[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
  BARBARA LEE, California
  MARK POCAN, Wisconsin
  KATHERINE M. CLARK, Massachusetts
  LOIS FRANKEL, Florida
  CHERI BUSTOS, Illinois
  BONNIE WATSON COLEMAN, New Jersey
  BRENDA L. LAWRENCE, Michigan
  JOSH HARDER, California

  TOM COLE, Oklahoma
  ANDY HARRIS, Maryland
  CHUCK FLEISCHMANN, Tennessee
  JAIME HERRERA BEUTLER, Washington
  JOHN R. MOOLENAAR, Michigan
  BEN CLINE, Virginia

  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, Jared Bass,
    Philip Tizzani, Laurie Mignone, Rebecca Salay, and Trish Castaneda
                            Subcommittee Staff
                            
                             __________


                                  PART 6

                                                                   Page
  National Institutes of Health.........                              1                                        
  Healthy Aging: Maximizing the 
Independence, Well-Being, and Health of 
Older Adults............................                            137
  U.S. Department of Labor..............                            175                                        
  Members' Day..........................                            239                                        
  Tackling Teacher Shortages............                            253
                                        
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
                                  
                             __________

          Printed for the use of the Committee on Appropriations
          
                   U.S. GOVERNMENT PUBLISHING OFFICE                    
49-737                    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

                 Robin Juliano, Clerk and Staff Director

                                   (ii)

