the Public Service Loan
    Forgiveness program. More than 3.6 million borrowers will also
    receive at least 3 years of additional credit toward income-
    drive repayment forgiveness.
        Can you tell me how the Department plans to pay for the
    planning, implementation, and execution of these proposed
    forgiveness programs?
        Secretary Cardona. Thank you. We recognize that one of the
    things we had to fix when we came in was the Public Service
    Loan Forgiveness program. It was enacted in 2007, was to take
    effect in 2017, and there was a 98 percent denial rate for
    those who qualified for it. So only 16,000 borrowers received
    forgiveness in the program.
        What we ended up doing was revisiting that program, fixing
    it. And as you mentioned, at least 40,000 borrowers were added
    to the list of borrowers who received loan forgiveness with the
    income-driven repayment changes.
        We are working really hard at FSA to build up systems of
    support for our students to make sure that they have the
    information, and we are processing their applications as
    quickly as possible.
        Mr. Cline. Thank you. I yield back.
        The Chair. Congresswoman Bustos.
        Mrs. Bustos. All right. Thank you, Madam Chair.
        Mr. Secretary, it is good to see you. You were kind enough
    to come with the First Lady to Sauk Valley Community College,
    which serves the congressional district that I represent in the
    northern part of the State of Illinois, so thank you for that.
        You know, I know you are on the road a lot and you have a
    lot of conversations. I had brought up to you at the time, we
    had a short discussion about teacher shortages, and that is
    what I would like to talk with you about this morning.
        In the budget request, I was really, really happy to see
    that President Biden requested an increase in 400 TEACH grants
    awarded. So these students will receive $4,000 if they commit
    to teaching a high-need subject in a high-poverty school for 4
    years. So really happy to see that.
        And we talked about this in your visit about teacher
    shortages continuing to be a major problem. I know this is
    affecting a lot of States all over our country. It is a big
    problem in the State of Illinois. And the Illinois State Board
    of Education says that Illinois school districts have about
    4,100--4,100--unfilled positions right now, and that includes
    teachers, paraprofessionals, and other licensed staff.
        So, Secretary Cardona, what I would like to ask you is,
    what impact will the President's budget request have on teacher
    shortages, such as programs like the TEACH Grant and through
    investments like the Teacher Quality Partnership Grant Program?
    I would love for you to address that if you could, please.
        Secretary Cardona. Thank you very much. Great to see you
    again.
        There is $350,000,000 in the budget to propose--to support
    recruitment and retention efforts. Just yesterday, I was with
    the 50 State Teachers of the Year and the National Teacher of
    the Year, Kurt Russell, talking about the importance of the
    profession. And while it seems that the profession is under
    attack at times and, you know, during the pandemic there was a
    great support for teachers, now it seems like teachers are
    being asked to do more and sometimes not given the respect that
    they deserve for what they have done during the pandemic.
        So it is a difficult time to recruit teachers, but in this
    budget, there is a clear commitment to making sure that we have
    enough teachers. And as mentioned with the question from Mrs.
    Lawrence, we have to create Grow Your Own programs in our
    districts. We have to create programs that get students
    thinking about teacher--becoming a teacher earlier on. I think
    of Tennessee's program where there is an apprenticeship
    available for students who want to become teachers.
        The funding in the budget would allow us to create systems
    that help us ensure that we are not going to have teacher
    shortages. I made reference earlier to January when, because of
    quarantining, we didn't have enough teachers. We didn't have
    enough substitutes. That is unacceptable. Our students deserve
    better.
        This funding will allow us to create systems to make sure
    that we have pipeline programs for our teachers and programs
    that are embedded in our high schools that connect to our
    colleges, to ensure that we have enough teachers moving
    forward, especially in those hard-to-fill areas like special
    education, bilingual education. We have to be proactive about
    this because it is unacceptable for students not to have highly
    qualified, prepared teachers in front of their classrooms.
        Mrs. Bustos. And this plays into it, kind of part two of
    this in a sense, teacher salaries. Obviously, that is part of
    retaining teachers. It is part of attracting people to the
    profession. And as you know, the salaries are too low across
    the country in many--especially in low-income districts. And in
    my home State of Illinois, we are working really hard to
    address this. But obviously, I think there is more that we can
    do even at the Federal level to retain and to attract people to
    the profession.
        Last year, I introduced something that we call the
    Retaining Educators Takes Added Investments Now Act. You know,
    we always like to come up with these acronyms. It is called the
    RETAIN Act. And along with other professions that the
    legislation, the RETAIN Act, it provides fully refundable tax
    credits for teachers in title I schools. So the credit starts
    at $5,800 and then ramps up to $11,600 over the years to help
    retain staff.
        So, Mr. Secretary, how could increased title I funding help
    school districts increase teacher pay and promote retention?
    And then part two of that is, what investments do you think we
    could put into programs that fight teacher shortages for this
    fiscal year?
        Secretary Cardona. Thank you for that, and I appreciate the
    efforts that you are taking to help address this issue.
        Imagine the headlines if we didn't have the American Rescue
    Plan funds to help incentivize teachers staying in the
    profession. We would be talking about schools being closed much
    more, so thank you for the support of the American Rescue Plan.
        I was talking to a principal yesterday who was telling me
    that, in her State, the starting salary for teachers is in the
    $20,000s. That is unacceptable. That is unacceptable. So we
    need to do more. Pay does matter, working conditions matter,
    and teacher voice matters.
        And to answer your question about title I, title I gives us
    the opportunity to ensure that there are enough reading
    specialists, that professional development is available to help
    these teachers become highly skilled in addressing achievement
    disparities that exist, and ensure that teachers have a
    competitive salary in urban districts or high-poverty districts
    compared to their suburban counterparts. That is what title I
    does.
        Mrs. Bustos. All right. Thank you so much, Mr. Secretary.
        My time is out, and I will yield back to our chairwoman.
        Secretary Cardona. Thank you.
        The Chair. Congressman Harder.
        Mr. Harder. Thank you so much, Chair DeLauro, for hosting
    today's hearing.
        And thank you, Secretary Cardona, for being here.
        I wanted to talk about doctors in the PSLF program. At the
    height of COVID, the ICUs in my community were over 100 percent
    capacity, not because we didn't have the bed space, but because
    we didn't have the doctors to take care of people. And one of
    the major contributors to that is that since the implementation
    of the Public Service Loan Forgiveness program, doctors in
    California and Texas have been excluded from partaking in this
    program due to State laws prohibiting direct employment of
    doctors by hospitals.
        This disproportionately affects rural and underserved
    communities like mine. We have about half of our physician
    residents after they graduate who move away from our
    communities to go and work in another of the 48 States that are
    covered by this program.
        I have sent you two letters on this. And in the fiscal year
    2022 LHHS report, it urged the Department of Education to
    address this regulatory exclusion through negotiated rulemaking
    this year. One of the letters that I sent you was signed by 67
    Members of Congress, almost the entirety of the California and
    Texas delegations, telling you how important this issue is.
        But I am very concerned that public documents released by
    the Department of Education throughout this rulemaking process
    indicate that the Department either still does not understand
    how to fix this issue or is not prioritizing fixing it.
        Specifically, the proposed language that has been suggested
    still requires a W-2 form for their employers, which would
    continue to exclude 100 percent of California and Texas
    doctors, because they don't get W-2 forms even if they work at
    a nonprofit hospital because they are banned from working
    directly for hospitals in California and Texas.
        So, Secretary Cardona, will you commit to having the
    Department fix this exclusion of otherwise qualifying doctors
    in California and Texas from the PSLF program this year?
        Secretary Cardona. Thank you for the question,
    Representative, and for your advocacy for these heroes who
    during the pandemic have bent over backwards to protect lives.
        As you are aware, the rule related to PSLF is under OMB
    review, and we hope to publish a notice of proposed rulemaking
    in the spring. And I know you have been in communication, and
    my staff will continue to be in communication with you about
    this issue, and I appreciate your advocacy here as we try to
    work toward a solution.
        Mr. Harder. Thank you. I just really want to emphasize to
    you and to your team that the proposed fix does not fix this
    issue, and every single physician in California and Texas will
    still be excluded. And it is, frankly, a little confusing to me
    that after all the whole volute that has happened because of
    this problem, that the negotiated and proposed language still
    falls short of our goal here.
        Can I at least get your commitment that you will do
    everything that you can to make sure the California and Texas
    doctors who meet all other PSLF requirements receive PSLF
    support?
        Secretary Cardona. I understand the problem. I commit to,
    number one, having a conversation with you specifically about
    this to hear your perspective, although I have read the letters
    and have had conversations. I want to make sure that you feel
    that I am giving you my best here to support the doctors in
    Texas and in California.
        Mr. Harder. Well, thank you. And I just want to underscore
    that this is bipartisan, bicameral. We have enormous support
    around this, because it will lead to 10,000 physicians working
    in underserved communities in California over the next 10
    years. It is a major game changer. And especially after what we
    have seen in COVID, I think now is the time to make sure that
    we are getting this addressed. And I want to make sure that the
    Department understands how their current proposed language
    falls short.
        I would like to also enter, Madam Chair, two records into--
    two documents into the record: The first is my bill language
    for H.R. 1133, the Stopping Doctor Shortages Act; the second
    document contains three language proposals that also fix the
    exclusion of qualifying California and Texas doctors from the
    PSLF program without impacting other healthcare professionals
    or allowing nonqualifying doctors to receive PSLF support.
        We know there is good language out there. These are three
    suggestions that do address this problem, and I would really
    encourage the Department and the Secretary to take a good,
    strong look at this. And I appreciate your effort to have a
    conversation on that. I am more than willing to do that
    anytime.
        So thank you again, Secretary Cardona, for testifying.
        And I yield back the remainder of my time.
        Secretary Cardona. Thank you.
        The Chair. Congresswoman Watson Coleman.
        Mrs. Watson Coleman. Thank you, Madam Chair, and thank you
    for holding this hearing, and it is good to see you.
        Mr. Secretary, thank you very much for being here.
        I am always interested in equity of opportunity, providing
    the opportunities for our children to be globally educationally
    competitive irrespective of where they live. I am also very
    concerned about all of the sort of research that we found
    lately that demonstrates that children of color, particularly
    Black girls, are disciplined more than their White counterparts
    for the same infractions. I am concerned that there have been
    issues of discrimination because of their hair, because of
    their dress codes, and things of that nature.
        I am impressed that you all have actually noted the
    challenge and the desire to ensure that educational opportunity
    is more evenly distributed and available. New Jersey is one of
    the most segregated States in the Nation when it comes to K-12
    schools.
        So my question to you is, while you have this commitment,
    what is it that you are actually going to do or be able to do
    that will positively impact the minority child's experience in
    the school? What will you do to prepare teachers? What will you
    do to prepare the administration? What kind of training, bias
    training, et cetera, is going to be made available? And how
    will you hold those institutions accountable who are not doing
    the things that you expect them to do, and what measures can be
    used to ensure their accountability and responsiveness?
        Secretary Cardona. Thank you for the question. As I said
    earlier, the focus during my time as Secretary will be to
    address disparities in this country, provide better access to
    college and career, and to support students' mental health
    needs. As we know, they are greater now.
        To your question, you know, there are several things in the
    budget proposal that will support our efforts, our specific
    efforts to diversify the staff in our schools, to make sure
    that the professional staff in our schools represent the
    beautiful diversity of this country; ensuring that title I
    schools have the support that they need so that they can have
    that intervention, that small group instruction, that evidence-
    based--those evidence-based strategies that we know close
    reading gaps and address the needs that our students have
    academically.
        We want to make sure that we are continuing to disaggregate
    data to ensure that all students are accessing public education
    adequately and equally and that they have the same
    opportunities for cocurricular activities, access to AP
    courses, access to higher education.
        So we are monitoring these things. We are more accessible.
    I said in the beginning I want our agency to be a service
    agency. I want us out in the field. I want us talking to
    educators, teachers, principals. And we are working with them
    to make sure that we are building capacity, we are providing
    greater oversight. And we are being very clear about, if you
    are using Federal dollars or even if you are not using Federal
    dollars, the expectation is that all students have an
    opportunity to succeed.
        I opened with I am a beneficiary of public schools and
    everything that this budget asks for, and I expect that for all
    students across the country. The budget will help us get there.
        Mrs. Watson Coleman. So do the school districts and the
    States understand what you expect of them? And what will happen
    if they are not even achieving or attempting to achieve those
    things that you think are very important and achievable that
    the Federal Government supports in terms of funding?
        And what is it that you actually think the Federal
    Government can do tangibly to desegregate these schools? Do you
    really believe that desegregated schools, particularly in the
    lower-income communities, can provide all of these educational
    opportunities and the innovations that are available? What can
    you actually tangibly do to help desegregate?
        Secretary Cardona. Thank you. First of all, I do believe
    the State chiefs, the superintendents, principal groups,
    teacher groups, they are aware of what we are doing, because we
    are at the table with them and they are at the table with us.
    And I believe we have a shared purpose. It is just a matter of
    drilling down and looking at those places where it is not
    working, building capacity through technical assistance, and
    ensuring that the funding is being used for the right things,
    but also holding them accountable and withholding funding if
    the actions go against equitable outcomes. That is what we are
    working on.
        Mrs. Watson Coleman. Okay. Yeah. I want you to know that,
    in closing, I am very supportive of community schools. And I
    think the community schools that have diversity of services to
    both the child and the parent and that even finds educational/
    recreational opportunities and after-school hours is vitally
    important to our communities, and I strongly support it. And
    anything I can do to that end with you, please count on me.
        Secretary Cardona. Thank you.
        Mrs. Watson Coleman. Thank you. And, with that, I yield
    back.
        Secretary Cardona. Thank you.
        The Chair. Congressman Harris.
        Mr. Harris. Thank you very much. And I apologize, but we
    have the Ag--as you know, because you appeared before us, we
    have the Ag Subcommittee.
        And, well, thank you, Mr. Secretary, for being here. I want
    to follow up first on something that the gentlelady from
    Washington brought up. You know, Elon Musk famously tweeted
    back in December of 2021, the fact that an 18-year-old can't
    take out a $10,000 business loan but can take out a $100,000
    student loan tells you everything you need to know.
        So I have a question for you, because, you know, the
    gentlelady brought up the issue of the importance of trade
    skills. And so, for instance, I met with new car dealers. They
    can't find mechanics, like, literally they can't find them.
        You know, when a mechanic finishes their vo-tech training,
    for instance, a set of tools cost them $15,000 or $20,000.
    Without that set of tools, they have got to go work for
    somebody else. They can't work for themselves. Nobody is going
    to lend them $15,000 or $20,000 out of school, but they have a
    marketable skill, a valuable marketable skill.
        Why don't we lend them money? Why do we lend the money to
    go to a 4-year college to study something in the humanities
    that may or may not bear any fruit and not lend the person who
    just learned a skill to get started in being a vibrant part of
    our economy?
        Secretary Cardona. Yeah. Thank you, Dr. Harris. As a former
    automotive technician student myself in high school, I had to
    buy those tools----
        Mr. Harris. Yep.
        Secretary Cardona [continuing]. And I know what you are
    talking about. And I fully support making sure we have better
    access to careers. I fully support creative pathways there and
    those that give students opportunities to try different
    pathways that maybe don't exist now. I am fully supportive of
    that.
        Mr. Harris. Great. Thank you very much.
        So I am going to spend the last few minutes just on the--my
    concern about the charter proposed rules. And I know you have
    addressed it. Again, I am sorry I couldn't listen to everything
    that was said. But, you know, in Maryland, I was there on the
    Education Committee in the State senate when we passed the
    charter school bill. It was to help Black students in Baltimore
    City. There were successful charter schools which were almost
    entirely minority.
        Secretary Cardona. Right.
        Mr. Harris. So when you come out with, you know, a proposal
    that a charter must serve a diverse population, these were
    actually designed to serve a nondiverse population in Baltimore
    City, a population that was underserved, that didn't have
    educational choice.
        When you say that, you know, the community impact analysis
    has to have evidence of over enrollment of existing public
    schools, that is not the issue. It is not that there aren't
    public school spaces available; it is that those public schools
    are failing and parents get the choice of charter schools.
        So are you aware of these concerns?
        Secretary Cardona. I am. And I do believe proposals are
    reasonable. I said at the beginning, before you were here, you
    know, I remember when I was in Connecticut, one of the last
    presentations before COVID shut everything down was Stamford
    Excellence Charter School. The achievement in that school was
    amazing, and we lifted it up as a great example. I know in
    Rhode Island there is a great learning community charter
    school, involves parents in ways that we want to see across the
    country. So we know there are great examples.
        And my department's technical support assistance is going
    to be available to help any school that wants to open to be
    successful. So I think these are reasonable, but I do
    understand that there is a lot of concerns. There is a lot of
    misinformation and there is a lot of myths that maybe we are
    not in support. I am in support of high-quality public charter
    schools.
        Mr. Harris. Thank you very much. So I did tune into a
    little part of your commentary.
        Secretary Cardona. Okay, good.
        Mr. Harris. You said you support quality schools.
        Secretary Cardona. I do.
        Mr. Harris. And you are right, look, some charter schools
    weren't quality schools, but some really are. And please don't
    throw out the baby with the bathwater.
        Finally, you know I am a strong advocate for the D.C.
    Opportunity Scholarship Program. I am very glad that the
    administration in this year's budget did not include the phase-
    out language. That was very disappointing to me. This is--
    again, this is a program that serves overwhelmingly minority
    students where the parents have, you know, waiting lists, they
    do the lotteries for this. I mean, these parents really want
    this to exist, and I am glad that the administration realized
    that and then took out the phase-out language.
        I am also glad they didn't include the poison pill
    language, the language that would, again, look at the timeline
    religious exemptions through a lens that basically would
    disallow a lot of the schools.
        This project, this is just a great--giving parents choice
    in a failing school system is a good idea, not a bad idea. I
    get it, it is controversial. I get it, union opposition. Again,
    I lived through it all in Maryland when I was in the State
    senate. I urge you, again, to support programs like this that
    are broadly supported by parents where we can demonstrate that
    they are qual--that there is a quality aspect to the education.
    And, again, I thank you for being here. I apologize for being
    so late.
        I thank the chair for her indulgence, and I yield back.
        Secretary Cardona. Thank you.
        The Chair. Congressman Pocan.
        Mr. Pocan. Thank you, Madam Chair and Ranking Member Cole.
    I also was one of those folks late because of the Agricultural
    hearing. So I want to say happy birthday to Ranking Member
    Cole. Hopefully there is a quality cigar in your day at some
    point.
        Mr. Cole. Several.
        Mr. Pocan. Several. Good, good. I want to make sure.
        Since a lot of the questions were asked, let me just hit a
    couple points and then I will ask a few questions. One, I have
    great concern on the teacher shortage issue as well. In fact,
    Madam Chair, it might be good to have a special hearing on this
    sometime, because I think it is such a big issue. I think the
    way you broke it down on pay and conditions and teacher voice
    is very accurate, and there is challenges in all three.
        You know, we saw the conditions with COVID and what has
    happened to teachers. We have seen places like Wisconsin where
    they have attacked public employee unions. And we have watched
    the devastating numbers of people not applying to go to become
    teachers.
        In my main school district, it used to be almost impossible
    to get in as a teacher. Now, they have positions where they
    only get two or three applicants for a teaching position. So
    this is a real issue, and I think whatever we can do to--I
    appreciate what you have in the budget, but I think there is
    probably more we are also going to need to do.
        Second, perhaps a little different than the ranking member
    on this, on the charter programs. I really appreciate the
    direction you are doing with the extra scrutiny and efforts.
    Wisconsin was one of the first States to have those, back now
    almost 30 years ago. Yes, there was some rough periods that we
    have corrected where, you know, we gave money to people who
    opened schools who said they could read a book by putting their
    hand on it and all sorts of interesting ways, but we still
    don't have the performance out of them. And I think when you
    look at the statistics that were given by the chairwoman, you
    know, I am glad we have that extra scrutiny.
        Completely agree with Representative Herrera Beutler on
    Pell. I went to school because I had Pell grants, and I am not
    lifting the ladder up. I am trying to make sure we are going to
    continue to try to double those Pell grants. Thank you for
    those efforts.
        And I guess where I will get to a question now is I agree
    with what Representative Clark and others said about the Office
    for Civil Rights budget. I am especially concerned that there
    is a trend among some States to have these so-called ``Don't
    Say Gay'' laws, and they are going to have some really big
    impacts, again, on teachers but also on students.
        And, you know, specifically in that area, are there some
    strategies that you are looking at? Because I have got the
    feeling you are going to have a lot of potential firings and
    expulsions and others because of those laws.
        Secretary Cardona. We are asking for an increase of almost
    $26,000,000. Really, it is our--one of our primary
    responsibilities to ensure all students have access to a school
    that is inclusive, where they feel welcomed, and that is what
    we heard from students, and that is what we heard from parents.
    We have been listening to parents. They want their children to
    feel welcomed and embraced.
        And what we are finding now across the country is that we
    have to be proactive to ensure that we are out there and
    communicating with these educators and these policymakers that
    are introducing policies that go against that. Our Office for
    Civil Rights is prepared. But what we want to do is build a
    culture of inclusivity. We really need to be proactive about
    this. OCR alone is not going to take care of this. We need to
    create a culture of acceptance and inclusion for all of our
    students.
        I recently visited students in Florida and parents who told
    me, all I want is for my kid to come back--just like every
    other parent--go back into school, make up for some lost time
    during the pandemic, and feel welcome, feel accepted, and that
    is under attack. And we are not going to tolerate it. We need
    to support every student, including our transgender students
    who are under attack in many places.
        As Secretary of Education, I need them to know I have got
    their back. And the Office for Civil Rights is here to support
    and take investigations if we have requests for them, because
    we take this very seriously. That is something that we are not
    going to compromise on.
        Mr. Pocan. Thank you. And then two questions around
    financial aid that have been brought up from my district. One
    around FAFSA. You know, there has been repeated verification
    points for the issue of requiring students to apply for that
    annually. I believe there might have been some relief around
    that through COVID in the requirement to reapply.
        Is there a way to start looking at those multiple-year
    applications that you don't have to every single year apply for
    it when people are looking for a 4-year degree so that you
    could have less disruption?
        And secondly, there was, again, some relief during COVID
    around Pell grants, and to the same end, if it was possible to
    have some of the relief that we had during that time period
    continue. We know there is going to be negligible effects, but
    there is a lot of paperwork involved, and also it holds back
    some families from being able to apply on the income
    verification side.
        Could you address those two points?
        Secretary Cardona. Sure. And, you know, they are connected
    in some ways. And I have to first acknowledge the dedicated
    people, career staffers in FSA, who have been working
    tirelessly to, you know, work on the systems that we are trying
    to improve.
        What we are trying to do is work closely with our services
    also to make sure that they are supported throughout this
    process, while also simplifying and making sure we have the
    data that we need without over--creating more paperwork or more
    challenges, more obstacles to this process. We will continue to
    do that, and I look forward to hearing more from you and your
    team to see what we can do to continue to improve that process.
        Mr. Pocan. Great. Thank you very much, Mr. Secretary.
        Secretary Cardona. Thank you.
        Mr. Pocan. I yield back. Thank you, Chair.
        Secretary Cardona. Thank you.
        The Chair. That concludes the first round of questions
    here, and it appears that we have some time and that we can
    allow for a 3-minute round of questions. So really for the
    quality of the discussion, et cetera, is really--it is rich and
    it is so critically important.
        I will just say to Mr. Pocan, I love the idea of a hearing
    with regard to teacher shortage, and we are going to take you
    up on that and pursue it. So thank you. I think it is a very,
    very big issue.
        Mr. Secretary, I would like to, one, say thanks with regard
    to the great work of you and your staff on borrower defense.
    More than 100,000 defrauded borrowers have received loan
    discharges under the borrower defense repayment provision. But
    we have got another, you know, tens of thousands of additional
    borrowers who are waiting for their claims to be adjudicated.
        I just read the article that was handed to me coming out
    today: Education Department approves $238,000,000 group
    discharge for 28,000 Marinello Schools of Beauty borrowers
    based on borrower defense findings.
        I think it is interesting, I know my colleague, Ms. Herrera
    Beutler, talked about for-profit cosmetology schools being
    worried about regulation. But if you take a look at the article
    and what was found here is that this was--the Department found
    schools failed to train students in key elements of cosmetology
    program, how to cut hair, I mean, some very basic things, so
    that cracking down on these schools that do--are predators is
    really critically important.
        Tell me what you are--I know we are waiting for a borrower
    defense rule. In the meantime, what are you trying to do to
    adjudicate these outstanding defense claims for groups?
        Secretary Cardona. Thank you. You mentioned today's
    announcement. Prior to that, over $2,000,000,000 in relief
    through borrower defense for 105,000 borrowers who were taken
    advantage of, misled. We really need to send a message that we
    are not going to let that slide, that these practices of taking
    advantage of students trying to chase that American Dream is
    something that we are going to be monitoring more closely.
        I am proud of the enforcement team being brought back up
    under Richard Cordray's very capable leadership. It is really
    creating a new culture to make sure that the return on
    investment for our students is there so that they are not
    saddled with debt for the rest of their life earning low-
    income.
        So I mentioned borrower defense. We are feeling similarly
    with income-driven repayment. We are feeling the same way with
    Public Service Loan Forgiveness. A lot of attention is on broad
    loan forgiveness. We are working really hard, especially this
    first year, to fix systems that are broken, that were not
    working for students, and borrower defense is one of those.
        The Chair. Okay. And I just would mention, I mean, the
    students and the taxpayers are the ones who should be worried
    about what is happening here, and there is overwhelming data
    that talks about what attorneys general have found----
        Secretary Cardona. Yep.
        The Chair [continuing]. About misleading students,
    harassing students, worthless degrees, major student debt. That
    has to be drummed out of the system.
        Secretary Cardona. Right. Right.
        The Chair. That is what we have to do. No one is saying
    let's not give people technical education. It is critically
    important to do that. And we can work with that, work with
    businesses, we can work with community colleges and getting the
    people what they need and the technical credentials to move.
    But we cannot allow corruption to take advantage of our kids or
    of the Federal tax dollars. Thank you, Mr. Secretary.
        I now yield to the Ranking Member, Mr. Cole.
        Mr. Cole. Thank you very much, Madam Chair.
        I have got two quick questions, one you might want to take
    for the record, but you may know off the top of your head. What
    percentage of the $76,000,000,000 in Higher Education Emergency
    Relief Funds remain unspent, and how does the Department plan
    to make sure that that money is actually used for COVID-related
    purposes?
        My friend, Mr. Cline, pointed out, we certainly have some
    egregious examples where people I think misused the money for
    things that none of us envisioned they would spend it on.
        Secretary Cardona. Thank you, Ranking Member Cole. I will
    get you specific numbers. I don't have it off the top of my
    head. But I will tell you, in my visits to higher education
    institutions, I have seen a shift. These institutions
    understand they have to meet the students where they are, in
    many cases, food insecurity, housing insecurity, dealing with
    some basic needs, books, not only tuition support. But I think
    if it weren't for the money in the higher education space, we
    would be talking about colleges closing. We would be talking
    about a dropout rate that is much higher.
        What I have seen anecdotally and in stories of students who
    have told me, I am only here because of the funds that the
    school is providing, that they wouldn't have had if it weren't
    for that. So I can get more information to you, but I can tell
    you firsthand----
        Mr. Cole. I would appreciate it, because I agree very much
    with your basic point. Look, this money was necessary and--so I
    won't quibble with that. I do worry, potentially it was an
    unprecedented new program.
        Secretary Cardona. Right.
        Mr. Cole. It is pretty easy. You don't have controls set
    up. So I just want to make sure, because I have seen some
    pretty egregious examples of money spent on things that I know
    nobody on this committee, on either side of the dais, would
    have approved of.
        Second question quickly, and this may call for a longer
    discussion another time, is title I, where, again, I think the
    purpose of the money is a really worthy purpose. I am concerned
    that over--you know, we spend a lot of title I money, and a lot
    of times we don't see much difference in performance over time
    in the places where--I am not disagreeing where it is targeted.
    I am wondering whether or not we are doing the things we need
    to actually use the money to get a better result for students.
        So can you just quickly give me some of your thoughts on
    that and how we can improve the performance to follow the
    dollars?
        Secretary Cardona. Thank you, Mr. Cole. And I agree with
    you wholeheartedly. Money doesn't always mean success if it is
    not being used well. That is why I am proud to be an educator
    and be able to say, if these funds are being used, they better
    be used for evidence-based practices.
        Deputy Secretary Cindy Martin has been working really
    closely with our Office of Elementary and Secondary Education
    to ensure that good teaching principles, good leadership
    principles are being used with these funds. We both served as
    educators at different levels, and we are really interested in
    making sure that there is a good return on investment not only
    for the students, but for the taxpayers who are funding this.
        Mr. Cole. Yeah. If you could--and my time is about up, so
    you don't have to respond, but if you could get us some
    information on that that shows where the dollars have actually
    markedly improved performance and, you know, what are the
    reasons why that worked.
        Secretary Cardona. Gotcha.
        Mr. Cole. In other words, what are the things we did with
    the dollars that actually helped kids get a better outcome.
        Secretary Cardona. Happy to do that. Thank you.
        Mr. Cole. Thank you very much, Madam Chair.
        The Chair. Congresswoman Roybal-Allard.
        Ms. Roybal-Allard. Mr. Secretary, this year we celebrate
    the 50th anniversary of the Federal TRIO Veterans Upward Bound
    program, which helps military veterans prepare to reenter the
    academic pipelines. A Department of Education study found low-
    income and first-generation veterans who participate in the
    TRIO Veterans Upward Bound program were 42 percent more likely
    to complete a degree than those who did not participate in the
    program.
        Can you address what steps the Department is taking to
    improve college access and completion for our veterans through
    this program or any other program that you may have?
        Secretary Cardona. Yeah. I can tell you, in some of my
    visits, some of the best stories are of our veterans who had
    access to higher education and their family had access to
    resources for all of them to find success.
        We have worked closely with veterans groups, and we have
    had them in the Department telling us how we can improve
    programming, how we can work together with DOD and Department
    of Veterans Affairs to make sure that the communication to them
    is streamlined.
        We will continue to work with them and to make sure that
    they have access to the programs and the benefits that are due
    to them. They have served our country, and it is important for
    us at the Department that they feel that we are supporting them
    in their process of accessing higher education.
        Ms. Roybal-Allard. I have several questions that I won't
    have the time for, but I will submit them for the record.
        Secretary Cardona. Please do.
        Ms. Roybal-Allard. But I just do want to make one point and
    that has to do with the issue that has been brought up by my
    colleagues with regards to trade schools.
        Secretary Cardona. Sure.
        Ms. Roybal-Allard. And I just want to point out that, in
    addition to the financial support and other things that have
    been talked about, I think it is also important for the
    Department of Education to change public attitude about going
    to a 4-year college versus going to a trade school. And then
    just quickly, let me just give you one example of what I am
    talking about.
        I was talking with some parents in my district and they
    were bragging about their--of their oldest child who was going
    to a 4-year college and, you know, how proud they were of them.
    And when I asked about, well, what about, you know, your other
    son, they were almost apologetic in telling me that that son
    was going to a trade school.
        And I think that there is various reasons, historical
    reasons, you know, for that being the way it is, but I think it
    is important that we find a way to give the same kind of status
    to those who go to a 4-year college and those who get a degree
    in some kind of trade school, for all the obvious reasons that
    have been mentioned. And I think the Department of Education
    can be helpful in helping the public and parents understand
    that both have tremendous value.
        Secretary Cardona. Absolutely. As a graduate of a technical
    high school, I couldn't agree more. We do have more work to do
    to change the culture, the stigma that is, unfortunately,
    associated with it. There are high-paying, high-skilled jobs
    out there.
        I remember visiting a place in Michigan--I can't think of
    the name of the school now, but it was a graduate program. The
    students that were studying plumbing were going into jobs
    making six figures when they left, with very little debt. They
    are doing pretty well. We have to change the stigma, and I am
    excited to do that work.
        Thank you.
        The Chair. Well said, both of you.
        We have another member of the committee that has joined us.
    Can you introduce her, Mommy?
        Ms. Herrera Beutler. Say, Hi, I am Isana Mae.
        Isana Mae. I am Isana Mae.
        Ms. Herrera Beutler. Isana Mae.
        The Chair. Okay. Well, welcome.
        Ms. Herrera Beutler. Thank you.
        Voice. Give her questions.
        Ms. Herrera Beutler. I don't know if anybody could handle--
    that would be a tough question.
        I wanted to ask, kind of following up along this, you know,
    I agree with the chairwoman that corruption and defrauding
    students and the American taxpayer should never be tolerated. I
    am in no way afraid of any kind of investigation into someone
    who is a bad actor, like full stop. I do think, though, my
    challenge is, is there are not similar applications of I feel
    like justice being applied.
        You know, one of the things that madam chair--and I agree
    with this--she said, we cannot allow corruption with Federal
    tax dollars, worthless degrees, and thousands of dollars in
    debt.
        Well, any average person watching this might think we are
    talking about, you know, one of the many students who went to a
    4-year liberal arts degree and has thousands of--hundreds, in
    some cases, of thousand dollars in debt, and they are working
    as baristas. You know, right now, we have over a million
    workers that just disappeared from the economy, and your
    administration that you work with is talking about forgiving
    their debt, and I am thinking and we are trying to get rid of
    trade schools?
        One way we can make this whole thing work is if we change
    the stigma, root out the bad, and apply that same level of
    justice. And it was frustrating to me as this rulemaking
    process is happening that I have good acting trade schools that
    provide good jobs in my district who are saying, Department of
    Ed won't respond to us. It is not even that they are giving us
    bad information or they don't like us; it is that they won't
    respond to us. That is not appropriate.
        And I would like to see that same measure being applied to
    our 4-year schools. Is it still true that financial aid
    counselors cannot counsel a student, Yeah, you know, you are
    taking out all this debt, yet your degree isn't going to help
    you pay that off? Like, it has been the rule that financial aid
    counselors can't actually point that out to students. I think
    we need to--I agree that the system needs to be cleaned up.
        Secretary Cardona. Yes.
        Ms. Herrera Beutler. And let me add to that nursing.
    Nursing is another area. If you are talking about forgiving
    loans, I know that you are talking about the Public Health
    Service Corps and the Public Service Loan Forgiveness programs.
    Those are great. But if you are going to talk about widespread
    forgiving of, you know, everybody's loans, there needs to--
    Federal taxpayers need to have some benefit there.
        So why can't we consider asking those people to serve in
    high critical need areas? They are going for a psychology or
    psychiatry degree, maybe help serve in a childcare desert. You
    know, maybe you should put in the same 5 years of service that
    a health service corps person would do to get that loan
    forgiveness. I think that needs to be considered.
        So that is a lot.
        Secretary Cardona. I appreciate it. Thank you for sharing
    that. I welcome an opportunity to have more conversation about
    how you are perceiving it, what you are hearing, and how we can
    at the Department of Education be more service-oriented to
    those who might feel like they are not hearing from us.
        Thank you.
        Ms. Herrera Beutler. Thank you.
        The Chair. Congresswoman Clark.
        Ms. Clark. Thank you, Madam Chairman.
        I was delighted to see in your budget another $616,000,000
    to help simplify the FAFSA process. I think few forms for
    students looking to further their education and families that
    support them create more of a daunting process than that
    particular form. So I would love a brief update on where you
    are with that.
        And, in particular, we have been looking at the issue for
    homeless, foster, and justice-involved youth that even a
    simplified process is still very difficult. So I would love to
    hear about your strategies for helping those students enroll
    and complete their postsecondary education.
        Secretary Cardona. Thank you. I couldn't agree with FAFSA
    simplification any more after having gone through the process
    with my own son several months ago. And as you know, the
    deadline was extended, but I am glad to say that homeless and
    foster provisions won't have to wait another year. That will be
    ready for the following year.
        We can't have a program that is intending to help students
    that need additional help make it so hard for them to
    understand it or their parents to understand it. I can tell
    you, one of my son's friends called me--called my son and said,
    ``Could your father help my mother with the FAFSA because she
    doesn't understand it?'' And that told me--and she knew that I
    am in education, so he said, ``Well, I will call him.''
        The process has to be much easier. It has to be accessible
    to those who need it most. There can't be barriers there that
    make someone think it is easier just to forget and ignore that.
    That is unacceptable. And I am glad we are moving forward
    toward simplification. I wish it could be ready now, but I am
    happy that for the homeless and those in foster care, they
    don't have to wait another year, that theirs will be ready in
    2023, 2024.
        Ms. Clark. And I know this is primarily a State issue, but
    one of the other factors that has come up, especially for
    foster youth, but it really applies across the board for some
    of our more vulnerable populations, is aging out of foster
    care.
        And 21 States still have not extended the age limit. But in
    a recent visit to a community college, talking to the
    administration and students, even with the extended age of 23,
    with all the interruptions of the pandemic, the high costs of
    housing, food insecurity, you know, I think we have to think
    about a different way that we address these needs and help
    these students finish without an arbitrary age cutoff. It just
    doesn't reflect the reality of many, many students, but also
    especially of homeless and former foster youth.
        We need to make sure that we are--we are looking at that.
    And it is often a State issue, but I am hoping we can
    collaborate and think about solutions.
        Secretary Cardona. Yeah, I appreciate that. And especially
    now after the pandemic where so many have faced disruption that
    might have taken them off course for a little bit.
        I am very eager to learn more about this and maybe work
    with you to hear specific examples of things we can do to help
    that process along.
        Thank you.
        Ms. Clark. Thank you. We will follow up. Thanks, Mr.
    Secretary.
        I yield back.
        The Chair. Ms. Frankel.
        Ms. Frankel. Thank you, Mr. Secretary.
        Well, the Governor of Florida has decided to be the leader
    in the cultural war of extremism in our country. And I know Mr.
    Pocan talked to you about the situation with what he calls the
    Don't Say Gay bill, but I want to talk to you about the WOKE
    bill.
        The WOKE bill is aimed at limiting how schools and colleges
    and businesses discuss race. It blocks any instruction that
    could hint at one race feeling guilt for past actions or that
    their race necessarily determines a person's status as
    privileged or oppressed.
        Now, I wanted to say I was at the Museum of African
    American History the other day. And if anyone hasn't been
    there, I just urge you to go there. And, you know, the first
    exhibit that I saw had all of these slave ships and showed how
    human beings were packed in these horrible, awful conditions.
    And I have to say, I had very strong emotions, all kinds of
    emotions, whether it was sadness, or guilt, or whatever.
        And I just do not understand how--I mean, it seems to me
    that, under Florida law now, children are not going to be able
    to be taught about slavery. One district recently canceled a
    workshop on the civil rights movement out of fear of violating
    the new law.
        And so, you know, what my constituents are asking me is can
    the Federal Government do anything to intervene against this
    craziness, this horrible effort by the State of Florida to
    basically block teachers from telling the truth or have
    students having any emotional feeling when they hear the facts?
        Secretary Cardona. You know, we--as a lifelong educator
    myself, I know the importance of making sure students feel
    engaged in learning. And while the Federal Department of
    Education doesn't have a role in curriculum, to me it is really
    important as an educator and as a father that our students are
    engaged and proactively introduced to the beautiful diversity
    that has made this country the most amazing experiment in the
    world. But that includes, you know, our history. That includes
    parts that we are not proud of.
        I trust that----
        Ms. Frankel. I understand. I agree with you, but is there
    anything that the Office for Civil Rights can do about this
    effort in Florida?
        Secretary Cardona. What the Office for Civil Rights can do
    is thoroughly investigate any request for investigations around
    lack of rights of students. And, you know, I can't speak
    prematurely to that, but I will tell you, we do believe that
    students should have quality programming, and we are concerned
    with some of the policies that are less curriculum, more about
    division, more about bringing politics into the schools. I said
    at the onset, our schools should not be the place for cultural
    wars.
        Our parents want our children to recover from what was
    missed during the pandemic, for the missed instruction. They
    want the mental health needs of their students cared for. They
    want all students to feel welcome. That is what our parents are
    asking for. We are not going to get distracted going into the
    cultural wars, but I also encourage our State leaders and our
    local leaders to make sure that they are also in the
    conversations around what our students need.
        And I know that our educators and parents want the same
    thing for their kids. They want their children to learn in an
    environment that is inclusive, that is welcoming, and that
    teaches the truth.
        Ms. Frankel. Thank you. I yield back.
        Thank you, Mr. Secretary.
        The Chair. Congresswoman Watson Coleman.
        Mrs. Watson Coleman. Thank you, Madam Chair.
        Secretary, the whole notion of community schools is
    something that we explored about three or four governors ago
    when the Governor of Florida believed that schools should be a
    community outreach. Parents can come there and get services
    they need. Children get services they need. School doesn't end
    at 3:00. I am so excited about those. I really believe that
    they are an answer to a lot of our issues in our particularly
    underserved communities.
        So I thank you for the work that you all are doing. I look
    forward to that expanding.
        I wanted to just draw your attention to the HBCUs and the
    TCCUs and the MSIs. I know that you all recognize the
    significance of them, the importance of them, and that is
    recognized in the budget because of the investments that you
    have increased in those areas.
        Could you please speak to the importance and impact of
    better funding these universities that primarily care for
    students of color?
        Secretary Cardona. They care for students of color, but
    they punch above their weight. HBCUs, for example--only 3
    percent of our colleges and universities are HBCUs, yet they
    are producing tenfold the percentage of Black doctors, judges,
    attorneys.
        So, for us, this is really about making sure that we are
    supporting institutions that have historically been underfunded
    and don't have the endowments in many cases that other
    universities have but are producing high-quality graduates and
    are contributing in positive ways to our economy.
        So, for me, you know, my visits to not only HBCUs but MSIs
    and HSIs and TCCUs underscore the importance of supporting
    these institutions that are helping next generation of many
    times first-generation college students find success and
    achieve that American dream.
        So it is a great investment, not only for these
    institutions, but for our economy and for our country.
        Mrs. Watson Coleman. I think that your budget proposal, the
    President's budget proposal definitely moves in the right
    direction in so many areas that are important to us, and I look
    forward to working with you. And I thank you for all the work
    that you have done and for the places you shared based upon
    your lived experiences, which are very important and very
    relevant.
        Secretary Cardona. Thank you, ma'am.
        Mrs. Watson Coleman. I yield back.
        Secretary Cardona. Thank you.
        The Chair. Thank you.
        With that, I will ask the ranking member if he has any
    closing statements.
        Mr. Cole. Yeah, just a few. And thank you, Madam Chair, and
    it is wonderful to be back here and maybe next time in our own
    room, but this is still good.
        And, Mr. Secretary, it is always a pleasure to have you.
        I come away from our hearing with four conclusions. One, I
    would ask you to really look carefully, Mr. Secretary, at this
    charter school issue. We had four different members on our side
    raise concerns about that, and I think they reflect what their
    governors are thinking in many cases or certainly what their
    constituents are. So we have a lot of concerns in that area,
    and we are going to continue probably to push pretty hard on
    that.
        Second, I would ask you--and you acknowledged this--to look
    at Impact Aid and Indian education. Again, I understand why the
    numbers are a little bit lower, but I think we could probably
    all agree those are areas that we want to continue to work on,
    certainly Native American education. I know a lot of that is
    actually in the Interior budget. That is a whole other
    discussion for another time as to where that would be
    appropriately funded, but we would certainly like to see some
    increases there.
        Third, on a very hopeful note, you know, as I draw away,
    and I listened to all the comments and your testimony, I see
    some terrific areas of cooperation, and they are pretty
    traditional for us here. Special education is something I think
    we all feel strongly about with IDEA in particular. Early
    childhood has been a favorite of this committee on both sides
    of the aisle for quite a few years. First-generation college
    students, I think we all think that is an investment that is
    not only a good investment, but helps us deal with inequities
    that we know exist over time.
        And finally--and your background would probably make you
    especially sensitive here--career and technical education
    where, again, as you pointed out in your testimony, there are
    some terrific job opportunities for kids, and we need to make
    sure that we don't disparage the 70 percent that choose to do
    another route than the traditional 4 years, and that can often
    lead to a very, very good outcome, and we don't want to miss
    those opportunities.
        Finally, the last thing I will say is just renew my
    commitment. Probably the best gift we can get you--of course,
    you want everything that you would ask for, and that is fair
    enough, but the best thing we could do for you is get you
    something on time and, you know, make sure that you have got
    the time to implement. So I want to reiterate, I want to work
    very closely with my chairwoman, whom I admire a great deal,
    and try to make sure that we get this done closer to the time
    so that you have got, you know, the full amount of time to
    implement these things.
        And we got you a budget I am pleased to have voted for, but
    we got it to you awfully late, and I know that has made things
    very difficult for your department. We are going to try and do
    a better job. And if we don't do a better job, I can assure you
    it won't be the fault of the House of Representatives or our
    chair. It will be the fault of the United States Senate. So we
    are going to push them pretty hard too.
        So thank you.
        And thank you for the hearing, Madam Chair. I yield back.
        Secretary Cardona. Thank you, Ranking Member.
        The Chair. Thank you very much.
        And I too am committed to seeing that we can get these
    bills done in time for people to be able to utilize the
    resources that they need and not wait several months before
    they can do that. And I want to thank the ranking member for
    his assistance in getting the bill, the omnibus over the finish
    line. And he knows that I welcome his support, and I will ask
    for his support and help and guidance as we try to make it
    through the next go-around.
        And this afternoon, we will have a meeting with the four
    corners. And, you know, I am optimistic about having, you know,
    a good direction and one where everyone understands the need
    to, you know, move quickly.
        Just a couple of points. We talked about, you know, the
    issue of technical schools and having youngsters be able to
    really realize their dreams and their aspirations. The fact is
    that 70 percent of people in the United States do not have a 4-
    year college degree, nor--if you can, fine, and if you can't,
    that is fine. But that means that is all the more reason why we
    have to address what is important to 70 percent of the people
    in this Nation.
        And, you know, that is critical in making sure that those
    institutions are the very best and are providing the kind of
    instruction that allows them to realize those dreams and
    aspirations.
        I would say I understand Ms. Herrera Beutler's need, you
    know. She has that little urchin there that, you know, needed
    to run off with. But I would just say, because I--at the outset
    in my questioning, I talked about a private institution, the
    University of Southern California, and what it costs for their
    master's degree program and what they are doing. So we need to
    root out that kind of--you know, I call it corruption, I really
    do, you know, out of wherever it is, to provide youngsters with
    what they need.
        And you started out--and I did as well--Mr. Secretary, that
    talked about--you know, I talked about Horace Mann:
    ``Education, beyond all other devices of human origin, is the
    great equalizer.'' Education is the great equalizer.
        There isn't a person on this panel here or even out there
    whose parents have said to them, ``Get yourself an education
    because it is the root to success.'' You know, your family said
    that to you. You know, that is what my parents told me, you
    know, over and over again. And the parents sacrificed to make
    sure that that happened so that we could realize our own dreams
    and aspirations.
        But no child should be denied a quality education because
    of their parents' economic circumstances, or where they are
    born, or if they have a disability, you know, or their
    ethnicity, or their race, their gender. That is not who we, you
    know, strive to be. And I know that that is the heart and soul
    of where you are.
        And so that--and as I said that education is the great
    equalizer, and it is our teachers, it is our public schools,
    our universities, they are more essential now than ever to be
    fulfilling that effort.
        Our job is--and you talked about it at the outset. You
    know, the numbers are important, because we have to take a look
    at what the funding is, et cetera, but what is the underlying
    mission? What needs to propel us to get those opportunities out
    to youngsters, whether it is K-12 or postsecondary? You know,
    how do we do that?
        We now have a new set of challenges as well. We have
    serious mental health issues with our kids. We have people who
    are struggling with hunger, housing costs with college, you
    know, students. There are disparities which are there. We have
    outside forces today that you don't want to create a new
    dynamic around education and use teachers in many respects and
    scapegoat teachers, you know. I mean, this is--it is tough. It
    really is. So we have to kind of navigate our way through.
        And I want to commend to you, because I think that your
    background, your experience is what we critically need at this
    juncture to navigate education. And, absolutely, people are not
    always going to agree on everything. We will disagree. But as
    the ranking member said, we do it with civility. We do it with
    the goal in mind. That is where we need to go in the course of
    our Nation's history. What is the goal? And on both sides of
    the aisle, like they did in the past when we created a social
    safety net in this country, it was Democrats and Republicans
    coming together and saying, ``This is the challenge. How do we
    get there?'' We want to help you get there, and that is what
    our goal will be here.
        And, with that, I thank you. I thank your team for all that
    you do and your commitment to our youngsters' education. So
    thank you.
        And, with that, this hearing is adjourned.
        [Answers to submitted questions for the record follow:]

