[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:]
 
 
 
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                                          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.
    [The information follows:]

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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.
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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.
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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.
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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.
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    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.
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    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

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                                                                   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