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

                              ----------                              

                                           Wednesday, May 11, 2022

                     NATIONAL INSTITUTES OF HEALTH

                               WITNESSES

DIANA BIANCHI, M.D., DIRECTOR, EUNICE KENNEDY SHRIVER NATIONAL 
    INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND 
    INFECTIOUS DISEASES
GARY H. GIBBONS, M.D., DIRECTOR, NATIONAL HEART, LUNG, AND BLOOD 
    INSTITUTE
DOUGLAS R. LOWY, M.D., ACTING DIRECTOR, NATIONAL CANCER INSTITUTE
LAWRENCE A. TABAK, DDS, PH.D., ACTING DIRECTOR, NATIONAL INSTITUTES OF 
    HEALTH
NORA D. VOLKOW, M.D., DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE
    The Chair. I now call to order the hearing on the fiscal 
year 2023 President's budget for the National Institutes of 
Health.
    This is a hybrid hearing, so we need to address a few 
housekeeping matters.
    I welcome my colleagues who are with us on the screen. For 
the 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. So 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.
    And with that, what I would like to do is to acknowledge 
and thank Ranking Member Tom Cole and all of the members of the 
subcommittee joining today's hearing, both virtually and in 
person.
    And a thank you to our witnesses testifying before us 
today. Dr. Tabak, welcome to the subcommittee. While you 
started in this role just a few short months ago, you have 
proven, in your over 12 years as a Principal Deputy Director of 
the National Institutes of Health and 10 years as the Director 
of the National Institute of Dental and Craniofacial Research, 
to be a thoughtful, efficient leader. Thank you for your 
commitment to making America a healthier place and our 
healthcare research more equitable. Our deep thanks.
    Let me also welcome institute directors joining Dr. Tabak 
today and our subcommittee this morning--Dr. Diana Bianchi, 
Director of the Eunice Kennedy Shriver National Institute of 
Child Health and Human Development; Dr. Anthony Fauci, Director 
of the National Institute of Allergy and Infectious Diseases; 
Dr. Gary Gibbons, Director of the Heart, Lung, and Blood 
Institute; Dr. Douglas Lowy, Director of the National Cancer 
Institute; and Dr. Nora Volkow, Director of the National 
Institute on Drug Abuse.
    I also want to note, and I think I have said this before--
we were able to do it once before--that I do intend to invite 
an additional panel of institute and center directors to 
testify before this committee later this year. We have not been 
able to hold a second panel in the past 2 years, but I value 
the research of every institute, every center, and want to make 
sure that the subcommittee has the opportunity to hear from 
others directly.
    I am also going to be reviewing the funding across all the 
institutes and centers, looking for patterns over time and to 
hear more about how the institutes and the centers set 
priorities. So, and I just say this with all sincerity. I mean, 
I also always think that this is one of the most exciting and 
exhilarating and meaningful hearings that we have before the 
Appropriations Committee.
    The work that you do, all of the staff, the grantees that 
the NIH supports, and what you have done to continue 
prioritizing COVID-19 research over the past 2 years, we would 
be nowhere close to where we are in defeating this virus. 
Through the research of the NIH's own science, and everyone 
talks about how quickly we moved and how successful we were in 
terms of a vaccine, that just didn't happen overnight. It was 
the years of research, of investment in the research that 
allowed us to move as quickly as we were able to.
    So through the research of our scientists, researchers, 
grant institutions, and partnerships with the private sector, 
our knowledge of the virus has dramatically improved, reliable 
detection and diagnostic technologies have been developed, 
treatment options have been implemented, and vaccines and other 
prevention methods were accelerated and distributed all in 
record time.
    NIH's response to COVID proved what I have known for a long 
time, that our significant and longstanding support for 
biomedical research is absolutely critical to ensuring we are 
prepared to prevent and address healthcare crises whenever they 
may arise. The work you do saves lives and protects families 
the world over. And with the proper resources and leadership at 
NIH, our biomedical research can move very quickly in very 
focused ways to achieve high-priority goals and continue to 
saves lives.
    None of these transformational advances would have been 
possible without the annual sustained investment in basic 
biomedical research made by this committee in a bipartisan way 
in recent years, which is why I am so proud that over the past 
7 years, Congress has increased NIH funding by nearly 
$15,000,000,000, or 49 percent. And I repeat that this has been 
done with a bipartisan effort.
    And in the 2022 omnibus recently passed, Congress provided 
a $2,250,000,000 increase over 2021. This includes an increase 
of $353,000,000 to fund a greater number of research proposals 
at the National Cancer Institute and support for the Cancer 
Moonshot initiative that will save lives by speeding cancer 
research progress and improving prevention, detection, and 
treatment efforts.
    We also provided an increase of $289,000,000 for 
Alzheimer's disease and related dementia research to help 
better understand the cause of Alzheimer's and advance research 
for diagnosis, care, treatment, and prevention for those with 
and at risk of developing this disease.
    I am especially proud of the $30,000,000 increase for the 
IMPROVE maternal health research initiative. The maternal 
mortality rate in this Nation is far too high, the highest of 
any developed nation. And more must be done to address this 
crisis that kills hundreds of mothers every year.
    These increased funds to support research on maternal 
morbidity and mortality will reduce preventable causes of 
maternal death, improve the health of pregnant people, 
especially those mothers, the victims of our Nation's health 
disparities who have been historically underserved.
    And health disparities impacting underrepresented 
communities are an unacceptable issue in nearly every corner of 
our physical and mental healthcare systems, which is why we 
delivered an increase of $50,000,000 for research to identify 
and reduce health disparities across our country.
    I am also proud of the $8,000,000 increase that Congress 
provided for the Office of Women's Health--Research on Women's 
Health, to further promote the interests and involvement of 
women in NIH-supported research. And I am personally grateful 
for the $159,400,000 in fiscal year 2022, the NIH grants that 
have been delivered. Many have been delivered to my own 
district, Connecticut's Third, following $572,800,000 in fiscal 
year 2021. That is NIH funding for the district.
    This funding has already advanced critical research 
efforts, strengthened the future economy, and grown 
opportunities in my community. But my hope, my hope is that 
this is replicated in cities and in small towns and in rural 
areas across the country. We have to move it beyond our cities 
to areas across our country.
    As we continue to build on these transformative 
investments, I am pleased that the President's budget request 
for 2023 proposes an increase of nearly $4,300,000,000 for NIH. 
I am pleased that included in the budget request is a proposal 
to increase research to address health disparities and the 
opioid crisis, two major issues impacting the health of far too 
many across the Nation.
    I am particularly glad to see the proposed $15,000,000 
increase for universal flu vaccine research and development, an 
issue that I have been fighting to address for years. And the 
request for double funding for gun violence prevention research 
at the NIH, building off the investments this subcommittee has 
made over the past 3 years.
    Despite all the great investments in the bill, however, I 
am concerned about the lack of balance between the budget 
request for ARPA-H and the request for other, more 
``traditional'' NIH activities. I know the President's fiscal 
year 2023 budget request for NIH was developed before the 2022 
omnibus was enacted and might have been different had it been 
enacted sooner.
    However, the proposed increase, $274,000,000 for core NIH 
activities, is insufficient and threatens the progress the 
committee has made in the past several years through 
significant, sustained investments in biomedical research. I 
have said it before, and I will repeat it. I am proud of the 
work we have done together to establish ARPA-H. It is clear 
that the $1,000,000,000 investment in 2022 funding this 
committee made to establish ARPA-H has the incredible potential 
to develop informative technologies that save lives.
    It is historic funding, and it will be used to research the 
causes and address debilitating impacts of major diseases like 
Alzheimer's, diabetes, cancer, ALS, and others that impact the 
lives of millions of Americans and exacerbate already existing 
health disparities. However, it is critical that we strike a 
balance between the investments that we make in ARPA-H and 
those in basic research and discovery at the NIH.
    Dr. Tabak, I know this was not your decision. But while I 
strongly support NIH and recognize its long record of success 
in supporting biomedical research, I believe that placing ARPA-
H within NIH is a mistake. It will hamper the agency's ability 
to achieve the breakthroughs I just outlined. I strongly 
believe that ARPA-H would be more successful in its unique 
mission if it were established as an independent agency within 
Health and Human Services.
    With that, let me just say I thank you all for joining us 
today. Your work, again, is invaluable to the health 
infrastructure of our Nation, to really improving our medical 
discoveries, for making these medical discoveries, and 
ultimately saving lives.
    I look forward to our discussion this morning and our work 
together in the months to come.
    And let me recognize Congressman Cole for his opening 
remarks.
    Mr. Cole. Thank you very much.
    Before I begin my prepared remarks, I draw one great lesson 
as a proud Yale graduate, it is a great thing to represent 
Yale.
    What a great magnet for research in good things.
    Well, good morning. I am pleased that we can come together 
in person this morning for the first time in 2 years to hear 
directly from the National Institutes of Health about the 
administration's budget proposal for fiscal year 2023. This is 
our first hearing in many years without our friend Francis 
Collins, and we all wish him well in his new endeavors.
    As I say every year, a sustained commitment to increasing 
funding for the NIH is a vital step to preserving our status as 
the world's leader in biomedical research and to finding cures 
for many diseases burdening our healthcare system. And we know 
the funding also does far more. Several studies have shown 
funding at the NIH has a multiplier effect, contributing to 
overall U.S. economic growth.
    Like the chair, I am proud of what this committee has done 
year after year on a bipartisan basis since 2015. The NIH 
budget has increased every year beyond inflation during that 
period, regardless of who was President, regardless of which 
party was in control of the Congress. And it shows that there 
are certainly some important things that we can work together 
on and I think will have positive results for the country.
    And I particularly want to praise my good friend--I make 
this point a lot--the chairwoman. When I was privileged to be 
the chair of this subcommittee for 4 years, she was kind enough 
to back my budgets--not the first one, but the last one, the 
one that passed--every single time. And I have been very proud 
to vote for her budgets for three terms since then.
    So we may start at different places, but we have a way of 
ending up at the same place. And this agency, the NIH, is a big 
reason why, quite frankly. So you actually contribute to 
bipartisan comity and cooperation.
    Given all that, I hate to kick off the hearing on a sour 
note, but I am probably where the chairwoman is. I am perplexed 
as to why the administration has chosen to pour billion of 
dollars in funding into the new ARPA-H program at the expense 
of ongoing basic research at the NIH.
    ARPA-H was funded for the first time in March and, I might 
add, with my support. Like the chairwoman, I see much potential 
good here. But as she pointed out in her remarks, there is 
still a great deal of controversy around it and different 
opinions from both Republicans and Democrats and, quite 
frankly, within their ranks over how it should be organized, 
where it should be placed.
    In the end, almost every decision was simply left to the 
Secretary of Health and Human Services, someone I hold in high 
record, but he is an executive official, and I think it is 
unprecedented for the creation of a new agency to lie largely 
in the hands of one individual.
    We still don't know the structure this new agency will 
ultimately take. We don't have a Director, any possible names 
of a Director, or any idea when this individual will be named. 
We don't have a physical location for the new agency. We don't 
know how grants will be made and who will be responsible for 
deciding how billions of tax dollars are disbursed.
    We don't know how ARPA-H will interface with existing NIH 
institutes and research or how we can ensure that will be 
value-added rather than an agency that competes with and 
siphons off talent. We don't know the rules for hiring staff or 
how they will be compensated.
    So I think it makes no sense to propose an enormous 
increase of $4,000,000,000 for this new agency while proposing 
what is essentially flat funding, and for some important 
agencies even a modest cut, for the rest of NIH. And I will 
have some tough questions about that today, but it sounds to me 
like we probably have some of the same concerns, Madam Chair.
    Next, I think everyone in this room needs to address the 
difficult topic of the loss of public confidence and 
credibility across our public health agencies, including the 
NIH, during the COVID pandemic. I fear that the mistrust in our 
Government public health system has eroded to a dangerous 
level.
    From our own leaders placing too much trust in the Chinese 
government in the beginning of the pandemic to locking down our 
society, economy, and schools, and mixed messages on masking 
and vaccine mandates, to what many believe is a cover-up on the 
role, if any, that the Wuhan lab played in the origins of the 
COVID virus, our public health agencies have made mistakes that 
need to be acknowledged and corrected.
    Now this has weakened confidence in our public health and 
Government systems for many of our constituents at a time when 
we desperately need to come together as a people and heal. I 
certainly pledge to work with my friends across the aisle to 
rebuild a bipartisan coalition of support for basic science and 
research and talk honestly about ways we can translate that 
information into evidence-based practices using data, not just 
talking points.
    Most of our constituents want to do the right thing to stop 
the spread of COVID. Many just don't believe what they are 
being told by Government officials anymore, and I suspect we 
will hear some difficult questions about that this morning.
    Much attention in the past year has gone to COVID, and 
rightly so. But I hope we can also continue our conversations 
and scientific advancement in such areas as cancer treatment 
and dealing with Alzheimer's, diabetes, other dread diseases 
and chronic illnesses.
    These diseases are responsible for the loss of hundreds of 
thousands of American lives every year. And again, I fear this 
work may be short-changed by the hyperfocus on the new ARPA-H, 
and I sincerely hope that will not come to pass.
    We have an excellent team representing some of the largest 
institutes and most promising frontiers of new discoveries 
before us today. As we know, NIH is composed of 27 institutes 
and centers, most of whose leaders are not able to be with us 
today. But even though we are not able to have each Director 
come before us, our offices continually learn about the ground-
breaking work and collaborative partnerships at all of the NIH 
components, and we are all very proud of that work and know our 
role in making sure that it goes forward. We know that the work 
done at NIH and each institute or center is a contributor.
    In closing, I want to stress that each dollar invested in 
the NIH is, in my view, a down payment on our future. This work 
has in the past and will change the course of disease 
detection, cures in the years and generations to come. I know 
Congress' commitment to advancing these shared objectives is 
unwavering and bipartisan.
    I want to thank you, Madam Chair, for holding the hearing 
and thank our witnesses for being here.
    I yield back.
    The Chair. I thank the ranking member.
    And Dr. Tabak, your full written testimony will be entered 
into the record. And now you are recognized for 5 minutes for 
your opening statement.
    Thank you.
    Dr. Tabak. Thank you, Chair DeLauro, Ranking Member Cole, 
and distinguished subcommittee members. I am honored to be here 
today with my colleagues representing the National Institutes 
of Health.
    This is a time for NIH and the entire biomedical research 
community to reexamine all of our efforts. During the COVID 
pandemic, we were driven by the urgency of the moment. NIH must 
learn from this experience and seize the opportunity to define 
a new normal.
    As Acting Director, I am committed to new strategies, new 
voices, and a renewed focus on the future. Now is the time to 
reflect on what worked and did not work to address COVID and to 
shape new strategies. Your sustained investment in NIH research 
set the stage for the new mRNA technology and immunogen design 
that were key to the development of safe and effective vaccines 
in an unprecedented timeline.
    Since these vaccines became available, it is estimated that 
more than 2 million American lives were saved, and more than 17 
million hospitalizations were averted. Now we need continued 
support for a wide range of biomedical fields, including 
behavioral and social sciences, to identify and successfully 
implement better ways of responding to the short- and long-term 
health effects of COVID-19; to prepare for future pandemics; 
and to ensure equitable protection of our diverse population.
    And it is not just about vaccines. Our Rapid Acceleration 
of Diagnostics, or RADx, initiative, fueled the development of 
many new approaches for COVID-19 testing that are already being 
used in our communities. To help ensure that such benefit was 
shared with those disproportionately affected by the pandemic, 
we initiated efforts like RADx Underserved Populations and the 
NIH Community Engagement Alliance. These experiences, along 
with other NIH-led efforts focused on COVID treatment 
development, demonstrate the extraordinary value of public-
private partnership.
    The NIH can build upon the momentum of the COVID response 
and apply it to other challenges through the Advanced Research 
Projects Agency for Health, or ARPA-H. Thanks to your inclusion 
of key authorities and funding in the omnibus, NIH is beginning 
to frame the basic administrative infrastructure for ARPA-H. 
This is a first key step in creating a permanent home for the 
strategic partnerships that are so urgently needed to address 
cancer, diabetes, Alzheimer's, and many other diseases.
    But we can't stop there. In addition to new strategies, 
biomedical research needs new voices. A growing body of 
evidence demonstrates that inclusion of diverse perspectives 
yields better outcomes. In the clinical setting, diverse 
medical teams provide more accurate diagnoses and improved 
health of patients while building trust. We do better science 
when we have a diversity of scientists from different 
backgrounds and communities, scientific fields, and various 
career stages.
    NIH continues to prioritize, fund, and empower early stage 
investigators so that they can succeed as independent 
researchers. In 2021, we reached an all-time high of early 
stage investigators funded, 1,513.
    The passion and commitment of our scientists is matched by 
the voices of people with a wide range of diseases and 
conditions. Conversations with patients and their advocates are 
sometimes difficult, but those are often the discussions that 
teach us the most. From the AIDS advocacy groups of the 1980s 
to today's groups for autism, ME/CFS, long COVID, and many 
others, these voices have refused to be ignored, and 
ultimately, all of us benefit.
    This is a moment for renewed focus on the future. I spend a 
lot of time encouraging early stage scientists, but I also 
think about the importance of engaging elementary school age 
children like those my wife has taught for over 40 years. 
During the COVID pandemic, exposure to the importance of 
science has been a big part of many of their lives.
    Past pandemics have inspired young people to become 
scientists, but the images they saw were usually of older men 
who looked pretty much like me. Hopefully, today's kids are 
seeing more scientists who look like them. So we need to do 
better. Our Nation needs all the bright minds we can find, and 
I hope you will continue to work with NIH to make this happen.
    The Chair. Thank you very much, Dr. Tabak.
    I am going to try to get in two questions in this first 
round, and I mentioned the subcommittee has increased the 
budget by roughly $15,000,000,000 over the past 7 years. It is 
almost 50 percent. What I would like to do is to just have you 
talk about how the NIH determines research priorities.
    In many years, NIH proposes to increase funding for a small 
number of initiatives--the BRAIN Initiative, Precision Medicine 
Initiative, this year significant increase for ARPA-H. In fact, 
the proposed increase is significantly larger than the increase 
for the entirety of NIH research combined.
    My question is what are the determining factors in setting 
NIH research priorities? Is there such an emphasis on large-
scale initiatives? If there is, what is being left behind? What 
happens to research in important areas of health that are not 
included in large-scale initiatives or ARPA-H? And how do we 
determine progress in these initiatives?
    Dr. Tabak. Well, as you know, it is a balance that needs to 
be struck, and in recent years, there has been an emphasis on 
large-scale investment because the scientific opportunity 
presented itself, either due to new technologies or emerging 
areas of concern. But in each instance, institutes and centers 
try and prioritize their effort based upon whether the science 
is ready to move forward, what the public health need is, and 
then whether or not the portfolio that they currently sustain 
is sufficient to move the field forward.
    Each institute and center has a strategic plan, and they 
work with closely their National Advisory Council to make sure 
that work that is supported aligns with those strategic plans.
    The Chair. I want to get on to my next question, but the 
concern is, you know, what do we believe these days is being 
left behind and that are not included in the large-scale 
initiatives?
    Dr. Tabak. Well, our success rate overall is roughly 20 
percent. And I think, historically, we have observed that 
meritorious applications come at least through the top one-
third. So the difference between the 20 percent and the 33 
percent represents what is being left behind, as you put it. 
Those are studies that are certainly worthy of support, but 
obviously, with finite resources, prioritization has to occur.
    The Chair. Let me just ask you this. You mentioned success 
rate. So the success rate for NIH research grants increased 
each year, from 17 percent in 2013 to 20.6 percent in 2020. 
However, despite a funding increase of $1,300,000,000 in 2021, 
the success rate actually declined to about 19 percent.
    I know there are several factors that are at play here, but 
why did the success rate decline despite the funding increase 
in 2021, and what is NIH doing in 2022 to avoid another year of 
decline in the success rate?
    Dr. Tabak. Well, as you know, the success rate is simply 
the number of applications that are funded divided by the 
number of applications that we receive. And in fiscal year 
2021, we received an unprecedented number of applications, and 
this increase is largely what drove the modest decrease in the 
success rate.
    Obviously, we can't control the number of applications that 
we receive, and as you alluded to, there are other factors. But 
the main driver for this decrease was the unprecedented 
increase in new applications.
    The Chair. Thank you.
    I am going to--I have got a few seconds left here. I am 
going to yield back and also to mention that I have to step out 
as there are two other hearings that I have to just pop into, 
and then I will be back. And I will ask Congresswoman Roybal-
Allard to take the chair.
    And with that, Congressman Cole.
    Mr. Cole. Thanks very much, Madam Chair.
    We really don't coordinate our questions, but they are 
pretty close some days. I want to go back to this concern that 
I think the chair and I both have about the disparate--or the 
imbalance, as we would both see it or--I don't presume to speak 
for her--as I see it, between ARPA-H and NIH.
    And I suppose my first--and again, I want to stress, Dr. 
Tabak, I recognize you don't get to make all these decisions 
either. And I suspect, honestly, we are speaking for more of 
you than any of you could admit. But I don't want to throw out 
the baby with the bath water, and to me, here the basic mission 
of NIH, which I think you all have done a remarkable job 
advancing over the years, is the most important element.
    And ARPA-H, you know, I hope over time will develop into 
something like DARPA, but we just simply don't know that yet. 
So tell me what would happen with $4,000,000,000 when we don't 
know the Director. We don't know the procedures. And you can't 
possibly have that set up to be fair to you because you didn't 
even know how much money or this thing was going to even exist 
until March.
    So we just sort of threw this at you with $1,000,000,000 
and say come back and show us something. I don't think we can 
probably afford to follow that with $4,000,000,000 more, 
particularly if we pinch the budgets of the other institutes.
    So, again, tell me what that $4,000,000,000 would do.
    Dr. Tabak. Well, our first step, of course, is going to be 
to build out the infrastructure, the administrative 
infrastructure of the organization. And from a practical 
standpoint with the new organization within NIH, we can draw 
upon some equities that are standard that are used across HHS 
and, indeed, from other departments, things like our electronic 
eRA system for grant following and tracking and so forth.
    A search is under way for the inaugural Director for ARPA-
H, and as you know, this is a presidential appointee. And our 
charge at the moment is to really focus on the administrative 
issues. We will certainly bring in a small group of senior 
operational people focused on the administrative side, but no 
program managers who will be driving the science will be 
recruited until the Director is in place.
    Mr. Cole. Again, I want to switch to another area, but that 
would suggest to me that we should be very cautious here about 
this amount of money, again because I just think it is going to 
take a while to set this up, get it right. And frankly, I am 
not convinced the other committees in Congress--Energy and 
Commerce is going to want to have something to say about this. 
They are not going to just let the Approps Committee create 
this out of whole cloth.
    So that, again, just makes me very uncomfortable on 
balance. Although let me make this very clear, too. I totally 
favor the amount of money we are talking about. I don't have 
any problem with that. I just have a problem with the 
distribution between NIH and ARPA-H, given how formed and 
successful one is and the other is in the process of being 
formed.
    Dr. Lowy, it is good to have you back, and I want to go to 
this question quickly that the chair touched on because I think 
probably in cancer, we are seeing one of the most difficult 
jobs is just the sheer number of applications that are quality 
applications you are getting. So what is the funding rate at 
NCI for applications, as compared to NIH district wide, and how 
promising is the science in cancer going forward?
    Dr. Lowy. Well, thank you, Mr. Cole.
    The funding rate at the NCI currently is 11 percent payline 
for experienced investigators and 16 percent for early stage 
investigators. Last year, thanks to the generosity of Congress, 
we were able to give more awards than we have ever given 
before, actually gone up by about 25 percent for experienced 
investigators over the last 4 years and about 60 percent for 
early stage investigators.
    But as you know, there has been a big increase in the 
number of applications to NCI, substantially larger than the 
rest of the NIH. This is very good news in the sense that it is 
a reflection of the optimism that people have of being able to 
make progress in cancer. But a direct consequence is that there 
is a decrease in the payline and success rate.
    Mr. Cole. Well, my time is up. But to me, again, you have 
just made the point as to why we need to get more resources in 
the various agencies, yours in particular. But I would say this 
across the board. We have got a lot of promising research here, 
and I don't want to tie up money as we create new agencies when 
you have got worthy recipients right now that could make 
immediate contributions to the mission that you have there.
    So, anyway, I am sure we will be having pretty robust 
discussion on that. I yield back, Madam Chair.
    Ms. Roybal-Allard [presiding]. Dr. Tabak, I would like to 
ask about the chimpanzee retirement to sanctuary. In 2000, 
Congress signed the Chimpanzee Health Improvement, Maintenance, 
and Protection Act into law, instituting a national sanctuary 
system to resettle the chimpanzees that are no longer needed in 
research by Federal agencies.
    Since November 2015, when NIH announced it would no longer 
support any biomedical research on chimpanzees, it has been a 
priority of mine to see these primates retired swiftly and 
successfully to the Federal sanctuary, Chimp Haven. However, in 
2019, despite congressional directives and strong humane 
organization recommendations, NIH made the unilateral decision 
to keep the remaining 44 chimpanzees at the Alamogordo Primate 
Facility, which is run by the Charles River Research 
Laboratories, a global corporation whose business model is to 
breed, import, sell, and experiment on nonhuman primates and 
other animals.
    Since that time, 12 chimpanzees have died, and at least 
half were euthanized. Multiple animal welfare experts have 
expressed concerns that Charles River management strategies may 
expose chimpanzees to an environment which results in 
chimpanzees meeting some criteria which leads to a euthanasia 
decision.
    Because invasive research on chimps was still legal when 
the CHIMP Act was passed, Congress recognized chimps being 
retired would likely be older or have serious health conditions 
because they would no longer be useful for research. In fact, 
NIH's own regulations recognized the possibility that chimps 
with infectious disease and other health conditions will 
survive at sanctuaries, and NIH has been moving chimps from 
chronic health conditions to Chimp Haven for years.
    Do you believe a laboratory facility managed by Charles 
River Laboratories can meet the physical and psychological 
needs of chimpanzees previously used in biomedical experiments 
better than the sanctuary created and designed specifically to 
meet the needs of chimpanzees retired from research?
    Dr. Tabak. It is a balance between the facility that the 
chimp is currently housed in versus their physical condition, 
their medical condition, if you will. And it is the opinion of 
a panel of veterinarians from NIH and from Chimp Haven and from 
the facility--in this case, Alamogordo--that a certain number 
of chimpanzees are just too frail to be moved safely.
    There is also some consideration where several of the 
chimps who are part of a social network, that they should 
remain for that purpose as well. So when you balance those two 
things, that is why there are some chimps remaining at that 
facility.
    Ms. Roybal-Allard. Well, Dr. Tabak, with all due respect, 
they appear to be dying or being euthanized at a much higher 
rate than would be expected if they were in sanctuary. And the 
Humane Society has filed a lawsuit to force the transfer of the 
remaining chimps. And both the Humane Society and Animal 
Protection New Mexico chimp experts have reviewed the chimp 
health records and strongly believe that the chimps could 
survive transfer and would have a much better quality of 
remaining life at Chimp Haven.
    So I guess there is disagreement on that, but I am very 
much concerned by the fact that the record of euthanasia and 
the fact that so many have already died I think does not uphold 
the recommendation of NIH. And I hope that you will look at 
that more carefully.
    Because my concern is I don't know what directive Congress 
could give that will make the NIH actually stop the current 
violation of the CHIMP Act and move these Alamogordo 
chimpanzees to Chimp Haven. I don't know what it would take to 
do that. And I won't expect you to answer that question, but I 
certainly hope that you will take that into consideration.
    I have one question, but I am running out of time. So I 
will yield to Mr. Harris.
    Mr. Harris. Thank you very much. Good to see you all again 
here.
    Dr. Fauci, I am going to ask you a question. Last week, the 
White House warned us that there may be 100 million cases, 
COVID cases this fall because of waning immunity and other 
things. We don't know what variant it is going to be. Depending 
on the variant, 1 in 20 could end up on a ventilator. Of those, 
it could be up to 40 percent actually die. And we all know 
people who have died from COVID. It is usually people who end 
up on a ventilator and have untreatable lung disease.
    Now you briefed us last year about the ACTIV-3 trial, with 
aviptadil and remdesivir, and because it doesn't appear that 
remdesivir does anything in those late-stage patients, 
aviptadil may be the last remaining therapy that we may have. 
And I and other physician Members of Congress actually have 
experience with some constituents who have recovered under the 
drug, under right to try. That, of course, is anecdotal. We do 
need more evidence than that.
    The NIH is to be commended to be taking on the risk of 
studying this medicine from a small drug company--it is a very 
small company that makes it--because nobody could have 
predicted that this was kind of a last drug standing for late-
stage COVID.
    But we are out of time now. I mean, the bottom line is if 
we are going to have a surge in the fall, and right now, we 
have no late-stage therapeutic for the person who has failed 
all other therapy, on a ventilator in the ICU, BARDA is going 
to need months to ramp up production of a therapeutic.
    So the question is--the problem right now is because the 
enrollment has slowed down in ACTIV-3, and I am sure you are 
aware of that, because there just aren't that many people with 
Omicron who proceed to that level. The question is, are your 
statisticians going to take an early look at that data to see 
if aviptadil works or works adequately enough to authorize it, 
scale it up, so that this fall, when we have this potential 
surge, we will have a late-stage therapeutic?
    Because we desperately need one. I mean, we still don't 
have something for those patients, and it is terrible. You go 
to the ICU. You fail remdesivir. You--there is nothing left. I 
mean, you call the family in for a meeting.
    Can you do that? Can you look at some of the data?
    Dr. Fauci. Yes. As you well know, Dr. Harris, that the 
company who sponsors this has the opportunity to present the 
data to the FDA for an application for an emergency use 
authorization. The NIH in our clinical trials provide all of 
the resources necessary to do that. So it is, with all due 
respect, it is not an NIH issue of whether or not this gets 
submitted to the FDA for an emergency use authorization.
    Mr. Harris. But your DSMB is going to meet I think this 
month on this.
    Dr. Fauci. Right, exactly.
    Mr. Harris. It could choose to take an early peek at the 
results.
    Dr. Fauci. Yes, it will. And one of the things that is very 
clear is that we don't interfer with the DSMB's--the way they 
look at clinical trial data. I think that would be a conflict. 
So we would always welcome what they do. And if they look at 
the data and feel it should be an early look, then we welcome 
that. We have nothing against that, I promise you.
    Mr. Harris. Okay, good. Because, I mean, they will never 
get to 650--I think that is the end number. I mean, we are just 
not enrolling patients anymore.
    Dr. Fauci. Right. It is a good news/bad news thing.
    Mr. Harris. Right. That is right. You understand it. So----
    Dr. Fauci. Indeed.
    Mr. Harris [continuing]. Thank you very much.
    Now, Dr. Tabak, I am going to ask you something because for 
years, I have been holding up a graph of the young 
investigators age of discovery. You are aware of this, the 2010 
Jones paper, which suggested the inventiveness kind of peaks 
that are in the late 30s or so. And yet I see the report from 
last November that looked at--from the NIH that looked at the--
by Dr. Lauer that looked at the long-term trends in the age of 
principal investigators. You are aware of this, right?
    Now you have created all kinds of committees. You have done 
everything. And the result is while age has been continuously 
increasing in R01s, the rate of increase has slowed over the 
last 10 years. Well, Dr. Tabak, it is not going to continue 
forever. It is not going to continue to age 100.
    I mean, saying that, I mean, I don't get it. NIH has failed 
at reducing the mean age. I am looking at it. The mean age 
increased in 2015 to 2020. Whether you are male or female, the 
mean age increased. The NIH is failing to address this 
properly. What are you going to do?
    I mean, it is nice to say, well, we need a diversity of 
people, and we need people who look like a college age 
graduate. But we are not funding those people. What is the 
concrete plan?
    Dr. Tabak. Dr. Harris, you are correct in the data, and we 
are doing several things. First, unfortunately, institutions 
around the country increasingly want their new faculty hires to 
have bridge funding before they give them a permanent 
appointment on their faculty. And that was never an intended 
purpose of some of these transitional awards, but they become a 
surrogate for deciding who gets a tenure track position or not.
    So one of the things that we are doing is we have 
instituted what was known as the Katz award, which is an R01 
application that does not require--in fact, no preliminary data 
is allowed for the submission of that award. The purpose there, 
of course, is it frees the young person from the work that they 
did as a postdoc or as a graduate student and allows them to go 
straight away to apply.
    We have also done a series of mentoring networks, if you 
will, around the country to convince young people that that 
first award, that first R01 is something that they should 
really be striving for sooner rather than later, despite what 
the old sages at their institution may be telling them. ``Oh, 
you will never get that award. It is too big. Apply for a 
small, little award.'' I mean, you know this well.
    Mr. Harris. I have been there.
    Dr. Tabak. And so we are trying very hard to get the word 
out that, in fact, we are incentivizing, we are prioritizing 
early stage investigators.
    Now the final piece of this, and I don't have a good answer 
for it, is--and it doesn't account for--it only accounts for a 
fraction of the time. Students enter graduate or professional 
schools later. They take so-called gap years--1, 2, or more 
years. That is something that I don't have a good solution for.
    But when you take all these things together, I think it has 
kept us sort of in stasis with regard to our ability to drive 
that number down. But we are going to keep working on it 
because it is important. I agree with you.
    Mr. Harris. Thank you, Madam Chair.
    Ms. Roybal-Allard. Mr. Pocan.
    Mr. Pocan. Thank you very much to the committee.
    And I really respect and appreciate all the work that 
everyone at the table does, as well as many of your peers.
    Dr. Fauci, I just want to single you out for a second to 
say thank you. You have been the face of everyone at this table 
and many other researchers, and you have taken a lot of unfair 
abuse, thanks to fringe social media and crackpot theories out 
there.
    On behalf of normal people, to you and your family, thank 
you. Because your family has also had to go through much of 
this. So, appreciate it.
    I wanted to ask you a question. You talked at I believe it 
was whip meeting, and you mentioned something about the number 
of coronaviruses we have had over several decades. And I found 
that very interesting because I don't think I have heard other 
people talk about that. What aren't we doing to address what 
potentially is the next whether it be coronavirus or anything 
else? What do we still need to be doing and we are not doing?
    Dr. Fauci. Well, thank you for that question. That is very 
important, and it is really part of the strategy that we have 
already put into place not only to address better the current 
outbreak of coronavirus, in this case SARS-CoV-2, but also as 
part of our forward-looking Pandemic Preparedness Plan.
    So, very briefly, what we are doing with regard to the 
current coronavirus is having already in place studies that 
have entered into preclinical and early clinical studies of 
what some people refer to as a ``pan-coronavirus vaccine,'' 
which is really very aspirational because the coronavirus 
phylogenetic tree is pretty big. If you focus on SARS-CoV-2, we 
have already had in the world four or five variants. The United 
States has experienced three of them.
    So the strategy is to develop a vaccine that would have not 
only effectiveness against all the current variants and any 
variant that might actually arise out of the SARS-CoV-2 group 
and then to extend that throughout the phylogenetic tree of 
coronavirus. So that just addresses coronavirus.
    But the Pandemic Preparedness Plan is built on a concept 
that was developed in our group by Barney Graham, who is the 
person who actually developed the SARS-CoV-2 mRNA vaccine for 
Moderna, that to take a representative microbe from each of the 
multiple families that have potential pandemic capability and 
to do studies that would essentially position us that if we do 
get an outbreak from an arenavirus or an alphavirus or a 
flavivirus, to be able to get a vaccine into trial and ready to 
go within 100 days and in the second 100 days to be able to 
start distributing it.
    So we are referring that to our prototype pandemic plan. 
That is what we are doing.
    Mr. Pocan. Great. That is great to hear. And again, I found 
that very helpful when you talked to us about it in caucus.
    Just a real quick, do you consider pandemics like COVID and 
other infectious disease like COVID a threat to national 
security?
    Dr. Fauci. Oh, there is no doubt about that. I mean, 
whenever you have something that threatens the economy and 
political stability of nations, it is part of global security. 
And that is the reason why we take very seriously outbreaks. 
And as you know, the SARS-CoV-2, COVID-19, is historic the 
likes of which we haven't seen in 104 years.
    Mr. Pocan. Thank you.
    Dr. Tabak, same question. Do you consider pandemics like 
COVID as a threat to national security?
    Dr. Tabak. Absolutely.
    Mr. Pocan. Short and sweet on that one.
    Dr. Tabak. Absolutely. Anything that destabilizes the 
economy and the Nation represents that threat.
    Mr. Pocan. It is interesting. We were talking about the 
$4,000,000,000 around ARPA-H and lots of conversation. And I 
look at the Department of Defense budget that comes in at, 
what, $770,000,000,000. It is 12 times NIH's. It is about 70 
times the CDC budget. I think it is time maybe for a more 
modern definition of ``defense.''
    Because I agree that this has been a national security 
threat. And since that budget seems to have such an easier time 
moving forward, if we could use more of those resources to 
protect our country and, for that matter, the globe, I think 
that would be helpful.
    I got 37 seconds. I think I can get this in. Dr. Tabak, 
with the global vaccine we just talked about having the chance 
of having this be a broader vaccine, will the NIH require its 
awardees to meet global access conditions on pricing, supply, 
and technology sharing for any future vaccine?
    Dr. Tabak. Can I turn to Dr. Fauci for that question?
    Mr. Pocan. Sure.
    Dr. Fauci. We don't have that capability of guaranteeing 
global access. That is part of the broader Government plan, 
which we are trying to do right now. And as you well know, 
$5,000,000,000 of the $15,000,000,000 was supposed to go to 
global, and that global was not necessarily to get vaccine 
doses. Because we do have enough vaccine doses for the 
developing world. It is to get vaccines into vaccinations, to 
develop the infrastructure to be able to do that.
    So we are very committed to that, and we have always been. 
But that is not within the realm of what NIH can do.
    Mr. Pocan. Thank you. My time is up. I yield back.
    The Chair [presiding]. Thank you.
    Before I yield to Mr. Fleischmann, I was just saying I was 
just in a hearing with Director Power at USAID, and that I 
would at some point to really hear from all of you about what 
the effect of not moving forward on a COVID supplemental will 
have on our ability to deal both domestically and 
internationally with this pandemic. I think we are at great 
risk.
    But that is not my question because I want to yield to Mr. 
Fleischmann, but I think it is an important issue, and it is 
one where we need your voices loud and clear about what the 
consequences are.
    Congressman Fleischmann.
    Mr. Fleischmann. Thank you, Madam Chair and Ranking Member 
Cole. I appreciate your having this hearing today.
    And to each and every one of the witnesses, thank you very 
much. I have enjoyed my tenure on this subcommittee. I love 
being an appropriator, but this committee, this subcommittee is 
really incredible. And the depth and breadth of the NIH 
research is truly outstanding. So, appreciate your being here 
today.
    I have two questions, if I may? As most of you know, I have 
substantial moral and ethical concerns surrounding fetal tissue 
research. Part of the debate right now is not necessarily about 
initial cell lines, but about the continued collection and use 
of aborted fetal tissue and the use of Federal dollars to 
support that research. Much of the available fetal tissue was 
obtained from children killed by abortion, and their bodies are 
then used for experimentation at taxpayer expense.
    Dr. Tabak, what is the NIH's plan for moving towards more 
ethical alternatives for research and treatment, sir?
    Dr. Tabak. We continue to support research for alternatives 
in this instance. But as you know, in order to validate the 
alternative, you have to compare it to something, and that, in 
fact, is in many instances fetal tissue.