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                                                Thursday, May 26, 2022.

             TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS

        The Chair. Let me begin the hearing and bang the gavel, and
    let us get underway.
        Again, some housekeeping issues to start with. The hearing
    is fully virtual so we have to address these issues.
        For the meeting, the chair, or the staff designated by the
    chair, may mute participants' microphones when they are not
    under recognition for the purposes of eliminating inadvertent
    background noise. Members are responsible for muting and
    unmuting themselves.
        If I notice when you are recognized that you have not
    unmuted yourself, I will ask the staff to send you a request to
    unmute yourself. Please then accept that request so you are no
    longer muted.
        I remind all witnesses that the 5-minute clock applies
    during today's public witness day. If there is a technology
    issue, we will move to the next witness until the issue is
    resolved, and you will retain the balance of your time.
        You will notice a clock on your screen that will show how
    much time is remaining. At 1 minute remaining, the clock will
    turn yellow. At 30 seconds, I will gently tap the gavel to
    remind witnesses that their time is almost expired. When your
    time has expired, the clock will turn red, and I will begin to
    recognize the next witness.
        With that, I would like to acknowledge and thank our
    ranking member, Tom Cole, for being here this morning, other
    members of the committee.
        And welcome to the Labor, HHS, Education Subcommittee's
    public witness day hearing. I think we all want to express our
    deep gratitude to the 24 witnesses testifying today and to all
    of those who sent written testimonies for the record.
        It is about your experiences and your testimonies. They are
    so invaluable to us. The work that we do together to fund the
    programs in this subcommittee's bill impact the lives of
    Americans across our country.
        At last year's public witness day hearing, I said that
    today's hearing is one of the most important things the
    committee does, and that has certainly rang true. With the help
    of public witnesses, we developed a fiscal year 2022 bill that
    has made transformative investments to tackle America's
    toughest challenges.
        Our bill grows educational opportunities with more funding
    for high-poverty schools, for students with disabilities, and
    for programs that expand access to postsecondary education. It
    strengthens lifesaving biomedical research with increased
    funding for the NIH. We bolster our public health
    infrastructure with an increase of investment in the CDC and in
    State and local governments.
        We tackle the urgent health crises--maternal health, mental
    health, gun violence, and substance misuse, while reducing
    unacceptable health disparities. We are supporting middle-class
    working families with more funding for childcare, for Head
    Start, for preschool development grants. The bill creates and
    sustains good-paying jobs with investments in job training,
    apprenticeship programs, and worker protection. All of these
    were made because of input from public witnesses.
        As we draft the 2023 bill, using the President's budget
    request as a starting point and direct input from stakeholders,
    including all of you, we will continue to transform the lives
    of Americans all across the country.
        Looking forward to your testimony this morning, and I thank
    you all for being here today.
        And with that, please let me turn it over to our ranking
    member, Congressman Cole, for any opening remarks.
        Mr. Cole. Well, thank you very much, Madam Chair.
        Thank you for holding this hearing. It has been a while
    since we have been able to have it due the pandemic, and I, for
    one, miss it a great deal.
        And I invite those of you that are testifying today to not
    just show up for your testimony, but if you have the time,
    listen for a while. And it is an education because it will give
    you a clear idea of the true range of this subcommittee, the
    diversity of the topics it deals with, the sheer quantity of
    requests that we get every year to address specific problems
    and to come and testify.
        Frankly, I don't think there is any other subcommittee that
    has anything like the number of people that want to come and
    participate, and it actually underscores something our chair
    likes to say quite frequently, that this is the people's
    subcommittee. And in many ways, it is. Because these are
    usually urgent issues that affect people's daily lives that we
    try to direct appropriate money toward ameliorating their
    circumstances, improving their circumstances, and generally
    bettering our society.
        So, again, I look forward to today's hearing. And for all
    of you who have come to testify, thank you very much for your
    interest in the work of the committee, and thank you very much
    for taking some of your time to educate us and our staff about
    the things that we need to focus on. It is enormously helpful,
    as the chair said, when we get down to actually putting
    together the bill.
        So, with that, Madam Chair, thank you again for the
    hearing, and I yield back.
        The Chair. Thank you.
        So we will get underway with our first witness this
    morning. That is Bob Lanter, who is the executive director of
    the California Workforce Association.
        Mr. Lanter, you are recognized.

         BOB LANTER, EXECUTIVE DIRECTOR, CALIFORNIA WORKFORCE
                              ASSOCIATION

        Mr. Lanter. Good morning, thank you.
        Good morning, Chairwoman DeLauro, Ranking Member Cole, and
    members of the Labor, HHS, Education Appropriations
    Subcommittee. My name is Bob Lanter, and I serve as the
    executive director of the California Workforce Association.
        CWA is a statewide nonprofit representing the 45 local
    boards, as well as a broad coalition of workforce stakeholders
    in California. My testimony today will focus on the Workforce
    Innovation and Opportunity Act Title I programs at the
    Department of Labor--Adult, Youth, and Dislocated Worker.
        The fiscal year 2023 budget request would increase funding
    for the Adult, Youth, and Dislocated Worker Programs to the
    fiscal year 2020 WIOA authorized levels. WIOA Title I should be
    funded at least to the amounts following--Adult Employment and
    Training Activities, $899,000,000; Youth Activities,
    $963,000,000; Dislocated Worker Employment and Training
    Activities at $1,600,000,000.
        While we support this proposed increase, we know more is
    desperately needed to respond to the ongoing impacts of COVID-
    19 on our Nation's economy. The House recently passed a WIOA
    2022 reauthorization package that includes historic investments
    for these programs, beginning in fiscal year 2023, and we
    strongly support those funding levels moving forward.
        The Federal funding approved through this subcommittee is
    the primary source that supports a national network of local
    workforce development boards, led by the private sector, and
    American Jobs Centers throughout each of your respective
    districts. These centers and their staff serve as a critical
    resource for job seekers, businesses, training providers, and
    other agencies to address the economic needs of their
    communities.
        We thank the leaders and members of this subcommittee for
    your efforts during the fiscal year 2022 appropriations
    process, which provided marginal increases--about 1 percent--
    for WIOA Title I programs when compared to fiscal year 2021
    levels. Unfortunately, this level of Federal investment does
    not address our current or future national workforce needs.
        In California, during the 2021 program year, our adult and
    youth formula allocations were cut by nearly 7 percent each.
    Twenty other States also experienced cuts to their adult
    activities during this time. This funding cut, during the
    height of COVID, reduced the capacity and services for
    individuals looking to re-enter the workforce, as well as
    businesses desperate to hire skilled workers.
        The labor market remains very fluid with record job
    openings and separations, and innovative talent pipeline
    development strategies are needed if we are to support business
    and provide opportunities to job seekers, particularly those
    working to achieve economic self-sufficiency.
        One of the advantages of the Federal workforce system, as
    funded by WIOA, is the ability to leverage and engage broad
    stakeholders, such as education and training, business, labor
    management partnerships, and economic development. Through
    these networks, Federal funds, invested locally through
    workforce boards, can be intentionally directed to communities
    where businesses and individuals need them most.
        Unfortunately, the impacts of COVID-19 hit the most
    vulnerable populations earlier and longer. The effects continue
    to create significant barriers to employment for minorities,
    women, disabled individuals, out-of-school youth, ex-offenders,
    and others.
        Affordable access to childcare, transportation, food, and
    housing often prevent individuals from enrolling in education
    and training programs or even getting or keeping a job. This
    type of support services and additional resources for them will
    expedite barrier removal.
        Career pathways are also developed in partnership with
    business, labor, education to incorporate in-demand skills into
    program delivery. Collaborations like this lead to better
    outcomes in job placement, wage gain, and skill development. In
    California, the High Road Training Partnership Initiative is
    designed to model sector-based strategies, ranging from
    transportation to healthcare to hospitality.
        Earlier in this Congress, the bipartisan Infrastructure
    Investment and Jobs Act was enacted as a landmark achievement
    to significantly increase spending on traditional projects like
    roads and bridges but also include broadband expansion and
    renewable energy sectors. Local boards in California and across
    the country are leading efforts to identify, train, re-train,
    and connect workers to these opportunities.
        The WIOA Title I programs must be funded beyond current
    levels to help reach the potential needed in constructing and
    advancing infrastructure projects by connecting them to our
    communities' vulnerable neighborhoods.
        In closing, increased Federal investments in WIOA Title I
    programs will facilitate thousands of successful workforce and
    economic development examples like those referenced earlier.
    Providing resources that are desperately needed by workforce
    stakeholders will lead individuals from unemployment and low-
    wage jobs to education and careers, allowing them to become
    economically self-sufficient and contribute to our Nation's
    economy and the future of America.
        Thank you very much, and I would be happy to take
    questions.
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        The Chair. Let me start with the ranking member, if he has
    any questions? Or I saw Mr. Cline, if he is on?
        Mr. Cole.
        Mr. Cole. No, Madam Chair. I have no questions.
        The Chair. Okay. I think I heard Mr. Fleischmann is on. Mr.
    Fleischmann.
        Mr. Fleischmann. Madam Chair, no questions. Thank you.
        The Chair. And Mr. Cline.
        Mr. Cline. I have no questions, Madam Chair. Thank you.
        The Chair. Thank you.
        I want to say a thank you to you, Mr. Lanter. We all know
    the benefits of the WIOA programs and how beneficial they are
    for adults, for youth, and the disadvantaged.
        One of our issues will be what we will be seeing as an
    allocation for the subcommittee. That has not yet been
    determined. But I think you can rest assured to say that if you
    have seen in the past, while it is not to the levels that you
    would like and that we would like, is that we understand the
    value of the programs, and our direction is to reinforce these
    efforts because we know that is where the security of the
    workforce and for the economic security of the people that
    these programs benefit.
        So thank you so much for being with us today. We really
    appreciate your time and your testimony.
        Mr. Lanter. Thank you, Chairwoman. Appreciate it.
        The Chair. We now recognize for 5 minutes as our witness
    this morning, Jodi Grant, who is executive director of the
    Afterschool Alliance, Washington, DC.
        Ms. Grant, it is wonderful to see you. Thank you for your
    outstanding work.