    But we have awarded a number of grants in this area, and we 
continue to make progress in that direction. But it is 
difficult work, and so we continue to fund that type of effort.
    Mr. Fleischmann. Yes, sir. And just for the record, I want 
to be clear that I can speak for myself that I would continue 
to wholeheartedly oppose the use of aborted fetal tissue for 
experimentation, and that is my personal position on that.
    Moving on to another topic, sir. The Undiagnosed Diseases 
Network has been a very successful program building on the 
strength of specialized knowledge at the clinical center in 
Bethesda and a network of 12 academic medical centers across 
the country, including the great Vanderbilt University Medical 
Center in my home State of Tennessee.
    For the past decade, the UDN program has been helping 
patients with rare and undiagnosed conditions find answers and, 
for many, an informed path toward treatment. Often, these 
families and individuals have been on a diagnostic odyssey, 
having seen countless medical professionals unable to give them 
a full pictures of their rare or unknown medical condition.
    My question, Doctor, is how does the NIH plan on supporting 
the network of UDN sites once the Common Fund support expires? 
And as a follow-up to that, how could we help develop a plan to 
sustain the work of UDN going forward, sir?
    Dr. Tabak. So, as you know, programs that are initially 
supported by the Common Fund do graduate, if you will, out of 
that program. It is meant to be an incubator space.
    In this instance, this program has done very important and 
outstanding work, and you reach a point where the effort begins 
to blend into standard of care versus research. And so we need 
to define where that boundary is and are working with the 
various groups around the country, as you said, to see what 
options we may have going forward to sustain that portion of 
the UDN that remains in the research space but allow that 
portion which is standard of care to move into that arena.
    Mr. Fleischmann. Yes, sir. Thank you.
    For Dr. Fauci, good morning, sir. There has been 
significant debate in the scientific community regarding the 
risk-benefit of gain-of-function research, including 
unintentional lab leaks and the intentional release of 
pathogens into the population. My question, Dr. Fauci, 
considering the impact the COVID-19 pandemic has had across the 
world, do you advocate for a continued pause of gain-of-
function research, sir?
    Dr. Fauci. I think it is very important, Congressman, to 
make sure that we abide by the set guidelines of the conduct of 
research. One of the problems with the word ``gain-of-
function,'' it means so many different things to different 
people. So what we have done, and we are very, very flexible in 
relooking at those guardrails, that when you are doing work on 
different pathogens, there have been a multiyear process that 
have set the guardrails of doing that.
    And those guardrails have worked really quite well. We, as 
everyone is, is obviously very sensitive to make sure that 
research that is conducted is conducted in a safe and effective 
manner and that is it peer reviewed before it is done by a 
group of people who are really qualified to make that 
determination.
    Mr. Fleischmann. Thank you, sir.
    Madam Chair, I yield back.
    The Chair. Thank you. Congresswoman Watson Coleman.
    Mrs. Watson Coleman. Thank you, Madam Chair, and thank you 
to the Acting Secretary.
    I don't know if these questions have been pursued because I 
was actually in another appropriations hearing, but I am very 
concerned about NIH and the investment that is made in 
diversity and inclusion. In not only the application of 
resources, but in the reviewers of grant applications as well 
as the recipients of grant applications.
    We were fortunate enough to have conversations with the 
former Director, who was committed to expanding the diversity 
of the workforce and the diversity of the raters and the 
diversity of the grants that were actually funded. And so I 
would like to know kind of specifically as you can, what kind 
of success you have had in moving in that area?
    Dr. Tabak. I want to assure you and all members of the 
committee that I am equally committed to diversifying of the 
biomedical research workforce. We have been using a variety of 
approaches to try and diversify our grantees. For example, we 
have developed the FIRST award, which is designed to build 
communities of scientists, a recruitment of cohorts, if you 
will, in an effort to ensure that you have a sustainable and 
inclusive environment for new hires. We have also increased 
support for the NIH MD Loan Repayment Program, which currently 
supports over 100 talented scientists each year from racial and 
ethnic minority backgrounds or scientists interested in health 
disparities or clinical research.
    Several of the institutes have specific programs. For 
example, the NIGMS MOSAIC Program is specifically designed to 
on-ramp individuals from diverse backgrounds into positions of 
tenure track faculty-level positions at universities.
    Mrs. Watson Coleman. Can I interrupt? Let me ask you this. 
Which of these initiatives are you talking about that have just 
been sort of implemented in the last year and a half?
    Dr. Tabak. The FIRST initiative----
    Mrs. Watson Coleman. Or are you talking about programs that 
have been in existence longer than that?
    Dr. Tabak. The FIRST program that I mentioned, it is in its 
second year, and we are currently looking at applications for 
Year 2. They are under review.
    The MOSAIC Program from NIGMS is new. It is within the last 
year. The Loan Repayment Program has been used in prior years.
    Mrs. Watson Coleman. How about your recruitment efforts and 
interactions with and outreach to the HBCUs? Has anything been 
innovative there? Has anything been increased there?
    Dr. Tabak. So the most recent innovation there has been a 
specific outreach with our contract organizations. Many HBCUs 
do not avail themselves of Government research and development 
contracts. And we had a specific outreach initially with four 
HBCUs, and I believe it is now up to 19, where we work together 
with their administrative offices to really guide them in how 
one goes about applying for successful R&D contract.
    Mrs. Watson Coleman. So I am really interested in what 
success has been built upon in terms of individuals who get to 
look at the grant applications and rate them and the number of 
grants that are actually funded that are directed to cultural 
competencies and the underserved communities, black and brown 
communities in particular.
    And so you probably don't have time to answer that, but 
through my chairman, I would like to ask for kind of an update 
where your agency is, where your institute is with regard to 
those issues, measuring from where you were to where you are 
now and just how you plan to move forward.
    And I thank you for this time, and I thank you, Madam 
Chairwoman. I yield back.
    Ms. Roybal-Allard [presiding]. Ms. Herrera Beutler.
    Ms. Herrera Beutler. Thank you, Madam Chair.
    You know, I wanted to ask you, Dr. Tabak, a couple of 
questions, and I do think in light of the ranking member's 
comments, just overall the NIH has--it has done some great 
things. I am a big supporter. I think most of us have been big 
supporters in terms of increasing your funding because we 
believe in what you are doing.
    But it has been a little challenging in the last couple of 
years when there were times when I do think the image has been 
called into question not--I am not talking about crackpots. I 
am talking about average Americans who maybe don't get to see 
up close and personal what is happening, and they get 
conflicting information.
    And one of the areas where I think it would possibly help, 
I found last year I followed some reports that genomic data, 
early genomic sequence from Wuhan, China, were deleted from the 
Sequence Read Archive. And we worked to get to the bottom of 
this, and I think partially just because there were concerns, 
rational concerns that the Chinese Communist Party had 
something to do with this, and where is the information?
    I wanted to see what, with regard to the Sequence Read 
Archive, you are doing to secure it from those types of either 
truly harmful things, or maybe it is an image thing, but what 
are you doing in that space?
    Dr. Tabak. There is no question that the communication that 
we had about the Sequence Archive, Sequence Read Archive could 
have been improved. I freely admit that. If I may, the archive 
never deleted the sequence. It just did not make it available 
for interrogation.
    Ms. Herrera Beutler. So, wait, you have the information 
still?
    Dr. Tabak. We have the information.
    Ms. Herrera Beutler. So it wasn't--the way it was reported 
is it was pulled out. The early genomic sequencing was removed 
by a Chinese researcher.
    Dr. Tabak. So anybody who submits to the Sequence Read 
Archive is allowed to ask for it to be removed, and that 
investigator did do that. But we never erase it.
    Ms. Herrera Beutler. Oh, so you don't have the information 
anymore?
    Dr. Tabak. We do. We never erase the information. We keep 
it----
    Ms. Herrera Beutler. So they were able to withdraw public 
viewing of it?
    Dr. Tabak. Public viewing. That is correct.
    Ms. Herrera Beutler. Okay. So researchers can apply to the 
NIH and get the information from you?
    Dr. Tabak. And so in the way that it was originally 
eliminated from public view, it was withdrawn, and that is the 
most difficult for people to access.
    The error that was made--and we found this out after a 
review of all of our processes--was it should have been 
suppressed. The distinction being that if it is withdrawn, it 
is kept archivally on a tape drive. Old technology, but that is 
how it is done. But when it is withdrawn, it can still be 
accessed by accession number, and so researchers are able to 
access that information.
    Ms. Herrera Beutler. So the information is still there?
    Dr. Tabak. That is correct.
    Ms. Herrera Beutler. That is helpful. Thank you.
    Dr. Tabak. The information was never lost.
    Ms. Herrera Beutler. I wanted to switch gears really 
quickly. I mean, I could spend a lot of time on that one, but 
on to overuse and opioids and overdose deaths. In Washington 
State, just in 2021, there was a 66 percent increase in drug-
related overdose deaths, and more than half of these are due to 
fentanyl.
    Your testimony talked about working on research to decrease 
overdose deaths. I wanted to see if you could explain how the 
2023 budget request is going to help you reduce that.
    Dr. Tabak. If I may, I would like to turn to Dr. Volkow 
here.
    Ms. Herrera Beutler. Sure.
    Dr. Volkow. Thanks very much for that question, and the 
budget is going to help us accelerate research in this area 
that is becoming very, very challenging. And it becomes 
challenging because the complexity of overdose deaths actually 
has increased and been made worse during the COVID pandemic.
    Initially, we started with research investments to improve 
the treatment of patients that suffer from pain so that they 
would not be given opioids when they didn't need it. Then it 
shifted to heroin, and then it shifted to synthetic opioids 
like fentanyl. And now fentanyl is being used to mix with 
cocaine, methamphetamine, and illicitly manufactured pills.
    So we need to diversify our scientific projects to go 
beyond interventions for prevention that just focus on pain. 
Very important, crucial, but not sufficient. We need to expand 
into addressing the needs and vulnerabilities of individuals 
that may be exposed by accident to these substances.
    So it goes a range of interventions from very much 
implementation sciences to services research and, at the same 
time, doing the research that can give us better medications to 
reverse those overdoses because naloxone is not so effective in 
this new era of very powerful drugs.
    Ms. Herrera Beutler. That is helpful, and I will yield 
back. I have more questions for Dr. Bianchi if we end up doing 
a second round. I don't know, Madam Chair. Yield to you.
    Thank you.
    Ms. Roybal-Allard. Ms. Frankel.
    Ms. Frankel. Thank you. And thank you to our panel today.
    I got a question. I think it is for Dr. Lowy, but whoever 
can answer it, I would be happy to hear from you. My question 
really has to do with patient navigator programs, which help 
low-income patients and those in underserved communities access 
early screening, diagnosis, and treatment. And specifically in 
terms of cancer, can you tell me how the Cancer Moonshot 
program will invest in patient navigator services to ensure 
access to any of the new treatments?
    Dr. Lowy. Congresswoman, thanks for this question.
    Patient navigation is one of several aspects of trying to 
provide optimal treatment for patients with cancer, which has 
become much more complicated in recent years, in part because 
of its success. In terms of approval of patient navigation, 
this is beyond the NIH, but we conduct implementation research 
to try to optimize patient navigation, along with many other 
aspects of trying to help people have appropriate and full 
access to cancer care.
    This includes doing patient care at home, changing 
radiotherapy, for example; shortening the duration of 
radiotherapy; and trying to look at patient navigation in the 
context of this overall issue of how to provide optimal care to 
virtually everyone in the United States who is unfortunate 
enough to develop cancer.
    Ms. Frankel. Well, thank you, and I hope you will work 
closely with whatever agency it is that directs the navigators 
because, obviously, you can have all kinds of new developments, 
but if we are not able to get it to our full population, I 
think we will be missing a lot.
    Dr. Lowy. Thank you.
    Ms. Frankel. I want to ask a question. Yes, so let me ask 
this question in terms of research on something sort of basic. 
I think everybody I have ever met in my life, and you hear 
about this on TV, all kinds of diets. And there is fad diets, 
and then you read about especially in underserved communities 
where people are not even getting access to the nutrition that 
they need.
    What kind of research is being done in that regard in terms 
of dieting and access to food for everyone?
    Dr. Tabak. So we have recently launched a new set of 
initiatives in nutrition. Among them is a study of so-called 
food deserts, where inadequate nutritional foods are available 
within a given neighborhood, and part of this research will be 
focused on how one can address that in the best way possible.
    Other areas of research have been powered by advances in 
analytical technology. Just as you have the human genome and 
the human proteome, you also have the human metabolome. And the 
metabolome is really a reflection of your nutritional state.
    And so we now can study things at the molecular level that 
give great insight into the value or not of various nutritional 
agents. So we are doing this from both the community-based 
level all the way through the molecular level.
    Ms. Frankel. At some point, I would love to just get some 
information on that. And then I know tomorrow we are going to 
be talking about, or this week, elderly, issues that affect our 
elderly. One is falls. But I do have a research question.
    The healthcare system is costing us over $50,000,000,000 
annually on falls for older people, 36 million older adults who 
report falls every year. I am sure it is much more than that.
    We heard about technology to monitor falls in older adults 
and habits that could change to reduce them. Is there a 
timeline for these products? Can you explain what they are, 
these products, to monitor falls? Is anyone on this panel aware 
of that?
    Dr. Tabak. Yes. So through the National Institute on Aging, 
their SBIR, small business program, has made several awards. 
For example, they have supported a small company, BioSensics, 
that has developed something known as ActivePERS, which is a 
medical alert pendant that does do automatic fall detection. 
And this has now been licensed and integrated into medical 
devices broadly, and it is available through a variety of mass 
market retailers.
    But they are supporting additional research to develop 
sensors, for example, that detect floor vibrations, which could 
be very valuable, obviously, for those who are hospitalized or 
otherwise infirm.
    Ms. Frankel. Okay. Thank you, and I yield back, Madam 
Chair.
    The Chair [presiding]. Mr. Moolenaar.
    Mr. Moolenaar. Thank you, Madam Chair.
    Good to see all of you today. Thank you for being with us.
    Dr. Tabak, I would like to start by asking you, I know you 
are new in this role, but you are familiar with policies, and I 
noticed you have a background as an ethics--advising on ethics. 
And it has recently come to my attention that there is a policy 
at the NIH where scientists and people can receive royalties.
    One of the concerns I have, and I would like you to speak 
to this issue, is the NIH is in the midst, as you know, of 
awarding grants for research, is also in the position of sort 
of evaluating or giving opinions on drugs that work or don't 
work. And the idea that scientists may be benefiting 
financially from work that they have done at NIH, that creates 
to me the appearance of a conflict of interest.
    And just building on what Mr. Cole said about public 
confidence in NIH, to me, one of the biggest concerns people 
had during this last couple of years is, were they getting 
truthful information from their Government? Could they trust 
what people were saying about the medicines?
    And to me, that creates a very disturbing appearance, and I 
would like you to comment on that policy and whether you are 
going to take a fresh look at that policy.
    Dr. Tabak. The award of royalties is based on the Bayh-Dole 
Act, which makes no distinction as to whether or not the 
inventor is paid by the Government, the private sector, 
academia, and so forth. So we are following the Bayh-Dole Act 
when it comes to that.
    Mr. Moolenaar. So if I understand what you are saying, so 
you are saying it is Federal law that allows the NIH to do 
that?
    Dr. Tabak. That is correct.
    Mr. Moolenaar. Okay.
    Dr. Tabak. But in terms of the potential for conflict, no 
individual who is in a decision-making role on a particular 
product would have benefited from being the inventor of that 
product because we separate out those functions. The 
individuals who make recommendations to leadership of 
institutes and centers are in the extramural space. The 
individuals who are making the discoveries that you speak to 
are in the intramural space. They are active scientists. And we 
do not allow those two things to interdigitate.
    Mr. Moolenaar. Well, but my understanding is leaders of the 
organization receive royalty payments. Some, I think, Dr. 
Fauci, you have said that you have donated your royalties to 
charities is my understanding.
    But what strikes me is you are in a position where you are 
saying certain drugs don't work, but then you can, at the same 
time, be getting royalties from other--and I understand you are 
saying there is a firewall. But that information has not been 
made public, and I think sooner rather than later you should 
make that information public because right now, I think the NIH 
has a credibility problem, and this only feeds into this.
    And I am just learning about this. People have always in my 
district been saying, well, so-and-so has a financial interest 
in a certain--they don't like ivermectin because they are 
benefiting from that royalty. Or they don't like 
hydroxychloroquine.
    Now you may have very sound scientific reasons for either 
recommending a medicine or not, but the idea that people have a 
financial benefit from certain research that has been done and 
grants that were awarded, that to me is the height of the 
appearance of a conflict of interest.
    Dr. Tabak. Again, NIH does not--we support the science that 
validates whether an intervention is or is not efficacious. We 
don't say this is good and this is bad.
    Mr. Moolenaar. Truthfully, I would say you had leaders of 
NIH saying certain medicines are not good.
    Dr. Tabak. Based upon the clinical trials that were 
supposed by the agency.
    Mr. Moolenaar. But if the agency is awarding who the 
beneficiary of the grant who is doing the trial, and there are 
somehow finances involved, that there is a financial benefit 
that could be accrued if someone's patent or invention is 
considered valid, do you not see that as a conflict or an 
appearance of a conflict of information?
    Dr. Tabak. I certainly can understand that it might seem as 
an appearance, but--and it is the sort of thing that maybe we 
could work together on so that we can explain to you the 
firewalls that we do have in place because they are significant 
and substantial.
    Mr. Moolenaar. Okay. Well, I would appreciate that, and I 
think in terms of restoring public trust, I think that would be 
a good next step.
    Thank you. I yield back, Madam Chair.
    The Chair. Congresswoman Bustos.
    Mrs. Bustos. Thank you, Madam Chair.
    Good morning to all of our doctors here today. Appreciate 
you being here. Thanks for your service.
    I am going to address my first question to you, Dr. Tabak. 
And I want to thank you for your work on biomedical workforce 
and appreciate what you are doing there.
    I want to start by looking at the administration's work to 
address inequities. So the NIH plays a leading role in 
advancing biomedical research, developing diagnostics, 
improving cures, treatments, ailments, diseases. And really, 
the impact the NIH makes is tremendous.
    And if I want to--you know all the stats, but I drill down 
to the State of Illinois where I am from. You have got 732 
awards that were given, totaling $311,000,000, and these are in 
these competitive grants. So we are very pleased with that.
    This opportunity to use the funding to advance biomedical 
research is tremendous, but it also plays a meaningful role in 
addressing health disparities. So that is what I would like to 
ask you about.
    I know that the NIH budget requests $350,000,000 in 
increase to support research on health disparities. Can you 
talk, Dr. Tabak, about what broader impact that the President's 
budget request would have on addressing inequities that lead to 
disparities in access to care and patient outcomes?
    Dr. Tabak. It will do so in several ways. Our work in 
health disparities increasingly is being done at the community 
level. We have learned that you can't just parachute into a 
community, study it, and then disappear----
    Mrs. Bustos. Amen.
    Dr. Tabak [continuing]. And you have to establish 
meaningful trust. That takes time, but it is obviously quite, 
quite worth it.
    And indeed, Dr. Gibbons has set up the so-called CEAL 
program. If I may, I would like him to comment on that.
    Mrs. Bustos. Please.
    Dr. Gibbons. Thank you for that question.
    This is critically important. Addressing health inequities 
often involves what we call the social determinants of health, 
the fact that the context matters, the place matters. And so, 
often, because these are such vexing problems, you need a 
multiprong, multilevel strategy that, as Dr. Tabak indicated, 
often begins in the community that, indeed, knows its assets, 
knows its challenges, and even can co-develop with us 
strategies to address them.
    Certainly, we, the NHLBI, have a program where it is 
cardiovascular health, which is clearly problematic in certain 
communities--low income, rural, communities of color--in which 
community-engaged research strategies are being shown to be 
effective in, for example, maintaining blood pressure control, 
preventing strokes.
    Indeed--you mentioned Illinois--we have teams in South Side 
of Chicago literally working on this, involving members of the 
community. Actually, we have mental health issues that are 
intersecting with their challenges in terms of their 
cardiovascular risk.
    That holistic approach that we can take in this context, 
this has been borne out to be very successful in addressing the 
pandemic and, indeed, has a broad array of capabilities for a 
variety of those conditions. Whether it is cardiovascular 
disease, HIV research, maternal morbidity and mortality, these 
strategies we are finding to be particularly effective.
    Mrs. Bustos. And could we drill down a little bit more, 
too, and can you talk about the President--and whoever is best 
to address this--the President's budget request for NIH 
supporting the recently announced Equity Action Plan? Would 
that be best for you to address, Dr. Gibbons or Dr. Tabak?
    Dr. Tabak. I can start. Actually, any one of my colleagues 
can speak to this because each institute and center is 
developing such a plan for their own individual organization, 
understanding that there is some variation among the groups. 
And in it, they will point out what gaps exist within their own 
organization both in terms of what they do externally, but also 
internally.
    And these plans are going to be shared among all the 
institute and center directors so we can learn best practices. 
And this will be an annual event, and so they will be updated 
going forward.
    Mrs. Bustos. Great. And just to play off of Dr. Gibbons a 
little bit about what you said, Chairwoman DeLauro and Ranking 
Member Cole have been great on this issue, but we actually have 
a Social Determinants of Health Caucus. I am co-chair of that. 
And then we have a bill called the Social Determinants 
Accelerator Act, where we initially asked for $25,000,0000 that 
would, to your point, Dr. Gibbons, that would start at the 
local level to come up with plans, and then we would have this 
interagency council that would then help decide where these 
grants go.
    And so we got $3,000,000 last fiscal year, $8,000,000 this 
fiscal year. The President put in his budget $153,000,000 for 
it. So we want--that number needs to grow. Obviously, that is 
the job of the appropriators to be able to get that through, 
but something that I think is really the answer to having 
these, looking at this at a very local level, the social 
determinants, and helping really get healthcare in a better 
place for so many people who need us to pay attention to this.
    So thank you very much again to all of you. Thank you for 
your service to America and for trying to make people 
healthier.
    With that, Madam Chair, I yield back.
    The Chair. Congressman Cline.
    Mr. Cline. Thank you, Madam Chair.
    My questions are for Dr. Fauci. Dr. Fauci, in October of 
2020, Dr. Jay Bhattacharya, a professor of epidemiology at 
Stanford; Dr. Martin Kulldorff of Harvard Medical School; and 
Dr. Sunetra Gupta of Oxford University issued the Great 
Barrington Declaration. The declaration of these medical 
scientists argued that the appropriate strategy for coping with 
COVID-19 was a strong targeted response designed to safeguard 
the most vulnerable populations--older persons with 
comorbidities--while avoiding mass lockdowns with damaging 
social and economic costs like the ones that we have seen and 
the forced isolation of younger and healthier persons with 
vastly less risk of severe illness, hospitalization, and death.
    In response, Dr. Collins described these medical scientists 
as fringe scientists, and you likened their responses akin to 
AIDS denialism. Dr. Collins, in an October 2020 email, called 
for a ``quick and devastating published takedown of the authors 
and the declaration.''
    The claim that the medical scientists opposing a strategy 
of comprehensive lockdowns were somehow fringe was proven to be 
baseless. Dr. Ioannidis, professor of the Department of 
Medicine at Stanford University, published a quantitative 
analysis of the professional publications as well as the social 
media visibility of the 47 original signers of the Great 
Barrington Declaration in the British Medical Journal this 
year.
    He found that among the 47 original signatories of the GBD, 
20, 19, and 21 respectively were among the top cited authors 
for career impact in the recent single year of 2019 for either. 
Likewise, Professors Galea and Stein of the Boston University 
School of Public Health cited the lack of reasoned debate over 
the Great Barrington Declaration as a sign of the growing 
intolerance of disagreement in the field of public health.
    So I will ask you on what basis did you and Dr. Collins 
identify these doctors, the authors of the Great Barrington 
Declaration, as fringe scientists out of the mainstream 
epidemiological science?
    Dr. Fauci. I never characterized them as fringe scientists, 
if you look at the record. That is incorrect. Okay?
    Mr. Cline. Dr. Collins did. You referred to their----
    Dr. Fauci. Well, you are asking me the question. I never 
called them fringe scientists.
    Mr. Cline. And your comment regarding AIDS denialism?
    Dr. Fauci. Well, the issue with the Barrington Declaration 
is that what they were stating is that if you let the virus run 
free in society and only so-called protect the vulnerable, and 
the question is who are the vulnerable in society that you are 
going to protect? And most public health officials totally 
disagree with the Barrington Declaration.
    And in fact, if you did that, let it just run free and not 
try to protect the population in general, we almost certainly 
would have had many more infections, many more 
hospitalizations, and many more deaths. So with all due respect 
to the scientists who signed the declaration, I completely 
disagree with them.
    Mr. Cline. Okay. Would you agree that during the times of 
the lockdowns, the data that we have seen following these 
lockdowns has shown that we have had increases in depression 
among young people?
    Dr. Fauci. There is no doubt that when you put----
    Mr. Cline. Yes or no, if you could just----
    Dr. Fauci. Well, I will answer the question. There is no 
doubt when you put restraints on society that it causes 
emotional and mental stress. There is no doubt about that. But 
you have to have a balance of saving people's lives from 
getting infected and hospitalizations.
    Mr. Cline. Would you agree that suicide rates have 
increased among young people?
    Dr. Fauci. Indeed, they have.
    Mr. Cline. Would you agree that domestic violence rates 
have increased?
    Dr. Fauci. Yes. The answer is yes, but I am wondering what 
that has to do with the question you are asking me.
    Mr. Cline. Would you agree that drug and alcohol use 
increased during these lockdowns?
    Dr. Fauci. Well, I am not sure the lockdowns itself did it, 
and I am wondering why you are asking me about lockdowns 
because there were not complete lockdowns in this country. 
There were restrictions, obviously, but there were not 
lockdowns.
    China is now going into a real lockdown. So I would 
disagree with characterizing whatever went on in this country 
as a full lockdown.
    Mr. Cline. All right. Moving on, when the prospect of a lab 
leak from Wuhan gained traction in April of 2020, Dr. Collins 
told you that you should find some way to ``put down this very 
destructive conspiracy.'' We also understand that Dr. Collins 
emphasized that the lab leak theory could damage science and 
international harmony.
    Did you direct letters to two professional journals be 
written, to Lancet and Nature Medicine?
    Dr. Fauci. No.
    Mr. Cline. You did not ask Daszak to write the letter to 
the Lancet?
    Dr. Fauci. No.
    Mr. Cline. Did you review it before it was sent?
    Dr. Fauci. No.
    Mr. Cline. I yield back.
    The Chair. Congressman Harder.
    Mr. Harder. Thank you so much, Chair DeLauro, for hosting 
this hearing.
    And thank you all, for our witnesses, for being here in 
front of the subcommittee.
    Since we last met, the American Lung Association released 
their 2022 State of the Air report. That report gave my 
district in California both Stanislaus and San Joaquin Counties 
an F grade. This means that they received an F grade for both 
ozone and particulate pollution in a 24-hour period, and a 
failing grade for particulate pollution annually.
    And this has huge health impacts for my constituents. One 
in five kids in our community has childhood asthma. I had it. 
My brother had it. I know what it is like to worry whether or 
not your inhaler is in your backpack every day. And these F 
grades illustrate what everybody in our community already 
knows, which is our air is bad. It is only getting worse. And 
frankly, I refuse to let my daughter grow up breathing worse 
air than I did.
    My question is for Dr. Tabak. With this continuing trend in 
my community and I believe in many parts of our country 
regarding poor air quality and the staggering cases of 
childhood asthma, what can the NIH commit to doing with this 
year's budget to ensure that Federal dollars are directed to 
programming and research to tackle the issues of air quality 
and asthma?
    Dr. Tabak. The budget does request resources to study the 
effect of climate on health, and certainly, this is part and 
parcel. If I may, I will turn to Dr. Gibbons, who is very 
deeply involved in this initiative.
    Dr. Gibbons. And thank you, Representative Harder, for 
pointing out that very challenging situation.
    We have known for many years, obviously, that air pollution 
has an impact actually on the lung development of children such 
that it stunts the development of lungs and predisposes to 
conditions like asthma, as you described. And we have actually 
seen trends over time that when the air quality improves, there 
is an improvement in that childhood lung function. So we know 
that if we can mitigate that exposure, it can have benefits.
    Certainly, we recognize that there are many communities--
often lower-income communities, communities of color--that are 
particularly besieged by the challenges of the particulate 
matter that you described. And clearly, that is an exacerbant 
that promotes not only lung disease, but cardiovascular disease 
and a lot of other complications.
    Now we are making progress in terms of the family history 
you have described with asthma. Certainly, we are getting 
greater understanding of the inflammation. In fact, the 
inflammation induced by those particles on the lung. And so our 
treatment strategies I think have improved substantially as a 
result of this basic research in which we are understanding now 
the pathways and now new therapeutic targets to reduce that 
inflammation and enhance lung health.
    And so, indeed, there is greater precision medicine now in 
how we treat asthma. But certainly, we still need to do a lot 
more at the root causes that relate to climate, climate change, 
and the effect of wildfires and everything that is exacerbating 
that whole spectrum of etiology of asthma.
    I will stop there.
    Mr. Harder. Thank you, Dr. Gibbons.
    How impactful do you think those wildfires are? Obviously, 
this is something we are seeing all across California. How 
influential do you think that is in some of the asthma and air 
quality concerns we are seeing?
    Dr. Gibbons. Yeah. No, it is an important observation. It 
clearly is contributory. We are seeing that pattern as measured 
in changes in those particulate matter. The air quality is 
deteriorating.
    Moreover, as you can appreciate there on the west coast, 
with the prevailing winds, even those changes in wildfire--
declines in air quality sweep across the country as well, and 
so we recognize that this is going to be a national problem. 
And with the trends of climate change, wildfires, and declining 
air quality, an ongoing problem that we hope we can potentially 
address the health effects through this trans-NIH program of 
climate change and health.
    Mr. Harder. Thank you. That is very helpful.
    I could just draw this attention to some of the efforts in 
this budget for a new community air quality monitoring and 
notification program, which is trying to, I believe, in 
essence, take some of the NIH research to make it as practical 
as possible. I think that is a no-brainer that we would really 
benefit from.
    So, so thank you so much, Dr. Gibbons. And with that, I 
yield back my remaining time.
    The Chair. Congresswoman Clark.
    Ms. Clark. Thank you, Madam Chairwoman.
    Again, it is an absolutely honor and delight to be here 
with so many representatives of NIH, and our deep gratitude for 
your science, your research, your leadership in this time of 
great challenge globally and certainly here in our country.
    I want to start with one of the increasing crises that we 
are seeing, and that is worsening mental and behavioral health. 
We are especially seeing this in our young people. And while 
much of the concern is focused on the limits of caring for this 
population, I am concerned that we need to be redoubling our 
commitment to better understand the issues that span 
neuroscience, traumatic brain injury, addiction, genetics, and 
more.
    So my question for Dr. Tabak and Dr. Volkow is how is the 
NIH ensuring this multifaceted topic is appropriately 
addressed, including coordination among multiple relevant 
institutes and centers? And do you have the resources necessary 
to meet this moment?
    Dr. Tabak. We do have opportunities across NIH for the 
different institutes and centers in this space to collaborate 
with one another. Through, for example, the BRAIN Initiative, 
which is now seeking to understand the circuits of--how the 
circuits in the brain work. But there is also emphasis on the 
community-based level of making sure that the appropriate 
mental health services are provided to those who need as well 
as efforts to avoid the stigmatization that accompanies mental 
health conditions.
    But let me turn to Dr. Volkow for her input.
    Dr. Volkow. Yes, thanks very much for that question, and I 
think that as we are addressing all of the challenges with the 
COVID pandemic, we realize that when we solve the public 
pandemic, the problems that have arisen from mental health 
issues are going to be remaining. And particularly vulnerable 
are children and adolescents, and we are already seeing that, 
with 30 percent increases in depression, anxiety, loneliness.
    We are seeing an increase in suicides among teenagers, even 
though it is not happening in adults. And we are also seeing an 
increase in intentional overdoses among adolescents. And for 
the first time, we are seeing overdose deaths in adolescents 
from fentanyl.
    So the situation is clearly urgent, and so what we are 
doing is, as Dr. Tabak was saying, we are joining our efforts 
across the different institutes to try to understand what are 
the effects and how they affect ultimately the behavior of a 
child. What are the trajectories, and what are the 
interventions that we can do to support them?
    It is clear that is going to have to be personalized, and 
it is clear, something that we have been discussing here, that 
the social determinants of health are crucial, and we have 
learned to recognize that those that are in adverse economic 
situations or social stressors are the most vulnerable. So 
understanding those factors so that we can develop 
interventions that can be targeted.
    And importantly, putting the resources that are necessary 
to provide those evidence-based interventions to protect our 
children and adolescents.
    Ms. Clark. Thank you so much.
    I want to go back to ARPA-H, and my colleague Mr. Cole 
raised the question around the National Cancer Institute, and I 
share those concerns. But ARPA-H also has potential to 
transform frontiers of biomedical research.
    I obviously think that if the decision has been made that 
ARPA-H should be located outside of NIH and outside of 
Washington, that Massachusetts, as the home of the most vibrant 
and promising biotech life science companies, leading-edge 
research, academic institutions, and hospitals, is a place 
where ARPA-H should go. But as far as I know, there is no 
proposed selection process for siting this agency and even less 
clarity on who will run it.
    Can you tell me, is there a plan on how to solicit and 
evaluate proposals to site ARPA-H, and when do you expect a 
Director to be appointed?
    Dr. Tabak. The search process is under way for the 
inaugural Director of ARPA-H. This is a presidential 
appointment, and so, obviously, this is being driven by the 
White House. There has been no commitment made to the physical 
location of where ARPA-H will be located.
    We obviously are continuing to frame this out for the 
consideration of the Secretary and for whoever the inaugural 
Director may be. But until that appointment is made, no 
decision will be made on a physical location.
    Ms. Clark. And there is no timeline for an approval 
process, selection process?
    Dr. Tabak. I can tell you that the search is definitely 
ongoing, and I know that the intention is to move that as 
rapidly as possible.
    Ms. Clark. Thank you. I see my time has expired.
    Thank you, Madam Chair.
    The Chair. Congresswoman Lawrence.
    Mrs. Lawrence. Thank you, Madam Chair.
    Doctor, I recognize that last September, the NIH announced 
10 grants focused on firearm violence prevention, including one 
focused on firearm violence prevention tactics in K through 12. 
As you know, we had the last mass shooting that happened was 
right outside my district at a high school. And so I hope that 
this research is happening in Detroit, which I hope are just 
the first of many to address the gun violence epidemic that we 
have.
    While I recognize that these awards were just made, can you 
speak to the importance of resuming Federal research into 
firearm violence reduction?
    Dr. Tabak. Well, as you point out, 10 awards were recently 
made. Future research directions will likely include work to 
better understand the interplay of the neurological, 
biological, psychological, and social and structural processes 
that may enter into this. Also emphasis on violence and trauma 
screenings and interventions need to be developed and then made 
available both in healthcare settings as well as school 
settings.
    And we have come to understand that the violence prevention 
efforts have to be multilevel and focused on mechanisms of 
action. So just to give you an example, one of the awards was 
made to evaluate the effectiveness of child and family 
traumatic stress intervention to reduce PTSS in youth after 
they were assaulted. It is things like this that will hopefully 
help us reduce and eventually eliminate these tragic events.
    Mrs. Lawrence. Well, I just want to tell you I am very 
excited about the grants, but this must become a priority for 
us in America. Too many moments of silence and best wishes for 
your family. We have to do something in America to address gun 
violence.
    In that vein, I want to commend the inclusion of more than 
$100,000,000 for targeted research on mental health. We know 
that mental health plays a major role in gun violence and 
incarceration in America. And COVID-19 just added another whole 
level to mental health awareness. And drug addiction, a lot of 
that is tied to mental illness.
    So my question is, can you highlight the impact of last 
year's investment on mental health research, and how does this 
year's increase build on the NIH work from last year?
    Dr. Tabak. So the work that has been recently supported is 
really to strengthen mental health response during the time of 
the pandemic. It really--it seeks to really increase uptake of 
those practices that we know that are effective. So, for 
example, it turns out that digital healthcare platforms are 
really good approaches, and we have to be able to figure out 
how to adapt those formats and platforms to where it is most 
needed.
    If I may, NIMH and NICHD issued a joint Notice of Interest 
that Dr. Bianchi may wish to speak to.
    Mrs. Lawrence. And Dr. Bianchi, before you speak, I just 
want you to know that the mental health piece and the virtual 
part of that was tremendous, and I hope we continue. You can go 
ahead.
    Dr. Bianchi. Thank you very much for your comments.
    One of the things that we are very excited about is the 
destigmatization of youth mental health issues, and we are co-
funding, along with a number of other institutes, but NIMH is 
the lead on this, we are funding a high school essay challenge 
to bring high school students in to write about their 
experiences and again with the goal of destigmatizing some of 
these issues. We need to bring this out in the open. There is 
no question that children and adolescents have been 
significantly affected by all kinds of issues related to the 
pandemic.
    Mrs. Lawrence. And also we must look at the workforce in 
mental health. We know and I hear all the time that schools and 
other places say we don't have enough social worker or mental 
health professionals to address the growing demand in this 
crisis of mental health.
    Thank you. My time has expired.
    The Chair. Thank you. We are going to move to a second 
round, and we will try to get in as many questions as we can 
and are going to allot 5 minutes per member for the second 
round of questioning.
    So, with that, let me--and I am going to try to get in two 
or three questions, if I can.
    Dr. Fauci, first of all, my congratulations on being named 
Chief Medical Adviser to the President. I also want to ask 
about universal flu vaccine. Can you provide us with an update 
on the development of the universal flu vaccine?
    It is 15--you are looking at $15,000,000 in an increase. 
What will we accomplish with those funds and with what we have 
there, with what is in 2022 and the additional funds that were 
requested in 2023?
    Dr. Fauci. Yes, well, thank you very much for that 
question, Madam Chair.
    Yes, the money that was given to us in the last 
appropriation has been very helpful, and I will summarize 
briefly what has happened since we spoke last. And the 
additional plus-up in the current 2023 budget will be very 
helpful.
    So what we have been doing over the last couple of years 
now is bringing a number of new concepts into the universal flu 
vaccine. As I mentioned to you I think when I briefed you in a 
previous time, one of the approaches is to use new platforms, 
one of which is referred to as nanoparticle, which is a 
component of a vaccine that allows you to tack on to these 
microparticles any of a number of immunogens, as we call them.
    One of them is one that is very common to virtually all of 
the flu within a particular group of influenzas. And in 
preliminary studies look really very good, both in the animal 
model and in Phase I studies in which you are inducing a 
response that goes well beyond just the particular flu that you 
are vaccinating against.
    In addition, a number of studies, both intramurally at the 
NIH campus in Bethesda as well as in our grantees, have now put 
into both preclinical and Phase I study a number of candidates 
using these various platforms. The results look actually really 
very good in the sense of a vaccination now that goes well 
beyond the particular isolate that you are dealing with and 
covers.
    As you know, flu is divided into two main groups, Group 1 
and Group 2, and the ones that we get exposed to, which are 
predominantly H1N1, H3N2 influenza B. In the influenza A's, we 
now look like we can get good responses that have both depth 
and breadth against multiple ones within either Group 1 or 
Group 2.
    So each months and years that go by, we are getting closer 
and closer to what I think would be a much more effective and 
universal vaccine. But thank you for the support. It meant 
everything to get us there.
    The Chair. All right. Well, thank you, and you know we will 
look to the $15,000,000 to see if we can continue that.
    Dr. Bianchi, just if I can, the $30,000,000 increase to 
ramp up the IMPROVE initiative. And Dr. Tabak's testimony 
talked about establishing Maternal Health Research Center of 
Excellence. Can you tell us a little bit about your research to 
reduce rates of maternal mortality and morbidity? Are you 
seeing progress? How are the Centers for Excellence going to 
help achieve long-term success?
    If you can tack onto that the $8,000,000 that we did in 
2022 for women's health research and research--for the Office 
of Research and where that is going?
    Dr. Bianchi. Thank you for your question and, importantly, 
thank you for the support for the IMPROVE initiative, which is 
an NIH-wide initiative, and it is addressing many of the themes 
that we heard about today in this session, particularly social 
determinants of health.
    The goals of the IMPROVE initiative are to prevent maternal 
mortality, which shows major health disparities, also to 
decrease severe maternal morbidity and, importantly, to promote 
health equity. Because of the timing of the budget this year, 
what we have decided to do this year is to have three very 
strong pillars that will roll into the Centers of Excellence. 
The Centers of Excellence Funding Opportunity Announcement will 
come out this summer.
    In the meantime, we have a major goal of increasing 
community partnerships, and in particular, we want to bring in 
communities that have knowledge of the local culture and have a 
trusted relationship. Trust has come up today as well. And so 
we need people who have a trusted relationship in the community 
to begin to implement changes that will result in improved 
maternal care.
    The other thing that we are doing is we are developing 
technologies that will particularly improve care for women who 
are in underserved areas, the so-called maternity deserts, as 
well as women in rural environments who don't have access to 
obstetric care. So we are looking at wearables. We are looking 
at apps on your cell phone as ways that we can monitor women 
who are in trouble and who need to get appropriate care.
    As far as the Office of Research on Women's Health, I think 
Dr. Tabak will answer that.
    Dr. Tabak. So the additional resources to ORWH, which we 
are very thankful for, they will invest that in their so-called 
BIRCWH program, which I think you are familiar with. This is an 
interdisciplinary program which provides mentorship to 
participants and connects the junior faculty--they are known as 
BIRCWH scholars--to senior faculty who have a shared interest 
in women's health. And this is really a program that is key to 
supporting multiple goals of the NIH-wide strategic plan for 
women's health research.
    The Chair. I am well over my time. I have another question, 
which I am going to try to squeeze in--not now, but later--on 
cancer immunotherapy.
    Congressman Cole.
    Mr. Cole. Thank you, Madam Chair. I couldn't help but 
reflect, my good friend from Massachusetts, when she made her 
pitch for ARPA-H, I thought, well, I could help her.
    The Chair. New Haven.
    Mr. Cole. The Patriots can come to Oklahoma City. I mean, 
we can work something out here. That is probably a private 
conversation.
    I do have two serious questions, and I will try and ask 
them both. One will be for you, Dr. Tabak. One, Dr. Volkow, 
will be for you. And you can just split the time.
    And this first one would probably be better directed to Dr. 
Hodes, but he is not here. So I am very curious, on the 
Alzheimer's front, we make considerable investments. We have 
got a lot of concern about just the sheer expense this disease 
imposes on us, not to mention the human tragedy. So how do you 
see the state of play?
    Obviously, we have had some controversy over a drug. 
Personally, I will just state for the record I don't care about 
the cost. I care whether it works. Over time, we can bring the 
cost down if it works. And I know that is not your decision to 
make. But any thoughts you have on that area?
    And Dr. Volkow, just to give you sort of a heads-up, what I 
wanted to get from you, I am very curious about your thoughts 
on marijuana use, just given the prevalence we have now. It 
looks to me like, honestly, the social use has outrun the 
science. We really don't know, to my way of thinking, the 
potential damage here, and the horse is already out of the barn 
probably. But I am curious about where you see the problem 
areas here, where the research is taking us.
    So, with that, if I may, Dr. Tabak, let me go to you first 
on Alzheimer's.
    Dr. Tabak. So just topline, we are funding more than 350 
trials in this space now. Seventy are pharmacologic treatment 
and prevention trials, 120 are nonpharmacological and 
prevention trials, and then the remainder are related to 
dementia care and caregiving intervention tools. Very 
important, obviously.
    Public-private partnership. AMPAD has identified over 558 
new drug targets. The IMPACT Collaboratory is developing 
pragmatic trial infrastructure to really look at how we improve 
care for these patients, and I am sensitive to the time. So let 
me turn to Dr. Volkow.
    Dr. Volkow. Thanks very much for the question.
    And indeed, the use of marijuana has gone up, particularly 
among those that are 18 years of age or older. And during the 
COVID pandemic, we have seen again this has increased, and 
among the areas that we are most concerned, of course, are 
pregnant women. And we have seen during the COVID pandemic a 
significant rise in the utilization of marijuana, whether it is 
for medical--so-called medical purposes or recreational use.
    All along, we have also been very concerned about the 
consequences of marijuana use among particularly the developing 
brain, and that actually goes starting in fetal development or 
childhood and adolescence. And the data already show that the 
outcomes are much worse for women that smoke marijuana during 
pregnancy, and the data also show that use of marijuana in 
teenage years actually significantly impairs the performance of 
these teenagers at school.
    But what is also worrisome is we have seen that significant 
increases in acute psychosis associated with the use of 
marijuana across all ages. This is in part driven by the fact 
that the currently available marijuana has higher content THC. 
So it is much more powerful. This is also associated with 
higher rates for accidents.
    There are other areas that are not clear, but the numbers 
seem to suggest that there is an increased risk, for example, 
of suicidal behavior among people that are using marijuana 
regularly. The extent to which they are using marijuana to 
escape suicidal thinking, as opposed to marijuana causing 
suicidal thinking is unclear.
    But we are prioritizing this area because the American 
public deserves to know--ultimately, they are going to be 
making a decision of taking marijuana for medical or nonmedical 
purposes--what are the potential consequences? And we, as a 
government, of course, need to identify what are potential 
adverse effects where we can put resources and do prevention 
interventions and their ability to support those that have 
become victims of its effects.
    Mr. Cole. I would just urge you to do what you can, in the 
time I have left, to get as much information out as quickly. I 
think we are going to wake up some day and find out that it is 
a lot like tobacco. We understood a lot more about it too late, 
and we have been reactive legislatively over the years at the 
State level and the Federal level to try and deal with that. 
And we could have the same thing here.
    I would ask this, Dr. Tabak. Again, I am not going to ask 
you to respond, but maybe Dr. Hodes could follow up. I am very 
interested in whether or not--and Dr. Collins told me one time 
we thought the investments we had made might bend the curve 
looking forward in the cost of care in this particular disease 
with Alzheimer's, and so I would love to know if we are making 
the kind of progress I know that Dr. Lowy and his folks at the 
National Cancer Institute have been making on that, or that is 
foreseeable?
    Dr. Tabak. We will certainly follow up with you.
    Mr. Cole. Thank you for that.
    I yield back, Madam Chair.
    The Chair. Congresswoman Roybal-Allard.
    Ms. Roybal-Allard. Congressman Cole actually asked the 
question that I was going to ask with regards to marijuana. And 
I just want to add to what was already said that according to 
the National Poison Data System, they identified a rise in 
marijuana use in children 0 to 6 years old, with over 70 
percent of those cases in States that legalized recreational 
use. And that is just a number based on those that have come to 
hospitals for emergency treatment.
    So there is--I share the congressman's concern on the fact 
that with the legalization of marijuana, there is also a 
decrease in the perceived harmfulness of it. And so I 
appreciate the research that you are doing, and I hope that at 
some point, as Congress considers legalizing it across the 
Nation, that you can give us some guidance on safeguards, and 
that could be put into that legislation if, in fact, that does 
happen.
    I want to follow up on a question that was asked by 
Congresswoman Herrera Beutler with regards to fentanyl. Several 
States have adopted preventive tools such as fentanyl test 
strips into their overdose prevention strategies. And as you 
are aware, approximately half of States continue to oppose the 
implementation and decriminalization of fentanyl test devices.
    What does research tell us about the effects of 
decriminalizing fentanyl test strips on opioid overdose? For 
example, is there a difference in the drug overdose deaths 
across States that have decriminalized fentanyl tests versus 
those that have not?
    Dr. Volkow. And that is an important scientific question 
and actually one that we were looking to. Currently, we do not 
have that data, but we can clearly tell you from the 
epidemiological studies that have actually reported a 
significant number of overdose deaths from individuals that are 
taking drugs like cocaine and methamphetamine that are 
contaminated with fentanyl was unbeknownst to the user. So 
providing them with a tool that enables them to actually test 
the drugs that they are buying to see if they have or not 
fentanyl could significantly decrease the risk of overdosing.
    Ms. Roybal-Allard. Drs. Tabak and Bianchi, on December 14, 
the congressionally directed National Children's Study was 
terminated despite ongoing congressional concerns that this 
study was critical to assess the impact of environmental risks 
upon children's health and development. To address 
congressional discomfort with the NIH decision, former Director 
Francis Collins instituted the Environmental Influence on Child 
Health Outcomes, known as the ECHO program.
    As you know, the ECHO program made use of existing 
maternal-pediatric cohorts which were recruited through the 
National Children's Study to address the five health outcomes 
of pregnancy and birth, upper and lower airway conditions, 
obesity, zero development, and positive health. And we are 
currently in the final year of the 7-year program, and before I 
retire from Congress this year, I would like to have some 
assurance that the ECHO program has either met most of the 
goals of the original congressionally directed study or that 
there is a plan in place to continue and build on the ECHO 
research thus far.
    Since its inception, can you highlight some of ECHO's key 
accomplishments with respect to its observational and 
interventional research component, and what approaches has the 
ECHO program taken to ensure that its research findings are 
widely disseminated amongst participants, policymakers, and 
other stakeholders?
    Dr. Tabak. So there are a number of impact, high-impact 
findings that I could share with you. ECHO is the first to show 
disparities in asthma incident rates across the United States 
by racial and ethnic populations in early childhood. Obviously, 
this might lead to solutions to address the health disparities.
    We spoke earlier about particulate matter in the air. ECHO 
has found ultrafine particles late in pregnancy are associated 
with the development of asthma in the first years of life, and 
this obviously has the potential to inform regulation of these 
ultrafine particles, which are not currently regulated by the 
EPA.
    Finally, there is an obesity study of over 37,000 babies 
and children from the 7-year ECHO cohorts. The obesity rates 
were higher among the older than younger children. The rates 
are higher in nonwhite races and ethnicities.
    Going forward, they are expanding to include 28,000 
additional women recruited during their pregnancy, and they 
have included a preconception pilot of 10,000 couples, which 
they estimate would result in about 3,000 births. So that 
ultimately will allow you to understand questions about health 
disparities and health equity, social determinants of health, 
as well as natural experiments or health crises as you follow 
these individuals longitudinally.
    Ms. Roybal-Allard. My time is just about up. But I just 
want to know is there any plan to extend the ECHO program 
beyond the 2023?
    Dr. Tabak. We certainly will be asking for additional 
support, yes.
    Ms. Roybal-Allard. Thank you.
    The Chair. Congressman Harris.
    Mr. Harris. Thank you very much. We have a lightning round 
here.
    Dr. Lowy, listen, I want to thank the NCI for actually 
issuing a Notice of Special Interest to promote research in 
understanding the mechanisms by which cannabis and cannabinoids 
can affect cancer biology, cancer inception, cancer treatment 
and resistance, management of cancer symptoms, et cetera.
    Dr. Volkow, is this ready, shoot, aim? I mean, we are 
basically approving a medicine because, as you said, so-called 
medical marijuana around the country without having done these 
studies yet. We don't know what the effect on tumors are of 
widespread marijuana use.
    I mean, this is a rhetorical question. It is kind of a bad 
idea, isn't it? Shouldn't we know the questions to whether--
testicular cancer, for instance, is the instance increased by 
marijuana--before we actually legalize it everywhere? A 
rhetorical question. You don't--yes.
    Dr. Volkow. This is why we do research.
    Mr. Harris. That is right. Thank you very much.
    Dr. Tabak, in your notes, you noticed--and your testimony--
that the nutrition research is going to be kind of overseen by 
the Office of the Director. Do you think it would be worthwhile 
to study whether SNAP purchases should be limited to the WIC 
nutrition-based food list in order to deal with the problems 
with obesity, diabetes, things like that. Do you think that 
would be a worthwhile thing to look at?
    Dr. Tabak. It is certainly something to look at.
    Mr. Harris. I think it is about time we do that. And we 
know from the COVID pandemic that obesity is a real problem in 
America. It leads to serious morbidities and mortalities, and 
yet as the Government through SNAP program, we kind of 
encourage obesity by allowing the purchase of things like soda 
and chips and things like this.
    Dr. Tabak, also because we talked about Alzheimer's 
research. I know that the Institute on Aging did not directly 
fund the Aduhelm research, but the FDA decision--and again, the 
firing of the CEO of the company. The FDA decision to take the 
particular track they have toward payment for it, do you think 
that is going to have a relatively chilling effect on privately 
funded Alzheimer's research going into the future?
    Dr. Tabak. Well, this is something that the NIH has no 
authority on.
    Mr. Harris. Well, I know. But NIH obviously cares about the 
broad spectrum of Alzheimer's research, both NIH funded 
directly and the fact that the private sector is an important 
R&D sector. Does it give you a little heartburn that there 
might be a pullback on privately funded research due to that 
CMS decision?
    Dr. Tabak. Partnerships with industry are very important to 
moving our agenda forward.
    Mr. Harris. Yes, that is what I imagine. Just one brief 
last question, Dr. Fauci. Ad majorem dei gloriam. Not everyone 
is going to know what that refers to, but you and I do know 
what that refers to.
    You are respected as kind of the scientific voice for the 
country. Does the physical and genetic life of a human being 
begin at conception? Does the physical and genetic life of a 
human being--not a human person, a human being--begin at 
conception?
    Dr. Fauci. I don't know if I----
    Mr. Harris. I will--you can do it as a QFR if you want, you 
can respond to that, but I will ask that question as a follow-
up.
    I yield back, Madam Chair.
    The Chair. Mr. Pocan.
    Mr. Pocan. Thank you, Madam Chair, and thanks for the 
second round.
    I also want to thank Dr. Volkow for the work at NIDA that 
you have been doing around research around kratom. I think the 
vast majority of States it is legal. My State, it is not, in 
Wisconsin. And I have worked with Republicans and Democrats to 
try to change that. But I think even the way you describe it on 
your website, you have always been an advocate for additional 
research.
    We know that it has helped many people to get off of 
opioids. Unfortunately, we are in the tens of millions of 
people there. But there are thousands and thousands of people 
who this has worked for quite well.
    And I just want to say thank you. You don't even have to 
answer a question. I just wanted to make sure I acknowledge the 
work that you are doing.
    I do want to ask Dr. Tabak a question. So you are a 
dentist, in addition to being a scientist, and I know that 
healthcare providers often take the Hippocratic Oath or a 
similar commitment to medical ethics. Do pharmaceutical 
companies have a similar obligation to prioritize the well-
being of the patients they serve, even if it means putting the 
greater good ahead of their own profits?
    Dr. Tabak. I am not aware of what their standards are.
    Mr. Pocan. Would you think that would be a good standard?
    Dr. Tabak. Of course.
    Mr. Pocan. Of course. Could you say that again?
    Dr. Tabak. Yes, of course.
    Mr. Pocan. Thank you. Okay. I just wanted to make sure I 
had that.
    And the reason I asked that--and I think I got a little 
ahead of myself, and Dr. Fauci, I had answer the other question 
on all the money that NIH is providing to the promising next 
generation pan-coronavirus vaccines is really a question 
currently with a drug--and I am probably going to kill the name 
because they do that to us--Xtandi? If I am saying it correct?
    So, right now, this is a prostate cancer medicine marketed 
in the U.S. by a subsidiary of a Japanese pharmaceutical 
company, Astellas. They charge U.S. taxpayers and consumers two 
to four times the price of that than other countries, despite 
U.S. taxpayers having funded the invention of this through NIH.
    Now this question is simple, the first one. Has it changed 
in the last decade no drug approved by the FDA has not had NIH 
investment? Is there a drug yet that is approved by the FDA in 
recent memory that has not had NIH investment?
    Dr. Tabak. Not to my knowledge.
    Mr. Pocan. So, specifically, to this drug, we are honestly 
price gouging. We are getting ripped off right and left, in my 
opinion, by pharmaceutical companies in so many cases. This 
drug in particular, under the Bayh-Dole Act, when the U.S. 
Government and taxpayers fund an invention, they have rights to 
that invention, including the right to march in and license 
competition when U.S. taxpayers are price gouged.
    You have gotten a letter from a number of elected officials 
on this drug, but this is just one of many that I think we 
could point out and have a long conversation on. Will you step 
in, as NIH, and be responsible stewards of medical and 
pharmaceutical inventions that uses tax dollars to help 
develop, ensuring that taxpayers aren't being forced to pay 
twice, once on the front end through NIH and then once again 
through these higher prices, more than other people in the 
world?
    Are you willing to start seriously looking at doing march-
in rights on these types of drugs?
    Dr. Tabak. So, as you know, it is a complex space. And up 
until now, neither NIH nor other agencies that have looked at 
this have thought that price, per se, met the criteria that are 
needed for march-in, which depend more on the availability of 
the drug. So, for example, if there are no manufacturing plants 
that are available to manufacture a drug, that would be an 
example of perhaps where march-in would be used. In this case, 
the barrier is strictly a financial one.
    We are just as concerned about high prices as any other 
person or agency, but we need to ensure that we are using the 
right tool for the right job. The request that you refer to is 
under consideration, and we are looking at it both specifically 
and in the context of a broader plan that the Department has 
for lowering drug prices.
    Mr. Pocan. I just hope we consider this. I sat down with 
someone recently who every year I meet with on his particular 
ailment, and his health is going down and down. And recently, 
there is a drug that he told me he had to--he was considering 
passing up that was $50,000. He had to do twice a year for his 
health.
    And I have watched his condition, and I just think it is 
time. This is something that, again, I think in the future, we 
will look back why we didn't address this, and I think we have 
had the tools to. And if you need additional tools, please let 
some of us know. We would love to give you those tools.
    Very quick, in 18 seconds, if possible. Dr. Lowy, I know 
the Cancer Moonshot were getting additional dollars, and that 
is great. How about some of the smaller cancers, things like 
the neuroendocrine tumor of the pancreas, those sorts of 
things? Are they also going to be able to see a good chunk of 
that money and the help from that money?
    Dr. Lowy. Rare cancers are, of course, very important. They 
represent about 20 percent of cancer, and the people who get 
them, it is just as serious as common cancers. So we, of 
course, thanks to the generosity of your committee, are in a 
position where we can study rare cancers.
    In addition, we can look at potential interactions, if you 
will, where findings in one kind of cancer might have 
implications for another. And very importantly, conducting 
clinical trials. So people with rare cancers, certainly all of 
our childhood cancer treatment and those trials involve our 
rare cancers. And then many of our trials really now are 
eligible for people who have particular molecular 
abnormalities. They are multi-arm trials, and so the remaining 
people with rare cancers who are eligible for those.
    Thank you very much.
    Mr. Pocan. No, thank you.
    And thank you for the extra time. I appreciate it, Madam 
Chair.
    The Chair. Congressman Fleischmann.
    Mr. Fleischmann. Thank you again, Madam Chair. And this has 
been really a truly outstanding hearing. So substantive.
    What a privilege, Dr. Lowy. Thank you again for all you are 
doing to combat cancer. I think this is something--I am part of 
the Cancer Caucus. Lost both parents to cancer, one when I was 
very young. But this is something that I think really our 
investments with you all are really proving to be great.
    I keep with my good friend Dr. Jordan Berlin at Vanderbilt. 
Sometimes we will just pick up the phone and start talking 
about stomach cancer or other different types of cancer, and 
the research is just truly incredible, as are the results. So 
keep up the good fight, sir. Thank you.
    If I may, on a different topic, organ transplant shortages. 
There is an unfortunate and overwhelming shortage of health 
organs in this country. Statistics show that over 100,000 men, 
women, and children are currently on the National Transplant 
Waiting List. Our traditional cadaveric organ donation process 
has become increasingly inadequate to meet the needs.
    A question for Dr. Tabak and Dr. Gibbons, if I may? Given 
the recent efforts in xenotransplantation, does the NIH have 
any plans to develop protocols and research into this area, 
given the shortage of organs readily available for patients in 
need?
    Dr. Tabak. Well, let me turn to Dr. Gibbons specifically.
    Dr. Gibbons. Certainly from the standpoint of the National 
Heart, Lung, and Blood Institute, there is still--this is an 
area that has been investigated pretty much for decades, and 
certainly, there have been some progress made, particularly 
related to newer technologies in genetic engineering, gene 
editing technologies that are maybe--at least on the horizon 
that there may be some feasibility here.
    However, I think we do need to be sure that the zeal with 
which this is being implemented is done in keeping with that 
science. And so it is quite clear that there still needs to be 
a lot more work done before this is really translated into 
clinical practice and still some major issues that may need to 
be addressed with regard to still acute rejection and what have 
you.
    Perhaps Dr. Fauci would be willing to comment on this as 
well, but this is an area that, as you say, has been on the 
horizon for many years. There are some opportunities for 
progress, but it is still early days.
    Mr. Fleischmann. Thank you, Dr. Gibbons. And yes, I am 
solicitous of anyone who would like to answer the question.
    Dr. Fauci. Well, I don't know if I could add much more than 
what Dr. Gibbons said, except that there are a lot of problems 
with xenotransplantation. I think we just recently had the 
experience of the transplant of a pig heart in an individual, 
and what happened was that there was a pig virus in the organ 
that was transplanted. And it was very likely that with the 
immunosuppression following the transplantation that you 
reactivated a cytomegalovirus from the pig, which might have 
actually caused the death of the individual.
    So it is a very important goal because of the reasons that 
you delineated in your question about the shortage that we 
have, and it is an area that continues to, as Dr. Gibbons 
mentioned, perhaps a lot more understanding about gene editing 
of the particular xeno that is going to be transplanted might 
actually make it much better. But there is a lot of work that 
needs to be done.
    Mr. Fleischmann. Thank you, Doctor.
    Madam Chair, I will yield back. Thank you.
    The Chair. Ms. Herrera Beutler.
    Ms. Herrera Beutler. Thank you, Madam Chair.
    And actually, I had not seen the end of that story. I knew 
that that transplantation had taken place, and I was watching 
it with great interest. Let this be a reminder that when it 
comes to certain organs like the one this gentleman needed or 
other organ donation, both deceased and living donation remains 
a really viable option. And not enough of us do it, and there 
are a lot of people waiting. So that was my point of personal 
privilege.
    On the maternal and child front, I was thinking I was going 
to ask Dr. Bianchi, but I think I am going to ask Dr. Tabak, 
and it is with regards to ARPA-H. I wanted to know if ARPA-H 
will be providing funding for pediatric research, and just kind 
of ask for that commitment that it not be left behind.
    Dr. Tabak. Well, obviously, we don't know what ARPA-H will 
be funding yet. That will really be driven by the inaugural 
Director and program managers that he or she hires and----
    Ms. Herrera Beutler. And the Members of Congress that bird 
dog that new directive with regard to pediatric research.
    Dr. Tabak. And certainly, I can't imagine that we would let 
children behind.
    Ms. Herrera Beutler. Thank you. I appreciate that.
    Now, to Dr. Bianchi. I wanted a quick follow-up on research 
with regard to stillbirths, and do we know more about this? Are 
we able to treat this better?
    Dr. Bianchi. Thank you for your question.
    And just for those people who don't know, stillbirth refers 
to spontaneous death of a fetus after 20 weeks in the womb, and 
it is a tragedy, and it is something that we still don't know a 
lot about. What we do know is about 20 percent of the 
stillbirths are caused by an extra chromosome. Presumably, 
there are some additional genetic causes that involve only one 
gene or a cluster of genes.
    And one of the things that we have funded in the past year 
in conjunction with the Human Genome Institute is an expert 
curation panel on gene mutations as a cause of stillbirth. So 
we know how to sequence the genome. We know that in the past 
year, there has been tremendous progress in the sequencing of 
the human genome, but what you need to know is how to interpret 
that information.
    And so we are funding an expert panel of computer 
scientists, maternal fetal medicine specialists, geneticists, 
et cetera, to look at these mutations and then determine which 
ones of them may be associated with stillbirth. But adverse 
outcomes of pregnancy are a very, very high priority for our 
institute and preventing those adverse outcomes.
    Ms. Herrera Beutler. Appreciate that. I wanted to talk with 
Dr. Volkow about research with regard to drug use. Washington 
State is--practically speaking, you can do drugs, just about 
anything, in front of an officer. You still can't technically 
sell drugs over a certain amount, but it is pretty--they call 
it the ``wild west'' for a reason. And my big concern, a number 
of years ago, we legalized recreational marijuana use, and the 
data on that is rolling in, and it is not promising.
    And when you add to it any type of substance, I am curious 
whether or not you all are following the different States with 
regard to these lax regulations. I don't even know how to talk 
about it. But essentially, some States allow you to do this. 
Are you following the population trends in these States?
    Dr. Volkow. Yes, absolutely. I think it is a unique 
opportunity that we have to understand how the different 
policies implemented by the State affect the outcomes in 
children, adolescents, and adults, and in this case, we know, 
for example, that the policy implementation as it relates to 
cannabis has significantly impacted the adverse effects of 
cannabis utilization. So we expect that unfortunately similar 
trends may start to emerge as other drugs by other States are 
legalized.
    Ms. Herrera Beutler. Well, and I think one of the things, 
we were talking about fentanyl and overdose deaths and those 
increasing. This isn't a one--there is multi-legs to this stool 
in terms of the problem. There is certainly homelessness and 
the challenge on that front, affording a home in my area. But 
that is different from drug legalization and how we approach 
people who have substance use disorder.
    And that is different from I think the predatory nature of 
gangs who bring drugs up from Mexico and make their own pills, 
and those pills--and then we have got children who come through 
the pandemic, and they are dealing with mental health 
challenges. And their friend says, ``Here, I have got a pill.'' 
For however much money, you can take it. And it is laced with 
fentanyl, and we lose that young person.
    Those are all happening right now. But I think the one 
thing we have a little control over is at least getting the 
data, and I am very, very hopeful that your look at this is 
going to provide information for lawmakers. It is very 
important.
    Dr. Volkow. Yes. We need to do it because we need to 
identify what areas are challenging and how to intervene. And 
this is the way that we are right now, for example, monitoring 
the increased overdose deaths that we are seeing in teenagers.
    And these overdose deaths are likely to be driven, as I 
mentioned before, by the combination of illicit prescription 
drugs, manufactured drugs, by fentanyl. So it is not teenagers 
looking for heroin or fentanyl. It is teenagers not knowing 
that they purchased an Adderall pill or a Vicodin that contains 
fentanyl, and then they overdose.
    Ms. Herrera Beutler. Yep. Thank you, Madam Chair.
    The Chair. Congressman Moolenaar.
    Mr. Moolenaar. Thank you, Madam Chair.
    Dr. Fauci, I wanted to ask your insights on when we will no 
longer call the current COVID public health emergency a 
pandemic. Are there criteria? Are there benchmarks? What kind 
of a process will we go through to make that determination?
    Dr. Fauci. There is really no firm, widely acceptable 
definition. When one talks about pandemic, you talk about a 
highly transmissible infection that is essentially widely 
distributed throughout the globe.
    I have spoken about this recently. When you are in the 
acute fulminant stage of pandemic the way we were in the United 
States just a few months ago, you might remember we had 900,000 
cases a day, tens of thousands of hospitalizations, and we were 
averaging 3,000 deaths a day. That is a really highly fulminant 
stage of a pandemic.
    We come down to a low level. Now we are, unfortunately, 
ticking up a bit. But when you get down to a level where it 
isn't disrupting society. It isn't causing deaths that stress 
your hospital system, and you have a level of infection that, 
for example, might be comparable to what you see with 
respiratory syncytial virus or parainfluenza, even though it is 
prevalent throughout, it wouldn't be considered a pandemic in 
the classic sense.
    But there is a lot of gray zone about the definition. So I 
don't think you are going to see all of a sudden one day there 
is going to be a declaration that the pandemic is over. It will 
likely be that it is no longer in the pandemic phase and it is 
more of an endemic kind of infection that you could live with.
    Right now, we are not there. I mean, if anybody asked that 
question, that is for sure.
    Mr. Moolenaar. And then from the public health emergency 
and the legal definitions in States and throughout the country, 
where do we stand with that, given sort of the open-ended 
nature of that?
    Dr. Fauci. Yes. I am not sure I can answer that with any 
authority, Congressman, because that is not essentially what we 
do here at the NIH. But there will be a time, obviously, when 
an examination of the level of infection and the level of 
impact in the country will then dictate whether or not it is 
pulled back as an emergency, but I don't think I can be able to 
give you a really good answer on that.
    Mr. Moolenaar. Okay, thank you. And then, on the vaccines 
for COVID, I think people are weary of this the last couple of 
years, they followed the recommendations of vaccines, boosters. 
But I think there is a certain weariness in the American 
public.
    What is your sense and recommendation going forward with 
respect to vaccinations, what a definition of ``fully 
vaccinated'' would be?
    Dr. Fauci. Yes. Well, it is very clear right now, if you 
look at the need for vaccination, I mean, if you look at the 
hospitalizations and deaths of those who are unvaccinated 
compared to those who are vaccinated and boosted, the data are 
stunning. They are striking, the difference. That is point 
number one.
    But I think the question you are asking, in the era of 
Omicron, it is very clear that a booster is needed, a third 
shot. If you look at both the durability of protection, there 
is no doubt not only to natural infection from which you 
recover, but also from vaccination over a period of time, there 
is a waning of immunity. And the data--and other countries like 
Israel have really good data that when you get X number of 
months out even from the third shot, you then get an increased 
risk, particularly among the elderly and particularly among 
those with underlying conditions, of hospitalizations and 
death.
    So, right now, we are in a situation, as you recall, that 
the FDA and the CDC have said that people 50 years of age or 
older are eligible for a fourth shot of an mRNA vaccine. Not 
only the third boost, the fourth shot. Right now, the advisory 
committee to the FDA met and are looking at what the 
recommendations are going to be as we get to the fall. Namely, 
what is going to happen when we get to September and October?
    It is very likely that all of us who have been vaccinated 
will have a diminution of the level of protection after a 
certain number of months, and it is likely that they would be 
recommended for everyone to get a boost then. And then it will 
be determined has that got to be every year, the way we do with 
flu? And we don't know that right now because of the fact that 
we are having different variants.
    But right now we are in an Omicron era, and the vaccines 
that we all got work pretty well so long as you do get a boost. 
I think sometime in the middle of the summer, we are going to 
know what the cadence is going to be about how often we are 
going to have to vaccinate people.
    Mr. Moolenaar. Okay. Thank you.
    Madam Chair, I yield back.
    The Chair. Thank you. With that, let me turn to my ranking 
member, my colleague here for any closing remarks.
    Mr. Cole. Thank you very much, Madam Chair.
    And I want to thank all of you, frankly, for not only being 
here and being so generous with your time, but for what each 
and every one of you do. I am a huge believer in what has been 
done at the NIH, and as I said in my opening remarks, it is one 
of the things that the chair and I share in common, and it has 
been one of the things, honestly, that has made it easier for 
us to get to contentious issues. When we disagree about 
something, we say, well, let us just send the extra money to 
the NIH. I mean, we agree on that.
    So you have been the beneficiaries of stalemates in other 
areas perhaps. But the work that goes on is really 
extraordinarily important, and the one pledge I will make to 
each of you and to my good friend the chair is we are going to 
try to continue to do what we have been doing since 2015. And 
that is make sure that you have resources above the rate of 
inflation to continue to expand your mission.
    I do, as I said, Madam Chair, share your concerns, have 
concerns of my own about the ambitious funding of ARPA-H in the 
President's budget. And simply because I think that may come, 
but I think it is a little bit soon, in my opinion, for us to 
do that now until we have a better sense of the structure and, 
honestly, resolve some questions that some of our colleagues on 
other committees have or differences.
    And again, this is not a partisan issue. I find a wide 
spectrum of opinions in each party as to how to structure this, 
where it should go, what the appropriate level of funding is. 
So at least for me personally, we are just not prepared to make 
that big an investment. And particularly if it comes at the 
cost of being able to continue the regular and steady increases 
that we have had for 7 or 8 years at NIH.
    I think that has been a good course for the country. I 
think it has paid off. I think you have used the resources 
well, and I am grateful for that.
    I am also particularly grateful for the role that the NIH 
and I think some of the things this subcommittee did pre-
pandemic, how it positioned all of you to help the country 
during the COVID crisis. I still always point out to my 
constituents at home what an enormous difference it made to 
have 3 vaccines in 10 months and what an extraordinary 
accomplishment that was. And it was a public-private 
partnership.
    If the resources aren't there early and often, you don't 
have the resources. You don't have the labs. You don't have the 
researchers. You have to--to my friend Mr. Pocan's point, you 
have to think about this as part of national defense, a point 
that I have made plenty of times. We have lost a million 
Americans in a year, or 18 months or so. That is an 
extraordinary thing.
    But it would have been a lot more had the investments not 
been made early and we not had the exceptional capabilities 
that we have at NIH and through our biomedical research 
community and had we not mobilized and dealt with this. And 
this won't be the last one we see. We know that the biosphere 
will continue to throw things at us, and we have to have this 
capability at all times.
    So I want to particularly end by thanking my good friend 
the chair. She has been a wonderful advocate for the NIH, long 
before I was in Congress and on this committee. Has played an 
important role from when she first arrived at the farthest 
distant chair to now her pinnacle not only as the chair of this 
very important subcommittee, but more importantly, as the chair 
of the entire committee.
    And that has been an advantage, I think, for folks engaged 
in biomedical research because she has been a tireless 
advocate, and she is in a position not only within this 
committee, but the entire committee to do that.
    And I also would be remiss not to tip my hat to our friends 
on the other side of the Rotunda, Senator Murray and Senator 
Blunt, who also have been extraordinary advocates. I think we 
have had an unusual collection of four folks who all wanted to 
move in the same direction, and again, it hasn't mattered very 
much who was the President or which party happened to be in 
power at a given time. And I think that is a tribute to all of 
you and the work that you do that you can unite us in that way.
    And that really does need to continue going forward because 
I think this is an indispensable national priority that I think 
we just got a serious lesson how important these investments 
are and need to continue to be.
    Last point, again, you can't just do it at the chair and 
the ranking member level. You have got to have a lot of members 
that are interested in doing this, too, and we do on both sides 
of the aisle. So we are going to try to continue down that 
course. Continue to make the resources available to you. Do 
what we are required to do in terms of asking tough questions 
or holding you accountable.
    But again, I think there are lots of critics, but I will 
just go back and look at what was done over the last 2 years 
and the speed of which it happened and the lives that were 
saved, I think, as a consequence of what you did, not to 
mention all the other things that happened to be going on out 
there simultaneously. It is not like you stop everything in 
cancer research or Alzheimer's or whatever. Those are important 
missions, and they go on as well.
    But to mobilize the way you did, again, in cooperation with 
the broader biomedical research community, public and private 
alike, is something that I hope you regard as with a great deal 
of personal pride. Because, again, you all deserve it, and you 
all are dealing with the ramifications of this awful pandemic 
and everything from mental health to depression to drug 
addiction, the consequences of this thing, which our chair has 
looked at through a series of really good hearings and put a 
lot of stress and strain on what we need to do.
    So, Madam Chair, thank you for your leadership in this, and 
I look forward to continue working with you.
    Yield back.
    The Chair. Thank you so much, and thanks to the ranking 
member. I think we are both so really proud of the support that 
we have been able to really to reach out and get in this. The 
ranking member said there are just that on this committee and 
just that on the House side, on the Senate side, there really 
is such an interest in our looking at the discovery to cure, 
which is what you are engaged in on a daily basis.
    And what we have been able to be able to provide for NIH 
research, the $15,000,000,000, almost 50 percent over the past 
7 years, we are really very proud of that. And it is also why 
we speak about critical--to strike a balance, to strike a 
balance and to continue to support important research really in 
all areas.
    And the concept of ARPA-H is very, very exciting. It needs 
to get lifted off the ground. We have started in that 
direction, but we need to get a sense and again create that 
balance and not leave behind areas of research that we need to 
try to be pursuing.
    I am very serious about wanting to review funding across 
the institutes and the centers, and what that has been over 
time because I want to see that we are creating opportunities 
across the 27 institutes so that each of the areas is rising to 
its potential and what we can do to alleviate some of the pain 
associated with illnesses or diseases that you know don't rise 
to that top level.
    And Dr. Tabak, given what you said, if there were more 
research in some of these areas, they could then be in that 
category where it is time to move because of the discoveries 
that have been made.
    I thank you, and we appreciate so much everything that you 
do to deal with scientific breakthrough. And the reason why we 
are so concerned around this is because of the--you save lives 
and you protect families, and that requires sustained 
investment, sustained investment over time. So we will look at 
that balance of effort.
    Also there are two or three things that I just wanted to 
mention. It started--there has been a kind of a conversation. I 
go back to what I said. I think that we were able to move as 
quickly as we did on COVID was because of the years of 
investment in research, and it allowed us to spring forward 
when this horrific pandemic was upon us.
    And I get annoyed when I see pharmaceutical companies who 
won't recognize the work of NIH scientists who were 
instrumental in moving forward. We know the power and the 
strength of the NIH, and it is--that is something that we 
really need to think through of this is taxpayer research, and 
we are so deeply invested. We want to continue to be deeply 
invested that to think about areas of cure where people can't 
get access to it because it is priced out of the market. They 
can't get access.
    My family could afford what I needed for ovarian cancer. 
Not every family can do that. That doesn't mean that women 
should die because they just don't have the financial 
wherewithal, especially when we see an industry which is just 
making money hands over fist.
    Talk about balance, we need to do that. We need to be able 
to negotiate price. We need to establish some parameters around 
where we need to go and bring down the cost so that people can 
afford to survive.
    So this is--I also just want to say, and I would like to 
hear your voices. Not now, obviously. We are well over time 
here today. But the pandemic is still with us. It is with us 
here, and it is with us overseas. And I view us as having a 
moral obligation for us to have a COVID supplemental bill, 
which allows us to continue to provide the vaccines and the 
treatment that people need here, and we have an obligation to 
make sure that we are looking at what you said, Dr. Fauci, is 
we have the doses. But the delivery system of getting the shots 
into arms and creating an opportunity for those countries who 
can do it to be involved in the manufacture.
    It doesn't have to be--those patents don't have to be on a 
permanent basis, but by God, they should be there now and 
allowing people to be able to survive. We are not safe unless 
we do something about curtailing the effort overseas.
    I just say to you, Dr. Lowy, and I am going to submit the 
question because immunotherapies are there, but they work, they 
don't work. There are correlative studies. I would love to get 
your view of how that is being used and how we can move 
forward.
    I am just going to make this last statement. For the 
record, it is clear that the leaked Supreme Court decision that 
would overturn Roe will have an effect--negative, I believe--on 
maternal mortality. So, and I believe that women will be harmed 
by this decision.
    I think that that is something that we need to take a look 
at and need to examine in a scientific way and not on the basis 
of politics or ideology, but we need to understand what that 
means to women's health.
    For all that you do every day, and we are so grateful, and 
please understand I think that this is a committee that wants 
to see you being able to think outside of the box, take your 
talent and make sure that we are finding that discovery to 
cure.
    Thank you. And with that, this hearing is adjourned. Thanks 
so much.
    [Answers to submitted questions follow:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    