          JODI GRANT, EXECUTIVE DIRECTOR, AFTERSCHOOL ALLIANCE

        Ms. Grant. Thank you.
        Chairwoman DeLauro, Ranking Member Cole, members of the
    committee, it is truly an honor to be before you today.
        And on behalf of the Afterschool Alliance, the afterschool
    field, families across America, thank you for increasing
    funding for the Nita M. Lowey 21st Century Community Learning
    Centers in fiscal year 2022. It provided vitally important
    support to afterschool programs serving 1.6 million kids. We
    ask you to build on that and help address the vast unmet need
    for afterschool programs by providing $1,790,000,000 in fiscal
    year 2023.
        The Afterschool Alliance is a nonprofit that supports more
    than 23,000 afterschool partners that are expanding learning
    opportunities for students nationwide. They keep kids safe and
    fed and offer them engaging, hands-on learning experiences that
    improve school attendance, academic achievement, and graduation
    rates.
        During the past 2 years, COVID-19 presented afterschool
    programs--and the students, families, and communities that rely
    upon them--with enormous challenges. Programs faced
    skyrocketing unexpected costs, serious health concerns, limited
    access to school facilities during closures, staffing
    shortages, and more.
        But I am so proud because the afterschool field rose to
    meet this challenge. Programs adjusted their schedules to
    address the urgent needs of children and families by providing
    meals, caring for children of essential workers all day long,
    keeping students connected during remote learning, providing
    safe spaces for online learning and in-person enrichment, and
    so much more.
        Afterschool programs are now helping young people emerge
    from the pandemic strong, resilient, and hopeful. None of that
    would have been possible without Federal support.
        Programs operate before school, during school, during--I
    mean after school, during the summer months, and they provide a
    safe learning environment, enrichment, caring adults and
    mentors. And 21st Century Community Learning Centers are unique
    because of the collaborations that bring the best of a local
    community's resources to its students.
        They offer holistic supports to students of all ages that
    can prepare them to be college and career ready. Community-
    based organizations, nationally affiliated non-profits,
    colleges, public libraries, parks and rec centers, faith-based
    institutions, traditional public schools, charter schools,
    museums, and others are all eligible for 21st Century Community
    Learning Center funding, but the ``secret sauce'' is that all
    of these entities join together to provide a quality learning
    experience for pre-K through 12th grade students.
        21st Century programs are helping students reconnect, re-
    engage, and develop the skills they need to be successful not
    just in school, but in life. And after school, students
    discover their passions, be it robotics, gardening, coding, or
    music, or dance. And at this moment, when so many of our youth
    are struggling, afterschool programs provide so much more than
    just academic and career support. They are a safe place where
    kids can have healthy interactions with each other and caring
    adults and, most important, a place where they belong.
        But there are not nearly enough funds. States are able to
    provide grants for just one in three requests for 21st Century
    funding. Across 10 years, $4,000,000,000 in local grants were
    denied due to insufficient funding. Before the pandemic, almost
    25 million students nationwide were on the afterschool
    waitlist.
        Students who regularly participate in afterschool programs
    improve their school attendance, health-related behaviors, and
    math and reading achievement. The COVID-19 relief funds you
    provided are helping students get caught up while providing
    whole child supports. But too many school districts are using
    those Federal COVID dollars only for academics. Without
    increased funding for 21st Century, students will miss out on
    the holistic afterschool and summer opportunities that can help
    them navigate the challenges created and exacerbated by the
    pandemic.
        Additional funding will also help ensure that programs have
    the resources to address staffing challenges, which is a major
    and growing concern. And afterschool and summer learning
    programs provide a lifeline for working parents and those
    trying to get back into the workforce.
        Finally, I want to end by quoting Kyla Anderson, a high
    school student attending a 21st Century Community Learning
    Center in Illinois. ``During the pandemic, I was social
    distancing and not doing certain activities. But at my 21st
    Century Community Learning Center program, I've been able to
    meet new friends, communicate, and be social with others. I
    wasn't a talker, but now I am. The mentors helped me stay on
    top of my work and encouraged me. Without my program, I
    wouldn't have the grades I do now, and I wouldn't be as social
    as I am.''
        I urge you to increasing funding for 21st Century Community
    Learning Centers by $500,000,000 to give more young people like
    Kyla opportunities to learn and to thrive.
        Thank you.
        [The information follows:]

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        Mr. Cole. Madam Chair, I think you are on mute.
        The Chair. Got it. I was just saying it is always wonderful
    to hear from you, Ms. Grant. This is a program I think we are
    all very excited about, and named after one of the titans of
    the House, the congresswoman who chaired this committee, Nita
    Lowey.
        And I was so glad you mentioned dance because you know my
    history of teaching in the afterschool program of teaching
    dance and calligraphy. I don't do either one of them at this
    time. [Laughter.]
        The Chair. So, but it is one of the--you made one point,
    which I just want to reinforce is, it is a quality learning
    experience. And that is what we are talking about here. This is
    not warehousing children, but this is really helping them,
    teaching them skills, enriching their lives, and it also has
    the added the benefit of helping parents who are at work.
        So it is a program that is near and dear to all of our
    hearts. You will keep advocating, and we will do our best to
    increase the dollars for that.
        And with that, let me recognize the ranking member.
        Mr. Cole. Well, thank you very much, Madam Chair.
        I just want to quickly associate myself with your remarks.
    This is actually one of the programs that I think both sides of
    the aisle really appreciates the quality of the work and the
    importance of the issue. And as the chair related earlier,
    obviously, we don't know where we are at yet in terms of
    allocations, and there is always lots of need.
        But anybody that comes in front of this committee and
    advocates for a program named after our esteemed former chair
    has a pretty good chance for success. Because we all think so
    highly of Chair Lowey and miss her a lot, and it wouldn't
    surprise me if she is watching the proceedings right now. She
    keeps a pretty close eye on what we do.
        But again, thank you for coming before us and advocating
    for such a worthy cause.
        Ms. Grant. Thank you.
        The Chair. Congressman Fleischmann.
        Mr. Fleischmann. Jodi, thank you so much for the
    presentation, and I will just associate my comments with our
    distinguished chair and ranking member.
        Thank you.
        The Chair. Thank you. Congressman Cline? Congressman Cline,
    any questions?
        Mr. Cline. No, Madam Chair.
        The Chair. Okay, thank you.
        Then again, Jodi, thank you very, very much. And thank you
    for your enormous commitment to this effort. You have, just
    over the years, just been such a cheerleader for one of the
    best things that we do at the Federal level. So thanks very,
    very much for being with us today.
        Ms. Grant. Thank you for all your support.
        The Chair. Thank you. Thank you.
        Now, a pleasure for me to recognize Mark Jenkins. Mark is
    the founder and executive director of the Connecticut Harm
    Reduction Alliance and a United States Air Force veteran.
        For the past 24 years, Mr. Jenkins has worked to deliver
    innovative prevention and intervention to the most vulnerable
    members across the State of Connecticut. His work has made him
    a well-respected individual in his field, known for his
    connections with folks on the street and in the service of
    community.
        Wonderful to have you with us today, Mark, to discuss
    responding to the overdose crisis, supporting harm reduction
    and syringe services programs through the Infectious Diseases
    and the Opioid Epidemic Program at the Centers for Disease
    Control and the U.S. Department of Health and Human Services
    here.
        Mark, you are recognized for 5 minutes.

     MARK JENKINS, EXECUTIVE DIRECTOR, CONNECTICUT HARM REDUCTION
                                ALLIANCE

        Mr. Jenkins. Thank you, Chairwoman DeLauro, Ranking Member
    Cole, members of the subcommittee.
        Again, my name is Mark Jenkins, and I am a service-
    connected, disabled veteran of the U.S. Air Force and founder
    and executive director of Connecticut Harm Reduction Alliance.
    Today, I am pleased to submit testimony on behalf of the
    alliance and as a member of a larger coalition of public
    health, HIV, viral hepatitis, and harm reduction organizations.
        First, I would like to thank the subcommittee for the
    fiscal year 2022 funding increase for the CDC's Infectious
    Diseases and Opioid Epidemic Program. New funds will help to
    strengthen services to prevent opioid overdose deaths and
    infectious diseases transmissions.
        I am here today to urge you to provide $150,000,000 for the
    program in fiscal year 2023. Such funding would expand access
    to overdose prevention and syringe services programs, or SSPs,
    which save lives and connect people urgently to needed care,
    including treatment for substance use disorders.
        Founded in 2014, the Connecticut Harm Reduction Alliance
    offers a wide range of services to help people who use drugs
    avoid overdose and live longer, healthier lives. We meet folks
    where they are at, in their time, place, language, and lived
    experience.
        Services we provide include syringe services programs to
    help prevent HIV, viral hepatitis, endocarditis, which is a
    heart infection, and other infectious diseases; naloxone, a
    drug that reverses opioid overdose, and overdose prevention
    trainings; HIV and hepatitis C screenings; shelter and housing
    referrals; COVID vaccinations; and referrals and transport to
    treatment for substance use disorders.
        We reach quite a lot of individuals, and last year, we
    engaged approximately 3,500 participants, distributed over
    4,200 doses of naloxone, and saved lives, many lives, reversing
    over 300 overdoses. Our staff works to build relationships
    based on trust and nonjudgmental respect.
        In Connecticut, there were 1,550 deaths due to overdose in
    the year 2021, an 11.9 percent increase over 2020. This is a 20
    percent higher increase than the Nation's over the same period.
        The U.S. overdose crisis is a true public health emergency,
    where nearly 108,000 people died last year from overdose, a 74
    percent increase over 2015, and deaths continue to rise in
    2022.
        In both Connecticut and the U.S., overdose deaths have
    increased the most among black people and communities of color.
    Our work must end these disparities and effectively prevent
    overdose deaths.
        Now, sadly, because of this crisis, both nationally and in
    Connecticut, we have insufficient access to syringe service
    programs. The alliance has become the State's largest
    distributor of sterile syringes, yet demand has outpaced
    supply, especially since funding for SSPs in Connecticut has
    remained the same while demand for life-saving services has
    skyrocketed.
        The CDC's Infectious Diseases and Opioid Prevention Program
    is the ideal place for Congress to appropriate funding to
    expand access to SSPs and prevent overdose. CDC is the Nation's
    expert on SSPs, and with additional funding, it could expand
    access to these critical services.
        In fact, new recipients of SSP services are five times more
    likely to reach and enter drug treatment. Studies also confirm
    that SSPs do not increase illicit drug use or crime and that
    they save both lives and money. And while Congress has funded
    drug prevention and treatment programs, until recently, almost
    no Federal funding supported programs that work directly with
    people that use drugs to help reduce the harms.
        On April 6, I celebrated 25 years free from the active,
    chaotic use of substance, substances that separated me from my
    family and community. Today, I am a well-respected, productive
    member of my community as a result of these very services. I
    ask that you consider the work that really needs to be done in
    allowing these services to come forward.
        I thank you so much for your time and consideration of this
    urgent request, and please do not hesitate to contact me if you
    have any questions.
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        The Chair. Well, thank you so much for powerful testimony
    here. And I want to say, one, thank you for your military
    service and your commitment to our country and of giving back
    in so many ways.
        And you are in the business saving lives. I think we all
    know what this opioid crisis has meant for this country. We
    also--we have been--COVID has kind of taken a little bit away
    from the front burner of the opioid crisis as well, but that is
    something that we have to pay attention to, and when you quote
    numbers, 108,000 people died from overdose in 2021. It is up 10
    percent. It is really pretty extraordinary. And thank you for
    talking about the syringe services program and how beneficial
    it is.
        You talk about hepatitis C. It is really one of the rates
    that, as you have pointed out, have increased in terms of
    infectious diseases. And I was at the Centers for Disease
    Control last Friday. One of the issues that we brought up,
    talking about how we try to do something about it, and it would
    appear that is what your efforts are about, and we thank you.
        We thank you for that. We appreciate your testimony, and
    you will be sure that we will give every consideration to your
    efforts in hoping to increase the resources that you need to be
    able to succeed.
        Congressman Cole.
        Mr. Cole. Thank you, Madam Chair.
        I want to join you in thanking Mr. Jenkins for his service
    in uniform, but also suggesting that perhaps the service, Mr.
    Jenkins, you are doing now may be even more important than
    that, and we appreciate it more than I can say.
        This is a problem I know the chair and I have wrestled with
    for many years. And we have seen that 20 straight years of
    increase in death by overdoses back in the late teens. And then
    we plateaued, and it actually started to come down. Then we got
    hit by COVID, and we have seen an explosion since then. I think
    driven by the social isolation partly with COVID and also,
    frankly, the explosion of illegal drugs coming across our
    Southern border.
        And so the problem has exacerbated itself during these last
    2 years, 2\1/2\ years, I think more than any of us anticipated.
    So this is something, again, I know the chair cares deeply
    about. Every member of the committee on both sides of the aisle
    cares deeply about because we see it in our own communities.
        So I am sure, again, we always wrestle with more need than
    money, and that is just the nature of appropriations,
    particularly in this area. But I can assure you that both sides
    of the aisle will be interested in working together to see what
    we can do to help you and others like you that are in the field
    really saving lives.
        And just, again, thank you very much for the work that you
    are doing, the service that you are giving. But certainly, the
    work that you are doing each and every day right now. It makes
    a big difference, and if we can find a way to help you, we
    will.
        With that, thank you, Madam Chair. I yield back to you.
        The Chair. Thank you. Congressman Fleischmann.
        Mr. Fleischmann. Madam Chair, thank you.
        Mr. Jenkins, I just want to thank you and wish you every
    continued professional and personal success, sir.
        Thanks.
        The Chair. Thank you.
        I am now pleased to introduce Jane Weintraub for your
    testimony with the American Association for Dental, Oral, and
    Craniofacial Research. And you are--and also, I might add, dean
    of the--professor of dental public health and former dean of
    the University of North Carolina at Chapel Hill, the Adams
    School of Dentistry.
        Ms. Weintraub, you are recognized for 5 minutes.

       JANE A. WEINTRAUB, DDS, DISTINGUISHED PROFESSOR OF DENTAL
    PUBLIC HEALTH AND FORMER DEAN, UNIVERSITY OF NORTH CAROLINA AT
    CHAPEL HILL ADAMS SCHOOL OF DENTISTRY, AMERICAN ASSOCIATION FOR
                DENTAL, ORAL, AND CRANIOFACIAL RESEARCH

        Dr. Weintraub. Chair DeLauro, Ranking Member Cole, and
    members of the subcommittee, thank you for the opportunity to
    testify on behalf of the American Association for Dental, Oral,
    and Craniofacial Research.
        AADOCR represents more than 3,100 individual and 100
    institutional members in the United States. Our mission is to
    drive dental, oral, and craniofacial research to advance the
    health and well-being of Americans.
        I currently serve as president of the AADOCR. I am also a
    professor and former dean at the University of North Carolina
    Chapel Hill Adams School of Dentistry and an adjunct professor
    at the UNC Gillings School of Global Public Health.
        For fiscal year 2023, we are seeking at least $540,000,000
    for the National Institute of Dental and Craniofacial Research
    and a total of $49,000,000,000 NIH's base budget. Despite
    NIDCR's impressive research agenda and scientific
    accomplishments, the Federal Government's annual investment in
    this institute has not kept pace with biomedical inflation nor
    overall funding increases for NIH.
        Funding of at least $540,000,000 in fiscal year 2023 would
    help bring NIDCR funding into alignment with the overall NIH
    appropriation and allow NIDCR to build on its myriad successes
    in its mission to improve dental, oral, and craniofacial
    health.
        Investments in NIDCR-funded research over the past three-
    quarters of a century have led to improvements in oral health
    for millions of Americans and continue to show promise in areas
    encompassing the prevention of dental caries, or tooth decay,
    periodontal gum disease, new diagnostic methods of oral and
    dental conditions, regenerative medicine, oral cancer
    prevention and treatment, and in assessing the efficacy of an
    HPV vaccine for oral and pharyngeal cancers.
        I cannot emphasize enough how integral oral health is to
    our overall health. Poor oral health can affect many activities
    that may be taken for granted, including the ability to eat,
    drink, swallow, smile, speak, and maintain proper nutrition.
    Poor oral health also creates an economic burden that
    disproportionately harms older adults, low-income and under-
    resourced communities.
        The oral cavity also serves as a window into many health
    issues, including, but not limited to, systemic diseases such
    as diabetes, HIV/AIDS, and Sjogren's autoimmune disease.
    Researchers are exploring the debilitating lack of salivary
    function and resulting dry mouth from radiation treatment for
    head and neck cancers, common medications, and even aging.
        The NIDCR played a critical role in responding to the
    COVID-19 public health crisis, funding approximately $3,900,000
    in high-impact coronavirus research. The institute's research
    into minimizing infection risk in dental offices, the use of
    biosensors to detect SARS-CoV-2 in saliva, the role of
    periodontal disease in COVID-19 complications, and exploring
    how the virus gets into the mouth and saliva all play a
    critical role in combating COVID-19.
        AADOCR is grateful for the investments Congress has made in
    the NIDCR, which have allowed the institute to build its data
    repository and registry in several disease and research areas
    to meet the increasing need for open-source data sharing. The
    institute is also poised to make significant strides in
    addressing public health burdens related to pain management and
    the opioid crisis.
        Pain associated with dental and oral facial conditions lead
    to school and work absences, costly emergency room visits, and
    hospitalizations, all of which have a detrimental impact on our
    economy.
        Early childhood caries can be very painful for young
    children and often need to be treated in a hospital operating
    room, an expensive procedure. As a benefit of funding from
    NIDCR, I had the opportunity to conduct a randomized clinical
    trial that tested and demonstrated the efficacy of fluoride
    varnish in preventing early childhood caries. This easy, low-
    cost method has since become a standard of care to help prevent
    this disease.
        Again, I appreciate the opportunity to testify and thank
    the subcommittee for its support of biomedical and dental
    research so that all Americans can enjoy good oral and overall
    health.
        Thank you very much.
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        The Chair. Well, thank you very, very much.
        Let me ask the ranking member if he has any questions?
        Mr. Cole. No questions, but just a quick comment to Dr.
    Weintraub.
        As I am sure you probably know, your profession is pretty
    ably represented on our full committee by Mike Simpson from
    Idaho. So I can assure you, you have a--the chairwoman will
    hear directly from Mike, and you have a very strong advocate in
    somebody that is, again, widely respected on both sides of the
    aisle.
        And I must add Mike recently won his primary. I was
    grateful for that. So he is likely to be back here for the next
    2 years as well.
        But again, thank you for your testimony.
        Dr. Weintraub. Thank you.
        The Chair. Congressman Fleischmann.
        Mr. Fleischmann. Thank you, Dr. Weintraub.
        This is wonderful. My personal friend and a great
    Tennessean, Dr. Jeannie Beauchamp, is the president of the
    pediatric dentists, but we have worked--nationwide. But we have
    worked very closely with dentists across the board.
        So thank you for your commitment to your profession and for
    this. And years ago, I was on the board of FACES in
    Chattanooga, which was a nonprofit dedicated to helping
    craniofacial, actually, surgeries and fund those. So thank you
    for what you do.
        Dr. Weintraub. Thank you.
        The Chair. And again, my thanks to you, Dr. Weintraub.
        You make the point about how important the research is,
    especially I think since we are not covering dental care these
    days and so forth. So the work that you do is particularly
    important, and I also, in reading your testimony, talk about
    your interest in ARPA-H and NIH, but we are going to try as we
    will to balance the two in terms of doing traditional research
    and then looking at the institute, which you point out, to see,
    in essence, how it has been funded over the last several years.
        One of the things we are going to try to do with a hearing
    in the fall is we had one set of institutes come in to provide
    testimony to us on budget, but we are going to try to get
    additional of the institutes to come in, including the
    Institute of Dental and Craniofacial Research, and hear from
    them about what the update is in research.
        We are really in your debt for your work, and it has often
    been interesting to me that we seem to divide the body up.
    There is the head, and then there is from the neck down. And
    unfortunately, we don't pay enough attention to the neck up.
    And thank you for being an advocate for all this, and we will
    do the best we can to try to address your concerns and your
    resource concerns as well.
        Thank you. Thank you for being here.
        Dr. Weintraub. Thank you very much.
        The Chair. It really is that I would very, very much like
    to welcome Dr. Marwan Haddad. He is here in his capacity as
    chair of the HIV Medicine Association, but I am so proud to say
    he is also medical director of the Center for Key Populations
    for Community Health Center, Inc., one of the largest community
    health centers in the Nation, based in Middletown, Connecticut,
    which is in my district.
        Thank you, Dr. Haddad, for your work to serve our
    community, particularly with those who live with HIV, with
    hepatitis C, LGBTQ individuals, especially during the pandemic.
    That really underscored for all of us the critical need for
    integrative and comprehensive healthcare.
        Happy to hear from you, and you are recognized for 5
    minutes for your testimony.

    MARWAN HADDAD, M.D., DIRECTOR OF THE CENTER FOR KEY POPULATIONS
       AT COMMUNITY HEALTH CENTER, INC., HIV MEDICINE ASSOCIATION

        Dr. Haddad. Chairwoman DeLauro, Ranking Member Cole, and
    members of the subcommittee, thank you for your invitation to
    testify.
        Again, my name is Dr. Marwan Haddad, and I serve as the
    medical director of the Center for Key Populations at Community
    Health Center, Inc., or CHC, in Middletown, Connecticut, one of
    the largest Federally Qualified Health Centers in the State.
        I am pleased to testify today on behalf of the HIV Medicine
    Association of the Infectious Diseases Society of America as
    the chair of the board of directors. HIVMA represents more than
    5,000 physicians and other healthcare professionals around the
    country on the frontlines of the HIV epidemic.
        First, thank you for the increase in Federal funding in
    fiscal year 2022 for a number of HIV programs, including the
    Ending the HIV Epidemic Initiative and several parts of the
    Ryan White HIV/AIDS Program. More than 2 years into the COVID-
    19 pandemic, it has taken a very hard toll on many people with
    HIV and populations at risk for HIV, increasing the demand for
    HIV-related services, substance use disorder, and mental health
    treatment, and services to address a rise in housing and food
    insecurity.
        As we continue to work to control and mitigate the impact
    of COVID-19, we must accelerate progress toward ending HIV as
    an epidemic by increasing Federal investments in HIV
    prevention, care, research, and supportive services.
        Now, when we talk about funding, things can become
    abstract, and we don't always make the connection to the impact
    the funding has on people. So I will share with you the story
    of a patient who I just saw last week to bring to light the
    importance and intersectionality of the programs under the
    subcommittee's jurisdiction.
        This man started to see me 7 years ago, seeking treatment
    for his opioid use disorder. I learned quickly that he had HIV;
    hepatitis C; mental health disorders, including depression and
    PTSD, with several past suicide attempts; and was currently
    unhoused because his partner kicked him out for having HIV.
        He lost the support of his family after they found out he
    was gay. He tried shelters, but because he was constantly
    stigmatized and harassed he preferred to live under the bridge.
        Over the years, we have kept him engaged in care, more on
    than off, treated him with HIV medication, and despite his
    housing instability and substance use, he continues to be
    virologically suppressed, meaning his viral--HIV viral level is
    so low, he cannot transmit it sexually to others.
        If it was not for the HIV case managers, our recovery care
    coordinators, and other key services, we would have lost him to
    follow-up. And while it took years, he is finally housed for
    the first time since I met him. He continues to experience food
    insecurity but is looking for a job and optimistic about
    getting rehired by a previous employer.
        I cannot emphasize enough how this story and so many
    stories like his highlights the importance and value of
    investing in the programs under the subcommittee's jurisdiction
    and how this investment directly and positively impacts their
    lives. So to meet the goal of the bipartisan Ending the HIV
    Epidemic Initiative of reducing new HIV infections by 90
    percent over the next decade, this will require an investment
    of at least $850,000,000 in new funding.
        In addition, increased funding for the Ryan White program
    in fiscal year 2023 across all parts is needed to ensure access
    to effective HIV care and treatment nationwide and for programs
    to be able to respond to the increased demand for services due
    to the COVID-19 pandemic. For fiscal year 2023, we specifically
    recommend a $25,500,000 increase for Part C of the program.
        CHC has relied on Ryan White program funding to provide HIV
    care to underserved populations for 23 years across
    Connecticut. And during that time, the needs of our patients
    have grown more complex.
        In 2021, we saw an increase in patients with HIV unlike any
    increase we have previously seen. Eighty-eight percent of new
    patients had at least one clinical comorbidity, 62 percent
    reported unmet mental health needs, 56 percent reported food
    and housing insecurity.
        Now unlike HIV care and treatment, there are currently very
    limited resources to support access to pre-exposure
    prophylaxis, or PrEP, for individuals who are uninsured or
    underinsured. Although PrEP is highly effective at preventing
    HIV infections, only 25 percent of the 1.2 million individuals
    who could benefit from PrEP have been prescribed it.
        Among populations heavily impacted by HIV, only 9 percent
    of black individuals who can benefit from PrEP received a
    prescription in 2022, and only 16 percent of Hispanic and
    Latino individuals. We had two patients in the last year, both
    individuals of color, who would have benefitted from PrEP, but
    instead acquired HIV prior to reaching us and while trying to
    access PrEP services.
        HIVMA, in partnership with PrEP for All, the Federal AIDS
    Policy Partnership, AIDS Budget and Appropriations Coalition,
    and HIV Prevention Action Coalition is urging $400,000,000 in
    funding for 2023 for a new national PrEP program within the CDC
    Division of HIV Prevention.
        Finally, I urge $150,000,000 in funding for the CDC to
    address the infectious disease consequences of the opioid
    epidemic, including through improved surveillance and
    monitoring and supporting and expanding access to syringe
    services programs, harm reduction, and overdose prevention.
        Thank you for your time and consideration of these
    requests, and I am happy to answer any questions.
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        The Chair. Thank you so much, Dr. Haddad. And thank you for
    your commitment to the work that you are doing. It is really
    very extraordinary.
        I think it just points to the fact that how valuable these
    programs are. We have programs here. What we need to do is make
    sure that we are investing the resources that we need to begin
    to address your concerns.
        I am happy to say that this committee, on a bipartisan
    basis, looking to ending HIV and working with the President's
    initiative, we have come together, and it is so promising. And
    again, I think most of the folks here today, and clearly, in
    your case, you are here saving lives. So we are very, very
    grateful for that.
        And the quality of the programs and the results of what you
    are doing just is inspirational to all of us and gives us the
    incentive to look at where we can go for the future. And
    obviously, you know that depends a lot on what the funds that
    are available. But we certainly know the relevance and
    importance and the critical nature of all that you are doing.
        So, thank you.
        Congressman Cole.
        Mr. Cole. Thank you, Madam Chair.
        And I just want to quickly associate myself with your
    remarks. I think you summed it up from a bipartisan perspective
    about as well as we can. Doctor, we would love to put you out
    of business.
        The Chair. Right.
        Mr. Cole. And if there was a way, but we would at the
    stroke of a pen. But thank you for what you do, not just for
    your specialty, but also more broadly, the whole community
    health center movement has, honestly, been transformative in my
    State.
        I know 20 years ago, when I got to Congress, I think we
    only had 5 of the centers in the State. We have about 60 now.
    It has made an enormous difference in the quality of healthcare
    for the folks that, frankly, are right at the fringes and quite
    often not able to get it.
        So I appreciate what you and your colleagues do to help all
    of us in our respective States and districts.
        So, with that, Madam Chair, I yield back.
        The Chair. Thank you. Mr. Fleischmann.
        Mr. Fleischmann. Thank you, Dr. Haddad. And my sentiments
    exactly with the chair and the ranking member.
        Thank you.
        Dr. Haddad. Thank you.
        The Chair. Thank you. And it gives me great pleasure to
    introduce Dr. Cynthia McCurren, the board chair of the American
    Association of the Colleges of Nursing. And Dr. McCurren, your
    testimony, we would love to hear it, and you are recognized for
    5 minutes.