                                            Thursday, May 12, 2022.

 HEALTHY AGING: MAXIMIZING THE INDEPENDENCE, WELL-BEING, AND HEALTH OF 
                              OLDER ADULTS

                               WITNESSES

MARTHA B. PELAEZ, PH.D., BOARD MEMBER, NATIONAL COUNCIL ON AGING AND 
    EVIDENCE-BASED LEADERSHIP COLLABORATIVE
PATRICIA LYONS, PRESIDENT AND CEO, SENIOR CITIZENS, INC.
KAREN ORSI, DIRECTOR, OKLAHOMA MENTAL HEALTH AND AGING COALITION
ROBERT B. BLANCATO, NATIONAL COORDINATOR, ELDER JUSTICE COALITION
    The Chair. Good morning. I apologize. We had technical 
difficulties with getting started here today. So, with that, 
let me provide some housekeeping efforts here.
    And I am going to bang my phone since I don't have a gavel 
here and to call this hearing to order.
    So the hearing is fully virtual. So we need to deal with a 
few housekeeping matters.
    For today's 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 staff to send you a request to 
unmute yourself. Please then accept that request so that you 
are no longer muted.
    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 or markups. 
That email address has been provided in advance to your staff.
    With that, let me just acknowledge and thank Ranking Member 
Cole and all the members of the subcommittee for joining us for 
this hearing. I want to just say a thank you to our witnesses 
for testifying before us today on this important topic, and we 
welcome you to the subcommittee.
    Dr. Martha Pelaez, a board member, National Council on 
Aging--did I pronounce the name right?
    Ms. Pelaez. Yes, you have.
    The Chair. Lovely, thank you so much. Board member, 
National Council on Aging and Evidence-Based Leadership 
Collaborative; Patty Lyons, President and CEO, Senior Citizens, 
Inc.; Karen Orsi, Director, Oklahoma Mental Health and Aging 
Coalition; and Bob Blancato, National Coordinator, Elder 
Justice Coalition.
    We will introduce you all once again before your testimony, 
but we are so delighted that you could join us this morning to 
discuss what is an important issue around healthy aging.
    I want to specifically recognize our colleague 
Congresswoman Lois Frankel for her interest in this critical 
topic. This is a member-driven hearing, would not have been 
possible without her advocacy. As you well know, the concept of 
healthy aging encompasses so many things, but its breadth and 
complexity are exactly why we are here today to be able to talk 
about it.
    This hearing is particularly important today because our 
country's senior population is growing. According to the Census 
Bureau, the United States population of individuals over age 60 
is projected to increase by 15.7 percent between 2019 and 2025, 
an increase of nearly 12 million more people.
    So we wholeheartedly believe this is something to 
celebrate. The fact that the percentage of older adults in 
America is increasing means that people are living longer. That 
is good. But it simultaneously highlights a need for renewed 
focus on how we can provide what kind of care and how we 
provide that care to aging Americans.
    Our growing population of older adults simultaneously 
brings with it a growing population at increased risk for 
health issues and a need of specialized prevention and 
treatment services. I am proud to be hosting the hearing today 
during what is Older Americans Month, which is a time for us to 
celebrate the contributions that older Americans have had and 
continue to have on our country. We acknowledge and recognize 
their unique needs.
    This month and the hearing today should serve to recommit 
the committee to the health and prosperity of our seniors and 
to our moral and fundamental responsibility to support older 
adults in the tailored way that they deserve and that they have 
earned. I am proud that these values are already reflected in 
the funding that this committee makes to support our seniors 
and their healthy aging through the Labor, HHS bill and other 
measures.
    Our bill funds the Department of Health and Human Services 
Administration for Community Living, including the 
Administration on Aging. And through the ACL, we support and 
invest in State and local aging networks as they work with 
national organizations and committed advocates to support and 
empower older adults.
    And little is more essential to supporting the needs of our 
seniors than ensuring that they don't go hungry. In the 
recently passed fiscal year 2022, in the omnibus, we included 
$967,000,000 for the Senior Nutrition Program, which helps 
older adults access nutritious meals and vital services to 
promote their health and well-being.
    We included $900,000,000 for senior nutrition for the 
American Rescue Plan and the COVID supplementals last year to 
ensure that low-income seniors received meals during the 
pandemic. The funds were critical to making sure thousands and 
thousands of seniors around our country did not go to sleep 
hungry.
    Ms. Lyons, as you mentioned in your written testimony, 
without continued and sustained funding, more seniors will be 
at risk of being left hungry and increasingly isolated, which 
is why I am thankful that you are joining us today in your role 
as board chair of Meals on Wheels. It is a program that is a 
lifeline to seniors, not just delivering a warm meal, but it is 
about making sure that older Americans live with dignity.
    I have gone door-to-door, and I am sure many of my 
colleagues have gone door-to-door, with the Meals on Wheels 
program. We know the power of this program in connecting older 
Americans with essential services, encouraging independence, 
providing safety checks, and making seniors feel less isolated.
    We have to also address preventable injuries to keep 
seniors safe and healthy. Within ACL, millions of dollars are 
used for fall prevention programs and grants that have been 
proven to reduce the number of falls and related injuries that 
older adults face. And that is the issue that Congresswoman 
Frankel highlighted when she asked for this hearing.
    In addition, the subcommittee funds the Centers for Disease 
Control and Prevention. CDC programs prevent elder falls and 
chronic diseases that directly impact the health of our 
seniors.
    Particularly important to the topic of this hearing is the 
Elder Justice Program, funded again within ACL. Mr. Blancato, 
as you have mentioned in your testimony, 10 percent of all 
older adults in this country fall victim to elder abuse. Those 
most vulnerable, historically underserved experience abuse at 
disproportionate rates. The funding we invest in the elder 
justice programs within ACL is used to develop the structure, 
the systems, and encourage justice for older Americans, and 
that prevents abuse and provides protection to those who need 
it most.
    Nothing is perhaps more critical to our conversation on 
healthy aging than the concerns for the specific physical and 
mental health needs of our seniors. Again, within ACL, the 
subcommittee funds the NIH's National Institute on Aging.
    We held a hearing yesterday on the fiscal 2023 budget with 
the NIH, and again, as Ms. Frankel asked the question about 
research on the health of older Americans, the issue of falls, 
et cetera, we were told that there was promising research to 
prevent and treat Alzheimer's and other diseases that 
specifically impact seniors. But I think we have to try to 
focus and move in the direction of more research as it has to 
do with cause of falls, the nature about women who fall more 
than men do apparently and so forth, to get to the heart of 
what this issue is all about.
    And so I am so proud of what this subcommittee has done to 
fund the Substance Abuse and Mental Health Services 
Administration, and this is on a bipartisan basis, I might add. 
In fiscal year 2022, we did $6,500,000,000 to the agency, 
including resources that support older adults facing mental and 
substance use disorders.
    Mental health issues plague seniors, which has been a 
growing concern for years. Social isolation, economic pressure 
caused by COVID, the pandemic has exacerbated our already 
existing problems, creating new barriers to reaching seniors 
when they are most in need. The pandemic highlighted the unique 
way that mental health issues compound with the physical ones 
and the needs of older people, not just in moments when they 
may be experiencing personal struggle, but all of the time.
    Because of the unique challenges many seniors have faced 
over the past 2 years, congressional Democrats and the Biden 
administration moved quickly to deliver emergency funding that 
helped those needs. There was $1,400,000,000 to implement the 
Older Americans Act and more through emergency supplemental 
bills, but it is about ongoing and sustaining support that we 
need.
    Four subject matter today we will talk about with our 
experts--fall prevention, senior nutrition, mental health, 
elder justice. The issues, of course, intersect, and the 
hearing is a crucial step as we try to build on what past 
successes are and learn more about what to do in each area.
    We can't talk about all the issues that are facing older 
Americans, but we can talk about these as well. And while we 
can't address everything, I am proud that we are starting a 
conversation here today.
    Looking forward to our witnesses today. Thank you in 
advance for the visibility that you give these issues and your 
understanding of how the programs interact and how they support 
the whole person with aging and the advice that you can give to 
us on steps that we can take moving forward.
    And with that, let me yield and turn to Ranking Member Cole 
for any opening remarks that he may have.
    Mr. Cole. Thank you very much, Madam Chair.
    And just for informational purposes, I will be able to stay 
through the testimony and probably opening round of questions. 
At that point, we have a conflicting hearing--or I do--on 
defense, and I am going to need to step away to that. So I 
regret that, but as the chair knows, we are in a busy time of 
year with lots of meetings and conflicts.
    Good morning again, Madam Chair and members of the 
subcommittee and our witnesses on the panel. I want to thank 
you all for being here today and look forward to our discussion 
on programs, benefits, and challenges for an aging population.
    One in six Americans is over the age of 65, and this 
percentage of the U.S. population is only expected to grow in 
the coming years. We all share in the goal of ensuring the 
health and well-being of American seniors. The costs of 
Medicare represent a real and significant threat to the 
Nation's fiscal future.
    In fiscal year 2020, Medicare represented the second-
largest portion of the Federal spending--Federal Government 
spending, excuse me, spending more than $775,000,000,000, or 12 
percent of the total budget. The largest program was Social 
Security. Both programs are supported by trust funds with 
antiquated--or anticipated insolvency. It is clear that the 
first step to securing the Nation's fiscal footing is 
addressing the cost of caring for our seniors.
    The programs we will be discussing today represent 
opportunities to lower costs by keeping seniors healthier, 
happier, and often living at home where they are most 
comfortable. One program we will highlight today, as the chair 
mentioned, is falls prevention.
    According to the National Institutes of Health, about 30 
percent of adults over the age of 65 fall each year. These 
falls can result in serious injury, even death, and decrease 
mobility, possibly leading to a loss of independence. Falls are 
estimated to cost upwards of $50,000,000,000 in healthcare 
costs, and that is with just one third of those who fall 
seeking medical care.
    I want to recognize Congresswoman Frankel for highlighting 
the importance of this issue. Supporting falls prevention 
programs are a common sense way to help seniors and reduce 
unnecessary healthcare costs.
    Falls prevention programs help seniors develop strength, 
balance, and mobility, and they also educate participants on 
common environmental risk factors that can be avoided or 
mitigated to avoid a possible fall. The Administration on 
Community Living has served nearly 150,000 people through their 
falls prevention programs since 2014.
    In addition to falls, mental health is another area where 
we know it is important for supporting older Americans. The 
social distancing and isolation taken as a preventive public 
health measure to address the pandemic impacted seniors 
disproportionately.
    Mental health issues left unaddressed can be a significant 
factor in suicide, and men aged 85 and older have the highest 
suicide rate of any group reporting to the CDC. Depression is 
the most common mental health problem in older adults, and it 
is correlated with higher rates of emergency room utilization, 
medication, higher outpatient charges, and longer hospital 
stays.
    Some people assume depression is a part of the aging 
process, but that is simply not the case. In most cases, 
depression is treatable, and we need those individuals 
suffering to feel comfortable discussing this issue with their 
providers and get the treatment that they need.
    Seniors can also be a target for abuse, scams, and 
discrimination. Elder justice programs help support adult 
protective services. During the COVID pandemic, numerous scams 
have been targeting seniors, in some cases using their 
information to bill Medicare, order tests that were never 
received, or encourage payment for services that are provided 
free of charge.
    Seniors who have caretakers can also be subject to 
physical, mental, and emotional abuse by these same caregivers. 
In many cases, without access to alternatives, individuals are 
afraid to report abuse if doing so would threaten their ability 
to live independently.
    The Adult Protective Services programs are funded in a 
patchwork across States with great variability among the 
States. The subcommittee has led efforts to provide more 
support at the Federal level to document these challenges 
across the States.
    Surveys show a vast majority of adults prefer to remain in 
their homes as they age. Fortunately, choosing to remain at 
home is often more cost effective for both the individual and 
the cost to Federal health programs. We all have an interest in 
helping seniors stay healthy and comfortable at home for as 
long as possible, and a key component of keeping seniors at 
home is providing meal support.
    Senior nutrition programs provide to seniors both in their 
homes, often through the Meals on Wheels program, and through 
congregate facilities like senior centers. Those services 
provide a vital lifeline to seniors through a warm meal and a 
friendly hello. For many older adults, the person delivering 
their meals may be the only face they see regularly, and senior 
centers provide critical connections to services and onsite 
training.
    The chair and I have both spoken ardently in support of 
these programs. So I won't belabor the point here, just to once 
again reiterate strong support for senior nutrition programs 
has been a unifying theme of this subcommittee.
    Again, I want to thank all our witnesses for coming before 
us today and sharing their time and expertise. Thank you, Madam 
Chair, for holding this important hearing.
    And with that, I yield back.
    The Chair. I want to thank the ranking member.
    And now just let me introduce our witnesses for their 
testimony.
    Our first witness today is Dr. Martha Pelaez. Your full 
written testimony will be entered into the record. You are now 
recognized for 5 minutes for your opening statement.
    Ms. Pelaez. Thank you.
    Chair DeLauro, Ranking Member Cole, subcommittee members, 
thank you for the opportunity to speak to you today about the 
urgent need to support falls prevention in older persons.
    As National Council on Aging board member, I represent the 
council's national voice for every person's right to age well. 
NCOA directs the National Falls Prevention Resource Center, 
which is responsible for educating the public about the risk of 
falls and how to prevent falls.
    As a professional, as an older person, as a daughter of a 
mother who died due to complications related to a fall, I care 
deeply about this issue. According to CDC, just like Ranking 
Member Cole mentioned, falls are about--fall is the number-one 
cause of injury and death from injury for older persons. Every 
11 seconds another person is injured by a fall, and every 19 
minutes an older adult dies as a result of a fall.
    The annual direct medical costs, as we have heard, is 
$50,000,000,000, of which 75 percent is shouldered by Medicare 
and Medicaid. With the aging of the population, these numbers 
will continue to increase if we do nothing.
    We must recognize that even though all falls cannot be 
prevented, we want to prevent those that are preventable and in 
other cases mitigate the impact of a fall, reduce the severity 
of the fall, and reduce associated healthcare costs, as well as 
improve the quality of life for those individuals who are at 
risk of a fall.
    To accomplish this goal, we recommend three strategies. 
First, early detection of fall risk factors with a consistent 
use of the screening tools during their Welcome to Medicare 
visit and the annual wellness visit. This is very doable. The 
CDC National Center for Injury Prevention developed the 
Stopping Elderly Accidents, Deaths, and Injuries, known as the 
STEADI initiative. This has become the gold standard for falls 
risk assessment.
    Every 5,000 healthcare providers who adopt STEADI produce a 
savings of $3,500,000 in direct medical costs over a 5-year 
period. So STEADI must become the universal tool used for fall 
risk screening, and reimbursement for its use must be 
incentivized.
    An essential component or companion to early detection is 
education and support of older persons as partners in the work 
of falls prevention. We have a number of evidence-based 
education programs that have been shown to not only reduce 
falls and falls risk factors, but also healthcare cost. Just 
as, too, A Matter of Balance is associated with a decrease of 
$938 in total medical costs per participant.
    Another program is a formal education program known as 
CAPABLE. With an investment of $3,000 per participant, that 
program has yielded more than $30,000 in savings in medical 
costs per participant.
    So the second strategy is to establish coordinated cross-
agency Federal effort to address falls. There are already a 
number of Federal agencies engaging in falls prevention, but 
there is no coordinated and comprehensive strategy under the 
purview of any one single agency.
    So the healthcare system spends $50,000,000,000 on older 
persons falls. However, the Federal Government appropriates 
less than 1 percent of this amount in falls prevention. And 
most of that funding has remained stagnant over the years.
    So a federally coordinated cost prevention national 
strategy would increase opportunities to leverage resources 
across disparate agencies and contribute to the sharing of 
valuable information.
    Strategy three is to promote Federal leadership in 
research, demonstration, and evaluation. The lack of an 
integrated and cohesive system of research result in 
inefficiencies, missed opportunities, and an absence of 
critical data in Federal aging research. This data is needed to 
calculate the impact and outcome of services.
    In conclusion, to achieve this vision, expanded Federal 
investments are crucial. So on behalf of NCOA, I applaud the 
leadership of Representatives Frankel and Morelle in laying the 
groundwork with their Government-wide fiscal 2023 request. I 
thank you for the opportunity to share recommendations, and I 
am happy to answer any questions the committee may have.
    The Chair. Thank you so much, Dr. Pelaez. The statistics 
you quote are really pretty extraordinary. Thank you.
    And again, we say thank you to Congresswoman Frankel for 
bringing this to light.
    Our next witness is Patty Lyons. Your full testimony, Ms. 
Lyons, will be included in the record, and so you are now 
recognized for 5 minutes.
    Thank you.
    Ms. Lyons. Thank you.
    Chair DeLauro, Ranking Member Cole, and distinguished 
members of the subcommittee, thank you for this opportunity. It 
is such an honor to be able to share my firsthand experience 
about the impacts of nutrition and the clear intersection that 
exists between all the topics the panel will address today.
    Regardless of age, nutrition is a critical part of the 
health, development, and overall quality of life. But it is 
simply fundamental to healthy aging. Despite the wide 
recognition of this, millions of seniors were struggling to 
meet these basic human needs prior to the pandemic, and these 
issues have only intensified since.
    We know in 2020, one in eight older adults were threatened 
by hunger, and it is estimated that almost half of all older 
adults are already malnourished or at the risk of becoming so. 
With the rising spending on healthcare, it is imperative that 
we invest more significantly in cost-effective programs that 
will allow folks to age with better health.
    The good news is that there are already simple and 
impactful solutions. Service providers such as mine seek to 
holistically meet the needs of older adults in their 
communities by providing a combination of nutrition, safety, 
socialization, and community connection supports.
    A study from 2015 found that older adults receiving home-
delivered meals and the social connection that it provides 
experience statistically significant improvements in their 
health as compared to their counterparts who do not receive the 
service. Those who received meals were more likely to have 
improved physical and mental health, including reduced feelings 
of anxiety and loneliness, fewer hospital admissions and 
readmissions, and fewer falls. All ultimately reducing our 
Nation's healthcare costs.
    By being invited to cross the threshold into the homes, 
there is the ability to observe, assist, and provide that sense 
of security. Last week, one of my clients fell in his home 
during the night. It was our volunteer who called us to give us 
an alert, and we contacted his sister, and together, we entered 
his home.
    He smiled at us when we came in, and he said to his sister, 
``I wasn't scared at all because I knew they were coming to 
bring my meal.'' This story is not unusual, unfortunately, but 
it exemplifies the true strength of these programs.
    The power and the importance of the OAA nutrition program 
was never more evident than during the COVID-19 pandemic. 
Overnight, thousands of programs like mine quickly adapted to 
continue safely offering to our clients the critical person-
centered supports that go well beyond the meal itself.
    Even prior to the pandemic, Federal funding for aging 
services was not keeping pace with increasing demand, rising 
cost, and inflation. Last year, a survey of our Meals on Wheels 
America members found that 97 percent of us already know that 
there are older adults in the community who need our services, 
but we are not able to provide it. Sixty percent of the 
programs reported that the major limitation to this is funding.
    Eight in 10 of our programs are still serving more meals 
and more clients than we were before COVID-19, and many of us 
are poised to have to take drastic steps such as discontinuing 
or cutting back those services in order to sustain our program 
due to this funding challenge.
    I want to thank the leaders of the subcommittee in 
particular. The ACL receiving that emergency funding necessary 
so that we could address the significant needs presented by the 
pandemic. But we are at a crossroads. Pandemic-level funding 
for these programs has to remain because we cannot go 
backwards. After all, we all now know what it is like to be a 
homebound, isolated older adult.
    This past weekend, my next-door neighbor, a young man of 5 
whose name is Griffin, came over to visit, and he asked me in 
all earnestness if I was afraid to be 100. I laughed, but I 
have to confess that I thought, golly, how bad do I look today? 
But I simply replied that, no, it is a little ways off for me.
    But I share this story because, as I thought more about it, 
I realized that I really am not afraid to turn 100, and it is 
because I know that the organization I work with will be here 
to help me, as we already help many 100-plus-year-olds.
    Organizations like Senior Citizens, Inc., are able to do 
this because of the funding that we receive through the Older 
Americans Act. I understand that you have got a lot of 
difficult decision that you are facing, and I know I have 
thrown a lot of statistics at you. But it really comes down to 
this.
    We can provide a year's worth of nutritional lifesaving 
support for less money than one night in a hospital or 10 days 
in a nursing home. So as you are developing the appropriations 
bill, I urge you to include an investment of $1,934,000,000 
into the OAA nutrition program so that we can ensure the 
health, safety, and social connectiveness that our seniors 
deserve and so that the Griffins of the world will have 
organizations like us here when they turn 100.
    So thank you for your leadership and your consideration.
    The Chair. Thank you. Thank you.
    Our next witness is Karen Orsi. Your full testimony will be 
included in the record, and you are now recognized for 5 
minutes.
    Ms. Orsi. Thank you. I virtually thank this committee for 
your focus on helping seniors and the opportunity to speak on 
mental health issues [inaudible].
    My name is Karen Orsi. I am with the Oklahoma Health and 
Aging Coalition in Oklahoma City, a Certified Community 
Behavioral Health Clinic, and I also serve on the executive 
committee of the National Coalition on Mental Health and Aging. 
I am not a clinician or a policymaker, but I am in the 
trenches, where I recognize the need for policy to support 
healthy aging.
    The model of my coalition's recovery has no age limit. 
Aging is the one thing we have in common. So my presentation is 
not about ``them.'' It is about ``us,'' as we age. They don't 
need culturally sensitive and age appropriate services. We will 
need specialized services.
    To remain independent and flourish, we need access to a 
spectrum of services that support continued health and 
independence. Without resources, healthy aging is elusive.
    Achieving wellness requires balance in all of the elements 
of wellness. Mental health and physical health happen in the 
same body, and my written testimony describes the mind-body 
connection in much more detail.
    Now all of today's focus areas are interconnected. For 
example, for nutrition, consider the time, planning, 
delivering, and funding of home-delivered meals. But if the 
person is depressed, that meal may go uneaten. Uneaten meals 
negatively impact weight, muscle, exercise, and the absorption 
of medications. Or if the person is financially stressed, the 
meal may be shared with a pet.
    And falls. The fear of falling may prevent a person from 
leaving home and contribute to loneliness, which, in turn, may 
increase physical and mental health problems. Loneliness can 
cause depressive symptoms, and in an attempt to dull emotions, 
self-medicating with alcohol and medications can increase 
instability and actually cause a fall.
    In social justice, aging does not provide immunity from 
abuse or neglect. And any resulting trauma impacts both 
physical and mental health and will probably require treatment.
    So it is natural to focus on the physical as we age, but it 
is usually from the neck down--blood pressure, heart disease, 
arthritis, diabetes. When we talk about brain health, it is 
usually associated with dementia or Alzheimer's. Depression or 
anxiety are often considered to be just another symptom of 
aging, not a medical condition requiring treatment.
    Now as we age, we experience an increased risk for 
developing behavioral health disorders because our aging bodies 
develop chronic diseases, and those diseases increase the risk, 
as do the medications to treat those diseases. Unaddressed 
trauma, loneliness, social isolation, numerous life and rule 
changes also increase the risk.
    And mental health disorders, trauma, and loneliness 
negatively impact your physical health. So those symptoms of 
mental health distress often overlap with symptoms with 
physical illness.
    Mental disorders complicate the treatment of medical 
conditions and increase the use of healthcare services and 
cost. Even a mild depression can have a serious impact on 
sleep, nutrition, exercise, disease self-management, muscle 
loss, balance, falls, memory, and increase risk of developing 
heart disease, stroke, and diabetes.
    Hearing loss, vision impairment, and incontinence can 
occur, and each can trigger depressive symptoms. These examples 
underline the importance of screenings at the time of any 
diagnosis and follow-up.
    A workforce shortage exists, but the level of care required 
by Medicare actually limits access to care, and not all 
providers accept Medicare. And of those who do, very few have 
training in geriatric issues.
    Older adults deserve behavioral health services that are 
culturally sensitive and age appropriate. Now isolation means 
being physically alone, while loneliness is defined by the 
satisfaction with your relationships. Loneliness has health 
risks similar to obesity and smoking. It can lead to 
depression, sleep issues, cognitive decline, poor 
cardiovascular function, and impaired immunity.
    And I can't talk about aging without challenging ageism. 
Societal norms that marginalize people, make them feel 
disrespected, unwelcome, incompetent, and invisible. Ageism is 
not just black balloons on your 40th birthday. Ageism impedes 
and impairs treatment of both physical and mental health 
issues.
    Through the ageism lens, aging is heeded as a disease 
itself, with the inevitability of decline, cognitive 
impairment, disease, disability, grief, sadness, loneliness, a 
decreased quality of life rather than as a process of 
development. Ageism, together with a lack of training in 
gerontology and geriatric issues, is dangerous to healthy 
aging.
    And now I need to address the antithesis to healthy aging, 
suicide. Older adults have one of the highest rates of suicide 
of all age groups, and the top circumstances are depressed 
mood, physical health problems and mental health problems. 
Early identification and treatment of disorders can result in 
positive outcomes at all levels.
    In closing, I want to bring hope. Not the eyes closed 
tight, fingers crossed hope, but the science and power of hope. 
Identifying and reducing hopelessness in life can improve the 
quality of life and functioning and be a preventive factor in 
suicide. My hope is for the implementation of a hope initiative 
for healthy aging that includes the integration of mental and 
physical health and the development of resources to support all 
of the elements of wellness.
    Thank you for your interest in mental health and its impact 
on healthy aging.
    The Chair. I did it. I unmuted. Anyway, sorry.
    Thank you. Thank you very, very much. Very powerful 
testimony.
    And I want to now hear from--we all want to hear from Bob 
Blancato, and Mr. Blancato, your written testimony will be 
included in the record, and you are now recognized for 5 
minutes.
    Mr. Blancato. Thank you, Chair DeLauro, Ranking Member 
Cole. Thank you for this hearing and inviting me to testify.
    Your focus on healthy aging is timely in the middle of 
Older Americans Month and the start of the Decade of Healthy 
Aging, as declared by the World Health Organization.
    Healthy aging is for more than one generation. It supports 
the well-being of American society overall. Healthy aging 
remains elusive for many older adults, especially the 1 in 10 
over the age of 60 who are victims of elder abuse. The triple 
evils of abuse, neglect, and financial exploitation pose a 
direct threat to healthy aging.
    Healthy aging includes physical, mental, and emotional 
well-being, but a 2018 NIJ report said elder abuse victims 
reported considerably higher rates of first-year depression, 
general anxiety disorder, and poor self-reported health 
compared to nonvictims.
    Financial security is necessary for healthy aging. The FBI 
reports that people over 60 make up the majority of cybercrime 
victims, with average victims losing $10,000. Romance schemes, 
preying on isolated and lonely older adults, had its victims 
lose $139,000,000 according to the FTC.
    The pandemic had led to more older adults being isolated. 
Another FBI report stated the elder fraud jumped by 30 percent 
in 2020, and older adults lost more than $100,000,000 just to 
COVID-19 related scams.
    I come as the national coordinator of the Elder Justice 
Coalition and a repeat witness to this subcommittee, which was 
the first to provide dedicated money for elder justice. 
Prevention is the key to healthy aging. Elder Justice, at its 
core, through its services and interventions works to reduce 
and ultimately prevent elder abuse and mistreatment.
    So, today, I urge the subcommittee to make continued 
investments in elder justice. First, maintain the emergency 
funding provided to the Elder Justice Act in the last two 
pandemic bills. Specifically, we call for $188,000,000 in 
funding for the elder justice Adult Protective Services, for 
continued APS formula grants. The President's fiscal year 2023 
budget level of $58,000,000 is insufficient to meet current and 
future needs.
    We support the President's request for $36,800,000 for the 
Long-Term Care Ombudsman Program in the Older Americans Act and 
ask for an additional appropriation of $52,000,000 under the 
Elder Justice Act to allow them to expand their work in 
assisted living facilities.
    How are these emergency funds used by APS and Ombudsman? In 
Connecticut, funds were used by the Ombudsman Program to pay 
overtime to extend work hours and cover weekends, enhance 
virtual work, and purchase a Zoom account to support a 
statewide family council.
    In Oklahoma, funds were used to hire an intake specialist 
for both APS and Ombudsman and hold a safe reentry ombudsman 
volunteer conference later this month.
    Other uses, supporting tribal APS programs, providing 
emergency housing and shelter to victims. In rural areas, 
purchasing and replacing vehicles for APS victims.
    But what critical service or program ends if this funding 
is not continued? As the pandemic eases its grip, people in the 
field expect an increase in reported elder abuse. Staff 
capacity to respond is critical. And with the ombudsmen, as 
they regain access, their workload investigating quality of 
life issues will also increase.
    We also recommend increased funding for Title VII of the 
Older Americans Act for public awareness programs, 
multidisciplinary elder abuse teams, and elder abuse hotlines; 
additional funding to ACL to expand elder abuse prevention 
training for all staff and volunteers in the Older Americans 
Act; and approving education materials for older adult 
participants. This would be especially necessary in the 
National Family Caregiver Support Program.
    Funding grants to Area Agencies on Aging and other 
community-based groups to address social isolation, as included 
in the House-passed Build Back Better bill. A vital program in 
promoting health aging is the social services block grant. The 
primary source of funding for APS in some States, but also it 
funds home-delivered meals, case management, and home care. Its 
funding has been frozen for years. It deserves an increase.
    Increased funding for nutrition and senior center programs 
in the Older Americans Act. They are part of elder justice, as 
congregate sites provides socialization to reduce isolation 
which helps to combat elder abuse.
    On the equity front, we ask the subcommittee to instruct 
ACL and its data collection system to do more to ascertain 
elder abuse prevalence in communities of color and LGBT 
communities. Let us coordinate all federally funded information 
and referral programs to help people find out where and how to 
report elder abuse. Let us have more funding for research and 
practice into self-neglect, the most frequent category of elder 
abuse reported to Adult Protective Services.
    And finally, where it falls in your jurisdiction, support 
for the President's recent nursing home reform proposals. 
Federal health and social service programs must expand their 
focus on prevention. Programs that promote the independence and 
dignity of older adults contribute to healthy aging. Keep 
investing in elder justice. It can address the related 
consequences of abuse including isolation, falls, malnutrition, 
and mental health.
    The most vulnerable older adults, including those with 
disabilities, are often the most susceptible to elder abuse. 
They deserve priority in how prevention services are accessed 
and provided. Healthy aging is a most admirable goal, but let 
us direct our resources to those who still lack it.
    A victim of elder abuse is never the same. If your support 
of elder justice prevents more victimization and promotes more 
healthy aging, it is a most worthwhile investment.
    Thank you.
    The Chair. Let me just say a thank you to all of you. This 
has really been quite extraordinary testimony this morning.
    We spend time--we provide resources. We spend time speaking 
about the plight and difficulties of older Americans, of 
seniors, and et cetera. But what you all have laid out is the 
staggering statistics, which should give us even more strength, 
if you will, in making the determination of where our resources 
are going and for what purposes.
    We do have programs and policy initiatives in place, but I 
think we have to think about whether or not they are meeting 
the moment that you all are laying out to us, and are we doing 
enough to provide for the physical and mental health of our 
senior population, older Americans?
    And once again, I want to just say a thank you to 
Congresswoman Frankel for her initiation of this effort, but it 
has really been very, very powerful testimony. I thank all of 
you.
    And with that, I am going to ask my questions, and then I 
will yield to Ranking Member Cole. And then what I will do 
because I am going to have to just head into a--just pop into 
another hearing and then I will come back, and ask 
Congresswoman Lee to take the chair as I do that.
    So with regard to my questions, Ms. Orsi, you referred to a 
culture of bootstrap strength, stoicism, and self-reliance. 
That is something many of us admire about this older 
generation. I know I did with my mother. My mother passed away 
at age 103, you know? And my God, didn't complain. Never 
complained.
    But as I say it is something we admire, but it also seems 
to be an impediment to recognizing and addressing all of the 
unique needs. So what can we do to overcome the stigmatism--the 
stigma, not stigmatism--that is in your eye. The stigma of 
mental health services in the aging community and make sure 
mental health is just as important to address as older adults' 
physical health?
    Ms. Orsi. Well, thank you for the question.
    The Chair. We are having trouble hearing you, Karen.
    Ms. Orsi. Let us see, if I can turn this up.
    The Chair. There you go. Much better, much better.
    Ms. Orsi. Okay. Yes, several layers to answer your 
question. The first thing is that you will find stigma across 
the board. However, there was pretty much a silver lining with 
COVID, as hard as that is to imagine, because now there is 
interest on mental health issues across the board and 
especially for older adults. It used to be a flashlight. Now 
there is a big spotlight on mental health issues.
    When I talk about older adults, I put--I kind of break off 
the category because what we are talking about is four to five 
decades of experience, depending on what your chronological 
ages are [inaudible] start at 50 and go to over 100. That is a 
lot of years. So when I am talking about older adults, I talk 
about boomers and then talk about advanced age.
    And the advanced age that you referred to, the people in 
the 80s, 90s, and 100s, they do not have a culture of asking 
for help because of that bootstrap. They do not have a culture 
of accepting behavioral health services. So that is an 
additional challenge.
    They do go to primary care for everything. So that is an 
opportunity if we would have our streams in primary care, it 
would get them more help. But it is a very high hill to climb 
for our advanced age population because of their culture, 
because of their experience. They don't know about treatment. 
They don't know about recovery. They don't believe in 
treatment. They don't believe in recovery.
    And as such, that is one of the battles that we are--
besides the whole stigma of mental illness, getting our 
advanced age population to believe in treatment and recovery, 
and that is--you know, why my mom, it was so important, I 
think. Recovery has no age limit.
    And the research shows that older people recover even 
better sometimes than our younger folks do for things like 
depression and anxiety.
    The Chair. Thank you.
    I want to ask Mr. Blancato a question. You talk about older 
adults lost more than $100,000,000 to COVID-19 related fraud in 
2020. And disturbing that elder fraud jumped about 30 percent 
nationally in 2020. What should have been done differently, Mr. 
Blancato? And what actions do we need to take to prevent elder 
abuse and fraud?
    Mr. Blancato. Thank you, Chair.
    A lot of things, I think. I mean, first of all, it is--and 
Ranking Member Cole referenced the COVID scams alone, which 
were atrocious. The fact that they occurred as quickly as they 
did at the time, things like vaccines became available and so 
on. I think it is a recognition that elder abuse is a crime, 
and we need to put the full resources of those entities of the 
Federal Government that are responsible for crime prevention to 
work.
    Now this has been done really effectively. The Justice 
Department has done good work, and the FBI has done good work 
in terms of rounding up scam artists, and the FTC and other 
entities as well.
    But as you know, in the Elder Justice Act in a program that 
is under your jurisdiction, the Elder Justice Coordinating 
Council has 14 different Federal agencies that work together 
using their resources that exist in fighting elder abuse. What 
they need to do is concentrate more of those resources on the 
scam issue and on the scam because, again, it is the loss of 
resources that promotes the loss of independence, which 
contributes to unhealthy aging for many older adults.
    The Chair. Thank you. I am going to try to get in an 
additional question here, and that is to Ms. Lyons.
    About senior nutrition, so evident during COVID. Impressed 
with the programs like your space and the challenges and how 
you nimbly responded to reaching seniors, what changes did you 
have to make in your meals program at Senior Citizens, Inc., 
during COVID that you believe should be here to stay?
    Ms. Lyons. Well, we learned an awful lot about what is 
critical. We learned that what we always knew, which is it is 
more than a meal. You have to provide that social element. That 
just drop shipping frozen meals is not what is critical. It is 
that social connection, which is what makes Meals on Wheels so 
powerful.
    I think one of the greatest things that this committee 
helped do was to provide the flexibility between transferring 
money between Title III(c)(1) and (c)(2), and we would love to 
see that remain. Because what happens is somebody goes to a 
senior center. They have to leave to go have surgery, something 
like that. We have to discharge them, then readmit them to 
(c)(2), where during COVID, we were able to shift those monies 
and were able to build almost like money follows the person, 
build that customized way to make sure that they keep their 
nutrition.
    The Chair. Thank you. I went over my time. So let me now 
yield to the ranking member, Mr. Cole.
    Mr. Cole. Madam Chair, you never go over your time. You are 
the chair.
    Let me ask, actually, the same question to all of you. We 
have had a number of hearings on a variety of topics, all of 
which have shown us that COVID has a very long tail. In other 
words, we had to get through the pandemic, but there are a lot 
of consequences, whether it is drug addiction, mental health 
challenges, you name it, that various populations face.
    So I am curious as to your impressions and thoughts about 
what is the tail for senior Americans with COVID? What do you 
see in your respective areas, problems that are going to 
continue even as the pandemic hopefully fades?
    And let me start, if I may, Ms. Lyons, with you because you 
sort of handle a panoply of different things.
    Ms. Lyons. I think we are seeing that the congregate sites 
are very slow to come back, which is why that flexibility is 
important. They are afraid to be around each other, but it is a 
critical element.
    My biggest concern is what will happen when the COVID 
relief money stops. I don't want to take a lot of time, but I 
will share with you a story. We started serving a client--and 
we provide pet food for our clients in home as well so they 
don't share their meal. And one day, our volunteer came to his 
door, and he gave her two cases of cat food. And she said, ``I 
am sorry your cat passed.''
    And he said, ``Oh, no. I have been eating this, but now 
that Meals on Wheels is a part of my life, I don't need to do 
this anymore.'' And he is somebody that was added during COVID, 
and I can't imagine what it is going to be like to tell these 
people that we can't keep serving them.
    Mr. Cole. A very good point. Mr. Blancato, how about you? 
What do you see in terms of any aftermath from COVID?
    Mr. Blancato. Congressman Cole, as I mentioned in my 
testimony, the concern we have and what we are hearing from the 
field is that as the pandemic eases and more people begin to 
report elder abuse, those cases are going to skyrocket, both in 
number and complexity.
    Because it may be that they have been unable to report for 
months at a time, and the abuse may have gotten considerably 
worse. So it is critically important, and that is why the 
emergency COVID funding to provide direct formula grants for 
Adult Protective Services, we have to recognize that they are 
the front lines providing help to both prevent elder abuse, but 
serve the victims who are confronted.
    But there is a real concern in the field about what we are 
going to find as things loosen up and as things go forward, and 
that is why a continuation of the emergency funding is 
critical.
    Mr. Cole. Thank you.
    Ms. Orsi, again, same question. What do you see as the 
lingering effects that are going to cause problems or 
exacerbate existing problems from COVID?
    Ms. Orsi. Well----
    Mr. Cole. Again, we are having a hard time with your audio. 
I don't know what the problem is, but----
    Ms. Orsi. It is probably my unstable Internet.
    Mr. Cole. When you lean forward, we get a better sound.
    Ms. Orsi. I will get closer. It has an impact [inaudible] 
COVID. I know this is blasphemous, but there has been some 
positive outcomes from COVID, and the one is which globally 
older adults have reported that they have handled COVID better 
than younger people, which just points to the resilience of 
older Oklahomans, older Americans, and that is what we can use 
in terms of helping people and providing assistance.
    Now the verdict is still out. Down the line, we are going 
to probably be seeing a lot more effects. Plus, we don't know--
we know that COVID has impacted the brains of healthy people 
that have never had mental health disease, but we really don't 
know what the outcome is going to be there.
    So I mean it is for all age groups that it has really been 
impacted. We are concerned for our older people because many 
times they have a poverty of resources, so when they are 
suffering, we don't have the ability to provide them the help 
that they need.
    Mr. Cole. Okay. And Ms. Pelaez, how about you? What are the 
things that give you pause as you look forward that are an 
aftermath of COVID? I think you are muted.
    Ms. Pelaez. Sorry. The important thing about falls, about 
the COVID period with relationship to falls is that not only 
the older adults, and we know that they were overrepresented in 
those who actually suffered and died from COVID. But even those 
who never had COVID had an increase in social isolation, an 
increase in just simply inactivity because of their own 
protection, self-protection from COVID.
    So that physical inactivity and that lack of conditioning, 
their mobility will affect their risk for falls. So we will see 
an increase in falls-related injuries just simply because of 
the fact of the social isolation and the inactivity that was 
actually produced by the pandemic.
    Mr. Cole. Thank you very much.
    My time has run out. So, Madam Acting Chair Lee, I will 
yield back to you.
    Ms. Lee [presiding]. Thank you very much.
    First, let me just thank all of you, our witnesses, for 
being here today. It is such an important discussion, and of 
course, I have to thank Congresswoman Frankel also because she 
knows how personal this is for myself, but how important it is 
for us to really know how to help our constituents. And what 
you have given to us already today has been an eye-opener, and 
so I want to thank you very much.
    I have a 101-year-old aunt, and I am her primary caregiver 
on the weekends. She lives in assisted living. My other aunt, 
who passed away a few years ago, was 100, and my mother passed 
away at 90. So I have learned a lot through experience, and 
what I have learned has not been that hopeful for myself, and I 
am going to give you an example. And I guess this speaks to 
mental health issues because I really hadn't thought about this 
as staff training and not knowing how to approach seniors from 
a mental health framework or perspective.
    My 101-year-old auntie, perfect cognitive skills, and she 
will just say, ``Oh, I don't want to eat today,'' or ``Oh, 
forget it, I am not going to drink my water.'' And the staff 
will say, ``Well, she says she is not going to do it. We can't 
make her do it.'' So what can I say? She gets dehydrated, then 
she has to go to the hospital. You know, the whole 9 yards.
    Yet when she was rehab, I know the staff would say, ``Oh, 
you have got to drink your water today. You don't want to end 
up in the hospital.'' Or, ``You have got to eat. This food is 
great.'' They encouraged her because they understood kind of 
how to do that. And so I just--so she did.
    When I am there, ``Oh, I don't want to do this,'' you know? 
I say, ``But Auntie Lois, you have got to for these reasons. 
Now, come on.'' And then she will do it.
    So, and I know that I hadn't thought about that in terms of 
mental health until today, and I am wondering, Karen, or anyone 
who can answer this, how are staff trained in terms of 
identifying how they talk to people, seniors, at that age and 
understanding this is a mental health issue really, and there 
is a way to approach seniors to help with their mental and 
physical health. Because if they don't get seniors to drink 
water, they get dehydrating, end up in the hospital.
    And that is a strategy that mental health--I am clinical 
social worker by profession. So that is a strategy I know that 
needs to be taught to caregivers.
    Karen, unmute, can you? Okay. Get a little closer to your--
--
    Ms. Orsi. This is one of the big areas [inaudible].
    Ms. Lee. Can you get a little bit closer? You are breaking 
up a little bit.
    Ms. Orsi. Okay.
    Ms. Lee. Okay, that is a little better.
    Ms. Orsi. I will keep trying. We have a lack of trained 
professionals to [inaudible]. So there is a huge issue, and it 
is not only the training for social workers, but workers in 
nursing homes and assisted living centers, et cetera, et 
cetera. And there are some definite methods that we are looking 
at, things like the four aims, things that matter--healthy 
aging societies, age-friendly societies.
    But we need to provide training to everyone that works with 
older adults. I mean, if you work at Subway, you get training 
on how to make sandwiches and how to work the cash register. 
But if you work with older adults, many times the workforce is 
so slim that if you apply, you are accepted.
    Mr. Blancato. And Congresswoman Lee, I would add to that, 
if I may? It is a shortage issue, okay? The absolute shortage 
reduces the amount of time that they can spend communicating 
with an older adult. And if they are not properly trained, that 
communication will go to waste.
    But we really have to address the staffing issue, 
particularly in nursing homes, assisted living facilities. 
Training is critical, but so is having incentives to have the 
right number of people on the ground in the facilities to 
address the many needs that are in there.
    Ms. Lyons. And if I could add, that is exactly--they nailed 
it exactly. It is the shortage. It is this constant turning of 
aides. But it should be part of the certification to become a 
CNA. It should be required that they have annual training on 
how to do that. We do this in our program, but it is not 
required, and it should be.
    Ms. Lee. So that would be part of the State certification 
process as a State-by-State process? Okay.
    Ms. Lyons. Yes.
    Ms. Lee. That is very helpful because--and I have noticed 
the staff turnover, staff shortage. But that could be deadly 
because of not encouraging and using mental health skills to 
get a senior to eat or to drink water or to do their rehab or 
to take their--help with a shower.
    So very helpful, and I want to thank you very much for 
that. And I will come back later if we have a second round.
    Now I will yield the rest of my time to Mr. Harris. Dr. 
Harris.
    Mr. Harris. Thank you very much.
    And thanks for all of your interest in taking care of our 
seniors.
    Let me ask, because several of you have mentioned 
nutrition. One concern of mine is that we don't promote proper 
nutrition enough, I think, in the Federal Government.
    So, for instance, if a senior citizen is on the SNAP 
program, they can go to a store, and they can buy salty potato 
chips, and they might have hypertension. They can buy foods 
that probably aren't good for them, that aren't--might not be 
providing optimum nutrition.
    Now we have the Women, Infant, and Children Program, where 
we say, okay, we are going to put guardrails on what you can 
buy because we think it needs to be nutritious. Could we 
envision having that kind of program for our seniors as well? 
Because their nutritional needs are different from other age 
groups. And again, anyone on the panel who would be interested 
in commenting on that.
    Mr. Blancato. If I may, Dr. Harris, I will start, and I 
know Patty has some thoughts, too, on this. It is a very good 
point.
    And I think the Government Accountability Office put out a 
report in 2019 making that exact point, urging that there be a 
better focus on the varied nutrition needs of older adults. The 
dietary guidelines, the next round of them in 2025 and 2030, 
are supposed to be done by HHS with a focus on the very point 
you raised about dealing with nutritious food.
    I think the other issue to point out is it still there is a 
price factor going into this. It is cheaper and easier to get 
bad food than it is to get good food, and we have got to 
address that. We have got to find ways to make that happen 
because we have a growing problem, malnutrition with older 
adults. One out of every two older adults is malnourished.
    I would also point out that in the fiscal year 2022 bill 
that was just adopted, there will be a White House conference 
on food, nutrition, hunger, and health in September. And I know 
these issues. We are going to--Meals on Wheels America and 
ourselves are going to work hard to have these older adults 
issues put into that conference so that we come out with some 
real recommendations with some teeth.
    Ms. Lyons. And Bob is exactly right. It is time that we do 
put some guardrails around that. But I will also say like in 
our State prior to the COVID relief funds, our seniors got $20 
a month in SNAP, and for many of them, it is not worth going 
through that process. So, with $20, there isn't a whole lot you 
can buy, and so you are going to get that comfort food that you 
want, like a potato chip or baloney, if you happen to be my 
family.
    But it is a big issue, and I think it is one of the reasons 
there are such strict USDA guidelines for home-delivered meals 
and congregate meals, and I think you should address it.
    Mr. Harris. Do you think--do you think those guidelines are 
adequate?
    Ms. Lyons. I do. We have to provide a lot of nutritional 
education as well, and I think just like you do with the WIC 
program, there should be some guidelines on how you can spend 
your SNAP dollars.
    Mr. Harris. Okay, thank you.
    Ms. Pelaez. I also would like to add to that that sometimes 
we forget about the fact that older adults themselves need to 
have good, evidence-based nutrition education and support for 
their own self-management. In other words, we sometimes don't 
just become bad eaters when we turn 80. We have had habits that 
are long building, and we now have multiple chronic conditions, 
and we really need to learn how do we actually change our 