    CYNTHIA McCURREN, BOARD CHAIR, AMERICAN ASSOCIATION OF COLLEGES
                               OF NURSING

        Ms. McCurren. Thank you, Chairwoman DeLauro, Ranking Member
    Cole, and members of the subcommittee, for this opportunity to
    provide testimony on behalf of the American Association of
    Colleges of Nursing, or AACN.
        I am Dr. Cynthia McCurren, and I am chair of AACN's Board
    of Directors, and I am also dean and professor at the
    University of Michigan-Flint School of Nursing.
        On behalf of more than 850 AACN member schools, which
    educate more than 565,000 students and employ more than 52,000
    faculty across the country, I would like to personally thank
    you for your leadership and continued support of nursing
    education, our workforce, and research, especially during these
    unprecedented times.
        As we work to combat current public health challenges and
    prepare for the future, AACN, along with 58 members of our
    Nursing Community Coalition, request at least $530,000,000 for
    the Title VIII nursing workforce development programs and at
    least $210,000,000 for the National Institute of Nursing
    Research, or NINR, in the fiscal year 2023.
        From the classroom to the frontline, we have all witnessed
    how critical a well-educated nursing workforce is to providing
    high-quality healthcare. While AACN saw student enrollment in
    entry-level baccalaureate nursing programs increase by 3.3
    percent in 2021, we also saw enrollment decline in our
    baccalaureate degree-completion programs and our graduate
    programs at the master's and Ph.D. levels.
        As we look to the future and the need for increased
    enrollments to support the healthcare demands of the Nation, it
    is important to recognize that more than 91,000 qualified
    applications, not unique applicants, were not accepted at
    schools of nursing nationwide in 2021 alone. This is in part
    due to insufficient clinical placement sites, inadequate
    numbers of faculty and preceptors and classroom space, as well
    as budget cuts.
        That is why Federal funding for nursing education and our
    Title VIII programs is so important. We must support our
    nursing schools, faculty, and students.
        As a leader in nursing education, I have witnessed
    firsthand the benefits Title VIII funding provides. From
    supporting graduate education for nurses who work and live in
    rural and underserved areas to training for sexual assault
    nurse examiners critical in our urban and rural areas, and
    promoting diversity within the profession by providing grants
    to students from disadvantaged backgrounds, Title VIII nursing
    workforce development programs have been and will continue to
    be a short- and long-term success story and must be provided
    with funding levels that reflect the population they serve.
        As we prepare the next generation of nurses and the faculty
    who educate them, we must also support the evidence that guides
    their practice. As one of the 27 institutes and centers at the
    National Institutes of Health, the National Institute for
    Nursing Research, or NINR, funds nurse scientists who work
    collaboratively with other health professionals to generate and
    translate new findings and lead translational research that
    helps address health equity and the social determinants of
    health.
        Bold investments in Title VIII nursing workforce
    development programs and NINR are imperative, not only as we
    confront existing health challenges, but as we provide
    tomorrow's equitable and innovative healthcare solutions.
    Therefore, AACN respectfully requests support in fiscal year
    2023 of at least $530,000,000 for the Title VIII nursing
    workforce development programs and at least $210,000,000 for
    the National Institute of Nursing Research.
        Together, we believe we can ensure that such investments
    will promote and improve healthcare in America.
        Thank you so much.
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        The Chair. Thank you so much.
        And my own experience with the nursing profession was some
    30 years ago and diagnosed with ovarian cancer and spent a fair
    amount of time in the hospital. And while I can applaud the
    surgeons and their great work helping to save my life, it was
    the nurses who came every day and who just by one look at me
    could tell whether it was a good day or a bad day, and they
    were always there.
        So we know the nature of the profession. We are also very
    conscious of--well, my view, and I will just be frank about it,
    I don't think the Institute of Nursing Research gets enough
    funding as I believe it should. And we will take a very, very
    hard, hard look at that.
        I also know that there is a very big, high debt of student
    debt for folks going through the nursing program. So loan
    repayment is another critically important effort. And you have
    so many nurses who are ready to retire that looking at the
    profession, what we need to do is seriously think about how we
    are really going to strengthen nursing because we know the role
    that they play, that they play like the critical role that they
    played during the pandemic.
        So you can be sure we are going to take a hard look at
    this.
        Congressman Cole.
        Mr. Cole. Thank you, Madam Chair.
        As in this and so many other areas, we certainly don't
    disagree. I know in my own State, a number of years ago under
    former Governor Fallin, we did a survey of critical needs in
    our workforce. This is pre-COVID. Number one was skilled
    nursing, literally.
        And having dealt with, as we all have, all my providers
    during this really critical time, I know how we stretch the
    nursing workforce and how it has been for hospitals to get what
    they need and how tough it has been on people in the
    profession. We have worked really, really hard--and frankly,
    how intense now the competition is not just within States, but
    across State borders--to try and get that workforce.
        All of which reinforces the request that you have made, and
    so just thank you and your profession for what you do
    selflessly. And again, these are needed skills. They are not
    going to go away, and these are important investments.
        And again, as the chair always points out, we don't know
    what our money is now, but I can't imagine you won't rank high
    on the areas that we all agree on the committee we need to
    focus on.
        So thank you for your testimony.
        Yield back, Madam Chair.
        The Chair. Thank you. Congressman Fleischmann.
        Mr. Fleischmann. Thank you again, Madam Chair and Ranking
    Member Cole, for your comments.
        I would like to say this. In my great State of Tennessee,
    we have several great colleges of nursing, and I have spoken
    with the students. They are--it takes a special person to be a
    nurse, but there is boundless optimism with the students that
    we are producing in our State.
        So thank you for what you are doing, so critically needed
    and very important. So I wish you continued success.
        And again, this is one of the areas of broad agreement on
    this subcommittee. So thank you very much.
        Ms. McCurren. Thank you. Thank you all.
        The Chair. Thank you very much.
        Let me now recognize our next guest, and that is Dr.
    Julie--and hoping I pronounce this right--Ajinkya. Thank you,
    and senior vice president and chief strategy officer with the
    APIA Scholars.
        And Dr. Ajinkya, please, we would love to hear from you.

        JULIE AJINKYA, SENIOR VICE PRESIDENT AND CHIEF STRATEGY
                         OFFICER, APIA SCHOLARS

        Ms. Ajinkya. Chairwoman DeLauro, Ranking Member Cole, and
    members of the subcommittee, my name is Julie Ajinkya, and I am
    the senior vice president of APIA Scholars, as you just
    mentioned. We are an organization that is focused on
    dramatically improving the educational outcomes of underserved
    Asian American, Native Hawaiian, and Pacific Islander students
    by ensuring access to affordable college opportunities and
    student success programming.
        And I am also professor of government with Cornell's Brooks
    School of Public Policy.
        Thank you for inviting me to submit testimony for fiscal
    year 2023 appropriations on behalf of the Asian American and
    Native American Pacific Islander-Serving Institutions,
    otherwise known as the AANAPISI program, and the students that
    it serves. Specifically, asking for an increase in funding for
    AANAPISIs to $100,000,000 annually, which would allow them to
    be funded at a per-institution and per-student level
    commensurate with other Minority-Serving Institutions.
        I would like to first begin by thanking all of you for your
    commitment that you have shown to AANHPI students by increasing
    spending for the AANAPISI program in fiscal year 2022. You all
    made a significant down payment for these schools and
    institutions by more than doubling funding for AANAPISIs
    compared to the prior fiscal year, from $5,000,000 to more than
    $10,000,000.
        This increase in funding will allow more AANAPISIs to
    better serve first-generation and low-income AANHPI students in
    higher education. Indeed, nearly half of AANHPI students attend
    AANAPISIs, and these colleges and universities enroll and serve
    about three-quarters of all low-income AANHPI students. Given
    that the AANHPI population was the fastest-growing racial group
    in the U.S. over the past decade, better serving these students
    is in the interest of the entire nation at large.
        Today, we would like to build upon that down payment and
    are requesting that you increase funding for AANAPISIs to
    $100,000,000 annually, which, again, would allow them to be
    funded at a per-institution and per-student level commensurate
    with other MSIs, like Hispanic-Serving Institutions.
        Ideally, this appropriation would be divided as $30,000,000
    in discretionary funding under Title III, Part A and
    $70,000,000 in mandatory funding for Title III, Part F, for a
    total of $100,000,000 in AANAPISI program funding for fiscal
    year 2023. This critical division would address the need for
    additional mandatory funding, given current statutory barriers
    that limit the amount of discretionary funding AANAPISIs can
    receive if they also serve students from other underserved
    populations.
        This funding is critical because of the impact AANAPISIs
    have on the students they serve, particularly because many of
    these students are the first in their families to go to
    college, come from low-income backgrounds, are often English
    language learners, and are dealing with higher rates of unmet
    mental health needs, particularly due to the spike in anti-
    Asian hate our communities have endured during the pandemic.
        We often hear from our network of students that they
    appreciate their AANAPISI programs understanding their
    identities and how it shapes their college experience. For
    example, Kristine Jan C. Espinoza, a proud AANAPISI alum from
    the University of Hawaii at Manoa, shared how attending an
    AANAPISI was a critical opportunity to be mentored by AANHPI
    faculty and encouraged to pursue further graduate education.
        Espinoza, now a doctoral student at another AANAPISI, UNLV,
    focused on researching MSIs and cherished how she felt like she
    belonged on campus by being around students who looked like
    her, learning from AANHPI mentors, and appreciated how even the
    physical campus environment reflected cultural elements she was
    familiar with.
        De Anza College, an institution located in Cupertino,
    California, with AANHPI students comprising nearly 40 percent
    of the total enrollment, provides another instructive example.
    De Anza used their AANAPISI grant to pair developmental English
    with an AANHPI literature course, including wraparound supports
    with an embedded counselor.
        Research then showed that the students who participated in
    this program passed their developmental course at a higher
    rate, were more likely to transition from developmental to
    college-level English, and were more likely to earn associate's
    degrees, all in less time. With increased funding, more
    institutions would be able to serve their students like De Anza
    College has.
        We are requesting the funding increase because AANAPISIs
    have been chronically underfunded since their establishment and
    until last year were the lowest-funded category of MSI per
    capita. Disappointingly, while 165 institutions have been
    identified by the Department of Education as eligible
    AANAPISIs, only 30 of those institutions receive AANAPISI
    funding.
        Equitable funding of all 165 eligible AANAPISIs at the same
    level as HSIs would require an annual funding amount of
    $100,000,000. I want to make clear, however, that any increase
    in AANAPISI funding should not come at the expense of other
    MSIs.
        Thank you for your continued support for the AANAPISI
    program, and we look forward to continuing to work alongside
    you and be a resource for you.
        Thank you.
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        The Chair. Thank you very, very much, Dr. Ajinkya.
        You make a very, very strong case for the relevance, first
    of all, of the education, the climate in which these--the hate
    crime which people have been living, and that is particularly
    focused on Asian, Pacific Islanders in the last little while.
    But it is the opportunity for education that is critical. We
    understand that on this committee in a bipartisan way and how
    we need to make that opportunity available because we know that
    education is that great equalizer, gives people the credentials
    for success.
        And your statistics, which we will take a hard look at, how
    you described the underfunding of the educational opportunities
    for AANAPISI is a very, very strong case. So we will take a
    very hard look at how we are able to increase the educational
    opportunities and make it possible for more to be able to get
    the kind of education that they need in order to succeed and to
    have our country succeed and our economy succeed.
        So, with that, let me recognize our ranking member.
        Mr. Cole. Thank you very much, Madam Chair.
        Again, I think the committee, on a bipartisan basis,
    recognizes the importance of the request and the significance
    that these types of institutions play, quite frankly. And
    Congress has a long history, all the way back to the founding
    of Howard University, of recognizing there are unique
    institutions that serve specific communities that all of the
    broader community then benefit from over time. And certainly,
    in my area, we had both HBCs and tribal colleges and
    universities, and these things are enormously important to us.
        So, again, I associate myself with the chair. We will give
    it a hard look and see what we can do.
        With that, yield back, Madam Chair.
        The Chair. Thank you. Congressman Fleischmann.
        Mr. Fleischmann. I thank the doctor for her testimony and
    for shedding light on this important issue, and I will yield
    back.
        The Chair. Thank you.
        It gives me great pleasure to offer a very, very warm
    welcome to former constituents Brian Wallach. He is the co-
    founder of I AM ALS and received his bachelor's degree from
    Yale University. Brian is joined by his wife, Sandra Abrevaya,
    who, like me, grew up in the city of New Haven.
        A few years ago, while Mr. Wallach was working as an
    assistant U.S. attorney, he was diagnosed with ALS. Just 37
    years old. Refusing to let this shocking diagnosis deter him,
    Brian partnered with Sandra to co-found I AM ALS. It is a
    nonprofit organization that provides critical support and
    resources to ALS patients, caregivers, and loved ones while
    engaging with policymakers. They promote ALS research. They
    mobilize communities to take action in this area, to spread the
    word or increase awareness of ALS to millions of people.
        Brian Wallach is a force, and a force along with Sandra,
    and so delighted to have them with us today. He is going to
    talk about funding for ALS research programs and some of the
    new initiatives that will help to accelerate development of
    therapies for all life-threatening neurodegenerative diseases.
        With our hearts and our arms open, we welcome Brian and
    Sandra Wallach.

      BRIAN WALLACH, CO-FOUNDER, I AM ALS, ACCOMPANIED BY SANDRA
                     ABREVAYA, CO-FOUNDER, I AM ALS

        Ms. Abrevaya. Thank you so much, Madam Chairwoman, for that
    introduction and that background.
        We are so grateful to be here today with everybody. And
    thank you to you and to Ranking Member Cole and to Congressman
    Fleischmann for the opportunity to speak to you once again
    about the fight to end ALS.
        Mr. Wallach. My name is Brian Wallach.
        Ms. Abrevaya. My name is Brian Wallach. I am 41 years old,
    and I have been living with ALS for almost 5 years now. I am
    here today with my wife, Sandra, who is my voice.
        Mr. Wallach. If truth be told----
        Ms. Abrevaya. Truth be told, when I first testified before
    you in 2019, I did not think that I would be alive to speak to
    you today.
        Mr. Wallach. I am one of the lucky ones.
        Ms. Abrevaya. I am one of the lucky ones, as 90 percent of
    those diagnosed in the same year as me are dead. That includes
    veterans, mothers, sons, and daughters from every single
    congressional district.
        Thanks to you and the other amazing champions on the Hill,
    we have made real progress since I first testified before you,
    and you have worked to pass and fund the ACT for ALS and have
    recognized that ALS should be part of the mission of the new
    ARPA-H.
        Mr. Wallach. Three years ago----
        Ms. Abrevaya. Three years ago, you told me that you would
    do everything in your power to fight for a cure, and
    Chairwoman, you have kept that promise. For that, I am humbled.
    But we still have miles to go before we rest.
        Mr. Wallach. May is ALS Awareness Month in the U.S.
        Ms. Abrevaya. May is ALS Awareness Month in the U.S. On May
    12, I AM ALS and hundreds of ALS advocates gathered in DC a
    mile away from the Capitol to plant thousands of flags for
    those living with ALS and those we have lost. This is the
    reality of ALS today.
        Mr. Wallach. My name was on one of those flags.
        Ms. Abrevaya. My name was on one of those flags.
        Mr. Wallach. For me, my reality is----
        Ms. Abrevaya. For me, my reality is that I can now barely
    speak. I am mostly confined to a wheelchair, and I can no
    longer raise my arm.
        Mr. Wallach. But I am still here.
        Ms. Abrevaya. But I am still here, and I will keep fighting
    for as long as I breathe.
        By passing ACT for ALS, Congress and President Biden made
    clear that the FDA and NIH must act now to implement these
    programs, most importantly the expanded access grant program.
    As President Biden said during the December signing ceremony of
    the bill, ``This law invests $100,000,000 annually for the next
    5 years. And this includes issuing grants that support research
    on and access to promising new therapies for patients who don't
    make it into clinical trials. This means hope for patients who
    would otherwise have no access to treatments that could
    possibly work for them.''
        Earlier this year, you approved and appropriated
    $25,000,000 to make this program real, and on May 12, NINDS
    released the Funding Opportunity Announcement for those funds.
        Mr. Wallach. I am here today to ask you----
        Ms. Abrevaya. I am here today to ask you to build upon this
    momentum by fully funding ACT for ALS for the 2023 fiscal year.
    Fully funding ACT for ALS means that we need to appropriate
    $100,000,000 in fiscal year 2023, including $75,000,000 for the
    expanded access grant program.
        This funding is not only desperately, desperately needed by
    those of us who are dying from ALS right now, but it will also
    change the course of ALS forever. Full funding will allow NINDS
    and FDA to move forward aggressively and quickly to implement
    the programs in ACT for ALS. We urge the agencies to work with
    the same urgency as Congress has shown, so that we can make the
    hope that ACT for ALS embodies for those who have suffered in
    the shadows and those who have been left to die for too long
    real.
        Mr. Wallach. The ALS community----
        Ms. Abrevaya. The ALS community, which includes clinicians,
    clinical researchers, people living with and impacted by ALS,
    and advocacy organizations, we are all united in support of
    expanded access programs. As NIH and FDA create and execute on
    the expanded access grant program mandated by ACT for ALS, we
    ask the agencies to incorporate the set of recommendations the
    ALS community provided to them this month.
        I also ask for your support in ensuring that ALS research
    is robustly supported by NIH and by the Department of Defense.
    These research programs are critical to unlocking treatments
    for ALS, as well as Alzheimer's, Parkinson's, multiple
    sclerosis, and beyond because all of these neurodegenerative
    diseases are connected.
        Thank you. Thanks to all of you, the path toward ending ALS
    is clearer.
        Mr. Wallach. But there is much more work ahead.
        Ms. Abrevaya. But there is much more work ahead. On behalf
    of the ALS community----
        Mr. Wallach. Thank you.
        Ms. Abrevaya [continuing]. Thank you. And I look forward to
    working with you to turn ALS from always fatal to chronic, and
    then to end it once and for all.
        Thank you, Chairwoman.
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        The Chair. Thank you, Brian and Sandra. You both always are
    such a great inspiration to all of us.
        And Congressman Cole will comment, Congressman Fleischmann,
    and other members of the committee, even though they are--they
    may not be present, but your efforts are beyond inspirational.
    That is not adequate.
        You have made ALS and the ravages of ALS not only on the
    individual with the disease, but on the families as well, on
    your family, but you have opened the eyes of this country. You
    have opened the eyes of Members of Congress to what our
    responsibilities are.
        And here, I look at you, Brian, and we have had the chance
    to talk here on several occasions, and I said to you in our
    last conversation, ``You are looking good, my friend. You are
    looking as good as I have ever seen you.'' And I know that
    there is treatment. And I am here to tell you that we are not
    going to stop fighting.
        We are not going to stop fighting because you are not going
    to let us, and we are not going to do it because you are that
    wind beneath our wings here. And we listen to you, and it gives
    us great courage to look at the dollars that we spend and where
    we spend them and know that while we have conquered other
    illnesses in this great country of ours, because we have great
    medical facilities, that we have the opportunity, as you have
    said, to make it chronic and to deal with ending.
        And we will continue that research, and I promise you that
    we will--that we will do that. And we have in the language of
    ARPA-H that one of the neurodegenerative illnesses which they
    will look at is ALS.
        I was at an event last evening where I met--and I am trying
    to remember his last name. First name was Roger, and I talked
    to Roger about you, Brian and Sandra. He is 6 years diagnosed.
        He was at this event last night in a tuxedo and just
    enjoying it and so forth, still ravaged by the illness, but on
    his feet. So there is hope that is out there, and we all cannot
    thank you for never, ever, ever giving up hope and making sure
    that we never give up hope as well.
        Love you both, and thank you for what you have done in
    calling attention to this ravaging disease. We are there. We
    are there for you, my dear friends.
        Congressman Cole.
        Mr. Cole. Thank you, Madam Chair.
        And Brian and Sandra, thank you. That was an extraordinary
    statement. And your advocacy is, quite frankly, inspiring and
    amazing and makes a difference. And for you to take the tragedy
    that has fallen into your lives and turn it into something
    where you can help others is really remarkably commendable.
        We talk a lot in Congress about the differences and get
    covered, but there are lots of things the chair and I work
    together on. And we have together in 7 years, we have increased
    NIH funding by 49 percent and tried to look at some of these
    things as not one-shot wonders, but sustained commitment over
    time that makes a difference.
        ALS certainly affects my office. My chief of staff's father
    has it. My district director's husband as well. So it is
    something, and Sandra, I particularly was pleased to hear you
    talk broadly about neurodegenerative diseases. My wife has MS.
    I lost my dad to Alzheimer's.
        So these things touch all of our lives, and I don't make
    this remark often. I never had anybody at a town meeting come
    up to me and say, you know, you guys are just spending too much
    on cancer and ALS and Alzheimer's. They might be worried
    overall about the budget. These are actually the places where
    the American people want us to be making continual investments.
        And because they see the difference and they see the impact
    on their loved ones, their friends, their associates. They want
    to be part of the solution. They want us to write the check
    that provides hope and services and hopefully some day put some
    of these things, as we have some things, in the rearview
    mirror, so to speak, where they are not threatening people's
    lives.
        So, again, I want to commend you for your advocacy. Brian,
    I want to wish you the very, very best. God bless you for
    beating the odds. You clearly have a fighting spirit. And we
    will continue to walk with you guys step by step because, as
    the chair said, this is a commitment we all believe in very,
    very deeply and a cause that we all want to continue to work on
    going forward together.
        With that, Madam Chair, I yield back.
        The Chair. Thank you. Congressman Fleischmann.
        Mr. Fleischmann. Thank you, Madam Chair and Ranking Member
    Cole.
        Sandra and Brian, we have seen very astute, wonderful
    presentations today across the spectrum of this great
    subcommittee, but your presentation today was truly the most
    inspirational and outstanding. And I do thank the chair and the
    ranking member for their very strong statements in support.
        I am a lawyer, like you, sir, and still keep my law license
    up. We have had many folks with ALS come into our office over
    the years, and I will say this. Like you, they are great
    fighters, and they are committed to seeing a cure for this
    horrific disease. So we wish you every success.
        And again, thank you for being an inspiration to so many
    folks who are afflicted with this. Again, the chair and the
    ranking member are absolutely right. We put these resources
    into this area, and the American people support this and this
    is what we ought to be doing in Congress.
        So, thank you.
        The Chair. Just one final word to Sandra, to you, and to
    you, Brian. Oftentimes, the media reports that people in this
    country believe that the Members of Congress who serve on
    different sides of the aisle in different communities, that
    they cannot lock arms and look at the challenges that face this
    country, look at the challenges that people face.
        And it is not true. We do lock arms. We do have our
    differences, but we understand the nature of the challenge that
    you face and that everyone with an ALS diagnosis or one of the
    other neurodegenerative diseases and so forth.
        And in this area, I proudly say that we come together. We
    have come together to provide the resources that are necessary
    in order for us to continue the research to look for that
    discovery to cure, to allow people to be hopeful about what
    their future is and what it can be. And the two of you, again,
    your strength, your determination really pushes us forward to
    make sure that we are working with you and that you are not
    alone.
        So, thank you. Thank you for being here today and for
    testifying. God bless you both.
        Mr. Wallach. Thank you so much----
        Ms. Abrevaya. Thank you so much----
        Mr. Wallach [continuing]. For your incredible words.
        Ms. Abrevaya [continuing]. For your incredible words.
        Mr. Wallach. And we look forward to building a better----
        Ms. Abrevaya. And we look forward to building a better----
        Mr. Wallach [continuing]. World together with you.
        Ms. Abrevaya [continuing]. World together with you. Thank
    you.
        The Chair. Take care.
        Let me now recognize Dr. Karen Knudsen, chief executive
    officer for the American Cancer Society, and that is the
    American Cancer Society, CAN, the Cancer Action Network.
        So, Karen, thank you. I had the opportunity to meet with
    Lisa this week and folks and anxious to hear your testimony. So
    much appreciative of your being here.

      KAREN E. KNUDSEN, CHIEF EXECUTIVE OFFICER, AMERICAN CANCER
       SOCIETY AND AMERICAN CANCER SOCIETY CANCER ACTION NETWORK

        Ms. Knudsen. Thank you so much for having me.
        And I would just like to say, for Brian and Sandra,
    absolutely incredible testimony, and I hear you on where to
    pick up on that theme of the importance of research.
        So I am Dr. Karen Knudsen. I am the CEO of the American
    Cancer Society. We are the largest nonprofit funder of cancer
    research outside the U.S. Government.
        As we meet here today, one in three men and one in two
    women over their lifetime will hear the words, ``You have
    cancer.'' But we are also at an unprecedented time in history
    where discoveries have been converted into meaningful progress
    in cancer prevention, detection, treatment, and even, in some
    cases, cure.
        Since 1991, when there was a formidable increase in cancer
    research from the U.S. Government and from the American Cancer
    Society, we have declined cancer mortality rates by 32 percent,
    resulting in more than 3.5 million deaths averted from cancer
    due to cancer research funding. It is clear that cancer
    research does, indeed, save lives. And more than ever before,
    that gap between discovery and clinical intervention has
    narrowed, and that has emboldened an entirely new generation of
    cancer researchers to strive for better anti-cancer strategies.
        Just in the last 10 years alone, we have witnessed an
    entirely new class of cancer therapeutics in the form of
    immunotherapy. Research also resulted in the development of a
    highly effective cancer vaccine, something we sought for a long
    time, against HPV-driven cancers.
        And thanks to that breakthrough, right now in this country
    we have the first generation of individuals vaccinated in the
    U.S. who will have protection against cervical cancer and up to
    50 percent of head and neck cancers that we heard about earlier
    today. And similar impactful research advances have been
    realized in this progress against 200 diseases that we call
    cancer.
        It is due to research that this cancer mortality rate is
    declining, and on this basis, it is that we ask Congress to not
    only maintain but increase the pace of discovery through
    enhancing cancer research funding. Despite our gains, we have
    much work yet to do. A subset of lethal cancers are now on the
    rise and show concerning trends that do require research,
    including unexplained increases in early onset colorectal
    cancer and in advanced prostate cancer, just to name two.
        Lung cancer remains a major challenge, accounting for 350
    deaths of Americans every day. At present, cancer remains the
    second-leading cause of death in the United States, with more
    than 600,000 individuals predicted to die from cancer this year
    alone in the U.S. The scientific community, I would opine, has
    shown again and again that the investment in cancer research
    yields returns in lives saved and is poised to increase the
    pace of discovery.
        Now, equally important is investment in research to
    mitigate disparities in cancer outcomes. Right now, black men
    have a twofold higher death rate from prostate cancer, stomach
    cancer, and myeloma as compared to whites. Black women have a
    41 percent higher death rate from breast cancer as compared to
    their white counterparts.
        Geographical disparities also exist. Lung cancer mortality
    is three to five times higher in Kentucky versus Utah or Puerto
    Rico. Cervical cancer is twice as high in Arkansas versus
    Vermont.
        Research is needed to help develop strategies such that all
    Americans will have an equal chance to prevent, detect, and
    survive cancer, an ideal to which the American Cancer Society
    also strives. An essential component of this work will also
    include access to clinical trials, which we all know in cancer
    is the most advanced form of care. Trial funding through the
    NCI is a vital resource through which Americans across the
    country benefit from research breakthroughs that can be
    lifesaving.
        We believe that investment in cancer research is a critical
    component in the investment in the health of U.S. citizens and
    the population as a whole. Our progress has been remarkable,
    and the U.S. scientific community stands ready to accelerate.
        So on behalf of the 1.9 million Americans who will be
    diagnosed with cancer this year alone, we urge the following
    three recommendations. First, funding of $49,000,000,000 for
    the NIH in fiscal year 2023 to allow the base budget to keep
    pace with biomedical research and development price indices,
    and to provide meaningful growth.
        Second, a critical inclusion must be at least
    $7,760,000,000 for the National Cancer Institute. Given this
    explosion in impactful discoveries, NCI is experiencing a
    demand for cancer research funding that is far beyond any other
    institute or center. Grant success rate from the NCI dropped
    from 13.7 percent in 2013 to now just above 11 percent in 2019.
        This situation is unique to the NCI, at a time when cancer
    researchers are making historic advances in new treatments and
    therapies. And by contrast, the success rate for the whole of
    NIH during that period actually rose.
        Third and lastly, we asked for $462,600,000 in funding for
    the CDC's Division of Cancer Prevention and Control, as they
    provide key resources to States and communities to prevent
    cancer by ensuring that at-risk, low-income communities have
    access to prevention programs.
        So I will stop there, and thank you for your attention, and
    I would be happy to answer any questions.
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        The Chair. Thank you very, very much, Dr. Knudsen.
        I also might add that in our meeting this past week, my
    meeting with some of your folks, you have an extraordinary
    nationwide network of folks who are out there advocating for
    what you are advocating for today. So I want to compliment you
    on that effort.
        We did have a hearing not that long ago with a number of
    the institutes from the NIH, and the NCI was there. I am proud
    to say, overall, I think over the last several years on a
    bipartisan basis, this committee has provided about
    $11,000,000,000 to the NIH. In terms of NCI, last year we did
    $352,000,000.
        We are also very much aware at that hearing about the
    success rate, the grants, et cetera, and a concern about that.
    But you are the second to the Federal Government in what you do
    by way of research. It is clear that while we have made some
    great strides, and particularly exciting about cervical cancer
    because that is an area, which--I mean, we can conquer cervical
    cancer. There are some it will take us many, many more years to
    deal with, but we can do that, and we are on the road to doing
    that.
        And when you speak about the increases in lung cancer and
    prostate cancer, it is very, very, very troubling. And then
    there is health disparities. I think, if anything, what the
    pandemic--we have known about disparities, but I think what the
    pandemic has highlighted is those health disparities in a whole
    variety of ways. So we are committed in this committee to
    addressing these needs.
        Our issue is always what is the allocation, how much are
    the resources that we have. But you can be sure that when it
    comes to this basic research--and I will just say one more
    thing. We were all troubled, and we made this known, that
    $274,000,000 to NIH in this budget versus $4,000,000,000 for
    ARPA-H. And we are for ARPA-H and doing what they need to do,
    but we are going to create that balance as we move forward, as
    we put the bill together.
        So thank you so much for being here today and for your
    advocacy and for the great strength of your national
    organization.
        Congressman Cole.
        Mr. Cole. Thank you, Madam Chair.
        Dr. Knudsen, thank you for being here. That was a very
    powerful and effective presentation.
        Look, this is something, you are very fortunate--maybe our
    chair is not, but you have a committee chaired by a survivor of
    cervical cancer. So we have an intimate knowledge here, sadly,
    at the expense of our chair. But we are happy she is here.
        Look, I couldn't agree more with science moves at a very
    uneven pace across multidisciplines, and the opportunity for
    cancer is now. There is just no question about it. And the
    success rates that you point to shows how much good science we
    are leaving on the table, so to speak, and how tough the
    decisions are, the folks we task with picking between which
    grant to fund and which one not to. Probably more difficult in
    your field than any other right now in research.
        So, again, this committee has worked really hard over the
    last 7 years at bolstering NIH. And I want to, again, associate
    myself with my friend the chair's remarks about what we both
    see as the imbalance between ARPA-H and NIH funding in the
    President's proposal.
        We both support ARPA-H. We put $1,000,000,000 there. Some
    of our colleagues might even have questioned us doing that
    because we didn't yet have the format, the Director, what have
    you.
        I know my chair is aware of this. We had good bipartisan
    progress from the Energy and Commerce a couple weeks ago,
    coming together to give us a framework. But again, we want to
    work with the President on that. We know it is a top priority
    of his, but it can't happen at the expense of our ongoing
    commitment to NIH.
        And again, we--both the chair and I recognize how unusual
    the opportunity in front of us here is, if we can find a way to
    make a commitment. So she has a lot of tough decisions to make.
    We always do on this committee. But I suspect that we will
    continue the tradition of doing well by the NIH.
        Again, that is something that we are not only committed to,
    but our two colleagues on the other side of the aisle--or other
    side of the Rotunda in Senator Murray and Senator Blunt have
    been extraordinarily helpful in this run of 7 years that we
    have had of sustained increases above inflation for NIH. And
    zeroing in on this cancer opportunity I think is really
    something that we need to give every possible consideration and
    support for.
        So thank you for the work that you and the American Cancer
    Society do and have done for many, many years. Thank you for
    the advocacy. It is really important.
        But again, I want to underscore the point you made so
    eloquently. You have got to seize the moment sometimes, and
    this is a moment in time where I think if we could find the
    resources, the kind of progress we could make that you spoke
    of, investment does make a difference. We do have people living
    longer, and we have saved lives. And you can measure it
    demonstrably.
        So there is not very many cases where we have got this
    direct a relationship between what we appropriate and the
    difference we make in the lives of the American people. So,
    again, thank you for what you do. Thank you for your advocacy,
    and we look forward in continuing to work with you and the
    American Cancer Society on a bipartisan basis going forward.
        Yield back, Madam Chair.
        The Chair. Thank you. Congressman Fleischmann.
        Mr. Fleischmann. Thank you again, Madam Chair and Ranking
    Member Cole.
        Dr. Knudsen, one of the nice things about being an
    appropriator and, of course, serving on this distinguished
    subcommittee is we touch so many different areas, and it gives
    us as members an opportunity to learn an awful lot. And since I
    have been in Congress, I have been involved with the Cancer
    Caucus. Your group has done a tremendous job.
        But I did want to call out specifically Dr. Jordan Berlin
    and his team at Vanderbilt. Whenever I have cancer questions--
    with difficult cancers, we have made so many wonderful strides.
    But there are still some cancers out there, some types of lung
    cancer, some types of stomach cancers and the like, that are
    still baffling.
        So the key again is investment in research and continued
    progress, but together, we are making this type of progress. So
    thank you for your advocacy.
        And again, this is going to be one of these areas where
    there is going to be really unanimity. This is not--shouldn't
    be an issue for appropriators, for Republicans, Democrats, or
    authorizers. This should be an all-out effort by Americans, who
    we represent, to defeat cancer.
        So thank you for your advocacy. And Madam Chair, I will
    yield back.
        The Chair. Thank you. Thank you.
        Let me now recognize Belinda Pettiford, president of the
    Association of Maternal and Child Health Programs.
        And Ms. Pettiford, you are recognized for 5 minutes for
    your testimony.

     BELINDA D. PETTIFORD, PRESIDENT, ASSOCIATION OF MATERNAL AND
                         CHILD HEALTH PROGRAMS

        Ms. Pettiford. Thank you.
        Chair DeLauro, Ranking Member Cole, and distinguished
    subcommittee members, my name is Belinda Pettiford, and I am
    grateful for this opportunity to appear before you today on
    behalf of the Association of Maternal and Child Health
    Programs, known as AMCHP.
        I proudly serve as the board chair and president of AMCHP,
    as well as chief of the Women, Infant, and Community Wellness
    Section here in the Division of Public Health for the North
    Carolina Department of Health and Human Services.
        In fiscal year 2023, AMCHP requests that the subcommittee
    fund the Title V Maternal and Child Health Services Block Grant
    administered by the Health Resources and Services Agency at
    $1,000,000,000, including a robust increase for the State
    formula fund. We are thankful to the subcommittee for the
    increases in funding for the block grant over the past several
    years and for recognizing the essential role Title V plays in
    improving the health and well-being of women, children,
    including those with special healthcare needs, and their
    families.
        As you may know, the Title V block grant is driven by
    evidence, flexibility, and results to ensure access to quality
    maternal and child health services; reduce infant mortality,
    maternal mortality, and preventable diseases and conditions;
    and promote family-centered, community-based, coordinated care
    for children with special healthcare needs. The block grant
    funding is distributed to every State and territory by a
    formula tied to the child poverty rate.
        Another significant portion of the block grant is awarded
    through Special Projects of Regional and National Significance,
    or SPRANS, which are discretionary grants that support a range
    of programs, including those to train the next generation of
    leaders in MCH, to support innovation to improve maternal
    health outcomes, and so much more.
        In order to illustrate the far-reaching impact of Title V,
    I would like to share a few examples of how the State formula
    funds are being used in various States.
        In Florida, the State Maternal Mortality Review Committee
    identified leading causes of maternal death and issued urgent
    maternal mortality messages to healthcare providers and
    hospitals around obstetric hemorrhage and hypertensive
    disorders to prevent future maternal deaths. In Massachusetts,
    the shift to provide home visiting services in a virtual manner
    ensured a new mother in crisis was able to get the counseling
    she needed.
        As this subcommittee's members are aware, our Nation is
    facing an unprecedented shortage of infant formula. Title V
    agencies around the country have been using their voices as
    trusted messengers to share critical information with families
    and healthcare providers about how to obtain formula, as well
    as to warn of misinformation that has been spreading through
    this crisis.
        In North Carolina, we are closely monitoring supply,
    working with the Federal Government, with manufacturers, and
    retailers to get more formula on North Carolina shelves. We are
    sharing information and resources and are working specifically
    with our Title V MCH partners to share this information with
    families.
        During the past 2 years, Title V-funded programs have been
    at the forefront of COVID-19 response efforts, with a
    particular focus on addressing the unique impacts of the
    pandemic on maternal and child health populations. The flexible
    nature of the block grant made it an easily deployable source
    of support for States to respond to the public health
    emergency.
        However, while the block grant is the backbone of our
    Nation's public health infrastructure for women, children, and
    families, that infrastructure has been severely strained as a
    result of this pandemic. Maternal and child health programs and
    the workforce need sustained, increased investment to rebuild,
    to recover, and best serve the Nation's maternal and child
    health populations now and into the future.
        Further, our Nation has longstanding racial, ethnic,
    geographic, and socioeconomic inequities in MCH outcomes. While
    incremental funding increases to programs like the Title V
    block grant make a difference in advancing maternal and child
    health, to make transformational improvements that finally
    address these inequities, we will require transformational
    investments in the block grant and complementary Federal
    programs that support maternal and child health, including
    CDC's Safe Motherhood portfolio of programs, HRSA's Healthy
    Start program, and CDC's Surveillance for Emerging Threats to
    Mothers and Babies Network.
        We thank you for funding the Title V Maternal and Child
    Health Block Grant at $747,700,000 in fiscal year 2022 and urge
    you to provide an increase to at least $1,000,000,000 in fiscal
    year 2023, including a robust increase for the State formula
    fund to ensure that States have the public health foundation
    they need to support healthy children, healthy families, and
    healthy communities now and into the future.
        And I thank you so very much.
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        The Chair. Thank you. Thank you very, very much for your
    testimony.
        I would just make some comments, but let me just ask the
    ranking member if he has comments and questions and follow it
    up with Congressman Fleischmann.
        Mr. Cole. I don't have any questions, but I want to thank
    our witness for her work. It is really important. I mean,
    again, as our colleague Mr. Fleischmann said, one of the great
    things about this committee is you learn a lot because it
    covers so many areas.
        And one of the things I was sad to learn over the course of
    my service on this committee is how poorly we as a country
    stack up with other countries in this area in terms of maternal
    health, and then now how great the racial disparities are.
    Something that we, as the chair mentioned earlier in another
    context, we all knew were there, but COVID really brought it
    home. And I know she will focus on this. We will focus the
    committee and do the very best we can.
        But I want to use this forum to also put out a challenge to
    some of our friends at the State legislature. I know that in my
    State, we don't fund enough in these areas, and we have some of
    the worst statistics in the country, quite frankly.
        And I am proud of what this committee does, and
    particularly under the leadership of our chair. But we are
    putting a lot of money, and I am always for having a rainy day
    fund at the State level. I live in a State that is a boom-bust
    State because of commodity prices in energy and agriculture,
    and so that is a wise thing. But when times are good and the
    Federal Government has put as much money out for a variety of
    healthcare purposes as it has over the last 18 months to deal I
    think very appropriately with COVID, some of that money needs
    to be directed toward some of these programs in terms of
    matches for what we do and what have you.
        So, again, this is an area of great concern and one that I
    look forward to working with the chair on as we move forward.
    But thank you for working on the front lines in North Carolina
    on a problem that really ought to embarrass us all as
    Americans. We need to do better in maternal and infant health
    than we are doing, and thanks for your efforts and thanks for
    your advocacy and bringing it here in front of the committee
    and making such an important case for all of us to hear.
        Yield back, Madam Chair.
        The Chair. Thank you. And I actually want to say thank you
    for the testimony.
        I think we have been talking about seizing the moment.
    There is such a very big focus and interest on the issue of
    maternal and child health programs, and we need to seize this
    opportunity to further them. It has been really--and that we
    have a heavy emphasis even in the 2022 appropriations bill, the
    2022 appropriations bill, great advocacy by so many members of
    our--of the Congress, our caucus, and so that that is an issue
    that has been put front and center in so many ways.
        And that, I assure you, will continue. But the advocacy
    needs to continue because, again, the disparities that have
    been demonstrated, and the issue with black women, this is
    pretty extraordinary. And oftentimes, we lose track of the
    serious issues that the childbirth may bring, and people just
    view that, well, you are going to have a baby. Everything is
    going to be okay. It is fine. But it is not the case. It is not
    the case.
        My own personal experience is with my stepdaughter, and 17
    years ago, we thought everything was fine. And at one point, we
    almost lost both my granddaughter, who is now 17 years old,
    though, and her mom. And it was harrowing, and we weren't--we
    had no idea that this was something that could come from a
    regular pregnancy.
        So, but I just tell you keep at it, keep at it at this
    moment because the window is open. The window in Washington
    shuts very quickly. So just continue the advocacy so that we
    can really join the ranks of other countries and they are
    paying attention to health and welfare of women and children,
    women's and children's health in this country.
        Thank you very much for your testimony.
        What I would like to do is to recognize Dr. Anne Matthews
    with the Rotary Foundation of Rotary International around the
    issue of global polio eradication at the CDC.
        Dr. Matthews.

    ANNE L. MATTHEWS, CHAIR, POLIO ERADICATION ADVOCACY TASK FORCE
        FOR THE UNITED STATES, THE ROTARY FOUNDATION OF ROTARY
                             INTERNATIONAL

        Ms. Matthews. Thank you very much.
        Chairwoman DeLauro, Ranking Member Cole, and members of the
    subcommittee, I am here today on behalf of 300,000 members of
    Rotary Clubs in the United States and to thank you for the
    committee's generous support and longstanding leadership toward
    a polio-free world and to also encourage continuation of
    funding to support the polio eradication activities of the CDC,
    the Centers for Disease Control and Prevention.
        We are seeking $276,000,000 in fiscal year 2023 for CDC's
    polio eradication efforts to protect the progress achieved to
    date and to capitalize on unprecedented low levels of virus
    transmission to end polio once and for all.
        Rotary International and the CDC are spearheading partners
    of the GPEI. That is the Global Polio Eradication Initiative, a
    global partnership launched in 1988, which reaches the most
    vulnerable children through safe, cost-effective polio
    immunization.
        Thanks to this committee's support, polio cases have been
    reduced by more than 99.9 percent since 1988. Twenty million
    people have been spared disability, and over 900,000 polio-
    related deaths have been averted.
        Last year, only 5 cases were recorded in the 2 remaining
    endemic countries of Pakistan and Afghanistan. This low number
    of cases reflects a high number of children effectively
    protected through immunization.
        Every year, the GPEI works to immunize 370 million children
    globally. There were also 40 percent fewer cases of circulating
    vaccine-derived polio virus in fewer countries in 2021, as
    compared to 2020. The novel oral polio vaccine type 2 was
    introduced in 2021 to accelerate progress in bringing outbreaks
    under control.
        This progress is encouraging, but fragile. Earlier this
    year, a child from Malawi was identified with polio that is
    genetically linked to virus in Pakistan, and another case has
    been found in Mozambique. These cases remind us that as long as
    polio exists anywhere, it is a threat to children everywhere.
    Now is the time to capitalize on progress to complete polio
    eradication.
        CDC's work is critical to protecting the progress and
    overcoming remaining challenges. CDC's Atlanta laboratories are
    key to confirming both the presence and absence of polio virus.
    They serve as a global reference center and training facility,
    providing expertise in virology, diagnostics, and laboratory
    proceedings.
        CDC also contributes technical expertise through the
    international assignment of technical staff to WHO and UNICEF
    to provide strategic and management expertise to priority
    countries. They also train and deploy public health
    professionals to high-risk countries through the Stop
    Transmission of Polio Program.
        The $276,000,000 that Rotary is requesting will ensure that
    CDC continues to provide this key technical expertise while
    building country-level capacity to maintain high levels of
    population immunity. This funding would also expand CDC's
    capacity in three critical areas of outbreak response,
    surveillance, and vaccine procurement.
        The global network of 145 laboratories and trained
    personnel established for polio also tracks measles, rubella,
    yellow fever, meningitis, and other deadly infectious diseases,
    including COVID-19, and will do so long after polio is
    eradicated. Our collective investment has already saved
    $27,000,000,000 in health cost since 1988, and it is estimated
    that investing in polio eradication now may cumulatively save
    an estimated $33,100,000,000 by the year 2100 in the form of
    reduced costs in surveillance and vaccination.
        We appreciate so much the help you have given and ask that
    you continue to support the eradication of polio.
        Thank you very much.
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        The Chair. Thank you very, very much for your powerful
    testimony.
        First of all, let me just say that we want to say a thank
    you to Rotary for the great work that Rotary does in this area
    and a variety of others. They really have a tremendous network,
    and they bring relief all over the United States, but also
    internationally. So I compliment you and Rotary.
        Sometimes we think that because there are not that many
    cases in the U.S. of polio that we tend to forget the rest of
    the world. But you make an absolutely brilliant case for what
    we should do internationally and what we can do. Because if we
    don't conquer it there, we are also at risk here. And I mean, I
    think that that is clear.
        And I just want to--I was at the CDC last Friday. They are
    a remarkable organization, and we should do everything that we
    can to make sure that they can continue in their global efforts
    overall because they play such a role internationally. And I
    know that the Gates Foundation plays a role in this effort as
    well.
        So thank you for your advocacy and your aggressive advocacy
    on this. It makes a difference. Thanks very, very much.
        Congressman Cole.
        Mr. Cole. Thank you very much, Madam Chair.
        I want to associate myself with your remarks, particularly
    when it comes to thanking Rotary for what you have done over
    the years to keep the focus on this disease.
        I am old enough to have been part of that first generation
    of children who got the polio vaccine and grew up--it is
    amazing to me. I don't know that my son has ever met anybody
    who had the disease. It was very common, as Dr. Matthews knows
    and my friend the chair knows, when I was growing up. And so
    you went to school with kids that had suffered the ravages of
    this disease, and the progress we have made is astounding and
    something that we can be really proud of.
        And there is a couple of lessons to draw here, and that is
    the importance of sustained effort over time. That if we spend
    the dollars, we really can make an enormous difference. The
    statistics you cited, Dr. Matthews, in terms of both the
    financial and, much more importantly, the human cost and in
    savings of the effort that has been made, both by Rotary
    individually with all the hard work you have done and in
    cooperation with the CDC.
        So I really do think it is important. This is a genie that
    can get out of that bottle. And as my friend the chair pointed
    out, we are not safe here until it is eradicated everywhere.
        And I would be remiss, finally, Madam Chair, if I didn't
    give a shout-out to my old friend, Ralph Monroe, who has been a
    tireless advocate for Rotary for many years. We were
    secretaries of state together back in the 1990s. He has been a
    tireless advocate, as I know Dr. Matthews knows, been up to
    Washington many times, and just embodies the commitment of
    Rotary as a service organization to do good all over the world.
        He has traveled all over the world in this cause and in
    this effort. And again, as the doctor knows, we are down to
    some places that are pretty tough for us to get at
    geographically, culturally, politically, you name it. But it is
    really important that this fight be fought to the finish.
        So, again, thanks for not taking your eye off the goal, so
    to speak, and making sure that our committee--which I think on
    a bipartisan basis, wants to finish this fight, too--stays
    focused on this really, really important mission.
        So thank you again, Dr. Matthews.
        And Madam Chair, I yield back.
        The Chair. Let me now introduce Mairead Painter, National
    Association of State Long-Term Care Ombudsman Programs, and I
    would just welcome you.
        Mairead is a graduate of the University of St. Joseph in
    West Hartford, and extensive background working to improve the
    quality of life for residents who need long-term care and with
    critical work with the informed choice process in Connecticut
    in nursing homes. And she has been an advocate for person-
    centered care.
        So, Ms. Painter, thank you for your work, and we look
    forward to hearing from you.

     MAIREAD PAINTER, CONNECTICUT STATE LONG-TERM CARE OMBUDSMAN,
    NATIONAL ASSOCIATION OF STATE LONG-TERM CARE OMBUDSMAN PROGRAMS

        Ms. Painter. Hello, and thank you.
        Chairwoman DeLauro, Ranking Member Cole, and distinguished
    members of the subcommittee, I offer this testimony today on
    behalf of residents in Connecticut long-term care facilities,
    as well as in collaboration with the National Association of
    State Long-Term Care Ombudsman Programs.
        Some may not know what a long-term care ombudsman is or how
    the work that we do assists constituents in your community. In
    every State, ombudsmen work to improve the quality of life and
    the quality of care for individuals residing in nursing homes,
    assisted living communities, and in some States, home- and
    community-based service waivers.
        The individuals that we serve may be your family members, a
    friend's parent, or even a veteran who served our country. No
    matter who they are or how they are brought into the long-term
    care system, there will be an ombudsman there from one of our
    programs to support them and advocate on their behalf.
        Ombudsmen respond to complaints, protect rights, and ensure
    that they are treated as individuals with autonomy, choice,
    independence, and access to quality healthcare. We perform all
    of our activities on behalf of and at the direction of
    residents while ensuring strict confidentiality.
        We thank you for the support of our programs, and today, we
    request funding that is directly tied to the need for resources
    so that State ombudsmen can hire and train additional permanent
    staff. Increasing the number of ombudsmen will enable us to
    respond to residents impacted by the pandemic, to meet an
    increase in demand, and to address the rise in long-term care
    complaints across our country.
        Over the past 3 years, residents have faced a virus that
    targeted them and drastic infection control measures that
    caused them to be isolated. Our offices have received thousands
    of calls reporting the impact of these restrictions, and the
    calls continue today.
        Restrictions also paused normal State and Federal surveys
    that ensure the quality of care and investigate complaints.
    Today, residents are still reporting a lack of access,
    oversight, and accountability.
        Our program representatives make regular visits to long-
    term communities to support residents. In 2020, nationally, we
    had 1,700 paid staff and approximately 5,100 volunteers. This
    was a significant drop from the volunteers we had in 2019, and
    we anticipate a further decline this year.
        These numbers are not sufficient to provide a regular
    presence in the 14,000-plus nursing homes, plus thousands of
    community residences, and assisted living facilities. As a
    result, our representatives have had to do more with less. To
    do this, we have used COVID relief funding to develop remote
    outreach, trauma support, and expand our use of technology.
        Ombudsmen greatly appreciate the COVID recovery funding,
    and without it, we could not have accomplished this critical
    work. But to continue to respond at this level and meet growing
    demand for our advocacy, we need to increase stable annual
    funding to recruit, hire, and train new staff and volunteers.
        Last year, with 8 regional ombudsmen, 3 support staff, and
    about 4 active volunteers, a Connecticut program responded to
    almost 4,500 complaints, in addition to hundreds of calls for
    information and consultation. That is almost the same number as
    at the height of the pandemic, and we do not see things
    slowing.
        In addition to nursing homes, ombudsmen have been given
    mandates to serve residents in assisted living but were never
    provided regular annual funding to hire staff and appropriately
    provide protections and outreach. We need dedicated assisted
    living and home- and community-based funding to hire staff and
    support residents in these settings. But the national funding
    has not been there, and as a result, our programs have been
    unable to adequately serve these citizens.
        Increased regular annual funding will allow us to effect
    change for individuals, as well as at the State, local, and
    national level. Therefore, let me respectfully request that for
    2023, we receive $65,000,000 for assisted living ombudsmen
    services under the Title VII Older Americans Act, $70,000,000
    for our current core funding under the Title VII Older
    Americans Act, and $52,500,000 under the Elder Justice Act for
    training and services and address increasing abuse, neglect,
    and exploitation.
        Current funding levels preclude ombudsman programs from
    quickly responding to complaints and monitoring facilities.
    Though the funds have been authorized since 2010, to date, no
    Elder Justice Act funds have been appropriated for ombudsmen in
    the annual appropriations process. Without our eyes/ears in
    these facilities, residents are at greater risk of abuse,
    neglect, exploitation, and any number of other rights
    violations.
        Thank you for your consideration of this request, and I
    welcome any questions.
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        The Chair. Well, thank you so much, and thank you for your
    testimony today.
        I think you really address an issue that is critically
    important, one that has been--the role of an ombudsman and you
    know what you can do. The strength of that role has been there,
    but I think it is what happened with the pandemic is that this
    was it opened up the Pandora's box. And people in assisted
    living wound up being, as you pointed out, isolated, and
    families without knowledge of what was going on, and the high
    rate of deaths within assisted living during the pandemic is
    extraordinary and really needs to be looked at.
        So your role is critical, and we need to recognize that and
    really take a hard look at what has been the past in terms of
    funding and see where we can go. Obviously, we have
    restrictions on the amount of money we have, but the points
    that you make about the complaints, the abuse, and we did a
    hearing about a week ago or 2 weeks ago that pointed up what is
    not happening in the elder justice area and the increase in the
    cases of abuse of our seniors. And so that we want you to have
    what you need in order to be able to deal with the volume of
    complaints.
        But to be able to give our seniors and their families the
    comfort of knowing that they are safe and that we--and they
    have an outlet in which they can make their voices heard as
    well.
        So thanks for the testimony.
        Congressman Cole.
        Mr. Cole. Thank you. I will just again associate myself
    with your remarks, Madam Chair.
        I want to thank Ms. Painter for her work and work of others
    like her during the COVID outbreak. It is important at all
    times, but that period where that particular population is so
    much at risk, what you and your colleagues did was pretty
    extraordinary, saved a lot of lives.
        So thank you very, very much, and thank you for your
    testimony.
        I yield back, Madam Chair.
        The Chair. Thank you.
        And now let me--hopefully, I get your name right here,
    Hannah Wesolowski, chief advocacy officer for the National
    Alliance on Mental Illness. And please proceed with testimony.
    You are recognized for 5 minutes.