habits. How do we actually begin to eat healthier? How do we 
seek opportunities to have better nutrition?
    We need to build that self-confidence as older adults. 
There are evidence-based programs that actually do that. So 
please don't forget the need to have the older adult as a 
partner in this process of healthier nutrition.
    And yes, regulations are good. Staff training is great. But 
we also need to build in some support to teach older adults to 
become better nutrition--have better nutrition that makes 
better decisions and change habits, which is not always easy.
    Mr. Harris. That is a good point. And I think that we 
should probably put those guardrails on a little earlier in 
life so that by the time someone reaches senior age, they have 
actually gotten the message that there are good foods, and 
there are not good foods, and I am afraid our SNAP program 
doesn't do it. Our WIC program does, to a pretty good extent, 
but our SNAP program doesn't.
    Anyway, thank you very much. I yield back.
    Ms. Lee. Thank you. I will yield now to Mr. Pocan.
    [Audio malfunction.]
    Ms. Lee. Something is wrong with your audio, Mr. Pocan. I 
think there is a technical issue.
    Okay. Shall I yield to Ms. Clark and then--okay, Ms. Clark, 
and then we will come back after Ms. Herrera to you.
    Ms. Clark. Thank you, Madam Chairwoman.
    And I really want to thank all my panelists for being here 
for the incredible work you are doing, and a special shout-out 
to Congresswoman Frankel for inspiring this hearing and 
continuing to focus on this really important topic.
    I want to go back to senior nutrition, and according to 
Federal definitions, we put all adults 60 years and older in 
one guideline, where, compared to children, by the time a child 
reaches 18, they are up to 5 different age categories of 
dietary guidance. So my question is for you, Ms. Lyons.
    How can we do better, and are we really meeting the dietary 
guidance needs of older adults, and how can we use extensive 
nutritional research to maximize food assistance programs?
    Ms. Lyons. That is a great question.
    I think if you asked our programs, we would say we are very 
constricted by the guidelines. It would be nice to have the 
flexibility to change the menus based on people's health needs. 
We do provide choice, most of our programs do, both home and in 
the congregate setting. But it is very, very defined.
    If we could have the flexibility to not provide greens to 
people who are on coumadin or some type of medication. We 
really are prohibited from doing a lot of customization. And I 
think--I think we should look as the medical industry and as 
nutritional industry where are those points? That the food 
desires of somebody who is 90 years old are a lot different 
from the person who is 65.
    Ms. Clark. Yes.
    Ms. Lyons. And you know, if we could have that kind of 
flexibility, if we had had that kind of information. There has 
just not been a lot of study on older adults because, frankly, 
not a lot of people are living to be 100, and so it does need 
to be addressed.
    Ms. Clark. Yes, which brings me exactly to my next point. I 
am very proud to have Tufts University and their incredible 
research into nutrition in my district, and they have 
identified eating patterns that help older adults slow the 
progression of conditions that we consider age-related, like 
cognitive decline. So are we putting enough Federal resources 
into research on nutritional needs of older adults?
    Ms. Lyons. I am sure there is a lot of money going into 
research. The disconnect is having that research then become 
part of that day-to-day process of providing it. I think there 
is usually a lag between what we have learned and how it gets 
implemented, and I think that is where we should probably 
invest a little bit of time of how do we make it part of that 
day-to-day meal-delivery process?
    Ms. Clark. Yes. Another concern I have is about 
malnutrition screening tests. They are very basic, but they are 
not routinely utilized. And one of the barriers to adoption is 
the lack of programs to address nutritional problems if 
identified, which you alluded to.
    We also lack consensus on the definition of malnutrition in 
older adults. So how can we bring providers and nutrition 
experts together to develop an effective screening program to 
identify at-risk older adults and begin to implement those 
policies to address malnutrition?
    Ms. Lyons. I think anytime you can bring everybody to the 
table, you are going to walk away with a much better product. 
And I think that includes involving not only experts, but 
people who are providers like us so that we can talk about the 
issues of the mass production and getting it out.
    And then also the people that are the end-users. Asking the 
seniors what is it that you want? What do you need? How do you 
define malnutrition? And then giving us the flexibility to 
provide more than just what is prescribed with an Older 
Americans Act.
    Most of us do that. Most of us use outside private money to 
get Ensure, to get all those other products that help support 
nutritional health. And you know, that is why programs like the 
OAA nutrition programs are so vital. But I think if we could 
bring everybody together and have a discussion on how do we do 
this on a nationwide level, it would make profound changes.
    Ms. Clark. Well, thank you. I see my time has expired, but 
I look forward to continuing this work together in a 
partnership.
    Thank you.
    Ms. Lyons. Thank you.
    The Chair [presiding]. Thank you. And let me now recognize 
Congresswoman Herrera Beutler.
    Ms. Herrera Beutler. All right. Thank you so much.
    And this has been incredibly informative. One of the things 
I wanted to ask about that I hear about nonstop from older 
Americans of my district, honestly from friends, parents, from 
my own parents, I hear a lot about inflation.
    In April, inflation was 8.3 percent, and the cost of food, 
housing, gas, energy, all of it is at record levels. And 
obviously, older Americans, specifically those on fixed incomes 
are worried about affording their prescription drugs, which I 
heard a little bit in what we talked about.
    Ms. Orsi, in your testimony, you highlight the eight 
elements of wellness, and then the mental and the physical 
stressors that seniors encounter at age. I was hoping maybe you 
could speak a little bit to the impact that inflation might 
have and how we might be able to address some of those things 
to better support vulnerable seniors?
    Or does it not? Am I just inferring this based on 
information I am getting from--kind of anecdotally?
    Ms. Orsi. There have been [inaudible] buying their 
prescription medications, not taking them, skipping tests, 
skipping doctor's appointments due to COVID. Now we compound 
that with inflation. So it is going to have a drastic impact. 
In order to really focus on healthy aging, my statement about 
the elements of wellness, it is this can't be just piecemeal.
    I am an aging advocate that has realized after years of 
working in the aging network I can't just promote mental 
health. I have also got to promote financial support and 
nutrition and fall prevention and social--social connectedness 
and resilience support and all of those issues.
    So in order to address inflation, what we are going to do 
again is to address the property of resources that we have, 
have those connections where with an older adult seeking mental 
health treatment, if we know they are financially strapped, we 
can immediately connect them to resources. But now what are 
those resources?
    That is another big issue, another webinar that we need to 
have is what are the resources that are available. It is easy 
to make a referral, but where does that referral lead? Does 
somebody answer the phone when you make a referral?
    Ms. Herrera Beutler. Thank you.
    Ms. Orsi. And especially can that person deal with older 
adult issues?
    Ms. Herrera Beutler. Thank you for that. And if anybody 
else wants to chime in there briefly, I have one more question. 
But if Ms. Lyons or Ms. Pelaez has any comments, you are 
welcome to?
    [No response.]
    Ms. Herrera Beutler. All right. Well, otherwise, robocalls. 
I got data from my--just from Washington State. As of March of 
2022, we received 50.9 million robocalls in one month. And 
obviously, we are all vulnerable to scammers. People who are at 
home maybe who are more isolated could be even more extremely 
vulnerable to scammers who may want to take advantage of 
robbing them of their life savings. We have all heard these 
stories.
    Mr. Blancato, actually, how can the committee target 
resources to protect seniors in this area, and how can we best 
educate them about the risks of these types of scams and help 
them avoid them?
    Mr. Blancato. Thank you for the question. And yes, I am 
sure that even while we have been having this hearing, we 
probably got some robocalls. That is how fast they come.
    Outside your jurisdiction, let me just point out that the 
Federal Communication Commission is doing a lot of good work in 
this space. They are penalizing companies that don't provide 
coverage and protection from these calls.
    But from the standpoint of elder justice, I think 
supporting the work of APS, Adult Protective Services, are a 
lot of things. Okay, they can intervene. Part of their 
prevention strategy is education. Okay, warning people what to 
avoid, how to--giving out tips. It becomes very important to 
have the tips available early in the process before you become 
victim.
    Because the answer is you don't even--the minute you say 
``hello'' you are in trouble, okay, on these kind of calls. And 
if you think about it, the average victim of elder abuse in 
this country is an older woman living alone between 75 and 80, 
okay? And now 46 percent of older women live alone over 75 and 
older.
    So the question is they are home all day long. The phone 
rings. It is a scammer on the other end. They need to know 
before that phone rings what to avoid. And older adults, the 
older American nutrition programs provide education in their 
facilities as well. We need to embark on more funding for 
prevention and education in this space.
    Ms. Herrera Beutler. Okay, wonderful. Thank you all.
    I have more, but I don't think it is short enough to fit in 
27 seconds. So, with that, I yield back.
    Thank you, Madam Chair.
    The Chair. Thank you. Thank you very much.
    I might also add as an addendum, one of the things that if 
we do not immediately put together a COVID supplemental 
package, we are going to put everyone, and seniors and people 
who are uninsured, the people who have been told that there is 
free testing. But if there isn't any money to cover that, when 
they go and they find out that they will have to pay, they will 
turn around and go home.
    And that is necessary. So the imperative of passing a COVID 
supplemental bill is important obviously for the humanitarian 
reasons, but for testing, for therapeutics, for vaccines, et 
cetera, and what that means for people who are with regard to 
their insurance coverage, but also getting their costs covered. 
But that package is equally as important.
    Let me now recognize Congressman Pocan.
    Mr. Pocan. Thank you, Madam Chair. I think this should be 
working. I switched computers. I apologized before. My official 
computer doesn't work so good. My personal one works just fine. 
Go figure.
    I want to go back to nutrition and specifically the Meals 
on Wheels program. I have done a lot of delivering of meals 
through various communities' Meals on Wheels, and I grew up in 
a lower middle class family. So my mother didn't have a lot of 
money when she retired and just recently passed at 93 years 
old. So she was getting Meals on Wheels for quite a while when 
she was in some senior housing.
    One of the things, though, that I have noticed, as much as 
that social connection is so very important and checking in on 
seniors, all those are extremely important. But in a number of 
the programs in my district, in order to save money on food, 
they have switched to contractors that are doing the jail food.
    And jail food is not the same as food that is made for 
seniors. And in one particular program, they dropped to a third 
of participation because the food was bad. And as I delivered 
food, I heard it from a number of the seniors.
    Do we need better guidelines? I know Representative Harris 
kind of asked that. But I am concerned that if this is a trend 
in order to save money--because we do offer I think 
pathetically small amounts in things like SNAP, et cetera, to 
feed people--I am worried that this program also will not be 
the great program for many other reasons besides nutrition that 
it is.
    Ms. Lyons and anyone else, can you address that?
    Ms. Lyons. It is a huge problem. I have been asked to 
provide food for--I live in Savannah, Georgia. So right across 
the river from us, and there is a jail that is doing the food.
    And they approached me, and they said people get sick. We 
have had people get food poisoning. We want you to do this 
program. But when I tell them how much it costs, they are like, 
``Oh, no, we can't do that.'' So it really comes down to then 
the demand versus what it really costs to provide a really good 
meal.
    I do wish the OAA had got--they do have guidelines, but 
nobody gets really penalized for not providing the grade of 
food that they should, for not providing--we are expected to 
keep these standards, but there is not a penalty. And so when 
States get desperate to serve rural areas or to save money 
because they have got so much, they are resorting to things 
like drop shipping of five frozen meals and not having that 
daily wellness check. Not having those minimum guidelines. 
Using day-old food.
    So you understand that because it is a matter of money and 
trying to meet a need. But you are absolutely right. There 
should be a minimum standard that is held to that by the Older 
Americans Act--I mean by the triple As, the Area Agencies on 
Aging. And in some instances, it would be better not to have 
food than to have bad food.
    Mr. Pocan. I will tell you that is exactly what happened at 
the last program I was at. I mean, privately, the people who 
worked there wanted to take me aside and explain that they drop 
off. They have had it, and I saw it when I talked to folks.
    In addition to that, I know that Social Security payments--
we tie increases to Social Security to the CPI. Right now, CPI 
is great because, unfortunately, with the COVID inflation.
    Ms. Lyons. Yes.
    Mr. Pocan. But I know there is another CPI out there that 
is the CPI-E that takes into consideration more expenses that 
seniors have, like around medication, rather than others. Do 
you find that is also something that I know it is not directly 
in your area, but that we should be providing more to people 
who get Social Security because as small as that amount is, it 
is extremely helpful. But that increase hasn't really kept up 
with what people need for real expenses.
    Ms. Lyons. True. One of the things that the OAA provides is 
that we don't have a strict income guideline because there is a 
recognition that when you are an older adult, there is a 
different cost of living. And you have got medical expenses, 
you have got caregiver expenses. You have got things that a 
younger person doesn't have.
    And it would be really nice if you could apply that same 
kind of recognition to Social Security, to SNAP, to things like 
that. But I know it all comes down to money, which is great 
that this committee is looking at how to keep people healthy 
because that is the investment that keeps that big sack of 
money at the end.
    Mr. Blancato. And if I could add one thing, Congressman, 
which is the Older American Act does target its services to the 
elderly in the greatest economic or social need, with 
particular attention to low income, rural, limited English 
speaking. So there is an effort to make sure that there is more 
reaching those individuals in the services that are provided.
    Mr. Pocan. One of my most rural areas I just came back 
from, this happened, and they are down to a third of the people 
because of the changeover of food. And I just feel like it may 
not be addressed enough, but I really appreciate it.
    Thank you for your time, and I yield back, Madam Chair.
    The Chair. I now recognize Congressman Cline.
    Mr. Cline. Can you hear me, Madam Chair?
    The Chair. Yes, we can.
    Mr. Cline. All right. Thank you. Sorry about that.
    We are dealing with some technical difficulties of our own.
    I want to ask all of our witnesses. I am a district that is 
very diverse. It has rural areas and urban areas. And so, to 
Dr. Pelaez, when talking about falls specifically, I know that 
older adults falls are becoming more prevalent and a growing 
issue of concern, and they are very costly. And the direct 
medical cost of fall injuries is $50,000,000,000, up from 
$38,000,000,000 a decade ago, of which 75 percent is shouldered 
by Medicare and Medicaid.
    Can you tell me, do you see a statistical difference in 
cases of injury due to falling in rural areas versus urban 
areas, the frequency or the severity?
    Ms. Pelaez. That is a great question, and I don't know that 
we have very good data to answer your question. That is one of 
the reasons why we really need to have better screening, better 
data collected, in a systematic and coordinated fashion.
    For instance, we know that fire departments, both in rural 
and urban areas, do a lot of the lift and assist. When someone 
falls alone, they call the fire department for help. They come, 
they lift that person, and that is what we call ``lift and 
assist.''
    If the person is not badly injured, so they don't have to 
go to the hospital, that is a statistic that never gets really 
recorded in anywhere except in the fire department. So having a 
coordinated system of better reporting, having more systematic 
screening. We know that older adults do not talk about falls. 
There is a stigma related to falls.
    If I have fallen, that means that I am getting weaker, and 
maybe my children are going to think that I am due to the 
nursing home. So I don't really talk about falls.
    So to answer your question, we really need to invest more 
in data, but I will check on--and there are some centers that 
really have good statistics on rural aging. So I will check and 
promise you that I will get back to you with any more 
information we get on that issue.
    But it does pinpoint the fact that we need better data 
collection and better screening, better reporting.
    Mr. Cline. Okay. I have such limited time. Ms. Orsi, can 
you talk about mental health, rural versus urban? Is there a 
difference in the type of need and the services available 
obviously, but can you speak a little bit to the rural-urban 
divide?
    Ms. Orsi. There is a great urban-rural divide, and our 
resources across the board are not as available to many people. 
And I am sure that if you are involved with any kind of rural 
situation you understand we have had some patient issues. We 
have a lack of service providers. It has been helpful to have 
the telehealth. That has been very helpful for people, but 
still it is not enough because not everybody has broadband.
    I mean, I have got good connections, and I am having issues 
today. But if you are in the rural area, there are a lot of 
issues that just are such challenges to try to get the help 
they need, and then not much help is available.
    Mr. Cline. Ms. Lyons, can you also speak to this? Meals on 
Wheels is a great program. I have participated in it many times 
in some of our more urban areas. But talk about the challenges 
in rural areas, specifically with the rising price of gas.
    Ms. Lyons. Yes, the rural areas are much more expensive to 
serve just simply because of the delivery piece of it. 
Volunteers with inflation are saying they can't afford to do 
these routes that are 30 miles going to one house. But that 
doesn't diminish the need by any means, and having the 
flexibility to charge a slight different price for rural versus 
urban helps a lot.
    But yes, it is--it is a challenge, and it even makes it 
more important that you have that socialization that comes with 
the meal because they are so isolated, as Ms. Orsi was saying.
    Mr. Cline. Thank you. I appreciate all the work that all of 
you do.
    I yield back, Madam Chair.
    The Chair. And now I am really so pleased to introduce the 
initiator, instigator, the source of this--the reason for this 
hearing and, again, to properly say thank you to you, 
Congresswoman Frankel. This is an extraordinary amount of 
information that I think we have to digest, and I appreciate 
your efforts to bring it to everyone's attention.
    Congresswoman Lois Frankel.
    Ms. Frankel. Thank you, Madam Chair, for bringing this to 
us today.
    And Mr. Cole, I know was here. I know he has got a deep 
interest in this, too.
    And thank you to the panel.
    Madam Chair, it is always something, usually it is 
something personal that usually brings something to people's 
attention, and in this case, it was very personal. I have 
probably there is 350,000 seniors who just live in my county 
that I represent, and one of them is very special to me. It is 
my 96-year-old mother, who I just want to tell you is, she is 
physically in good shape now. But she had a number of falls, 
and finally, the fourth one, she broke her leg. And I have seen 
how it dramatically has changed her life.
    She had superb medical care, but she was someone who was 
living independently before. She is very clear of mind. She is 
still of clear mind. She is now afraid to live by herself, uses 
a walker. And when I saw the medical expenses, I was shocked. 
Of course, she is on Medicare, but she also had some personal 
expenses, which is not really as relevant.
    But this is why I started looking into this because, all of 
a sudden, my friends tell me, well, their parents all fell. And 
then my mother said, oh, all my friends have fallen. And then 
one of my friends fell, and she broke her jaw. And then I fell, 
and I broke my finger. I mean, I am going like ``Is everybody 
falling?''
    And the answer is when you get to a certain age, yeah, a 
lot of people are falling. And I just want to say the 
$50,000,000,000 figure is the tip of the iceberg, folks, right? 
It is the tip of the iceberg because it doesn't even include 
what Medicaid, for example, is going to spend if someone goes 
into a nursing home or into assisted living facility.
    And there are so many other things. It doesn't even deal 
with what it affects the family and how you become a caretaker 
that you weren't a caretaker before. And we love our parents 
and so forth. I would do anything for my mother, but I want to 
tell you, it is like she can't really do anything on her own. 
And getting the walker in and out of the car, I mean, it 
changes everybody's life in a lot of ways.
    And I saw someone who is very clear mind now who, we talk 
about nutrition and isolation and so forth, who how just 
having--she is in an assisted living facility--how that affects 
her, just her well-being and how she feel everyday about 
herself.
    So, and then multiply this out. Thirty-three million with 
falls reported. Hello? What would you say? A lot more falls 
than are actually reported.
    And Madam Chair, I wanted to just let you know that I have 
made a request--actually, myself and a number of members--
because this is an appropriations committee, a number of 
requests to the committee to take a look at some of the falling 
shortfalls, and I wanted to discuss this with our guests.
    The Interagency Coordinating Committee on Health and Aging 
and Age-Friendly Communities has been authorized, but never 
funded. Could somebody--also the Research, Demonstration, and 
Evaluation Center for the Aging Network, also authorized but 
never funded. Could any of you please speak to the value of 
funding these programs?
    Ms. Pelaez. So, Representative Frankel, yes, the problem is 
that what you are referring to is occurring at all levels. ACL 
falls prevention competitive grants have provided important 
seed money for local and State organizations to reach out to a 
variety of partners and develop their own falls coalition, but 
those are not funded. So the sustainability and the 
effectiveness becomes extremely limited.
    We have seen that the authorizing of coalitions that 
actually have the funding to bring Federal agencies that all 
have relevant resources and responsibility for falls would 
leverage the amount of funding that is available and would 
actually create the sustainability of cost-effective measures 
that can be happening at the local and regional levels.
    So what I am saying is that these coordinating councils, 
these interagency groups are effective. We have seen them in 
the Elder Justice Coalition. We have seen it in other areas. 
But they need to be funded, and that is basically the bottom 
line.
    Ms. Frankel. Madam Chair, I think I have run out of time, 
but if we have another round, I will continue with my questions 
on this area.
    Thank you, Madam Chair. I yield back.
    The Chair. Congressman Harder.
    Mr. Harder. Thank you so much. And thank you, Chair 
DeLauro, for hosting today's hearing.
    And thanks to all our panelists for being here.
    We are in the middle of an urgent and growing crisis of 
affordability amongst our seniors, at least in my community. 
With inflation on the rise, the skyrocketing cost of 
prescription drugs, and the shrinking supply of affordable 
housing, seniors in my community are really finding it harder 
and harder to get by.
    Every year, I hear from more seniors who are unable to 
afford their housing, their food, their medications. Our 
housing prices have gone up by 20 percent in the last year 
alone, and that could be the difference between living down the 
road from your grandkids or being forced to move out of your 
community.
    And ultimately, I think this is a big problem for a lot of 
seniors that have to choose between a roof over their heads, 
lifesaving medications, or a meal. And frankly, it seems to be 
getting worse.
    Ms. Orsi, given your expertise on wellness for older 
Americans, are you seeing those financial challenges impact the 
quality of life of our seniors, and what are you hearing?
    Ms. Orsi. [Inaudible.] They are wellness issues. In order 
for a person to be healthy, we have to look at the whole 
picture. So we have to find ways that we can better support 
people in terms of their financial along with their mental 
health.
    In terms of answer, I don't have one. I wish I did. But I 
am sure, together, we can come up with some good answers.
    Mr. Harder. Thank you. What about affordable housing in 
particular? I think every community has its own set of unique 
challenges, but our community is growing very quickly, and a 
lot of our seniors are feeling forced out of their homes, or at 
least forced to live far away from the families that they love.
    What do you think the Federal Government can do to support 
seniors who are going through some of these challenges on 
affordable housing or other financial burdens and upheavals? I 
will open that up to your or any other panelists that may have 
other ideas or suggestions on that topic.
    Ms. Orsi. So I am not a financial [inaudible] many times an 
older person will not have choices, and they are forced to live 
somewhere that is maybe you and I might consider a little 
undesirable. But it is either that or the streets. So what are 
the choices?
    At the same time, we know that a large number of our 
homeless population are older adults. So, again, in terms of 
housing, it is all ages are suffering from the housing 
situation right now, but particularly our older adults. But 
older adults, a lot of times, are the invisible population. 
Despite our numbers, we are still pretty invisible.
    We are still always talking about investing in children, 
which we should do. But we need to invest in the old adult 
population that got us here.
    Mr. Harder. Yep. And what about that cross between 
prescription drugs--oh, sorry. Patty?
    Ms. Lyons. No, sorry.
    Mr. Harder. What about that intersection between 
prescription drugs and other healthcare needs? How acutely felt 
do you feel like those financial strains are for older 
Americans?
    Ms. Orsi. Well, they are extremely felt [inaudible] We 
didn't talk today too much about medication prescription at 
all. But medication, older adults receive one third of all the 
medications that are prescribed in this country. And we have 
they are in pain. They get a lot of opioids. We have an opioid 
problem. So the prescription drug price is really important, 
but another piece that we really need to look at is the number 
of meds that people take.
    Now granted, when you have got a lot of chronic conditions, 
you need to take medications, but a lot of those create adverse 
events, increase hospitals and falls and all that other stuff. 
And I have got a friend who is a geriatric pharmacist that does 
training with me, and he says that the amount of drugs that are 
prescribed to older adults are America's other drug problem.
    So besides mere cost, I think we really need to be focusing 
on what is the amount of prescription drugs that people are 
taking.
    Ms. Pelaez. So that also requires a great deal of 
investment in educating our medical community. The primary care 
providers are the ones that are the front door for the medical 
system to older adults. And most of them have never taken one 
course in geriatrics, let alone geriatric pharmacy.
    So how do you really invest in medical education and 
educating the health systems on how to provide better care for 
older adults? That, in itself, will begin reducing falls 
because medications are one of the many factors that need to be 
reviewed in order to prevent falls.
    Mr. Harder. Well, thank you so much. I see my time is up. 
So I yield back to the chair.
    Thank you.
    The Chair. Well, we have completed a first round of 
questions. I would like to do a second round. And let me just--
because this is a all virtual, let me just check to see who of 
the members are still remaining.
    I believe Ms. Lee, Ms. Frankel, myself. Are there any other 
members on the Democratic side of the aisle who are still here?
    [No response.]
    The Chair. And I am not sure who is still on the phone on 
the Republican side of the aisle.
    Dr. Harris, Congresswoman Herrera-Beutler.
    [Pause.]
    The Chair. Okay. Well, it would look like this. Myself, Ms. 
Frankel, and Ms. Lee, who are still on. And so, with that, I am 
just going to say--oh, is Congressman Harris on?
    Mr. Harris. I am here, but I have no further questions.
    The Chair. Okay, lovely. Thank you so much.
    Then move to the three of us for 5 minutes, 5 minutes each, 
and then, Andy, will you be doing--Congressman Harris, will you 
be doing closing for Congressman Cole or----
    Mr. Harris. I can do that. It will be brief.
    The Chair. Okay, and I will just move then to close after 
that. But let me just ask, if I can, I would like to get in two 
or three questions at a clip here.
    I was interested in what you said, Dr. Pelaez, about just 
primary care and the need for primary care. But also as you 
attach to that the training of a workforce, if you will, a 
geriatric workforce. So we need a nursing and a medical 
community that is trained to recognize elder abuse and the 
mental health needs, the trauma, the identity, falls-related 
injuries.
    U.S. Census Bureau says America is graying starting in 
2030, when all boomers will be older than 65, older Americans 
will make up 21 percent of the population, up from 15 percent 
today.
    And so let me just ask Ms. Orsi, is--and others can chime 
in. Is today's geriatric workforce robust enough, is it diverse 
enough to adequately serve the growing population of older 
adults and all of their unique needs?
    Ms. Orsi. No. No, we don't. We do not have training 
ability.
    The Chair. So let me ask others, if you want to chime in?
    Mr. Blancato. Yes. Absolutely, Madam Chair. It has been a 
longstanding problem. The reimbursement rate under Medicare for 
geriatric physicians has been declining for years, providing no 
incentive for people to come into the field.
    And when you talk about even on the training side, too many 
older adults go to emergency rooms with a bruise, and they 
assume it was a fall, but it could have been elder abuse 
because you don't have forensic centers that can identify that. 
That is one of the recommendations I made in our testimony. We 
consider funding through grants, forensic centers specific for 
elder abuse like we have for child abuse. But we need to do 
more in the geriatric care space, for sure.
    Ms. Pelaez. Actually, when you really think about families 
with children, they would never think of taking a child to a 
primary doctor that was not a pediatrician. But we have 80, 90, 
100 years old that are being taken care of by primary care 
physicians who really have learned to care for older people in 
a very strange way.
    I have had doctors who say, ``Oh, I am expert in taking 
care of older people because that is all I do.'' But when you 
really try to find out where is their science-based training, 
and there wasn't any.
    So we really need to improve the medical education of 
people who take care of older adults. We need to demand that 
they have minimum criteria to do what they do. Otherwise, it is 
not fair. We are really compounding the problem by allowing a 
medical system that continues to ignore the needs of 
geriatrics, and that is very important.
    That would be important at all levels--for mental health, 
for nutrition, for elder abuse, for falls, for everything. But 
particularly with falls, my mother was 94 years old when--she 
was chronic heart failure, but she really was falling a lot.
    And I took her to the doctor. The nurse practitioner wanted 
to do all sorts of tests, but I said no. But she is falling. 
What can you do for her? And eventually, she said, ``Well, 
don't--Mrs. Pelaez, don't fall again.''
    And I said to her--and I said to her, ``What about physical 
therapy? What about an occupational therapy? What--.'' She 
said, ``Oh, what a great idea.''
    So this is what we are encountering day in and day out in 
our communities. That is what we can [inaudible].
    The Chair. Well, I will just make a note on that, and I do 
have another question. I told you my mom passed away at 103 
years old. And I am an only child. So I was back and forth from 
New Haven, Connecticut, to Washington, and so forth. But I was 
not there during the week.
    So at one time, we had seven caregivers for my mother so 
that she would have around-the-clock. But it is wonderful, and 
I will trade--and they were mostly women. They were all women. 
The women were just extraordinary with her. But the medical 
training, they did not have, which it was of concern to me.
    I mean, they were good. They ministered. They got her to a 
doctor, or they took care of giving her the pills that were 
laid out. But it is interesting in terms of the profession, and 
quite frankly, we need to think about people that need to be 
paid more than a minimum wage. They need to be paid what they--
and then we really need to take a whole look at and provide--
help to provide the training because these are good jobs for 
people.
    And that is something that we need to think about is what 
we are doing here in terms of training and making sure that 
people--and I know Congresswoman Lee will talk about her mom, 
et cetera. We all have this issue, and we want to make sure 
that we have the best. You feel an obligation to have the very, 
very best treatment for your loved one at this stage.
    So, and we should take a look at what we need to do in this 
area of training and providing this kind of training. Let me 
just ask at the same time, I am going to just try to get both 
of these in. This is about nutrition, and this is about falls.
    It is about preventing those emergency room visits, and 
when you are looking at a falls prevention program, it is how 
do we prevent--you have got good ideas, and I thank you for 
them. How do we prevent the injuries, and whether it is with 
regard to nutrition or whether or not it is a fall, et cetera, 
on the prevention side rather than dealing with it after the 
fact?
    Ms. Pelaez. Right. We need to invest in public health and 
aging. Prevention, public health, they are the experts in 
prevention. We need to really have a robust public health 
approach to preventing falls.
    There are many programs that have been proven to show that 
if they are done correctly, they are evidence-based, they help 
build muscle mass. They help create better balance. They help 
modify your environment.
    There is a need for a person-environment fit. As you grow 
older, your environment has to be more supportive of whatever 
deficits in function you have. We have to approach falls from a 
public health perspective, from a community perspective, in 
addition to look at it as also related to medical conditions.
    That is why we are emphasizing the STEADI screening tool. 
Because we cannot fix what we don't know. So if we don't really 
do proper risk assessments in our wellness visits, we don't 
know what we need to fix within that environment. But we also 
have to create a community-based health, public health 
approaches that actually help older adults improve balance, 
maintain physical activity, maintain good nutrition, but also 
modify their environment so the environment continues to be 
supportive of people's needs.
    Technology is great. We have demonstration programs that 
need to be funded so we actually identify what are the best 
ways to deal with prevention. Investment in prevention is key.
    The Chair. Thank you. Thank you.
    With that, Congresswoman--go ahead, Bob. And then I have 
got to go--yes, I am well over my time.
    Mr. Blancato. All right. Quick point.
    On the Welcome to Medicare exam, they are needing more 
focus on falls prevention and education. In nutrition 
education, we should blend nutrition education and falls 
prevention, and we should also increase the reimbursement for 
DEXA screening.
    The Chair. Okay, thank you. Congresswoman Lee?
    Ms. Lee. Thank you very much.
    You know, this is so important I am beginning to feel like 
this is like a group support session or a group therapy 
session. I wish we would have had this meeting like 10 years 
ago or 15 years ago. Then I can see so many similarities and 
commonalities on the issues that all of us have.
    Chair DeLauro mentioned my mother who lived to be 90, and I 
tell you, same situation. Caregivers, great people, but not 
trained. They needed better pay, better training.
    I learned so much about this because I was the one from 
afar who had to constantly manage her care. And so fast forward 
to now, my aunt, 101, I know a heck of a lot more than what I 
did then. So I am still managing her care, but there is still a 
lot of the same issues. Ten years later, my mother--well, 7 
years later, my mother passed away 7 years.
    So it is just so important that we really have as a 
priority, care, treatment, the needs of our seniors because 
they deserve the best care in the world. Just like our children 
deserve the best teachers in the world, our seniors deserve the 
best care in the world at that point in their lives.
    So let me ask you, because I have always wanted to ask this 
question, and I don't--and given we have such experts here, I 
want to know about this, if it is true or not and what criteria 
factors into this. Okay? And maybe we are in denial about this 
as we age.
    Fifty is the new 30, right? Sixty is the new 40, right? 
Seventy is the new 50. Eighty is the new 60. Ninety is the new 
70. Okay. Now, are there any--is that scientific, or is that 
something we are just saying to keep us hopeful that we can 
stay 50 years old as we age?
    Ms. Pelaez. What we know is true is that we are living 
longer, and we are also--but we look forward to live longer and 
fewer years, those added years to our lives, without frailty 
and disability. That is our goal. So that is where it comes 
that now 80s are 60s, or whatever. We want to compress the 
amount of years that we actually live with disabling 
conditions.
    And again, we are succeeding to a certain extent. But 
because we are growing, our population is becoming not only 
older, but the older people are living longer. So that we are 
increasing the octogenarian and nonagenarian and centenarians 
in our communities. Those are the people we need to focus on 
and see how we can actually ensure that the longer years that 
they have earned are really healthier years.
    And to do that, we need to really invest in prevention with 
a geriatric focus lens with actually understanding how do we do 
that. Communities, community support is going to be the key 
and--because healthy aging is more than medical, biological 
treatments. We know how to cure some medical conditions, but we 
still are learning how do we maintain older people robust, 
active, and healthier to enjoy the number of years that we have 
gained in terms of longevity.
    Ms. Lyons. And I would add, if you don't mind, I am an only 
child, and my mom lived with me the last 5 years of her life. 
And she passed at 95. One of the things that we haven't talked 
about, and I know I am supposed to be focused on nutrition, but 
we also run an adult daycare program, which is a perfect 
alternative for people who are living with family members.
    So they are taken care of at night, but while we are 
working, my mom went to our adult daycare center. There were 
CNAs there. There is an RN there. They can help her with 
toileting. They can help her with those things that she just 
needed. She wasn't ready for a nursing home, but she just 
needed a little bit of support.
    So I just throw that out there. As you are looking at all 
this and talking about healthy aging, that is a good middle 
piece that doesn't receive a lot of funding.
    Medicare and Medicaid will pay for a nursing home, but they 
don't pay for adult daycare, and that is a good middle piece. 
And it keeps them safe. It keeps them from being scammed by 
personal care homes that say they are going to take care of 
them, but they don't. I mean, it just filters all the way 
through.
    Ms. Lee. Thank you very much. I yield the balance of my 
time.
    Thank you. So I guess, really, 60 is the new 40. We can 
psych ourselves up to believe it, but that is basically, 
though, because of all of the what you said, Martha, about all 
of the other factors that have increased life spans.
    The Chair. Congresswoman Frankel.
    Ms. Frankel. Again, thank you. Thank you all.
    I recently talked with folks from CDC, and they described 
what they thought were the four pillars on fall prevention. 
Clinical care, make sure there's a fall prevention routine as 
part of clinical care. Increase awareness among older adults 
and their caregivers. Engage emergency responders. And address 
specific populations because they have different needs. I think 
one of my colleagues brought that up before.
    So I want to do, see how I can get through this. But the 
clinical care, for example, you talked about a program called 
STEADI evaluation, if you could tell me a little bit more about 
that. And do doctors get paid for this assessment?
    Ms. Pelaez. Not right now. There is not much incentive to 
really--we know that in the wellness visit, it is required to 
do a depression screening. But there is no requirement to 
really do a fall test.
    They ask have you fallen? But there is not a risk 
assessment of falls. That would be a huge step in the right 
direction.
    Ms. Frankel. Yeah, I agree with you on that. I am just 
thinking of my own mother's journey because before she had her 
really bad fall, she had had another fall before where she had 
a wound. I mean, so she was with a doctor, a primary care 
doctor, wound care. She had paramedics, all these touches, and 
I kept asking, like you, what can we do? And there was really 
no response, other than, well, she is old, I guess, you know.
    So is there any payment or any training for first 
responders in terms of other than, okay, we have a patient 
here. Do they have to report? Do they have contacts? I mean, 
what--is there any program? I know there are some fire 
departments that do have programs for that. Is there any kind 
of a national effort?
    Ms. Pelaez. Yes. Actually, Pinellas County--Pinellas, our 
county, is doing a great job. And that actually came from the 
fact that it is very costly for fire departments to do those 
calls that are not reimbursed. So they decided that they were 
answering more falls calls almost than fire calls. So the fire 
and falls became actually a dual issue for them.
    They are exemplary in terms of the education they give to 
the first responders, the resources they invest in community 
education, the partnerships they have formed with the local 
falls coalition. And it is an excellent example of how 
resources from different sectors can come together and actually 
address a problem that affects everyone. So, yes, I think that 
Pinellas County--the Pinellas, our county is a great example 
that could be replicated.
    Going back to the demonstration research of funds, I think 
one of the missing links is that we really don't have or don't 
invest enough resources in evaluating those efforts of those 
models of innovations. This country has been building 
innovation, but when we innovate, we need to evaluate and say 
is investment in this innovation going to actually be better in 
terms of cost-effectiveness, in terms of quality?
    We are not at the point that we can actually do this 
demonstration nationwide and have everyone learn from it. So 
that is one of the reasons that we call so much not only for 
the interagency coordinating body, but also the funding of 
demonstration projects that help us learn from those 
experiences.
    Ms. Frankel. And let me just emphasize that those are both 
authorized programs not yet funded, if I understand that 
correctly.
    Ms. Pelaez. Yes.
    Ms. Frankel. And the other point, well, I see I am running 
out of time, but I would just say that educating older people 
gets difficult, especially as they may lose some of their 
ability to understand. Do you want to quickly comment on that?
    Ms. Pelaez. Yes. There are really two sets of people, maybe 
three. But primarily, those who are mentally able, but they 
really have to make--to understand how their bodies have 
changed, how their environment is changing. They need to 
understand how they can prevent falls.
    And the program A Matter of Balance, the CAPABLE program. 
There is tai chi. There are a number of programs that do that 
very, very well. They are evidence-based. They are proven to be 
effective.
    But then there are programs for people with dementia or 
people who really are unable themselves to learn how to avoid 
falls. Those programs are really targeting the caregivers, the 
family, the environment. Technology is helping, actually, a lot 
to help families create better caregiving for people with 
dementia with a focus on avoiding falls.
    And we really need to learn from those and scale them. 
Scale them and make them really nationwide movements.
    Ms. Frankel. Thank you so much. Thank you.
    I yield back, Madam Chair.
    The Chair. Thank you. Thank you.
    I see that Congresswoman Roybal-Allard has joined us. So 
let me yield time Congresswoman Roybal-Allard.
    Ms. Roybal-Allard. Thank you so much, Madam Chair. And I 
apologize for being late, but I was chairing another hearing. 
But I did want to attend whatever I could of this hearing 
because it is such an important hearing.
    I have one question that I just want to pose to anyone on 
the panel. Today, people are living longer than ever before, 
but they are not necessarily living healthier. In fact, 58 
percent of adults over the age of 65 have two or more chronic 
conditions.
    I have read recently about the field of general science 
which aims to better understand the aging process and how it 
drives the entire range of age-related diseases and conditions. 
The hope is that we can delay or prevent multiple aging 
conditions at once and rather than tracking them one at a time.
    Can any of you talk about how research on the aging process 
could help address the many health problems that older people 
face?
    Ms. Pelaez. I will be glad to start the conversation. I 
think the point is extremely important, but I also want to say 
that you can live very healthily even with multiple chronic 
conditions.
    I have at least four chronic conditions that I am dealing 
with, and I consider myself a great, very healthy human being 
because they are managed, because I am able to control their 
symptoms and deal with them, and they really do not affect my 
function in any way. So we have to do both. We have to really 
continue to learn how investing in the biomedical research that 
will help us understand better the aging process and what can 
be done about it along the life course, and we also have to 
really invest on this concept of wellness.
    And wellness is different from disease in many ways. 
Diseases can be managed. Chronic conditions can be managed, and 
you can be very healthy living with chronic conditions if you 
have, actually, the proper support to do that.
    Both are super important, and we really--because whatever 
we are going to learn by investing in bio research is going to 
be a long-term investment, and it is not going to happen 
overnight. So we need to be doing both.
    I hope I answered your question.
    Mr. Blancato. I would like--oh, go ahead, Karen.
    Ms. Orsi. I will just make a quick comment. Granted, that 
is a very important topic, but I think also we are all aging 
advocates on this call. But I think in order to be an aging 
advocate, we always have to go back to ground zero. Many of our 
older adults are aging into Medicare. There is a lot of chronic 
diseases because they did not have access to healthcare when 
they were younger.
    So we have to focus on from the beginning. To be an aging 
advocate, I have also got to be an adolescent advocate. People 
need to have healthcare and access to it. And if they get that 
proper care, then we wouldn't have such a chronic condition-
centered older population.
    Mr. Blancato. Congresswoman, I remember when I worked for 
the House Committee on Aging, when your father chaired the 
committee years ago, and we would talk about research back then 
and the need to coordinate it.
    I think right now, you are at a point where there is a lot 
of research going on, but the question is how do you do an 
inventory in such a way to determine the most important that 
should be continued to go from research to practice? And I 
think what you are talking about is very important, and I think 
this hearing also from the standpoint of investing in 
prevention as an element and showing how research into 
prevention can show results, good results, I think is 
important, too.
    So, hopefully, we can analyze that a little more deeply. 
Because there is a lot of good research going on in the 
National Institute on Aging and the National Institutes of 
Health and places like that.
    Ms. Roybal-Allard. And I just want to point out not just 
prevention, which is absolutely key, but also the fact that 
when someone does have a chronic disease, as was mentioned, 
they have to have affordable access to the right kind of 
healthcare. And something that the chairwoman has been pushing 
for some time and has mentioned several times in our hearings, 
they also have to be able to afford the medication that is 
needed, which is something right now that is not necessarily 
true.
    So I just want to commend the chairwoman for her consistent 
advocacy and efforts to make sure that prescription drugs that 
are needed for maintaining someone's health will be affordable.
    And I yield back, Madam Chair.
    The Chair. Thank you. Thank you very much for those kind 
words.
    And just as a moment, couldn't get to your event last 
night, but congratulations on your award from the Coast Guard. 
Just unbelievable. There was 5-minute voting--and you have to 
talk to Dr. Harris about that--22 votes, 5-minute votes each. 
So it was a little tough to get back and forth. Anyway, so--but 
congratulations.
    Ms. Roybal-Allard. Thank you. It was a lovely evening.
    The Chair. Okay. Congressman Harris, let me ask you to make 
a closing comment, and then I will as well.
    Thank you.
    Mr. Harris. Yes, thank you very much. Thank you very much, 
Madam Chair, for having the hearing.
    Look, I think most people don't realize that we have about 
45 million people over age 65 right now, and by 2060, that is 
going to be 90 million. I mean, we are not anywhere near the 
plateau phase of the aging demographic in the United States. We 
are nowhere near it. And the sooner we start to plan for the 
problems that are going to be associated with that, the better.
    One topic that was brought up is Medicare. The fact of the 
matter is, Madam Chair, you know we are going to have to deal 
with Medicare. The Part A trust fund goes broke in 3 years. 
Part B expenses are projected to double in the next 20 years. 
And yet our providers are facing a 9 to 10 percent payment cut, 
not keeping up with inflation, payment cut.
    And the elderly tend to retire in rural, more rural areas 
where it is already difficult to find providers. This is going 
to be--if we don't pay attention to this, we are going to be 
left with our seniors who can't get access to the needed 
medical care because, as has been mentioned many times, there 
are usually many comorbidities in our elderly population.
    It requires specialists. The need for geriatricians has 
already been brought up. But when you are dealing in a 
specialty that is compensated for by Medicare with decreasing 
payments every year, it is not a way to attract our youngest 
and our brightest into the field. So we have so many complex 
problems associated with the changing demographic. The sooner 
we deal with it and begin seriously thinking about this, the 
better.
    So I want to thank--I want to thank everyone on the panel, 
and I yield back to you, Madam Chair.
    The Chair. Thank you so much.
    And again, I want to, you know, a shout-out to 
Congresswoman Frankel, who initiated this effort. But I have 
been struck not only in your personal testimony at the outset, 
but in the course of the hearing that the rich data and 
information is stunning. And I just don't say that and say, 
``Oh, my God, isn't that wonderful?'' But we are--become liable 
if we have got all the studies. And Bob, you pointed that out. 
I mean, well, we have got a lot of data. We have got a lot of 
research. We need to do some specific research in some of the 
medical areas, and that we can try to do it.
    But we have enough data for us to be able to look at some 
of the mechanisms that we currently have and how they need to 
be extended or plussed up or provided more revenue in the area. 
There are some areas where we are--we have to focus on. We 
talked about workforce. We talked about training. We talked 
about an infrastructure, if you will, around this. We talked 
about training.
    You have been all wonderful in your testimony to not only 
lay out the problem, but to help us to think through, you have 
laid out some of the solutions. And we need to and I believe we 
will try to take up these efforts as we move forward with the 
appropriations bills.
    And it has also been stunning to me that everyone on this 
call has these concerns. Barbara Lee pointed that out. My mom 
would say to me, ``Rosa, these are supposed to be the golden 
years, but they are the lead years.''
    Because we are all excited that my mother lived to 103 
years old. It is unbelievable living longer, but I dealt with 
the feeling all the time of the quality of her life and what 
was the quality of her life?
    And that is what you were focusing on. That is where you 
are guiding us. And I think that we need to be very cognizant 
of, again, the agencies that are tasked with this effort, 
whether it is nutrition, whether it is mental health, whether 
it is the propensity for falling, and understanding that 
better.
    We are going to go to the NIH, and again, most--it is 
women. Most of these falls occur with women. Why? Why is that? 
What is it that--we have Dr. Harris here, but what is the 
medical difference, the gender differences that provide that? 
What are we doing with the Older Americans Act?
    And I will just say this. We focus on Social Security. Yes, 
I think you are right about Medicare and what we need to do. 
But I don't think we spend enough time reflecting on the things 
that you all have focused us about today and how we can 
translate that into assistance for older Americans.
    We do not have to write an omnibus healthcare bill, but we 
do need to know where in the system we can plus-up and make a 
difference.
    So I will just say to you I am hopeful. I feel that you 
will say yes to this, but I know your resources. But as we go 
down and looking at the appropriations bills and we are putting 
them together, that we can call on you to be resources and to 
check in with you about if we are following the right path.
    So, thank you. Thank you very, very, very much for the work 
that you do and for your testimony.
    And with that, I am going to call this hearing to a close. 
Thank you very, very much.

                                             Tuesday, May 17, 2022

                          DEPARTMENT OF LABOR

                                WITNESS

HON. MARTY WALSH, SECRETARY, DEPARTMENT OF LABOR

               Opening Remarks by Chairwoman Rosa DeLauro

    The Chair. I would like to call to order the hearing on the 
fiscal year 2023 budget request for the Department of Labor.
    This is a hybrid hearing, so we need to address a few 
housekeeping matters.
    For the 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 stop your 
remarks if you do not immediately see the screen switch. If the 
screen does not change after several seconds, please make sure 
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.
    With that, I would like to acknowledge Ranking Member Tom 
Cole and all of the members of the subcommittee who are joining 
today's hearing, both in person and virtually.
    And I want to say a thank you to all the members and our 
witness for your flexibility as we start this hearing earlier 
than expected to welcome the Prime Minister of Greece later 
this morning.
    I would very much like to welcome you, Secretary Walsh, 
first in-person hearing of this subcommittee as Secretary of 
the Department of Labor. You joined virtually last year and 
happy that it is in person today.
    I want to first thank you for how hard you have fought this 
past year, throughout your entire career, for American workers 
and for working families. These last 2 years have been 
difficult for so many, especially for working families. Far too 
many people lost their jobs. Small businesses and restaurants 
were forced to close. Schools were shut down. Our childcare 
infrastructure collapsed.

                     PANDEMIC AND INFLATION IMPACTS

    And the pandemic exacerbated what we have known for a long 
time, that pay has not kept up with the costs of living. Too 
many Americans were already struggling, and the pandemic took a 
massive toll that left so many reeling.
    Workers are living paycheck to paycheck. They are 
struggling to pay taxes that are too high. Big corporations 
with monopoly prices are pushing--or monopoly profits are 
pushing up the prices. And now we are facing a war abroad that 
has spiked inflation and created an energy and a cost of living 
crisis as well.
    And economic opportunity remains hard to reach for millions 
in underserved communities. The employment rate for black and 
Hispanic workers remains considerably higher than that of the 
overall population. Workers without a college degree face more 
barriers to employment than college graduates do.
    Far too many women have been pushed out of the workforce or 
forced to consider new employment over the last 2 years as 
sectors that employ predominantly women continue to suffer, and 
access to childcare and workplace flexibility make returning to 
the workforce that much harder for mothers.
    We need to be doing even better for the communities that 
need us the most. That is really why we were all elected. 
Franklin Roosevelt's Secretary of Labor Frances Perkins, the 
first woman appointed to a presidential Cabinet, said--and I 
quote--``I came to Washington to work for God, FDR, and the 
millions of forgotten, plain, common working men,'' and I would 
add women.
    Working for the forgotten and for our workers should be the 
reason every single one of us is in Washington, and we know, 
Mr. Secretary, that that is why you are here. We have a 
responsibility to protect and lift up our workers. So thank you 
for joining us today to discuss the Department of Labor's 
budget. We appreciate all you have done and will continue to do 
to protect workers and support their families.

                  WORKFORCE AND EMPLOYMENT INVESTMENT

    Just the important work of rebuilding our economy began 
last year. I am proud that the Congress passed the first fiscal 
year 2022 Government funding omnibus in March, including a 
$653,000,000 increase for DOL programs. With $550,000,000 more 
for employment training programs, we help workers reenter the 
workforce, earn better wages, improve their families' economic 
stability.
    We increased funding for registered apprenticeships to help 
Americans develop into new high-skill trades. We strengthened 
State grants and job training programs that help ex-offenders 
return to the workforce, supporting those with significant 
barriers to employment find good-paying jobs, helping employers 
hire and retained skilled workers.
    With $50,000,000 for Strengthening Community Colleges 
Training Grants Program, we are meeting the demand for skilled 
workers by providing training at community colleges. I am proud 
that this committee was instrumental in creating this program 
in 2020 and the Apprenticeship Grants Program in 2016, both of 
which are growing our economy from the bottom up and lifting 
people into the middle class.
    A priority of mine for years has been to strengthen worker 
protection agencies at DOL, and we worked closely, proud to 
work closely with DOL to bolster the Wage and Hour Division, 
the Occupational Safety and Health Administration, and the 
Employee Benefits Security Administration. We provided a total 
of $1,800,000,000. These critical agencies protect against wage 
theft and worker misclassification, enhance the health and 
safety of American workers at a time when potential workplace 
hazards threaten millions of us.
    To support working conditions abroad, we increased the 
International Labor Affairs Bureau, ILAB, capacity for high-
impact international assistance that combats some of the 
world's most abusive labor practices, including the use of 
child labor and forced labor. And with funds from the U.S.-
Mexico-Canada Agreement, the USMCA, ILAB is making huge strides 
to enforce the labor provisions of our trade agreements while 
helping workers and employers in Mexico make their workplaces 
safer.
    Protecting workers must always include protecting those who 
find themselves unemployed. We are addressing longstanding 
problems in the unemployment compensation system that 
disproportionately harm workers of color, service industry 
workers, blue collar workers by modernizing technology and 
expanding reemployment services for job seekers.
    We included district-specific community project funding to 
support workers in our home districts and try to meet the 
needs, including funding for job training, workforce 
development, apprenticeship programs. And the America COMPETES 
Act strengthens our workforce while keeping our economy 
competitive.

                        FY 2023 BUDGET PROPOSAL

    As we begin fiscal year 2023, we need to build on these 
investments. The budget request proposes $14,900,000,000 for 
DOL programs, a 13 percent increase over 2022.
    There is a plan to look at workers and their families and 
how they can access opportunities they need and deserve. To 
support workforce development, the request would increase 
investments in State grants for workforce training, 
Apprenticeship Grants, and other job training programs, double 
funding for Strengthening Community Colleges Training Grants to 
reach students when they need it most.
    The budget request also continues our efforts to rebuild 
the unemployment compensation system to help unemployed workers 
make ends meet while they look to quickly reenter the 
workforce. And supporting our workers means maintaining a 
strong commitment to worker protections. Pleased to see the 
request of an increase of $355,000,000 for worker protection 
agencies to rebuild this critical, important mission that has 
gone underfunded for decades.

                          WORKER UNIONIZATION

    We must do even more to support our workers, the people who 
keep our Nation running. I am proud that we were able to 
support the people who keep this body running, congressional 
staffers, with a bill paving the way for staffers to unionize. 
This example should reverberate across our Nation. More needs 
to be done not only in this building, but everywhere. Workers 
deserve a fair shot at a good-paying job.
    I want to lend my voice and my support to the millions of 
American workers joining together and unionizing to fight for 
higher wages and better working conditions. We have seen 
successes at Amazon, Starbucks, and other corporations, and 
that there is no better way to strengthen the middle class than 
to ensure that workers have a seat at the table, which is why I 
strongly support the PRO Act, strengthening workers' bargaining 
rights and their ability to freely choose to join a union as 
they fight for a better future for themselves and their 
families.
    Mr. Secretary, the work that you and the rest of the 
Department do to provide safety and opportunity for our workers 
makes our country better, pushes our economy forward. We have 
made progress over the past year, but as you know, there is so 
much more to do. People need to have Government look out for 
them, and those who are working and the vulnerable who work 
hard.
    This budget request and our support for our workers will 
ensure that we live up to these ideals, and I look forward to 
working with you over the next year and to today's discussion.
    And with that, let me recognize Ranking Member Cole for his 
opening remarks.