    HANNAH WESOLOWSKI, CHIEF ADVOCACY OFFICER, NATIONAL ALLIANCE ON
                             MENTAL ILLNESS

        Ms. Wesolowski. Thank you.
        Chairwoman DeLauro, Ranking Member Cole, and members of the
    subcommittee, on behalf of the National Alliance on Mental
    Illness, I want to thank you for your bipartisan support and
    commitment to mental health.
        NAMI is the Nation's largest mental health organization. I
    am honored to be here today to speak on behalf of people across
    the country with mental health conditions and their loved ones.
        The mental health challenges we face as a country are vast
    and will continue to grow as we recover from and grapple with
    the effects of the pandemic. If we do not invest in mental
    health now, we will pay the price for decades to come. Bluntly,
    our Nation is at a breaking point when it comes to mental
    health.
        We have an urgent youth mental health crisis, as
    highlighted by our Surgeon General last year. And just this
    week, we had another heart-breaking tragedy in a school. This
    puts immeasurable trauma on not only the children in that
    community, but kids across the country. Add to that the impact
    of the last 2 years and our existing mental health crisis, and
    we are facing an avalanche of need.
        I urge every member of this subcommittee to think about the
    children in your life--your kids, grandchildren, nieces,
    nephews, neighbors. Picture the face of one child in
    particular. Children like them are crying out for help, and we
    need you to listen. We can make a difference if we act urgently
    and in a significant way. If not, we are saying we are
    satisfied with our children suffering in silence, with
    sacrificing their futures.
        Think back to the face you pictured. Would it be okay if
    that child had to struggle in silence? There are unprecedented
    numbers of children experiencing anxiety, depression, and
    suicidal thoughts. More than half of parents are concerned over
    their kid's mental well-being.
        During the pandemic, rates of teens visiting the ER after a
    suicide attempt, especially girls, skyrocketed. And 45 percent
    of LGBTQ youth seriously considered suicide in the past year.
    We do not have to accept this. We can do something.
        Children spend much of their time in schools, which gives
    us a chance to intervene early. But we have a severe shortage
    of counselors, social workers, and psychologists in our school
    system. The President has proposed $1,000,000,000 for the
    School-Based Mental Health Services Grant Program. This funding
    is desperately needed to vastly increase the number of mental
    health professionals helping kids and their families get the
    help they need.
        But our crisis doesn't end with children. Nearly two in
    five adults struggled with their mental health in 2020,
    compared to about one in five before the pandemic. The
    Community Mental Health Services Block Grant Program helps our
    States fill needed gaps to address this growing demand. We urge
    you to include the President's proposal to increase the block
    grant to nearly $1,700,000,000, funding that is critical to
    helping people on the ground.
        While our goal is to help children and adults as early as
    possible, sadly, NAMI hears every day from desperate families
    with loved ones in crisis and nowhere to go for help or from
    individuals who have fallen through the cracks and are trying
    to piece their life back together.
        In 7 weeks, 988 will be available as a nationwide hotline
    for suicide and mental health crises. I applaud Congress for
    the bipartisan support of this number, and NAMI is deeply
    grateful to this committee for drastically increasing the
    investments for the hotline and services that provide a mental
    health response to people in crisis.
        But even with those increases, we don't have the funding to
    help everyone. Just take the call centers that will answer 988
    calls. They are often staffed by volunteers.
        We are asking people to volunteer their time to respond to
    people calling on the worst day of their lives. While these
    trained counselors are amazing, we cannot build a sustainable
    system relying solely on their good will.
        Because of 988, we have a once in a generation opportunity
    to re-imagine how we respond to people in crisis. We cannot
    miss this chance. Too many lives will be lost or ruined.
        The call centers that will answer 988 calls rely on a
    patchwork of inadequate funding. To meet the growing demand, we
    need to fund not only the National Lifeline Network, but also
    fund local call centers answering the 988 calls to ensure
    culturally competent local capacity in every corner of this
    country.
        A fully developed crisis response system also requires
    mobile response teams staffed by mental health professionals
    and crisis stabilization services. Unfortunately, most people
    don't have access to these services, and people are dying
    because of it.
        NAMI is deeply grateful for your leadership in bringing the
    new Mental Health Crisis Response Pilot Partnership Program to
    our communities. It will spur the availability of mobile crisis
    teams as the primary in-person response to people in crisis.
        But the work is not yet done. As you know, there is need
    for more teams like this to serve both adults and children. We
    urge you to increase funding of this program to $100,000,000 to
    help people in more communities across the country.
        As I wrap up, I need to recognize that I am here today to
    speak on behalf of the people who cannot be here, the people
    who are struggling, the parents that are trying desperately to
    find help for their kids, and all those who lost their futures
    because our system routinely fell short.
        It is imperative that we address this crisis and make
    mental health among our Nation's highest priorities, turning a
    breaking point into a defining moment.
        Thank you for this opportunity.
        [The information follows:]

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        The Chair. Thank you.
        Let me, first and foremost, say that NAMI is the gold
    standard. Thank you for really the years and years of work in
    this area. You are extraordinary in the work that you carry on.
        The issue is that mental health was an issue before the
    pandemic, under the radar probably, but serious. And serious
    enough to be considered a crisis, but it didn't--it didn't
    manifest itself in the way to those of us who were working on
    it that we had to deal with this crisis in some way in mental
    health.
        So, but the pandemic brought this to light. Now more than
    ever we are looking at people who are struggling as a result of
    so many issues that are out there. It is isolation. It is
    losing a parent or grandparent, a loved one, et cetera. I don't
    know how many families have been touched by the loss of
    someone. With a million lives lost, it is like every family has
    suffered something somewhere. That has to be addressed in a
    formidable way, and we have to recognize that we need to do
    that.
        We are excited about the 988 line, and we also want to make
    sure that we are providing the resources so that people--it
    works. So that someone is not dialing the number, and there is
    nobody home at the other end. So we need to make sure that that
    is there, and we need to focus as a country on what is a mental
    health crisis, not specifically caused by a pandemic, but a
    mental health crisis in this country exacerbated by that and
    high suicide rates.
        And think about it. I saw a little boy this morning who
    was--survived yesterday, but he was looking at his friends all
    around him being killed, and how do you deal with that child?
    How do you help that child to succeed?
        Anyway, thank you so much for your testimony, and we will--
    this is a high priority.
        Congressman Cole.
        Mr. Cole. Thank you very much, Madam Chair.
        I want to thank our witness for being such an effective and
    thoughtful advocate.
        I remember a number of years ago, when I was chair of this
    committee, and we passed the CURES Act. And my friend Tim
    Murphy, who is no longer, sadly, in Congress but is a child
    psychologist and has become an expert on post traumatic
    stress--and still stays in touch with me and, ``Hey, think
    about this. Think about this program.''--came by my office as a
    Member who had done a lot of work on adding mental health
    provisions in that. And I said this is all great, but the
    authorizing committee, I am glad this is all authorized. Sadly,
    my budget has been cut by $5,000,000,000 by the Budget
    Committee.
        Now, at the end of the day--and we have to mark up to that
    number. The chair is going to have this challenge. At the end
    of the day, I suspect our overall number will go up as we get
    to a deal with the Senate, and we are going to need Democratic
    support, and they have got some concerns in these areas that I
    share. So we will do a little bit better.
        But I had to say you have got to prioritize this for me a
    little bit. And he said, well, if you can only do one or two
    things, the most important thing is to fund the programs that
    get us more mental health professionals. We simply do not have
    enough people.
        And I think your remarks about 988 are illustrative of
    that. It is partly money, but partly we need to make those
    investments in the pipeline to make sure that we have the
    professionals to actually respond to the situation. And this is
    one where I think we have been slower than any of us would like
    to get there, but we are starting to begin to understand.
        Maybe the pandemic brought it home a little bit more, and
    you are quite right about that. This committee has had under
    the chair's leadership multiple hearings where we have talked
    about the long-term impact and people that were isolated,
    whether it was in nursing homes or school kids that lost the
    structure and focus in their life.
        So thank you for keeping us focused on this important task,
    and I will continue to work with my friend the chair, and
    hopefully, we can make some progress.
        With that, Madam Chair, I yield back.
        The Chair. Thank you.
        Thank you, and thank you for your testimony.
        I would like to recognize Thomas Fleisher. Dr. Fleisher,
    executive vice president of the American Academy of Allergy,
    Asthma, and Immunology, you are recognized for 5 minutes for
    your testimony.

     THOMAS A. FLEISHER, M.D., EXECUTIVE VICE PRESIDENT, AMERICAN
               ACADEMY OF ALLERGY, ASTHMA, AND IMMUNOLOGY

        Dr. Fleisher. Thank you.
        Chairwoman DeLauro, Ranking Member Cole, and members of the
    subcommittee, thank you for the opportunity to testify on the
    HHS fiscal year 2023 appropriations.
        I am Tom Fleisher, executive vice president and a former
    president of the American Academy of Allergy, Asthma, and
    Immunology that I will refer to as AAAAI for the rest of the
    talk. On behalf of our organization, I am before this
    subcommittee today with three requests.
        A $6,100,000 funding increase for the Consortium on Food
    Allergy Research, also known as CoFAR, and supporting report
    language, report language to support education and awareness
    related to the need for penicillin allergy evaluation in order
    to de-label non-allergic patients, and third, funding to
    address antimicrobial resistance.
        The AAAAI wishes to express its appreciation to the
    subcommittee and to Congress for the passage of the fiscal year
    2022 omnibus spending bill, which provided an additional
    $3,000,000 to CoFAR, increasing its budget to $9,100,000.
        Food allergies affect 32 million Americans, including 6
    million children. Each year, more than 200,000 Americans
    require emergency medical care for allergic reaction to foods.
    That is the equivalent of one trip to the emergency room every
    3 minutes.
        CoFAR was established within the NIAID in 2005 and has
    resulted in many advances, including the discovery of genes
    associated with increased risk for peanut allergy and the most
    promising potential immunotherapy treatments for egg and peanut
    allergies. Additional breakthroughs, scaled across other major
    food allergies, could significantly improve the quality of life
    for tens of millions of patients.
        The AAAAI and other stakeholders enthusiastically support
    the $6,100,000 funding increase for CoFAR in fiscal year 2023
    and accompanying report language, as submitted to the
    subcommittee, by Representatives Ro Khanna and Anthony
    Gonzalez, as well as others. This would bring CoFAR's annual
    budget to $15,200,000.
        CoFAR has been able to accomplish breakthroughs in the
    under-researched field of food allergies. It is crucial that we
    continue investing at proportional levels given the scale of
    this condition, which impacts 8 to 10 percent of the U.S.
    population. Further, food allergies disproportionately impact
    low-income communities of color.
        I would also like to speak to the growing threat of
    antimicrobial resistance, which, combined with the dwindling
    pipeline of new antibiotics, requires policies that prevent
    inappropriate use of antibiotics. According to the CDC,
    approximately 10 percent of the U.S. population self-report
    being allergic to penicillin, yet 9 out of 10 of these patients
    are not allergic when formally evaluated, meaning fewer than 1
    percent of the population is truly allergic to penicillin. The
    CDC has cited the importance of correctly identifying truly
    penicillin allergic patients to decrease the use of broad-
    spectrum antibiotics.
        To this end, the AAAAI urges the subcommittee to include
    report language that encourages the CDC and other appropriate
    Federal agencies to undertake physician and patient-directed
    education to heighten awareness of this important issue.
        We also support CDC's work in the area of AMR. The AAAAI
    supports $100,000,000 in funding for the National Healthcare
    Safety Network and $397,000,000 for the Antibiotic Resistance
    Solutions Initiative. These programs would benefit from
    significant new resources to achieve the goals outlined in the
    National Action Plan for Combating Antibiotic Resistant
    Bacteria.
        Thank you for your past support of food allergy research,
    antimicrobial resistance, and penicillin allergy evaluation. We
    appreciate your consideration of these requests for fiscal year
    2023 and look forward to working with you to advance these
    important health issues.
        [The information follows:]

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        The Chair. Thank you very, very much for really focused
    testimony here and the work that the academy does. The areas
    that you have outlined for years trying to deal with the issue
    of antimicrobial resistance and that we need to spend time in
    trying to really deal with it, and it would be interesting to
    know, given the vast array of antivirals and drugs and
    antibiotics that have been used throughout COVID here, of what
    kind of an effect that is going to have for the future.
        I am not a scientist, but you are in a position to sort
    that out. So very, very big issue and one that we have focused
    on the committee.
        Secondly, when you talk about the food allergy research,
    really incredible. I don't know if you at some time will talk
    about being lactose intolerant, which it was only several years
    ago that that occurred, and what one does about that. But I
    watch people all of the time and have family--now my 5-year-old
    grandson, it is fish. My God, he gets deathly ill.
        But the work in that area I think is--I think we can--and
    again, I am not a doctor and I am not a scientist, but we make
    strides, and we can continue to look at this as a way in which
    we can alleviate that stress, pain, or potentially death. But
    this could be prevented. We can deal with prevention in this
    area, which is where we ought to try to focus our attention.
        And the CDC does a great job. I mean, the CDC has been
    extraordinary in this effort historically. So look forward to
    working with you as we go forward. And the caveat is always how
    much money are we going to have?
        Dr. Fleisher. Thank you.
        The Chair. And that is always the way forward. But thank
    you for the focus. And on penicillin as well, it is very
    interesting. You do learn something every day, and through this
    committee you learn something.
        So, Congressman Cole.
        Mr. Cole. Thank you, Madam Chair.
        I know my friend the chair is trying to move us along
    because we are already over time, and so I am going to keep my
    remarks brief and associate myself with hers. And please don't
    take the brevity of my remarks as anything other than trying to
    help in terms of time because these are important topics and
    interesting.
        And I think my friend the chair put her finger on it. The
    problem is always how much money do we have? And I noticed, Dr.
    Fleisher, you were on for quite a while so you got an earful of
    the number of requests that my friend the chair is going to
    have to wrestle through and then put together the votes on both
    sides of the aisle to get all this across and done and,
    hopefully, on time.
        So we are going to work with her on that, try to be as
    supportive as we can, but we really appreciate your testimony.
        With that, Madam Chair, I yield back.
        The Chair. I thank the ranking member.
        And just that I see all these people waiting, and I think
    we are about an hour behind and so forth because it is so--
    these issues are so critical.
        But Dr. Sandra Harris-Hooker, senior vice president for
    research administration, professor of pathology at Morehouse
    School of Medicine. We welcome your testimony, and you are
    recognized for 5 minutes.

       SANDRA HARRIS-HOOKER, SENIOR VICE PRESIDENT FOR RESEARCH
    ADMINISTRATION AND PROFESSOR OF PATHOLOGY, MOREHOUSE SCHOOL OF
                                MEDICINE

        Ms. Harris-Hooker. Chair DeLauro, Ranking Member Cole, and
    members of the subcommittee, good morning, and thank you for
    the opportunity to present testimony in support of programs
    impacting health, minority health, and health disparities.
        And greetings on behalf of our president and CEO, Dr.
    Valerie Montgomery Rice.
        Morehouse School of Medicine is one of four historically
    black medical schools. These four schools have trained
    approximately half of the black physicians in this country. The
    subcommittee's investments in health professions training,
    medical research, and public health have been very meaningful.
    They provide our institutions with resources needed to drive
    improvements in health status for all Americans and help us to
    provide our students with opportunities for careers in health-
    related professions, which is clearly a national priority.
        I would be remiss if I did not thank the subcommittee for
    its responsiveness to the COVID-19 pandemic. Your commitment to
    providing the resources needed to establish the Higher
    Education Emergency Relief Fund has been tremendous and allowed
    us to respond to the needs of our students, faculty, and staff,
    as well as play a leadership role in improving public health
    practices in communities nationwide.
        Our complete list of funding recommendations is included in
    our written testimony, but with the limited time for my oral
    remarks, I want to focus on two key programs important to the
    Morehouse School of Medicine and other minority health
    profession schools.
        The first is the Research Centers at Minority Institutions,
    acronym RCMI, which is administered by the National Institute
    on Minority Health and Health Disparities, NIMHD. Historically,
    the RCMI program has provided the resources needed for our
    schools to begin to build, with emphasis on begin to build, a
    research infrastructure comparable to non-minority
    institutions, allowing us to attract world-class researchers,
    expand research facilities, and support cutting-edge
    investigations into questions about why health disparities
    still exist and how to improve the health status of each
    American.
        As the subcommittee has increased funding for NIMHD,
    funding for the RCMI program has not grown at the same rate.
    Furthermore, RCMI program funding opportunities have become
    more focused on research project grants and less on capacity
    building. While both of these are certainly needed, our schools
    need the resources to build capacity to successfully compete
    for research project grants and other funding opportunities.
        As the subcommittee considers its funding recommendations,
    we urge that the RCMI program be provided with a detailed level
    of funding that is consistent with the growth of the NIMHD
    budget. Moreover, we urge the subcommittee to re-emphasize the
    historic infrastructure-building focus of the program,
    including providing $15,000,000 annually--of annual funding to
    support clinical and translational research infrastructure in
    historically black medical schools comparable to that provided
    to majority medical schools.
        Funding for infrastructure for clinical research resources
    and facilities is critical to advancing health equity among the
    most vulnerable populations in this country.
        Secondly, in March, President Biden signed the bipartisan
    John Lewis NIMHD Research Endowment Revitalization Act. This
    new law solved a glitch in the underlying NIMHD Research
    Endowment Program statute that precluded several historically
    eligible institutions, including Morehouse School of Medicine,
    from even competing for this important program.
        This endowment helps us to build an endowment that would
    enable us to be on the average of other health professional
    schools. Now that this eligibility glitch is resolved, we ask
    that $50,000,000 be put into that fund.
        Thank you very much for the opportunity to present this
    testimony to the committee, and I am pleased to answer any
    questions or provide additional information.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        The Chair. Thank you so much for your testimony.
        Let me yield to Congressman Cole for any comments or
    questions he may have.
        Mr. Cole. Just very quickly, Madam Chair, I want to thank
    Dr. Harris-Hooker for her testimony and for spotlighting what
    this committee has learned during--probably knew before, but I
    think is much more acutely aware of about the social disparity
    in both outcomes and the unrepresentative nature of many of our
    healthcare providers and how important it is to address that
    imbalance going forward.
        And very much appreciate the work of the medical schools
    associated, the four you mentioned, with Historically Black
    Colleges and Universities--what an extraordinary contribution
    they have made to the country's healthcare--and what we need to
    do to expand capacity, quite frankly, going forward.
        So thank you for coming before us. And with that, I yield
    back to the chair.
        The Chair. Thank you very, very much.
        And I associate my comments with those of the ranking
    member. I think the historic black college medical schools and
    the professional training, one of the most serious areas is
    that we need to have many, many more minority medical
    professionals here to deal with what has been demonstrated in
    terms of the disparities that exist in our healthcare system.
        So, and the training is critical, and you are equipped to
    do it. You need the resources to do it, and we understand that.
    And again, we will be looking at what those numbers are and
    making a decision, but I thank you for the very strong
    testimony and the work of the historic black medical schools.
        So thank you very, very much, Dr. Hooker.
        Let me now recognize Katie Ray-Jones, who is the chief
    executive officer of the National Domestic Violence Hotline.
        Katie, you are recognized for 5 minutes.

    KATIE RAY-JONES, CHIEF EXECUTIVE OFFICER, THE NATIONAL DOMESTIC
                            VIOLENCE HOTLINE

        Ms. Ray-Jones. Thank you.
        Good afternoon, Chairwoman DeLauro, Ranking Member Cole and
    distinguished subcommittee members.
        Thank you for the opportunity to provide testimony on the
    importance of continued Federal investment in the Hotline,
    which is authorized as part of the Family Violence Prevention
    and Services Act and administered by the Family Violence
    Prevention Program, a program of the Family and Youth Services
    Bureau under the Administration for Children and Families at
    the Department of Health and Human Services.
        The Hotline, established in 1996, is the only 24/7/365
    national organization that directly serves victims of domestic
    violence, their friends, and family via phone, chat, and text.
    We are currently experiencing our highest contact volume in our
    25-year history, and to help meet this overwhelming need, I am
    here to request the subcommittee increase investment in the
    Hotline in fiscal year 2023 to $27,000,000.
        The Hotline's services are free and confidential. We have
    the most comprehensive survivor resource database in the
    country. Our advocates help victims and their families and
    friends, whether they are in throes of an emergency, seeking
    local help, or just in need of someone to talk to in that
    moment.
        Our expertise is routinely sought by national and regional
    media; Federal, State, and local governments; service
    providers, law enforcement, and nonprofit colleagues.
        On December 30, 2021, a Hotline advocate answered our 6
    millionth contact since our inception. Truly a bittersweet
    milestone. In calendar year 2021, the Hotline over 620,000
    contacts. We also knew once life returned to any kind of
    normalcy from the devastating impact of COVID-19 there would be
    more survivors needing support who had not felt safe to reach
    out during the height of the pandemic.
        Sadly, our instincts were accurate. In February 2022, the
    Hotline experienced the highest monthly contact volume in our
    history, 74,000 contacts reaching out for help in 28 days. Also
    in February, in an effort to use their technology to help
    survivors connect with our services, Google launched a new
    crisis search engine optimization. After this launch, the
    volume nearly doubled overnight, a powerful and somber
    illustration of how many are impacted by relationship abuse and
    need services or support.
        We desperately need to add a record number of new advocates
    on the line and implement technology advancements to manage
    this kind of volume. We need to increase our impact through
    loveisrespect, an initiative that engages, educates, and
    empowers young people to prevent and end abusive relationships.
        We also deeply value working in partnership with several
    national organizations to serve victims with specialized needs.
    The Hotline has worked with the National Indigenous Women's
    Resource Center to help design and implement a Native-run
    domestic violence helpline that provides culturally specific
    assistance to Native victims of domestic violence. And in March
    2017, Strong Hearts Native Helpline was launched.
        In addition, the Hotline also works with Abused Deaf
    Women's Advocacy Services to provide intervention, education,
    information, and referrals to callers who are deaf through the
    National Deaf Domestic Violence Hotline. While we are proud of
    how we have expanded our reach and services in order to meet
    the Hotline's primary goal of serving all survivors, we are
    also aware there remain some specialized populations we have
    yet to serve, such as those who choose to cause harm.
        This includes about 9 percent of our total contacts who
    reach out seeking information and support for changing their
    harmful behaviors. With additional and specifically dedicated
    funding, such as the $1,000,000 championed by Representative
    Lloyd Doggett out of Texas, we hope to explore opportunities to
    help abusive partners recognize their behaviors and access
    support to change them.
        It takes a comprehensive, multilayered national, State,
    regional, and local approach to fully support survivor safety
    and recovery. While we offer important emergency and support
    services for victims of domestic violence, our goal is to
    connect these survivors with local programs that have resources
    to help victims identify shelter, transitional housing,
    culturally specific programs, legal assistance, and economic
    supports necessary to help them escape their abusers. We urge
    the committee to also provide robust support to these
    lifesaving programs.
        Throughout my testimony, I have shared with you the
    tremendous impact of the dedicated advocates at the Hotline. As
    a result, I urge the subcommittee to continue its bipartisan
    support for the Hotline in fiscal year 2023 through an
    appropriation of $27,000,000. These funds would allow us to
    increase staffing by hiring additional advocates and support
    staff. When someone reaches out for help, we need to be able to
    answer.
        In conclusion, I would like to share feedback from a
    survivor who called the hotline.
        ``This conversation has been incredible. I feel like the
    tears in my heart are starting to dry up. Thank you for
    supporting me and helping me reach my own solutions. I feel so
    much hope and empowerment and like the healing has begun for
    me.''
        As you said, Chairwoman DeLauro, earlier, we need to seize
    the moment. And when someone calls for help, we need to be able
    to answer.
        Thank you for your time, and thank you again for your
    continued support for victims of domestic violence.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        The Chair. Thank you. Thank you for your advocacy.
        I think we all know and you just talked and you quoted
    ``hope and empowerment.'' That really is key and critical to
    this effort, and it has been we have moved so far with regard
    to domestic violence. Again, the problem exacerbated by the
    pandemic, hearing more about that. And so that we need to,
    again, as I say, seize this moment to act on it and to provide
    you with the trained personnel, help you with the trained
    personnel because somebody on the end of that line has the
    ability to empower, to save a life, and someone who isn't
    trained, it can go in a different direction.
        But we are there. I mean, our people are there. Again, it
    is a question of what the money is going to be. But overall,
    there really is a very basic understanding of what the
    circumstances are and how we have to deal with that hope and
    empowerment.
        Congressman Cole.
        Mr. Cole. Thank you very much, and I will try and be brief,
    Madam Chair.
        Number 1, I want to thank our witness. Very effective, very
    powerful advocacy. I particularly want to thank you, as a
    Native American, for the work that you have done in that area.
    That is a community, as you know, that has been
    disproportionately suffering from this issue.
        And I want to thank two other people, too. I want to thank
    the President of the United States, who, as a Senator, did
    Violence Against Women Act and has been probably the foremost
    champion in this area over the years. And I want to thank our
    chair because we wouldn't have gotten the Violence Against
    Women Act reauthorized if it hadn't been riding on the back of
    our bill when we finally got an omnibus bill done.
        And we had struggled, my friends on both sides of the aisle
    that were supportive of that legislation, to try and work
    through some of the knotty issues because how anybody can be
    against that legislation is beyond me. But had not been for
    this committee and our chair, that would still be lingering out
    there, would not have gotten across the finish line in this
    most recent omnibus bill.
        So even though we are not supposed to legislate on
    appropriations, sometimes we do, and it has to be with the
    consent of both sides, obviously. And in this case, we got
    that. But we wouldn't have it without the leadership of my
    friend the chair.
        But thank you again for highlighting this. Thank you for
    the incredible work that your volunteers and advocates and
    professionals do, helping people in an incredibly traumatic and
    difficult and often isolated situation. And when they reach out
    and ask for help, as my friend the chair said, it needs to be
    there. And robustly and quickly, and we need to help people get
    out of these situations or through them in a way that protects
    them physically and emotionally and their children physically
    and emotionally and, hopefully, helps anybody engaged in this
    activity to find a different way to work through whatever their
    issues and problems are.
        But again, Madam Chair, you have been a leader here. I
    appreciate it. I look forward to continuing to work with you on
    it.
        Yield back.
        The Chair. Thank you. Thank you very much, and we will work
    with you, Katie Ray.
        Let me now introduce Rick Ginsberg, dean of the School of
    Education at the University of Kansas, the Learning and
    Education Academic Research Network of the LEARN Coalition.
        Mr. Ginsberg.

     RICK GINSBERG, DEAN OF THE SCHOOL OF EDUCATION, UNIVERSITY OF
     KANSAS, THE LEARNING AND EDUCATION ACADEMIC RESEARCH NETWORK
                           (LEARN) COALITION

        Mr. Ginsberg. Thank you, Chair DeLauro, Ranking Member
    Cole, and members of the subcommittee. We appreciate your work
    on all of our behalf.
        I have been dean at the School of Education and Human
    Sciences at the University of Kansas for 17 years. But in my
    role as dean, I am also co-chair of the LEARN Coalition, a
    coalition of 41 leading research universities of education
    across the country, which supports critical investments in
    research aimed at advancing the scientific understanding and
    improving of learning and development.
        We advocate for greater funding for these priorities across
    all Federal agencies, and today, I will be speaking on the need
    for increased funding towards IES and two institutes with NIH,
    the National Institute of Child Health and Human Development
    and the National Institute on Mental Health.
        I want to start by noting that the LEARN Coalition is
    deeply appreciative of the increases provided to IES and NIH in
    fiscal year 2022, and we hope to build on this momentum to
    continue that strengthening in fiscal year 2023.
        We are also grateful for the inclusion of the report
    language in fiscal year 2022 on the importance of the
    administration appointing members to the National Board of
    Education Sciences. Unfortunately, NBES has been unable to meet
    due to lack of a quorum since 2016. We encourage the
    subcommittee to continue urging the administration to fill
    these important roles.
        Turning to the main purpose of my testimony, I am here
    today to request no less than $815,000,000 for IES overall,
    with $225,000,000 dedicated to the Research, Development and
    Dissemination line-item and $70,000,000 for the National Center
    for Special Education Research, NCSER.
        IES is essential to developing a comprehensive, reliable
    evidence base, ensuring that teaching and learning practices in
    our country are grounded in evidence and research. While only
    12 to 15 percent of NCER and NCSER's applications have received
    awards over the past several years, the number of grant
    competitions offered by IES are currently severely limited due
    to chronic understaffing within the agency.
        Furthermore, NCSER was unable to fund all the grant
    applications rated outstanding or excellent in fiscal year 2021
    due to a lack of sufficient funds. Such evidence displays how
    IES is currently too understaffed and too underfunded to
    support the Nation's education research infrastructure.
        We believe that an appropriation of $815,000,000 for IES
    overall, with $225,000,000 designated for RD&D will support the
    continued examination of what works and what does not work to
    further our education system's curriculum, instructional
    techniques, and assessments. This additional funding should
    also bolster IES's work towards COVID-19 recovery.
        IES is also integral to the education research training
    pipeline by providing key training and grant opportunities to
    increase the number of education researchers who can
    successfully compete for IES-funded research. Making the case
    for more IES funding, the renowned National Academy of
    Sciences, Engineering, and Medicine just released a report in
    March called ``The Future of Education Research in IES.''
        The Academy urged Congress to increase appropriations for
    IES, as it is severely underfunded despite an expanding
    workload. Indeed, the Academy report recognized--and I am
    quoting them here--that IES ``does not appear to be on par with
    that of other scientific funding agencies,'' in terms of the
    amount of the dollars.
        In addition to our request for IES overall, we urge
    Congress to provide $70,000,000 for special education research
    through NCSER. NCSER currently has a budget that has remained
    relatively flat since 2014. That is a long time. This has
    negatively impacted the research that provides special
    educators and administrators the evidence-based resources
    needed to improve academic outcomes for students with or at
    risk of disabilities.
        Last, I would like to emphasize the importance of increased
    NIH funding. The LEARN Coalition was disappointed that the
    President's fiscal year 2023 budget request did not include a
    healthy increase for the base NIH budget, but rather focused on
    increased ARPA-H funding. ARPA-H funding certainly is
    important, but that should supplement and not supplant NIH
    funding. Specifically, we believe the two programs require
    strong Federal funding.
        This is why the LEARN Coalition is requesting
    $2,020,000,000 for NICHD to examine brain functions and the
    impact of different educational services on learning and
    development. We also support an increase in funding for NIMH to
    $2,570,000,000. This increase will help further understanding
    of the behavioral, biological, and environmental mechanisms
    necessary for developing interventions to reduce the burden of
    mental and behavioral disorders and optimize learning and
    development.
        The LEARN Coalition believes that, collectively, these
    investments in education research will drive improvements in
    school, teacher, and student performance in the coming years.
        Thank you again for considering these requests. I am
    certainly happy to answer any questions you may have.
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        The Chair. Let me yield to the ranking member for comments
    or questions that he may have.
        Mr. Cole. I will try to make two quick points. First of
    all, number one--well, three points. Thank you for your
    testimony. It is very helpful, very illuminating.
        Secondly, I think it is fair to say that the chair and I
    agree with you about the imbalance between NIH funding and
    ARPA-H, and we say that as joint supporters of ARPA-H. And I
    suspect you will see that addressed in the bill. We don't want
    to lose the record that we have built up of working together in
    a bipartisan fashion to steadily increase NIH funding. I think
    that has paid enormous dividends for the country.
        And finally, I couldn't help but note looking behind you
    the very proud Kansas Jayhawk. As a fellow Big 12 guy, I want
    to take this opportunity to congratulate you on that amazing
    national title where you--where Coach Self and your Jayhawks
    pulled off one of the great games I have ever seen in an NCAA
    final. So, well done, Kansas.
        So, with that, Madam Chair, yield back.
        The Chair. Thank you. Thanks very, very much.
        And the ranking member addressed the issue that we will try
    to create the balance in NIH and with ARPA-H in terms of basic
    research. But also I think it is fascinating in the testimony,
    we had a hearing, it may have been yesterday--you lose track of
    time around here. But where we heard that with regard to
    special education teachers, that there really is such a
    shortage, and they feel that grows bigger with the number of
    kids that we are trying to provide an education for.
        So the role of being able to increase that number or
    understanding how it needs to be taught and, therefore, then
    the training of professionals in this area I think could really
    be helpful overall in terms of a quality education for our
    kids. But it is the data, you are a little bit like--this seems
    to be like the Bureau of Labor Statistics, the BLS for
    education with the information that you put together, but it is
    how you learn and how you teach. Basic fundamental questions of
    that underlie so much of what we do in the K through 12 space
    and then higher education.
        So the function of your efforts are really critically
    important in underlying the kind of directions that we can go
    in in terms of our programming. So I thank you very, very much
    for this rich testimony about a vital area with regard to
    education, and thank you very much for being with us today.
        Thank you.
        Mr. Ginsberg. Thank you both.
        The Chair. Let me introduce now Antonio Flores. Dr. Flores,
    president and CEO of the Hispanic Association of Colleges and
    Universities. Please, we recognize you for 5 minutes for your
    testimony.

     ANTONIO R. FLORES, PRESIDENT AND CEO, HISPANIC ASSOCIATION OF
                       COLLEGES AND UNIVERSITIES

        Mr. Flores. Chair DeLauro, Ranking Member Cole, and members
    of the subcommittee, thank you for the opportunity to testify
    on the importance of investing equitably in Hispanic-Serving
    Institutions for fiscal year 2023.
        The Hispanic Association of Colleges and Universities,
    HACU, was founded in 1986 and is the only national association
    that represents HSIs. These 559 institutions enroll over 5
    million students in the United States, the District of
    Columbia, and Puerto Rico.
        I urge you, respectfully, to fund Title V Parts A and B of
    the Higher Education Act as follows--$250,000,000 for
    Developing Hispanic-Serving Institutions, Title V, Part A, or
    $67,150,000 above fiscal year 2022, and $100,000,000 for
    Promoting Postbaccalaureate Opportunities for Hispanic
    Americans under Title V, Part B, or $80,340,000 above fiscal
    year 2022.
        HSIs educate more than 5 million students annually,
    including two-thirds of the estimated 3.8 million Hispanic
    college students in American higher education. Most of them are
    first-generation college students and come from low-income
    families. They also, HSIs, enroll twice as many African
    Americans as all the Historically Black Colleges and
    Universities combined, more than 40 percent of all Asian
    Americans in college today, and twice as many Native Americans
    as all the tribal colleges and universities put together, as
    well as a sizable number of non-Hispanic Whites.
        Additionally, while only accounting for 16 percent of all
    the colleges and universities in the country, HSIs enroll 31
    percent of all the Pell recipients. Despite their great
    diversity and need, HSIs remain at the bottom of the Federal
    funding priorities, compared to other Minority-Serving
    Institutions and HBCUs.
        Federal investments are essential to strengthen our
    workforce by enhancing educational attainment, especially in
    STEM and other fields of national priority. The U.S. Census
    Bureau reported that from 2010 to 2020, Hispanics accounted for
    more than half the total growth of our national population and
    are now over 63 million strong. And it has estimated that the
    Hispanic population will grow by 93.5 percent from 2016 to
    2060. Therefore, from 2020 to 2030, three of every four new
    workers joining the American labor force will be Hispanic.
        HSIs educate and train the most diverse and underserved
    communities and do so with fewer Federal resources per student
    than their peer institutions. As the Nation looks to rebuild
    the economy after the pandemic, it is critical that Federal
    investments strengthen our workforce by enhancing the
    educational capacity of HSIs to pave the path of success and
    opportunity for Hispanics and other underserved Americans.
        As the Hispanic growth rate in K-12 enrollment continues to
    accelerate, the number of Hispanic high-school graduates is
    expected to increase by 49 percent between 2012 and 2028,
    compared to 23 percent for Asian/Pacific Islanders and to a net
    drop of 3 percent and 15 percent for blacks and whites,
    respectively.
        The Bureau of Labor Statistics has projected that the
    Latino share of the workforce will increase dramatically from 1
    in 10 in 2010 to 1 in 3 by 2050, while white workers will
    decrease in number considerably. Blacks will remain at 12
    percent. Asian Americans will increase from 5 to 8 percent, and
    all others from 2 to 5 percent.
        For America to remain competitive in the global economy, a
    much better educated and trained Hispanic labor force is
    required. HSIs must be placed at the top of Federal investment
    priorities without further delay.
        HACU and its supporters wholeheartedly commend the U.S.
    Congress and the administration for funding generally HBCUs and
    other Minority-Serving Institutions, and we urge them to
    continue doing so. Likewise, we exhort Congress and the
    President to invest with equal commitment in HSIs and their
    underserved students. They truly are the future of the Nation.
        On behalf of HACU and the Nation's 559 Hispanic-Serving
    Institutions it represents, I thank you most sincerely for your
    time and consideration of our request.
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        The Chair. Thank you so much. I really appreciate your
    testimony, Dr. Flores.
        And really, you never sit back on what you have done, but
    always to move forward. But I was very excited that what we did
    in this conference committee in the 2022 bill, we increased the
    HSIs about 23 percent, and it was historic in terms of that.
    And I am just going to leave it with this, that it is my
    intention that we continue that historic climb with regard to
    HSIs.
        Mr. Flores. Thank you.
        The Chair. So I thank you for what you do, and really, it
    is a pleasure to listen to you.
        Thank you.
        And with that, let me yield to Congressman Cole.
        Mr. Cole. Thank you very much, Madam Chair.
        And Dr. Flores, that was an excellent presentation. Really
    compelling, frankly. And the statistics that you laid out are,
    I think, more than informative. I think they are persuasive as
    well, and I agree with the chair. These are institutions that
    are doing an amazing job, and as your numbers suggest, they are
    only going to become more important in the future as this
    population becomes a larger percentage of our total population.
        So this is an area that I know my friend and I will work on
    together. I was very pleased to see the increase in the
    appropriations in the 2022 bill, and I pledge to continue to
    work with her to see that we try to move forward in this area.
    But again, thank you for an excellent, excellent presentation.
        With that, I yield back, Madam Chair.
        The Chair. Thank you.
        Let me recognize Janet Hamilton, the executive director of
    the Council of State and Territorial Epidemiologists.

       JANET HAMILTON, EXECUTIVE DIRECTOR, COUNCIL OF STATE AND
                      TERRITORIAL EPIDEMIOLOGISTS

        Ms. Hamilton. Chair DeLauro, Ranking Member Cole, and
    members of the subcommittee, thank you for the opportunity to
    testify today. I am Janet Hamilton, executive director of the
    Council of State and Territorial Epidemiologists, or CSTE. CSTE
    represents public health epidemiologists nationwide working to
    respond to emerging public health threats. For fiscal year
    2023, CSTE asks that you provide at least $250,000,000 for
    CDC's Data Modernization Initiative, or DMI.
        Since I last testified in front of this committee 3 years
    ago, we have made progress in our public health data systems,
    delivering data faster to save lives, but we are not done yet.
    As we saw during COVID-19, our public health data systems were
    not prepared, nor is COVID-19 the last threat we will face. As
    we speak, a monkey pox outbreak is spreading globally, and a
    completely new threat is causing unexplained hepatitis in
    children. State and local public health departments are busy
    responding to these potential cases, but they cannot do this
    without the key data pieces to inform the investigation.
        Public health response happens at the local level, and we
    must preserve the role that State, territorial, tribal, and
    local health departments play in our public health data
    infrastructure. Led by the CDC, State and local health
    departments need a nationwide public health surveillance system
    to detect and respond to the threats. To build this
    infrastructure, we need the resources to support our existing
    laws. All States have laws that require the reporting of
    certain public health threats by physicians, hospitals, and
    laboratories. It is the process by which these data are
    reported that the DMI seeks to improve.
        With our partners in the Data: Elemental to Health
    Campaign, CSTE called on Congress to provide the first-ever
    dedicated funding for public health data systems in fiscal year
    2020. Thanks to this subcommittee, Congress has provided more
    than $1,000,000,000 through annual and supplemental
    appropriations for DMI. Data: Elemental to Health estimates
    that the actual need for data modernization is at least
    $7,840,000,000 over 5 years. Yes, we know that is a big number,
    but we also know how important it is to get this right.
        There are five key pillars of the Data Modernization
    Initiative that are part of an enterprise-wide interoperable
    approach. More details are available in my written testimony,
    but to recap quickly, first, electronic case reporting, or ESR,
    assures that when providers see patients' demographic and
    clinical information, along with test results for reportable
    conditions, they are rapidly shared with State and local public
    health. ECR is closing health equity blind spots. Initial
    implementations demonstrate over 90 percent completeness of
    race and ethnicity data, far better than the 65 percent we had
    without this critical tool.
        State, local, tribal, and territorial health department
    staff contact and interview cases and then provide the case
    investigation data to the National Notifiable Disease
    Surveillance System, NNDSS, the second pillar of DMI, but
    resources are lacking. With COVID-19, there are numerous
    examples where health department staff conduct outbreak
    investigations or identify clusters from genomic sequencing but
    are unable to electronically share those data with NNDSS due to
    agency infrastructure shortages.
        The third pillar of DMI is electronic lab reporting where
    labs submit test results to public health as soon as they are
    available. Test results often serve as the first piece of
    information received by State and local public health to launch
    a rapid response. The fourth pillar is electronic vital records
    systems, which ensures real-time transmission of birth and
    death data for statistical and surveillance purposes. And the
    fifth pillar, the National Syndromic Surveillance Program,
    helps detect, monitor, control, and prevent emerging diseases.
        These five pillars are interwoven, and each plays a key
    role in moving us from a sluggish, outdated, and burdensome
    patchwork system to a 21st century public health data
    infrastructure that provides complete, accurate, and
    instantaneous data. We do not have a science problem. We have a
    resource problem. To make our public health systems work now
    and in the future, we need regular, sustained annual funding
    for our public health surveillance systems and data workforce.
        Again, we respectfully request the subcommittee provide at
    least $250,000,000 for DMI in fiscal year 2023. Thank you.
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        The Chair. Thank you very, very much. We put in, I guess,
    $100,000,000 in the 2022 bill for data modernization. I think
    we have had enough hearings, and, again, that was done on a
    bipartisan basis. I think there is a recognition that we nearly
    had the collapse of the CDC during the pandemic because of a
    lack of public health infrastructure. So let me be succinct
    with you. We are committed to doing that. Again, I was at the
    CDC on Friday, and we had a report on data modernization, which
    is extraordinary, and progress has already been made. We are
    going to work to continue to move that forward.
        And also, I want to try to take a look at introducing what
    are the kinds of authorities the CDC needs to have in order to
    be able to collect data on a uniform basis and have the data
    reported back to the CDC in real time, and not have a patchwork
    of data that is out there that is held back from the CDC. So I
    will leave it there but committed to increasing that
    opportunity. We have to come out of this pandemic with the
    public health infrastructure so that, in fact, this doesn't
    happen again with regard to the CDC. The CDC is too vital to
    our, you know, healthcare system.
        Congressman Cole.
        Mr. Cole. Thank you very much, Madam Chair. Dr. Hamilton, I
    remember the last time you testified because it was one of the
    very last hearings that we had----
        Ms. Hamilton. Yes.
        Mr. Cole [continuing]. Before COVID hit us, and in that
    sense, prophetic in the warnings that you and others were
    issuing about the need to do exactly what you are here
    advocating for today. And I will reiterate the chairman's
    support. We think what you are doing is important. We think
    these investments are critical. We think they need to be
    sustained going forward, but it is always timely for you to
    come back and remind us, and I will be working with the chair
    so we can continue the progress we have made. I think it is
    absolutely essential to the public health and well-being of the
    American people going forward that we get out of this patchwork
    into a much more uniform, modern, and effective system that
    gives us the information we need to respond in a timely fashion
    to threats that genuinely, as we saw, can quickly get out of
    hand and be just devastating to our population and, honestly,
    people around the world.
        So, again, I don't think this is an area of any debate
    between the chair and me. I think this is an area where we will
    have to scratch our heads and see how we find the resources for
    all these worthy causes, but there is just no question this
    investment needs to be made. But thanks for coming before the
    committee. Thank you for the work you and your colleagues in
    public health have done and for the extraordinary performance
    over the pandemic where, you know, I have just seen local
    public health people do amazing things. And the data has made a
    difference as Congress has tried to come together and figure
    out what to do during the pandemic to both minimize the loss of
    life and get us through this to the other side of it with our
    economy intact and our people damaged as little as possible. So
    thanks for your contributions.
        I yield back, Madam Chair.
        The Chair. Thank you. I recognize Ms.--let me see if I have
    this right--Szilagyi.
        Ms. Szilagyi. Very good.
        The Chair. Okay. That is great. Thank you. President of the
    American Academy of Pediatrics. Wonderful to have you with us
    today. Thank you.

       MOIRA SZILAGYI, PRESIDENT, AMERICAN ACADEMY OF PEDIATRICS

        Dr. Szilagyi. Thank you so much. To Chairwoman DeLauro and
    Ranking Member Cole, thank you so much for the opportunity to
    participate in today's public witness testimony. My name is
    Moira Szilagyi. I am a primary care pediatrician and president
    of the American Academy of Pediatrics. On behalf of be AAP, I
    thank you for all of your efforts to fund programs that are
    essential for the optimal health and well-being of children.
        While I address numerous programs that are important for
    children's health in my written testimony, my original plan
    today was to focus on three programs of particular importance:
    firearm injury and mortality prevention research, the Pediatric
    Subspecialty Loan Repayment Program, and the Pediatric Mental
    Health Care Access Program. I plan to talk about the need to
    address the serious gaps in the pediatric workforce by
    increasing funding for the Pediatric Specialty Loan Replacement
    Program to $30,000,000 to improve access to care for children
    with special healthcare needs. This program is vital and very
    much needed. And I had planned to discuss increasing funding
    for the Pediatric Mental Health Care Access Grant Program to
    $14,000,000 to help meet the mental health challenges facing
    young people and the rates of suicide, anxiety, and depression
    that have all been exacerbated by the COVID-19 pandemic,
    especially among people of color. We do need to increase mental
    health services for children and enhance the capacity of
    pediatric primary care providers to screen, treat, and refer
    children with mental health concerns.
        But then we got the news about the school shooting at Robb
    Elementary School in Uvalde, Texas, on Tuesday, and that is
    what is at the top of my mind today: 19 students and two
    teachers killed by gunfire. Just like the 10 people shot at the
    Tops Supermarket in Buffalo and the one person killed and five
    injured at the Irvine Taiwanese Presbyterian Church in my home
    State of California just weeks ago, there is never any
    justification for this kind of violence anywhere, ever, and yet
    we as a Nation have been here before too many times. Columbine
    High School, Sandy Hook Elementary, Marjorie Stoneman-Douglas
    High School, and so many other schools have been sites of
    terror, violence, and death.
        Many more daily acts of gun violence do not even make the
    headlines but also rob children of their childhood and families
    of their children. Just visit a hospital emergency department
    to see the daily toll of firearm injuries. In fact, a CDC
    report published just this month showed that the U.S.
    experienced a historic rise in gun deaths in 2020, and
    communities of color were disproportionately harmed. As a
    pediatrician, parent, and grandmother, and someone whose
    personal life has been effected by gun violence, I urge you to
    stand up for those killed or injured by gun violence.
        The AAP was extremely grateful when this subcommittee
    agreed to provide Federal funding for gun violence prevention
    research in the 2020 fiscal year for the first time in 25
    years, and we are tremendously appreciative of Congress
    providing $25,000,000 to the CDC and NIH for firearm injury and
    mortality prevention research for the last 3 fiscal years. But
    if events from the past several weeks show anything, it is that
    we need to do more, and one thing we need to do is increase
    research on ways to reduce gun violence and disparities in gun-
    related deaths, and to prevent the next shooting at a school, a
    church, or another public setting.
        Federally-funded public health research has a proven track
    record of reducing deaths, whether from motor vehicle accidents
    or smoking. The same approach should be applied to increasing
    gun safety and reducing firearm-related injuries and deaths,
    including suicides. Continuing and expanding CDC and NIH
    research is critical to that effort. We strongly urge Congress
    to increase the funding level for firearm injury and mortality
    prevention research to $35,000,000 for the CDC and $25,000,000
    for NIH.
        We should never become accustomed to acts of gun violence.
    We owe to the children in that classroom in Uvalde, the people
    shopping at Tops, and the parishioners at the Irvine Taiwanese
    Presbyterian Church to increase our efforts. Thank you so much
    for allowing me to testify today. I look forward to continuing
    this conversation.
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        The Chair. I am going to yield to Congressman Cole for any
    comments or questions.
        Mr. Cole. Well, I want to thank the witness for her
    testimony. It is very powerful and certainly very compelling
    given the tragic events that we have had this week. And I want
    to compliment the chair. She is the one that started this
    pattern of investments in gun violence research and, I think,
    has been probably the leader in Congress on that, quite
    frankly. So, again, I don't know where we will end up, but
    despite what some people think, this has not been a matter
    where we have had any big differences, quite frankly. We
    signaled that, I think, maybe in 2019, Madam Chair, when we put
    language in there to try and let the CDC and the NIH know
    please go ahead if you decide that, and then my friend, the
    chair, followed up with an appropriation, I think, the very
    next year when the hint wasn't taken. So let's just put the
    money specifically there and give you an unmistakable signal.
        So, you know, I don't think studying problems hurt. I think
    it helps, and, again, I tip my hat to the chair for having been
    a leader in this area, and I yield back.
        The Chair. I thank the ranking member for really the
    cooperative effort. We had hearings on this, and this is an
    issue of public health, and that is how we want to try to, you
    know, to deal with it. And it is no way to restrict anybody's
    rights to own a firearm, but to understand, as well you pointed
    out, that, you know, we have done this with automobile safety,
    we have done with smoking, you know, and we have come out with
    some very, very good remedies here that have cut down
    automotive accidents and deaths, and the same with smoking.
        There isn't any reason why not to do this. We are going to
    continue. We are going to continue to do this, and every time
    an event happens, like it happened 2 days ago, there is more
    and more need for us to understand. For me on the education
    side, I would put a mental health professional in every school
    in the United States, you know. That would be, you know, a way
    to help deal with our kids. But the aftermath of what happens,
    I really have got in my mind's eye this little boy that I heard
    this morning who survived. He is a 4th grader, and he was
    shaking while he was talking about what he saw around him, you
    know, with his pals, his friends, who were killed. And, you
    know, what happens in that beautiful little brain? What goes
    on? How can we prevent this? How can we do this?
        So thank you. Thank you for your focus on this and so many
    other areas that you focus on. You really provide direction for
    us, and we rely on your data, your work, and your commitment,
    so thanks very much. I appreciate it. Thank you.
        Let me introduce Mark Anthony Figueroa, A GEAR UP alumnus,
    and the National Council of Community and Education
    Partnerships. And I know how the ranking member feels about the
    GEAR UP Program. So, Mr. Figueroa, please, your testimony, and
    you are recognized for 5 minutes.

     MARK ANTHONY FIGUEROA, GEAR UP ALUMNUS, AND NATIONAL COUNCIL
                FOR COMMUNITY AND EDUCATION PARTNERSHIPS

        Mr. Figueroa. Thank you. Madam Chair DeLauro, Ranking
    Member Cole, and distinguished members of the subcommittee,
    thank you for giving me the opportunity to provide testimony on
    the profound impact that the Gaining Early Awareness for
    Readiness for Undergraduate Programs Initiative, better known
    as GEAR UP, has had on my life. My name is Mark Anthony
    Figueroa, and it is my honor and pleasure to be sharing this
    testimony on behalf of the GEAR UP alumni and over 500,000 GEAR
    UP students across the country.
        Given the program's return on investment, I respectfully
    urge the committee to appropriate $435,000,000 for GEAR UP in
    fiscal year 2023 to support an additional 80,000 students
    across our country so that they, too, can have the support I
    received in GEAR UP.
        As you may know, GEAR UP provides 6- to 7-year grants to
    States and partnerships comprised of K-12, higher education,
    and community-based organizations that strengthen pathways to
    college and careers in low-income communities. GEAR UP exposes
    students and their families, starting in the 7th grade, to
    comprehensive intervention that follow them through high school
    graduation and, ultimately, through the first year of
    postsecondary education. GEAR UP uses early and sustained
    interventions to ensure that students are successful in
    rigorous courses, are knowledgeable about the steps necessary
    to prepare for life beyond high school, and ultimately enroll
    in a high-quality certificate, associates, or bachelor's degree
    program that suits their goals. In the most recent year in
    which we had a large class of graduating seniors, the
    postsecondary enrollment rates of GEAR UP students were over 31
    percent higher than low-income students nationally. Considering
    that GEAR UP achieves this critical goal at a cost of
    approximately $645 per student per year, I strongly believe
    that the investment in GEAR UP pays significant dividends. GEAR
    UP is a powerful catalyst for sustained community improvement.
        I grew up in the eastern part of Washington State in the
    city of Pasco. This part of the country is filled by passionate
    Latino, and Latino immigrant, and migrant families working in
    predominately agricultural fields. With long days and hard
    work, preparing for higher education can be challenging and a
    first for many. As a first-generation migrant student and the
    eldest of six in my family, postsecondary education seemed like
    a very distant, daunting, unknown land with no clear path
    towards it. However, participating in the GEAR UP Program
    helped me actualize my dreams of a postsecondary education
    through mentors, college and career fairs, FAFSA nights, and
    college admissions workshops.
        Being the first in my family to pursue higher education, my
    parents and I had so many questions. It is a daunting process,
    especially if done alone. Nevertheless, GEAR UP was there to
    support and walk us the entire way. Because of GEAR UP, I was
    admitted and graduated from Washington State University. With
    these experiences and the competence that GEAR UP gave me, I
    was able to develop strong leadership skills, community
    connections, and discovered all the ways to give back to my
    community.
        During my time at Washington State University, I connected
    with other first-generation migrant students, and we encouraged
    one another to follow our dreams. I was elected and served
    student government and also helped lead a student ministry at
    the intersection of faith and culture. Having led the way with
    the support of GEAR UP, I am now there for my parents and five
    sisters as they navigate the college-going process. Currently,
    I work with local civic engagement organizations to encourage
    marginalized members of my community to elevate their voices
    and get involved.
        As a current diversity advocate, a former high school
    history teacher, a soccer coach at the high school where GEAR
    UP supported me, and a graduate student pursuing a master's
    degree in theology, I can attest to the truth that GEAR UP does
    work. For me, none of this would have been possible without the
    guidance of the GEAR UP program. Through my own achievements in
    attending postsecondary education, I can see the generational
    barriers in my family have been removed for future generations,
    and they may find the same success that I have through
    education.
        While the support that GEAR UP provided me was truly
    priceless, the only way that other students will be able to
    access the educational experiences I had because of GEAR UP
    will be to continue to increase funding. Acknowledging that I
    am just one of thousands of families GEAR UP has positively
    impacted highlights the impact of the GEAR UP Program. As you
    take on the work of preparing for the fiscal year 2023
    appropriations, I respectfully urge you to consider increasing
    the investment in the GEAR UP Program to $435,000,000 so that
    80,000 more students just like me can benefit from the program
    as I did.
        Thank you to the committee for taking time to hear my
    testimony.
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        The Chair. Thank you for your testimony, and you are the
    face of the GEAR UP Program, and what a success story it is.
    And I am going to yield to a Congressman Cole, and then I will
    say something, but, Congressman Cole----
        Mr. Cole. First of all, to our witness, Mr. Figueroa, I
    could not have done a better job. And to our friends at GEAR
    UP, you could not have had a better representative to come
    before this committee. This is a program, as the chair knows,
    that she and I have worked on together for 7 years. And I don't
    know what the final number will be, but for 7 years in a row,
    we have been able to increase this program, and you are a
    shining example of why these investments pay off.
        I always tell people if we can get you to and through
    college, you know, you are, on average, going to make
    $1,000,000 more in your lifetime. Don't worry, the Federal
    Government is going to get a share of that $1,000,000. And so
    this is literally a program that pays for itself, in my view,
    and I often point that out in connection with TRIO, a companion
    program in many ways, but that has produced over 5,000,000
    college graduates for this country that probably would not have
    had the opportunity to go or succeed at college. I feel the
    same way about GEAR UP.
        My own State is full of first-generation college students.
    I am a first-generation college student, and the point you make
    about families wanting to do this, you know, but not knowing
    how to navigate the way, not necessarily knowing how do we
    prepare, what are the things that we need to make sure that our
    son or daughter does at the appropriate age so they are ready
    to go. We don't want to just get them to college. We want them
    to have the background to succeed, as you clearly are doing, in
    higher education.
        So thank you for your eloquent advocacy for this program
    and for the personal example, and thanks for pointing out what
    a difference the program will make, not only for you, but for
    your brothers and sisters. And that is one of the big spillover
    impacts of this. I just think these programs are so wise and,
    again, such good investments for our country to make, not just
    individually for your future, but collectively in our own
    future. These things pay off big, big, big time for us, and,
    again, I salute the chair. She has always been a terrific
    partner in progress in this area, you know, whether she was
    chair or ranking member. I know how deeply she believes in the
    program, and we are going to continue to work together, and
    hopefully we can continue to come up with good results.
        But thank you, Madam Chair. With that, I yield back to you.
        The Chair. Thank you, and last year in 2022, it was
    $378,000,000, I understand it, and obviously we will take a
    look at the money. But, you know, oftentimes people say, you
    know, is this Federal program working, is that Federal program
    working. GEAR UP works, and you are the poster child here for,
    you know, the success, and, as the ranking member pointed out,
    with the spillover effect. So GEAR UP will be front and center
    for us as we move forward. Thank you so much for your
    testimony. Thank you.
        Mr. Figueroa. Thank you.
        The Chair. And for your success. Thank you for what you are
    doing. An M.A. in theology. Okay. This is great.
        Mr. Figueroa. Yes, thank you.
        The Chair. Thank you. We now have Esther Lucero, president
    and CEO of the Seattle Indian Health Board. Esther, you are
    recognized for 5 minutes.

      ESTHER LUCERO, PRESIDENT & CEO, SEATTLE INDIAN HEALTH BOARD

        Ms. Lucero. It is still morning time in the Seattle area,
    so I would just say [Speaking native language]. My name is
    Esther Lucero, Chair DeLauro, and it is a privilege to meet you
    at least in this virtual setting. And Ranking Member Cole, it
    is always a pleasure to work with you, and I am always honored
    to see another native person in such a prominent role but also
    with such longevity. So we are seeing each other in a different
    committee this time, and I am pretty excited about that.
        So let me give you a little bit of perspective on the
    Seattle Indian Health Board. So we are a really unique
    organization in the sense that we are deemed an urban Indian
    health organization, and we were the very first urban Indian
    health organization to become a federally-qualified health
    center. So what that means is we see all people, but we see all
    people in the native way. Now, another thing that makes us
    unique is we operate the Urban Indian Health Institute, which
    is one of 12 tribal epidemiology centers in the Nation, and we
    are deemed a public health authority for the Indian Health Care
    Improvement Act and permanently reauthorized in the Affordable
    Care Act.
        Now, these things are significant because what it allowed
    us to do was have an incredible response to COVID, and when I
    say ``incredible,'' it was truly community driven, and it was
    truly culturally attuned. And I want to make sure that this
    committee, in particular, recognizes the value of community
    health centers. And it doesn't always place so much dependence
    upon county systems or State systems in regards to being a
    public health authority. The reason I say that is because we
    have an incredible relationship with our 29 federally-
    recognized tribes here in the State of Washington, and they
    advocated so that we could actually have a more community-
    centered response to COVID. And for that reason, we have 98
    percent of all of our American Indians/Alaska Natives in
    Seattle in the King County region who are vaccinated, and I
    think that is a true testament to what we are capable of doing,
    especially with the public health arm where we were able to
    provide culturally-attuned education and awareness, and really
    develop trust with our communities.
        So the reason I bring up COVID is because we were able to
    show one another what we are capable of, right? There were so
    many things that we said we couldn't do, like telehealth, for
    example, but we did it, right? We were able to pivot on a dime
    to make sure that we could meet the needs of our people. Now,
    something else that occurred through COVID is that we have seen
    the most significant increase and investment in Indian Health
    Service in my entire history, probably in my lifetime. And when
    we think about this particular committee, Medicaid has been
    used to grossly supplement an underfunded system, right? And so
    when I think about that, we were actually successful at
    securing 100 percent FMAP in the 2-year pilot.
        And how that resulted was, it resulted in an $18,000,000
    cost savings for the State of Washington, which was then
    allocated to an urban Indian line item. And now we are using it
    as a pilot to demonstrate the impact of traditional new
    medicine as a billable service. Now, obviously, if we can
    extend a 100 percent FMAP in perpetuity, then that would
    actually increase our ability to provide culturally-attuned
    services, which inevitably result in cost savings in the
    emergency centers, right, because culture actually is
    prevention and one of the best ways to overcome trauma.
        Additionally, we operate a 65-bed residential treatment
    program in our treatment center, which we had to push pause on
    services because there was a lack of infrastructure dollars.
    Now, we are about to reinstate that facility and expand it to
    92 beds for a couple of reasons. One is the opioid crisis
    reminded us that we have to actually adapt our environment to
    not only do the traditional abstinence-based recovery programs,
    but also to do medically-assisted treatment in an impatient
    facility. We also have a desperate need to expand our services
    to support the needs of pregnant and parenting women, and so we
    have identified a site and will be purchasing that site and
    rebuilding to address those needs.
        Now, the reason that is significant is because another
    thing we saw is finally we had investments in infrastructure
    related to behavioral health, right, build expansion through
    HRSA, and also, we are able to use our grant dollars to expand
    in other ways. And I would like to see that continued because
    the problem is that we don't have enough beds. The problem is
    we don't have enough housing. The problem is we just don't have
    enough resources to solve some of these things that are
    exacerbated by things like the pandemic.
        And so when I think about, you know, things that are really
    challenges, I think about workforce development, and here we
    are in the age of the great resignation, and we need a
    significant investment, particularly in mental health services.
    If we are going to put a mental health provider into every
    single school system, like you said, Chair DeLauro, then we
    must invest in our workforce. And so we are asking for a
    $1,000,000,000 investment in the Indian Health Care Workforce
    Development Program so that organizations like ours can
    continue to really add and build to that infrastructure.
        So I just want to say thank you for your support, and it is
    an honor to be here with you today.
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        The Chair. Thank you so much, and thank you for the
    richness of the presentation, just real strong leadership in
    this effort. Really, it is more than encouraging, it really is,
    you know, and the ranking member can speak, you know, in a
    granular basis about the Indian Health Service. It has been a
    priority of his, you know. Really, I think it is historic. You
    know, it is all about who he is. But I am happy to hear you say
    that the increase that we did do for the IHS was historic. It
    doesn't end there, but what we need to do is to try to make
    sure that we don't have a separate healthcare system that is
    not functioning for, you know, for the Native-American
    population. It just shouldn't be. There should be parity in the
    kind of health opportunities that people should have.
        If it is on its own, then, for gosh sakes, let's make sure
    it has the resources, it has the trained personnel, and
    everything that is needed to deal with a myriad of problems
    that occur, you know. We have talked about, you know, violence
    against women before. We know that that is there. We are
    talking about, you know, pediatric care and children. And so I
    want to ask you, and I want the ranking member to speak, what
    is your situation with infant formula, you know, and how you
    all are handling, you know, that effort. And telehealth, how
    can we help you, you know, with that? And I thank you for the
    work that you did through COVID, but we need many more
    conversations about the Indian Health Service and how we should
    be strengthening it, and what its direction is for the future,
    and where it should be. But so glad that you are there, and
    thank you for such a powerful, powerful testimony.
        Congressman Cole.
        Mr. Cole. Thank you very much, Madam Chair, and it was a
    terrific presentation. Thank you so much for making so many
    important points in such a brief presentation. And I want to
    thank my friend, the chair, who has been extraordinarily
    helpful on these issues. There are a lot of things, of course,
    and the witness and I would agree, that need to be done.
    Someday we will get forward funding, just like the Veterans
    Administration, with both our urban Indian health centers and
    for IHS. And I was very pleased to see Secretary Becerra bring
    up the idea of mandatory funding. I know that is controversial
    on both sides of the aisle with our budget hawk friends, but
    the reality is, this is the treaty and trust obligation that
    United States willingly assumed but has never fully funded, and
    we have made some progress.
        I particularly want to echo what you had to say about the
    outstanding job that our urban Indian health centers did and,
    frankly, our tribal governments did with the resources we put
    at their disposal during COVID. In my home State of Oklahoma,
    the number one vaccination site was the health care center at
    the University of Oklahoma in the middle of Oklahoma City. The
    number two was run by the Chickasaw Nation in Ada, Oklahoma, a
    town of 25,000, and, I don't know, the last count I got, it was
    somewhere well over 75,000 vaccinations, and that is a while
    ago. And they set it up, ran it, made it available to everybody
    as most of our tribes did. You didn't have to be tribal. It was
    just another network.
        And, frankly, in Oklahoma, as rural as we are, having the
    distribution of vaccination sites and, in many, cases given
    particularly the early vaccines that had to be stored in
    unusually, you know, cold temperatures, honestly, if you didn't
    have Indian hospitals in these areas, there wasn't anybody else
    capable of actually housing the facilities. It is one of the
    reasons why, again, while they had a separate allocation, they
    opened up their allocations to anybody who would show up for a
    vaccination. So they became, for us, an alternative healthcare
    system that served every single Oklahoman, not just tribal
    members, and that gave us a lot more reach than we otherwise
    would have had.
        And, again, this committee, you know, wrote the check and
    did great work under my friend's friends leadership, the chair,
    so we are going to continue working on these problems. Our
    colleague, Representative McCollum, is always a fighter on the
    forward appropriations front. She has got the legislation. I
    remember we both still offer it, but we would always co-sponsor
    one another's bill. So we never knew who was going to be in the
    majority, but we knew if we had one on both sides, we would
    have a chance of moving it forward. And she has been a great,
    great worker in these areas, you know, from her time as the
    chair of the Interior Subcommittee. She now chairs a much
    bigger committee obviously with Defense Subcommittee, but she
    hasn't lost her passion and her focus on Native issues.
        So we have a lot of friends on these issues in this
    committee, and, again, it is an area where I am really proud to
    say the effort to move forward has been bipartisan because,
    again, trust and treaty obligations know no boundary on the
    basis of partisanship. These are agreements we have coming
    forward, and I want to thank you. You know, the job you have
    done in Seattle and, frankly, through the Northwest, some of
    our best, you know, urban health care centers are in the
    Northwest, and the tribes there are leaning forward. They are
    very, very advanced and sophisticated in the care that they
    offer, and, quite frankly, offer the additional resources
    beyond the Federal resources that tribes, if they are doing
    well economically, invest in these facilities. I mean, that is
    above and beyond.
        I know certainly in the case of my own tribe, many of the
    tribes in Oklahoma--Cherokees and Choctaws--run amazing systems
    where they take the Federal dollars, Madam Chair, use that.
    They contract directly with the Federal Government, but then
    they put their own money on top of it to provide additional
    resources. And, again, they don't just do that for their
    tribes. If you are contracting, you know, any Native American
    can show up at any Native-American facility and be eligible for
    the care. You are not allowed to say, oh, we just take care of
    Chickasaws here. So when they are putting in extra money, they
    are putting in, quite often, to help members from tribes that
    might not be quite as blessed economically as they are.
        And so, yeah, I just appreciate your great work, your great
    testimony. Madam Chair, thanks for indulging me on the time. I
    know it has been a long day----
        The Chair. Oh no, no, this is important.
        Mr. Cole [continuing]. On this particular panel, and thanks
    for all your help in this area. You have been spectacular.
        The Chair. Thank you.
        Mr. Cole. I yield back.
        The Chair. Thank you. I just want to have a question.
    Infant formula. How have you fared, Esther?
        Ms. Lucero. It has been very challenging, but, you know, we
    do what we do, which is we reach out to community, and we try
    to identify where our rations are, and we try to do that
    through the groups that we actually serve. So that is how we
    have been able to respond is trying to pool our resources to be
    able to meet the needs of our most vulnerable people. So I wish
    I had a better answer but, you know, again----
        The Chair. Well, we are going to keep at it. The issue at
    the moment is to deal with supply, but the safety issue is
    very, very critical. On that, we have to really be clear that
    the product on the shelf is safe for the babies to take. And I
    see my friends of the American Academy of Pediatrics, and I
    think that this is woefully underreported, the number of
    youngsters, babies who are going to emergency rooms with, you
    know, vomiting or diarrhea. And, you know, it is directly
    related to a recalled product that was contaminated.
        So, again, thank you. Thank you, but keep in touch with us
    on that as we go forward. That would be very, very important
    information, if the distribution is getting to you, and, you
    know, to the tribes. So please, please do.
        Ms. Lucero. Absolutely. Thank you again so much.
        The Chair. Thank you. Thank you.
        Mr. Cole. Bye-bye.
        Ms. Lucero. Bye.
        The Chair. And let me introduce Lodriguez Murray, senior
    vice president, public policy and government affairs, at the
    United Negro College Fund. Lodriguez, please, your testimony,
    and I recognize you for 5 minutes.

      LODRIGUEZ MURRAY, SENIOR VICE PRESIDENT, PUBLIC POLICY AND
             GOVERNMENT AFFAIRS, UNITED NEGRO COLLEGE FUND

        Mr. Murray. Chairwoman DeLauro, Ranking Member Cole, my
    name is Mr. Lodriguez Murray, senior vice president for public
    policy and government affairs for UNCF, United Negro College
    Fund. You may be familiar with our motto, ``A mind is a
    terrible thing to waste.''
        UNCF has two functions. First, we raise funds on behalf of
    private historically black colleges universities, or HBCUs.
    Second, we also are a significant scholarship granting
    organization. Annually, UNCF awards over $100,000,000 in
    scholarships to approximately 10,000 students at some 1,100
    different colleges and universities. UNCF is the second-largest
    private provider of scholarships in the country overall.
    Additionally, we are the largest private provider of
    scholarships to minorities. That means UNCF doesn't just
    represent 37 member institutions or the 100-plus HBCUs, but we
    really represent the concerns of low- to moderate-income
    students wherever they are enrolled.
        Personally, I am an HBCU and a UNCF product. When I arrived
    at Morehouse College, I was a first-generation college student
    and a first-generation high school graduate. Largely because of
    UNCF support, I was able to graduate Morehouse nearly debt
    free. This is why my testimony today is a full circle moment.
        HBCUs have received a great deal of attention recently. The
    coronavirus pandemic has brought much-needed attention to long
    persistent disparities. HBCUs have been at the forefront of
    improving education and health disparities long before the
    issues have recently become vogue. For over 150 years, HBCUs
    have been educating the progeny of slaves and now do more to
    educate and graduate underserved students than any other group
    of higher education institutions in the country.
        Now, there has been an influx in funding to HBCUs. This
    subcommittee and, Madam Chair, your full committee have been
    responsible for funding that has stabilized many HBCUs and
    allowed us to successfully navigate the coronavirus pandemic.
    As much funding as has come our way, I want to be clear: as 2-
    year influx cannot reverse 150 years of systemic, persistent
    underfunding. Now, while we are thankful for President Biden's
    requested proposed investments in HBCUs, I do want to draw your
    attention to a few budget lines.
        The Department of Education Strengthening HBCUs
    discretionary program should be funded at no less than
    $500,000,000; the Strengthening Historically Black Graduate
    Institutions discretionary program, no less than $100,000,000.
    We should forgive the remaining balances of institutions
    currently participating in the HBCU Capital Finance Program. We
    should double the Pell Grant, and we should strengthen the
    pipeline of training programs at the Department of Health and
    Human Services.
        Now, the top funding request for HBCUs is $500,000,000 for
    strengthening HBCUs, that program at the Department of
    Education. That program holds particular importance in our
    community because an institution can use the fund up to 17
    different legislative ways, depending on the institution's
    needs. Currently funded at $337,000,000, all 100 accredited
    HBCUs compete for this pool of very limited resources. This
    month, our institutions graduated nearly 50,000 students. Based
    on that fact that our institutions provide so much of the
    diverse workforce that our country values, it is our collective
    view that Congress should increase the program to reflect the
    value of our graduates. We recommend $500,000,000 for the
    discretionary program. This is, again, HBCUs' top funding
    priority.
        While the President's budget was funded at the authorized
    level, I must call the subcommittee's attention to one fact.
    There is one single HBCU that received a funding increase last
    fiscal year of $100,000,000 all by themselves. All 100-plus
    HBCUs were forced to share in the collective, much smaller
    $25,000,000 increase. This disparity in cap on the overall
    Strengthening HBCUs Program, it has to be done away with. We
    must invest $500,000,000 in this program and an additional
    $100,000,000 in the Strengthening Historically Black Graduate
    Institutions Program.
        I want to reemphasize the HBCUs meet a national need:
    bright, capable graduates who tend to come from underserved
    backgrounds. However, the education they receive enables them
    to become productive citizens who contribute to our country in
    numerous ways, and I don't even have to mention the fact that
    well over 40 percent of the CBC members, your colleagues, are
    HBCU graduates. UNCF produced a report on the economic impact
    of HBCUs in November 2017. UNCF found that one single
    graduating class of HBCU students will earn a minimum
    $130,000,000,000, collectively--one class--over their lifetime.
    HBCUs collectively hire and fire like a Fortune 50 company.
    Moreover, our institutions altogether have an annual economic
    impact of $150,000,000,000.
        HBCUs do what no other type of institution in this country
    does or attempts, and for that, we hope this panel will support
    us by implementing the funding requests I have made today.
    Thank you, and I am happy to answer any of your questions, and
    I want to commend you on such a long hearing and for your
    attentiveness.
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        The Chair. Thank you so much, Lodriguez, and it is great to
    see you again. I was pleased to be with you. We did that by
    Zoom--I lose track these days--but with Congresswoman Alma
    Adams where we all gathered and so forth. Thank you for your
    strong presentation, and I think we are very, very attuned to
    the role that HBCUs play in our Nation and in our education,
    and very, very, you know, proud that so many of our members are
    graduates of HBCUs.
        So what we did do in the last go-round, as you talked
    about, the $363,000,000, it was about a 7-and-a-half percent
    increase, and understanding we want to strengthen the HBCUs and
    the number to $500,000,000. I am going to be upfront with you.
    We need to know what our numbers are, you know, clearly. We
    went up last year in doing this, and we made an increase. We
    are committed to maintaining the strength of the HBCUs. We just
    need to know where our numbers are going to come out, and how
    we are going to allocate the funding. But there is, you know,
    the commitment to continue to support HBCUs, you know, in the
    most robust way that we possibly can. And, again, thank you for
    the clarity of your testimony, and the strength of the
    testimony, you know, and the strength in the last meeting we
    had a well. It was a great gathering, so thank you.
        And let me yield to the ranking member.
        Mr. Cole. Well, thank you very much, and thank our witness.
    That was an excellent and very powerful presentation, and,
    frankly, quite compelling. And obviously, we have had several
    representatives of different minority-serving institutions that
    have testified before us today, and there is a common theme
    that runs through them all, which is the disproportionate
    contribution that these institutions make, and how high a
    percent of, whether it is medical professionals, and I am sure
    if we were talking lawyers, and obviously politicians, people
    might think we have too many of those. I don't know. But it is
    capped by law, so, you know, you don't have to worry about
    that.
        But really, these institutions are tremendous value and
    have historically overperformed on limited resources. So,
    again, I know that I associate with the chair's remarks. It
    gets down to the numbers and what we can do, and we don't know
    that yet, but, again, this is not an area where we tend to
    disagree or debate. It is an area where we put our heads
    together and see what can we find in common. And obviously,
    there are a lot of our colleagues on both sides of the aisle
    that are enormous supporters of HBCUs, and weigh in as well,
    not just on the committee, but from other committees as well.
        So thank you for the presentation. Thank you for your great
    work for the institutions that you represent, and we look
    forward to working with you going forward. I yield back, Madam
    Chair.
        The Chair. Thank you. Thank you very, very much. And now
    let me introduce Nancy Gonzales, owner of Lil' Bears Family
    Daycare, and a member of the American Federation of State,
    County, and Municipal Employees, to talk about childcare and
    development of block grants. And, Nancy, don't take it in any
    negative way. You are the last witness today, and we are sorry
    you got to wait so long, but we are delighted to hear from you,
    and thank you because of the importance of the Child Care
    Development Block Grant.
        Ms. Gonzales. Okay.
        The Chair. You are recognized for 5 minutes.

      NANCY GONZALES, OWNER, LIL' BEARS FAMILY DAY CARE; AMERICAN
          FEDERATION OF STATE, COUNTY AND MUNICIPAL EMPLOYEES

        Ms. Gonzales. Good morning to my congressman,
    Representative Josh Harder, Chairwoman DeLauro, Ranking Member
    Cole, and members of subcommittee. Thank you for the
    opportunity to talk about childcare investments and the need to
    double funding levels for the Department of Health and Human
    Services Childcare and Development Block Grant--CCDBG--and
    provide $12,300,000,000 for fiscal year 2023.
        I am Nancy Gonzales. I am a State-licensed family childcare
    provider in Modesto, California, and the owner of Lil' Bears
    Family Day Care. I am a proud union member of the 20,000-member
    strong United Domestic Workers Childcare Providers United,
    American Federation of State, County, and Municipal Employees.
    I have been providing childcare services out of my home for the
    past 16 years and have worked as a childcare provider for the
    past 29 years. I care for babies and children as young as 4
    months old and up to 12 years old, weekdays from 4:30 am to
    6:00 p.m. I open early to help families that have long commutes
    to work. Modesto is a rural area, and sometimes long commutes
    are required to get to work.
        It pains me to say this, but our country takes childcare
    for granted. It really does. Our childcare system is broken for
    families who need childcare for the underpaid, mostly black and
    brown women like me, who are the majority of childcare
    providers. Emergency funding has been helpful in raising rates
    in some States and helping to keep childcare programs open, but
    it is only a band aid for the immediate health crisis. We need
    sustainable care that that comprehensively fixes childcare to
    make it accessible and affordable for families and to pay
    providers living wages. That will require much larger
    investments.
        Doubling CCDBG will make a down payment on a real childcare
    system. Investments in CCDBG will help families and address
    fairness and equity for providers. One of the biggest problems
    for providers and why programs are closing is low pay.
    Childcare providers are paid poverty-level wages. Family
    childcare providers generally charge less and earn less. Family
    childcare providers report that they earn $23,000 or less in a
    year. Private pay is inadequate to ensure living wages.
    Adequate government funding is essential to ensure providers
    can earn living wages and make childcare affordable for
    families.
        Childcare providers like me are faced with the dilemma of
    raising rates, knowing families will leave our care and be
    forced to place the young children in less safe arrangements,
    so I keep my rates low, but it just enough to cover everything
    my own family needs. And because CCDBG funding is not enough,
    the rate the State pays us does not cover the full cost of care
    so we can earn a living wage. Many childcare providers are
    forced to rely on public assistance. We work multiple jobs. We
    can't afford health insurance or save for retirement, and we
    are struggling to deal with increasing costs. In some places,
    expenses are at 40 percent, while reimbursement rates have not
    increased to keep up.
        Supporting worthy wages for home-based childcare providers
    is also an issue of equity for low-income parents, especially
    those who work jobs outside of the traditional 9:00 to 5:00
    hours. Most center-based childcare doesn't offer care during
    these hours, and these parents depend on in-home based
    childcare. And finally, family childcare is often the choice in
    communities of color. After everything we endured during the
    pandemic as frontline workers, childcare providers can't take
    much more. Thousands of providers closed their doors during the
    pandemic. Many never returned. Employers all over California
    and the country are hiring for jobs that pay better and have
    better benefits than being a childcare provider. That means
    less childcare.
        Access to care is a big problem right now. More than half
    the people in the U.S. are in childcare deserts where childcare
    is either unavailable or very limited. In California, the
    problem is even worse, especially for low-income and Latino
    families. I want to thank Congressman Harder for introducing
    legislation to address the shortage of childcare providers in
    these key areas.
        After all the problems I described, why do I still work in
    childcare? Simple: I love this work and the children I care
    for. So do my fellow childcare providers, but we do have
    futures and families to take care of, too. I urge you to double
    CCDBG's budget to begin to create a childcare system that pays
    childcare providers living wages, entices providers to join the
    field and stay in, fixes childcare deserts, expands the program
    to cover more families, and makes high-quality care affordable
    and accessible to all families.
        I appreciate Chairwoman DeLauro's leadership and others on
    this committee to work on these and other ways to fund and fix
    childcare. Thank you so much for your time, and have a great
    day.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        The Chair. Thank you so much, and I just will, you know,
    quote what you said in your testimony. It pains me as well
    because our country has taken childcare for granted, and it was
    demonstrated during the pandemic that it is an industry, if you
    will, that nearly collapsed, you know. And as we have dealt
    with an automobile industry, or hospitals, and anything else,
    when that kind of thing happens, it is the role, in my view, of
    the Federal Government to step in and to do something about it.
        And the piece of this is that, given what happened, women
    were pushed out of the workforce because, you know, their jobs
    went away. There was no paid family and medical leave, so
    people were staying home. Their kids were at home. We had the
    childcare centers that went out of business. They just
    shuttered. And so the entire childcare crisis, you know, it was
    a perfect storm for understanding what was going on because the
    issue of low wages has been there for childcare workers for so
    long, and it is one that we need to address. But the other
    piece of this is, if this economy is going to recover and women
    are going to go back to work, we have got to have affordable,
    accessible childcare for families. Otherwise, they are going to
    stay home because you are not just going to, you know, abandon
    your children. It needs to be viewed as not taking it for
    granted, but it is being viewed as a cornerstone of a thriving
    economy and how this economy succeeds.
        And so my hope would have been, and don't know what the
    vestiges of Build Back Better would be if we ever get a Build
    Back Better piece of legislation. Maybe we get something, but
    my hope is that, as was the case earlier, that childcare would
    be the central portion of that. That is on that side of it, but
    in terms of the Child Care Development Block Grant, I think we
    did a $254,000,000 increase last year. I know what you are
    asking for is to double the amount of money. I am not going to
    lie to you. That is hard given that we don't know yet what our
    numbers are going to be, but I want you to be assured that
    childcare is now front and center. And as we have been saying
    in a number of the presentations today, we need to seize this
    opportunity. We saw what happened in this emergency, and we
    cannot let that happen. We cannot let the childcare industry be
    destroyed. Families rely on it. It has got to be affordable.
        In the State of Connecticut, it is between $15,000 and
    $18,000 per child. How many people can afford to do that, you
    know? And so we have got to make it affordable. It has got to
    be accessible. We have to pay wages. We trust our most precious
    resource, our children, with the childcare workers, and yet we
    are not willing to pay them a livable wage. So big issues that
    you have brought to light. It is critical, but I am going to
    just say that the advocacy on your part, you know, you need to
    continue that advocacy because it is so palpable. It is there.
    There are so many examples all over the country of what has
    happened with childcare in the United States, and we have to
    address it and address it in a very substantial way.
        You know, just this last note. My mother worked in the old
    sweatshops in the City of New Haven, but I went to my
    grandmother's store, you know, and that was my childcare. The
    fact of the matter is grandmothers, grandfathers, aunts,
    uncles, everyone is in the workforce. Those days are gone.
        Ms. Gonzales. Yes.
        The Chair. Those days are gone, and we need to have a very
    substantial childcare system in the United States. Let me yield
    to the ranking member.
        Mr. Cole. I don't know that I have much to add. I think our
    witness can understand how passionate our chair is about this
    and how knowledgeable. Look, this is something she knows a
    great deal about and has made sure our committee has had robust
    hearing and discussion about throughout her entire tenure as
    chair, and then rose up and responded, I think, magnificently
    during the coronavirus crisis when she understood what was
    happening to this industry and how critical it would be to our
    recovery to have it up and operational, help through a
    difficult time.
        So I, like the chair, don't know where we are going to end
    up. If you have had the opportunity, and since you were last, I
    am sure you have waited a long time. [Laughter.]
        You have gotten to hear some of the requests that our chair
    and our subcommittee have to deal with, and they are pretty
    compelling, but we really do take this seriously. We do try and
    take care of the needs really as well as we possibly can with
    the resources that are entrusted to us by our colleagues. So I
    don't think you need to worry that your voice won't be heard at
    the table. I think your voice is sitting at the head of the
    table. [Laughter.]
        But thank you so much for the work that you do, and thank
    you for taking the time to testify, and thanks for being so
    patient with us. This is an important day for us, a big day for
    us, and I am sorry you were at the very end of the line. But,
    again, thank you for not being at the end of the line in terms
    of what this committee does, and thank you for being patient
    with us and allowing us to get through our other witnesses.
        So with that, Madam Chair, I yield back.
        The Chair. You know, listen, and again, we are in sync.
    Thank you so much, the Ranking Member. Thank you so much,
    Nancy, for your patience. And it is a long day, but as I said
    at the outset, as did the ranking member, we get so much out of
    this day with public witnesses, and there are a number of areas
    that, you know, are new information, you know, for us, and that
    gives us, you know, the opportunity to think about these areas
    when we are putting the bill together. And I can commit this to
    you. I cannot commit dollar amounts. We just don't know where
    we are, but that there is a thoughtful process and one that
    incorporates, you know, the testimony of the people who
    testified here today. And with that, I am going to call this
    hearing to a close.
        The hearing is adjourned. Thank you.
        Mr. Cole. You bet.
        The Chair. Thank you, Tom.

                               W I T N E S S E S

                                  ----------
                                                                       Page

    Becerra, Hon. Xavier, Secretary, Department of Health and Human
      Services.......................................................     9

    Cantor, Pamela, founder and senior science adviser, Turnaround
      for Children...................................................   145

    Cardona, Hon. Miguel, Secretary, Department of Education.........   188

    Darling-Hammond, Linda, president and chief executive officer,
      Learning Policy Institute......................................   147

    Eden, Max, research fellow, American Enterprise, Institute.......   148

    Shriver, Tim, co-founder and board chair, Collaborative for
      Academic, Social, and Emotional Learning.......................   150