                 Opening Remarks by Ranking Member Cole

    Mr. Cole. Thank you very much, Madam Chair.
    Mr. Secretary, it is wonderful to have you here.
    Before I get into my prepared remarks, I want to make three 
quick observations. This is a big day for our committee. You 
are going to name this hearing room after our former chair of 
the whole committee and longtime chair of this subcommittee, 
Mr. Obey. So that will be a happy moment, and I thank you and 
congratulate you for doing that.
    Second, God thank the person who got us new chairs up here 
on this podium.
    The Chair. That is right.
    Mr. Cole. If you haven't noticed, we can all move and get 
in and out. I don't know who the staffer is that who did it 
under your brilliant leadership, but please give that person a 
raise.
    The Chair. A raise, right.
    Mr. Cole. That was wonderful.
    And finally, just as a housekeeping matter, I am going to 
have to leave at about 9:45 a.m. because Rules is meeting to 
redo our structure. So I apologize to you, Mr. Secretary, and 
certainly to you, Madam Chair, and my colleagues for having to 
depart early. That is not the normal pattern for me.

               INVESTMENTS IN DEFENSE INDUSTRY WORKFORCE

    But I am particularly pleased, Mr. Secretary, to have you 
here in person in this year's hearing and welcome you to our 
subcommittee. And I want to start by thanking the Secretary for 
traveling to my district recently, which he was kind enough to 
do at my request, to visit Tinker Air Force Base, which is 
America's largest defense aircraft maintenance depot and 
keeps--it is actually the world's largest--keeps many of our 
Nation's most important national security aircraft in safe 
operational order long after their normal life span.
    As I have raised before in this subcommittee and Defense 
Subcommittee, our aircraft depots and, in fact, all of DOD and 
the economy at large have serious shortages of qualified high-
skilled workers. The Secretary was very helpful in helping us 
think through that problem and helping us come up with ways to 
begin to address it. So we appreciate that.
    We have got a particular need for advanced software 
developers, computer engineers, and other cyber professionals. 
And I suspect we are not alone in needing that particular set 
of skills.
    The Secretary took the time to meet with key base 
leadership, the union leadership, and several workers onsite to 
investigate the issue. I will ask a question on that topic 
later, if time permits. But I look forward to working with you, 
Mr. Secretary, and your team in the coming months to pursue 
cooperative solutions along with the Air Force.

                        FY 2023 BUDGET PROPOSAL

    Now turning to the President's budget request for the 
coming year, I must reiterate several concerns. Last year, 
President Biden signed the American Rescue Plan into law 
without a single Republican vote. This legislation pumped 
nearly $2,000,000,000,000 of new spending into our economy, 
much of it unneeded and poorly targeted. I firmly believe that 
the law has been a direct cause of the 40-year high inflation 
we are currently experiencing.
    Gas prices are averaging well over $4 a gallon, and prices 
in the grocery stores are up in double digits. History has 
taught us we cannot spend our way out of inflation, yet this 
year's budget seems to think we can do just that. I 
respectfully disagree.
    The spending levels requested in this budget double down on 
those same levels resoundingly rejected by Congress from the 
last budget. To enact such an increase in this environment 
would irresponsibly add to the national debt and further push 
our economy into possible recession.
    In fact, some believe we are already on the course of 
seeing a recession within the next year, a fact I find 
incredibly unfortunate. I believe the worst effects of the 
President's economic policies could have been avoided if such a 
sharp partisan approach to spending had not been pursued early 
in the administration.
    The fiscal year 2022 appropriations represents a 
compromise. It did not include the more than 17 percent 
increase for non-defense agencies requested by the 
administration. Instead, we came together and funded joint 
priorities in a bipartisan manner at reasonable levels, and I 
certainly hope we can do that again for fiscal year 2023.
    My second concern centers around the lack of support we are 
showing for employers. Unemployment is at an all-time low of 
3.6 percent. That is a good thing. In my State of Oklahoma, we 
are significantly below the national average at 2.6 percent.
    Businesses are struggling to find workers, and a worker 
shortage is exacerbating the inflationary pressures, further 
pushing our economy into a downward spiral. Yet I do not see a 
workforce policy from the administration reflecting the 
realities of many businesses. Recent proposals to ``modernize'' 
the Davis-Bacon standard for a prevailing wage return us back 
to a definition that has not been used for nearly 40 years.
    The budget requests a more than 20 percent increase for the 
Wage and Hour Division, a more than 35 percent increase for the 
Office of Federal Contract Compliance Programs, a 15 percent 
increase for the Occupational Safety and Health Administration, 
and nearly 200 additional staff for labor enrollment in the 
Department.
    Specifically in your budget materials, you cite the need 
for greater enforcement of those participating in the sharing 
economy. With unemployment at record lows, we do not need 
excessive executive overreach, stifling innovation and 
flexibility for both workers and employers.
    Innovative solutions like those found in the sharing 
economy have enabled millions to find work when they want it 
and help those find workers when other options were not 
available. We should be supporting these new forms of 
employment, not smothering them with overly aggressive rules, 
regulations, and enforcement.

                        APPRENCTICESHIP PROGRAMS

    I do want to commend your support for the apprenticeship 
programs. We have seen these programs flourish in recent years 
under multiple administrations. I think apprenticeships 
represent an opportunity and a pathway to high-paying jobs, 
many of which do not require a college degree.
    However, I am disappointed by the lack of support to 
alternatives to registered apprenticeships. I hear from 
businesses regularly about the limiting structure and 
cumbersome model of registered apprenticeships. The model was 
not built for the economy and the opportunities of today, and 
it is not doing enough to support today's worker.
    It is underutilized by many industries, notably the growing 
sector of information technology, cybersecurity, and supply 
chain logistics. I think the administration should do more to 
support intermediaries in these areas and alternatives to 
registered apprenticeships to bring opportunities to these 
aggressively growing businesses and to American workers.
    These are just some of the policy differences that I am 
sure we will discuss today. I am hopeful that we will work 
through this shortened budget year, and will be able to once 
again find the middle ground.
    I have said before, and I will say it again. The chair and 
I have worked together for the past 7 years to find a spending 
level we can both support in the final appropriation, and we 
have been able to do that seven times in a row.
    So I certainly hope to do so again, and I would certainly 
not like to see our 7-year streak broken, and I don't believe 
it will be. I think we will be able to find common ground and 
get this bill down to you and give you a budget within a 
reasonable period of time so you can go about your important 
job.
    I know the chair doesn't want to drag this into next year, 
and I don't want to drag this into next year. We both want to 
get our work done on time.
    So I want to thank you again, Mr. Secretary, for appearing 
before us today. I want to thank you in particular for taking 
the time to come to my district. That was a very generous act 
on your part, and I look forward to your testimony and our 
continued work on our shared priorities.
    With that, Madam Chair, I yield back.
    The Chair. I thank the gentleman.
    And Mr. Secretary, your full written testimony is going to 
be entered into the record, and with that, you are recognized 
for 5 minutes for your opening statement.

                   Opening Remarks by Secretary Walsh

    Secretary Walsh. Thank you very much, Madam Chair. It is an 
honor to be here today. And Ranking Member Cole as well and 
members of the subcommittee. It is great to be in person. Last 
year was my first----
    The Chair. Your mike?
    Secretary Walsh. Oh, sorry. Can you hear me?
    The Chair. Yes.
    Secretary Walsh. It is on, yes. Last year was my first 
hearing when I did Zoom, and it was hard to, quite honestly, 
get into a rhythm here. So it is great to be here today.
    I am pleased to outline President Biden and Vice President 
Harris and the administration priorities for the Department of 
Labor's fiscal--2023 fiscal year. My mission, as Secretary of 
Labor, is to empower all workers morning, noon, and night.
    The frontline workers who have carried us through the 
pandemic and the worst days of the pandemic, the marginalized 
workers who face barriers to employment opportunities, the 
veterans who serve our Nation, the rural workers who serve 
through targeted workforce training programs, the Department of 
Labor stands with all workers in every community to build a 
stronger, more resilient, and more inclusive economy.

         DEPARTMENT OF LABOR'S RULE IN THE AMERICAN RESCUE PLAN

    I am proud of the Department of Labor and what we have 
accomplished this past year. We have successfully implemented 
the key provisions in the President's American Rescue Plan. 
That plan was very important to opening up our economy, 
supporting healthcare workers, supporting pensions, supporting 
Unemployment Insurance in our country, protecting workers from 
COVID-19 and heat exposure, strengthening retirement security 
and access to mental health services that we need to do more of 
in this country.
    We expanded career training programs to connect more 
Americans to more opportunities and connect more industries to 
skilled workers. We implemented the President's $15 an hour 
minimum wage for Federal contractors. We had people in this 
country that were earning $7 an hour, trying to raise a family 
on. That is impossible.
    We had legislation--we worked on legislation to stop 
surprise billing, medical billing, and protections for tipped 
workers that Chair DeLauro and Chair Murray advanced in 2018.
    We advanced Government-wide initiatives to support workers' 
organizing rights, climate action, and infrastructure 
implementation. In all our work, we are committed to equity for 
the most vulnerable workers in all of our communities across 
America.

                           ECONOMIC RECOVERY

    We have in this moment a unique opportunity to help workers 
truly thrive. The President's plan has produced a historic job-
driven recovery, and Congress has made transformative 
investments in workers through the Bipartisan Infrastructure 
Law and other actions that Congress has--that you have taken.

                          GOOD JOBS INITIATIVE

    In the Department of Labor, the Good Jobs Initiative, we 
are partnering across Government to make sure these investments 
create good jobs and access for all people. I am committed to 
supporting congressional efforts to invest in the workforce 
training, childcare, education, healthcare that working 
families need and depend on in this country, in every single 
community and our neighborhoods in our country.

                       FY 2023 BUDGET SUBMISSION

    This 2023 budget submission builds on these investments and 
renews our pledge to serve workers, job seekers, and retirees 
in America. The workforce development budget requests 
$303,000,000 to expand registered apprenticeship programs, 
proven programs that work to help people get better jobs and 
get into a good industry; $100,000,000 for community college 
partnerships with employers. And I have been to about 10 
community colleges in the last few months to go around and talk 
about the importance of investments in every community.
    One hundred million dollars for career training in growing 
industry sectors, such as Tinker Air Force Base when I was 
there last week with you, Mr. Leader, and we talked about the 
challenge that the Air Force has with competing with the 
private sector and getting good-paying jobs into those areas. 
These are powerful tools for connecting diverse workers to 
skilled opportunities, and they meet critical supply chain 
needs in our economy.
    For example, the administration is working urgently to 
ensure that infant formula is safe and available for families 
all across our country. While this work is led by the FDA, our 
work is to increase the number of qualified truck drivers on 
the road to address the issues that many others have not over 
the long term, and we are going to continue to do that. And it 
is critical to providing good careers of workers for people of 
color, women in rural America, and veterans opportunities to 
get into those good-paying jobs.
    The budget increases funding for our veterans through our 
Veterans Employment and Training Service Agency. It increases 
funding for our Women's Bureau to expand access for women to 
careers where they are underrepresented.

                       WORKER PROTECTION AGENCIES

    The budget invests $2,200,000,000 in the Department's 
worker protection agencies. This work is more essential now 
than ever as we rebuild the staffing levels. That includes 
OSHA's efforts to double down on the number of inspectors by 
the end of the President's first term.
    It will restore MSHA's capacity for enforcement in mine 
plan equipment reviews. It would restore staffing on Employee 
Benefits Security Administration to protect workers' health, 
retirement, and disability benefits. It would increase funding 
for our Wage and Hour Division to safeguard the wages of 
vulnerable workers. It would offer our Office of Federal 
Contract Compliance Programs to ensure Federal contracting 
advances America's promise of fairness to all workers in this 
country.
    The budget increases funding to the Office of the Labor 
Solicitor, rebuilding the entire Department's capacity to 
enforce the laws. We are also requesting resources for the 
Bureau of International Labor Affairs. ILAB ensures our 
training partners uphold their labor commitments--our trading 
partners, excuse me, uphold their labor commitments so American 
workers can compete on a level playing field.

              STATE UNEMPLOYMENT INSURANCE FUNDING FORMULA

    This budget fully funds and updates the State funding 
formula for Unemployment Insurance. This would be the first 
comprehensive update in decades. It allows States to serve 
claimants more efficiently, and our request includes 
$150,000,000 to strengthen the integrity of the system. Every 
single one of your States has had a problem over the last 2 
years with Unemployment Insurance.
    Finally, the budget requests nearly $4,000,000 to support 
Good Jobs Initiative. This enables us to advance the 
President's priority of good jobs with the free and fair choice 
to join a union.
    As Labor Secretary, I have traveled across this Nation to 
meet with workers and employers and better understand the needs 
of people and communities in this country. Despite all they 
have been through, workers are showing up each and every day to 
move our communities forward. In return, we must do all we can 
to ensure their well-being and empower them with opportunity.
    I want to thank you all once again for the opportunity to 
testify to you in person today. I look forward to discussing 
our budget request with the committee, and any questions that I 
can't answer, we will work with your teams to make sure we get 
the answers for you by the end of today, hopefully. Depending 
on how early we get out. [Laughter.]
    The Chair. Thank you very, very much, Mr. Secretary.
    I was really interested in--because we have been discussing 
the issue of infant formula for the legislation, et cetera--but 
the tie-in with the truck drivers. I really hadn't thought 
about that and if we can move product where we have a greater 
supply, and that is what the head of FDA had said to me 
yesterday, that we have some places that have supply. But if we 
can move that quickly, then we can get the product back on the 
shelf so parents are not at risk.
    So, thank you.

                 ENFORCEMENT OF WAGE THEFT PROTECTIONS

    Mr. Secretary, last week, along with my colleagues, we 
introduced the Wage Theft Prevention and Wage Recovery Act. It 
is legislation to put hard-earned wages back in workers' 
pockets, crack down on employers who unfairly withhold wages 
from their employees.
    Every day, employers do cheat their employees out of 
legally owed wages. They violate employees' overtime, minimum 
wage, and tipped work rights. Wage theft disproportionately 
harms low-wage workers, amplifying poverty and making the 
enforcement work at the Department's Wage and Hour Division all 
more critical.
    Mr. Secretary, how can the Department proactively stop bad 
actors from withholding hard-earned wages from workers? How is 
the Wage and Hour Division prioritizing meaningful enforcement 
efforts to ensure that corporations are not stealing wages from 
our most valuable workers?
    Secretary Walsh. Thank you, Madam Chair, and I look forward 
to certainly partnering with you to ensure that this bill moves 
through Congress that is being moved through.
    The Wage Theft and Wage Recovery Act would strengthen the 
fundamental protections that would allow workers the full 
compensation that they have earned, and it will crack down on 
corporations that subject workers to abuses, quite honestly. I 
mean, we have to do everything we can in our power to take the 
steps that people aren't losing their wages, their hard-earned 
wages. That is the bottom line here, I think.
    And certainly, at the Department of Labor and my past roles 
as working in the building trades or working on a construction 
site, when somebody does their job, they expect to get the 
wages. I have spent a lot of time going around this country and 
been in a lot of church basements talking to workers that, 
quite honestly, have been taken advantage of because they feel 
they have no power to support themselves on fighting back for 
their back wages that they are owed.
    Anyone in this country, in the United States of America, 
that goes to work any day, every day, should be paid for every 
single minute that they work. That is the bottom line. And this 
bill will help us ensure that illegal practices that are 
disproportionately hurting low-income workers are overturned. 
And we have to make sure we protect all workers in this country 
as we continue to move forward, and I think that that is 
something that is really important.
    We also have to continue to support 35 percent of our 
workers that are tipped workers, and we have to make sure that 
our tipped workers as well aren't taken advantage of. Those are 
the folks that serve us the food, that serve us the coffee, 
that clean our tables, that bring us the food when we go out to 
restaurants, and it is appalling to think that in 2022, we have 
people in this country that are being taken advantage of. And 
again, mostly low-income workers, workers of color, women.
    That, quite honestly, should not be the case. So I look 
forward to working with you and Congress, this committee and 
Congress, to pass that law, and I hope it is a bipartisan 
effort because the wage theft is happening on both sides of the 
aisle.
    The Chair. Thank you. Thank you for your efforts in that 
area.

                         ROLES OF ILAB IN USMCA

    Let me just ask a question about ILAB and USMCA. Since the 
passage of the USMCA, the implementation act included 
$210,000,000 from this committee for ILAB, and so there has 
been great progress made in this area as noted. ILAB, in your 
testimony, you have talked about integral to supporting the 
first independent union elections at General Motors at the 
plant in Silao, Mexico, and the Tridonex auto parts facility in 
Matamoros.
    So, in April, the Department announced $28,000,000 in 
investments to combat forced labor and human trafficking and 
support workers' capacity for negotiating these collective 
bargaining agreements that would raise wages and improve 
conditions in Mexico. How will you support ILAB's critical 
monitoring, enforcement, and capacity-building roles in the 
USMCA? As we continue to make progress in Mexico, what other 
areas of the world can we focus on to support workers and, as a 
result, American businesses?
    Secretary Walsh. Well, thank you very much.
    Last month, Deputy Secretary Julie Su traveled to Mexico. 
She met with their Labor Minister in Mexico to talk about what 
is happening on the ground. She came back and reported to me 
that she felt really good. We have hired four labor attaches--
there is a fifth one coming--in Mexico to look at the trade 
agreement.
    She felt positive when she was talking to the Labor 
Secretary--Minister, I should say, and their commitment to 
enforcing labor laws in Mexico. And certainly, I support ILAB 
in all of their efforts to make sure that wherever we are in 
the world, whatever work we are doing in the world, that we are 
doing it collectively together.
    We are also working, which you didn't ask me the question 
now, but I just want to quickly say also looking at child labor 
and how that impacts--how that impacts labor negotiations and 
how it impacts labor all across the world. We saw last year--
and I will stop. I know my time is over.
    Last year, we saw the first time in 20 years an increase in 
child labor abuses in this world. So we are focused on working 
to--partly due to the pandemic and partly due to a whole bunch 
of different reasons, but we can't be standing by as a country 
and watching those happen.
    The Chair. I would hope that you will just keep in touch on 
that issue. I think that we really ought to be leading in the 
effort in eliminating child and forced labor that exists. And 
we may not eliminate it, but we should do all that we can as 
the U.S. to curtail it.
    So, thank you. And with that, let me recognize our ranking 
member, Mr. Cole.
    Mr. Cole. Thank you very much, Madam Chair.

                 INCREASING REGISTERED APPRENTICESHIPS

    Mr. Secretary, in my opening remarks, I mentioned the 
bipartisan agreement on apprenticeships and how important they 
are, and this committee has increased funding for those under 
administrations of both parties. But we have only had a modest 
increase in the number of folks that are actively registered 
apprentices.
    What are the sorts of things we can do to increase those 
numbers? We all know this is a good pathway to a great job and 
the skill sets that our economy really needs. So what is the 
Department thinking about that we could attract more people 
into these opportunities?
    Secretary Walsh. Yes, I think that, first and foremost, we 
have to let people know that these opportunities exist. And I 
think that what we are doing at the Department of Labor is we 
are looking at other industries where we can expand registered 
apprenticeship programs similar to the building trade model, 
which is the gold standard, looking at in other areas how do we 
do that.
    We were able to, with the trucking challenge, with the 
supply chain challenges we had, were able to in a matter of 48 
hours turn around an application. We have over 100 companies 
right now that are working on--that have an apprenticeship 
program in the trucking industry. We have 400 that have signed 
up. We are able to turn that around in 48 hours and move that 
forward.
    Not to keep bringing it up, but at Tinker Air Force Base 
the other day when we were there, I started thinking about 
opportunities for apprenticeships working with community 
colleges. Just for the members of the committee, there is a 
need over the next year at Tinker for 3,000 engineers.
    They have about 1,500 engineers from the local colleges in 
Oklahoma. There is about 1,500 other opportunities that are 
needed there, and they are competing with the private sector. 
So they can't compete fiscally with the private sector because 
of the cost.
    So you think about a program like that, creating an 
apprenticeship program that allows Tinker to hire people to 
come in as apprenticeships, get on the job training, working 
with schools, working with universities. And over a very short 
period of time, a couple years, you can scale those workers up 
where they already have an understanding of how the base works.
    That is how I envision these programs working. Not just in 
engineering, but in high tech, biotech, anything, any industry 
we want to think about we could create a program. But we are 
going to have to need--the companies, the private sector is 
going to have to work with us. And the public sector, to some 
degree, investments. But I really think it has to be a private 
sector really investment because that is the best way it is 
going to be.
    The last thing I will say, we signed an MOU with the 
country of Austria a month ago to talk about what--Austria and 
Switzerland have a really robust apprenticeship program. And 
when they do it, I mean, it is embedded in their philosophy.
    We are not there yet as a country, and we have to get there 
slowly because I think a lot of people, as you mentioned in 
your opening remarks, are resistant to it. And they have to 
understand this is not a program we are creating just for the 
sake of creating a program. It is actually a process, a program 
we are creating for advancement for educating people to go to 
work and get good jobs.
    Mr. Cole. Just for the record, you can mention Tinker as 
much as you would like. Go right ahead. [Laughter.]

                UNEMPLOYMENT INSURANCE FRAUD PROTECTION

    Mr. Cole. You mentioned in your remarks some of the 
modernization efforts on Unemployment Insurance programs. And 
look, I recognize we are coming out of an extraordinarily 
difficult period, where we had systems that were strained well 
beyond what their capacity was ever meant to be or anybody 
could envision. I mean, when you are going through a pandemic 
and you make decisions that we are going to have slowdowns or 
shutdowns, and you got to give people an alternative, and these 
systems simply weren't set up to handle that volume well. So I 
am glad you are, number one, looking at that.
    We have had quite a few reports about fraud. Again, when 
you put this much money through the system, that is going to 
happen and particularly when the system can't handle it. So I 
am interested in going forward, if you could detail a little 
bit more about what are the specific things you are going to 
try and help State uninsurance funds do? What are the 
protections in terms of fraud going forward that you would 
highlight?
    Secretary Walsh. Yes, when Congress made the appropriation 
last year, I wasn't quite sure how many States and territories 
would be involved and want to be interested in doing something 
with Unemployment Insurance. We have 49 States that are very 
engaged in this process. We have put together tiger teams that 
have gone in to identify challenges in different States and 
identifying, working with them and making investments through 
grant programs to make sure we fix the challenges that these 
States have had.
    I think that the unemployment system ultimately is going to 
need an investment both on a State and a Federal level to bring 
their systems up to 21st century standards. Many of their 
systems are working on systems that were built in the 1980s and 
1990s, and the infrastructure is just not there. But what we 
are doing with the Unemployment Insurance office is working to 
make sure that where making this $2,000,000,000 investment, we 
need to make sure that every single penny of this 
$2,000,000,000 goes toward modernizing and fixing the 
challenges that we experienced through the pandemic.
    Pre-pandemic, the fraud numbers were very low. Post 
pandemic, the fraud numbers were high because of the pandemic 
and the amount of money that went through the system, and I am 
expecting those numbers to come back down. But I am not 
expecting the problems to go away if we don't fully address it.
    So we are working with States right now. Some States are 
making their own investments. We are taking that $2,000,000,000 
that Congress gave us, and we are investing it. Our team is 
working really hard on it. They are strong, but powerful, but 
mighty team. They are the same team, quite honestly, that was 
able to distribute the money from the CARES package and the 
American Rescue Plan that Congress supported over the last 
couple years.
    Mr. Cole. Thank you very much. My time has run out.
    And unfortunately, as I mentioned earlier, I am going to 
have to leave. So I regret that. But again, thank you for 
visiting my district, and thank you for the job you do. It is 
much appreciated.
    Secretary Walsh. Thank you, Mr. Ranking Member.
    Mr. Cole. Yield back.
    The Chair. Congresswoman Roybal-Allard.

                         CHILD WORKFORCE SAFETY

    Ms. Roybal-Allard. Mr. Secretary, welcome. Before I ask my 
question, the chairwoman mentioned the international child 
abuse of children in the workforce, and I just want to point 
out that in our own country, we are also guilty of child abuse 
in the workforce. And I am talking particularly about children 
that work in agriculture, who are the children--are the only 
children in agriculture are not protected under our labor, 
child labor laws. And as a result, children that work in 
agriculture die at much higher rates than children in any other 
industry, not to mention the impact it has on their education 
and also on injuries.
    And I do want to thank your office for helping me put 
together, providing me with information, and I am introducing a 
bill, H.R.--or I have introduced, it is 7345, the Children's 
Act for Responsible Employment and Farm Safety of 2022, which 
is intended to address this issue to protect children in 
agriculture. And it has all kinds of exemptions, of course, for 
family farms, and we have tried to address every concern that 
has been raised. So I just wanted to bring that up to this 
subcommittee because it is a little--a dirty little secret that 
we have in this country about these children.

             OSHA RULEMAKING DELAYS FOR HEALTHCARE WORKERS

    Mr. Secretary, I am a co-chair of the Nursing Caucus, and I 
am very concerned that nurses and other healthcare workers have 
experienced high rates of infection and death from COVID-19 and 
increasing rates of workplace violence during the COVID-19 
pandemic. This is due to the fact that there is a failure of 
healthcare employers to have in place any kind of workplace 
violence prevention plans.
    But more importantly, it is also largely due to OSHA's 
failure to act. OSHA has, for many years, said that they were 
in the process of writing a proposed rule on workplace violence 
in healthcare settings. Given OSHA's lack of action, Congress, 
this House has tried to correct that and has passed a couple of 
bills to make that happen.
    It seems inexcusable to me that OSHA has yet to finalize a 
rule to protect these healthcare workers. Can you please 
explain why OSHA has been unable to put together a rule to 
protect these healthcare workers, and hopefully, can we expect 
something this year?
    Secretary Walsh. Thank you, Congresswoman. Thank you for 
raising this important issue. And I certainly look forward to 
working with you on the legislation, and your office.
    I don't know if I would describe OSHA has failing. I know 
that there has been, in the last year and a half, OSHA has been 
full out working hard on temporary standards dealing with 
COVID. Workplace violence is also one of those issues we have 
to work on.
    In the last 4 years, OSHA has lost significant amounts of 
money, have been significantly understaffed, and there are some 
concerns there. So we are staffing up OSHA. I will promise you 
right now I will make this a priority. We have had 
conversations. We have done more than conversations.
    I actually had a group of nurses in my office. Last week 
was Nurses Week in the United States of America. I had a group 
of nurses in my office from around the country. One of the 
issues they brought up was workplace violence and particularly 
not just during COVID, but pre-COVID.
    And workplace violence isn't just around nursing. It is 
about other professionals well. So I give you my commitment 
that I will work with your office on this.
    Ms. Roybal-Allard. Okay. I appreciate that. And I see my 
time is almost up. So I yield back.
    The Chair. Congressman Harris.
    Mr. Harris. Thank you very much.

                      H-2B VISA ABUSE PROTECTIONS

    Very good to see you, Mr. Secretary, and again, thanks for 
the visit back in March. The first thing I would like to talk 
about a little bit is the H-2B visas, which we talked 
extensively in our office about.
    At that time, you indicated that there may have been--you 
were going to look into whether or not adequate protections 
exist against abuse in the system. Were you satisfied? I mean, 
are there ways we can improve it to make sure that we get the 
workers, but the employers don't abuse the system?
    Secretary Walsh. Yes, thank you for that.
    There is always ways we can strengthen protections for 
workers when it comes to H-2B visas. We are in the process 
still of looking at that, but I am satisfied where we are 
today. We were able to get the allotment of 35,000 out.
    Thank you for meeting with me. I know it is important to 
your district and is important to a lot of people's districts 
on this podium and in this Congress. So we are going to 
continue to strengthen that.
    The system of H-2B visa changed in 2014. Congress used to 
allot--as you told me, Congress used to allot. We didn't have 
to do this additional every single year or every single twice a 
year. I think, for me personally, that was a better system than 
having to do this.
    But I want to make sure that as we do the H-2B visas, as we 
do an allotment, whether it is 20,000 or 35,000 or whatever the 
number is, I want to make sure the workers that are being 
brought into this country to work in tough industries that work 
really hard have the protections that they deserve. So as of 
right now, I feel confident. But we are looking longer term to 
make sure that workers have good protections.
    Mr. Harris. No, thank you very much.
    And please, if you find areas where we can tighten it up, 
again, to protect the workers. Because the employers I work 
with, they need the workers. They are willing to follow the 
rules. Just tell them what the rules are.
    And those who aren't willing to follow the rules shouldn't 
be getting the workers. It is that simple.
    Secretary Walsh. Right.
    Mr. Harris. So, but thanks for your help on that. 
Hopefully, we can get back to the old system, maybe returning 
workers or something, so you are not involved twice a year 
because I am sure you have better things on your mind.

                            B-1 VISA PROGRAM

    The other issue I did want to bring up, and you probably 
will have to get back to me about it, is the issue of how we 
are constructing offshore wind because there is going to be a 
push for it. It is interesting that there is also a visa system 
involved. It is called the B-1 visas, which are outer 
continental shelf visas, which we give to ships that are going 
to do the construction, and they bring in the labor.
    Now, normally, it is not American labor doing this. I mean, 
I was a little surprised. I thought we were going to construct 
these offshore wind mills. We are not.
    There are lot of ships, Nordic country ships. And then they 
hire workers from non-Nordic countries because Nordic countries 
obviously would be competitive in salary with our salaries. 
They hire other, Eastern Europeans, things like that, where 
they pay much less. So we are losing American jobs because I 
think of the way that visa system works.
    So if you could look into how the B-1 visa system works, 
and let us know if there are ways that we can get some of those 
jobs to be done by Americans. Those are good jobs, those 
construction jobs, and I think the system, for instance, by 
allowing these countries, these Nordic countries to apply, get 
the visas, but then hire other countries' workers at a low cost 
I think just undercuts our abilities.
    Do you have any knowledge about that? Because this is one 
of the growing industries.
    Secretary Walsh. Yes, the issue there is the work that is 
on the shore, our workers can do that. When you get to the 
rigging out in the harbor, out on the sea, the companies will 
often say that our workers aren't trained and aren't able to do 
the work.
    But I think that we will be able to scale up our workers 
pretty quickly, our tradespeople, to be able to do this work. I 
know that this is an ongoing conversation. I am not as familiar 
with the visa that you just brought up, and I will look into 
that. But I think what we really have to do is make sure that 
we have good training programs.
    Our workers can do that work. It is just a matter of some 
new technology that has come into the United States of America, 
and for the most part, it is a brand-new industry, offshore 
wind. That means we have talked about it for a long time, but 
now we are starting to see actually the fruits of construction 
there.
    And I think after a short period of time, meaning get one 
of these up, we should be able to have the workforce that is 
trained. Our workforce in America, our building trades can 
build anything.
    Mr. Harris. Yes, I agree.
    Secretary Walsh. There is no reason why we can't be 
building offshore wind.
    Mr. Harris. And again, if you could look into that?
    Secretary Walsh. I will.
    Mr. Harris. If there is a loophole they are exploiting or 
something.

                  MINIMUM WAGE FOR TIPPED WAGE WORKERS

    And finally, the last thing is one of the industries 
hardest hit by COVID was the restaurant industry. They still 
have concern over a minimum wage that would include tipped wage 
workers. I mean, they--and you understand the issue. I mean, 
the fact of the matter is that a tipped wage worker whose wage 
is less from the employer has to earn the minimum wage when you 
add tips in.
    So any efforts to expand the minimum wage that doesn't take 
into account a tipped wage I think would hurt our restaurants. 
And these, as you know, a lot of them, small businesses, at 
least especially in my district. If you come out and visit, we 
will bring you to a place, a mom-and-pop place that barely 
survived COVID that has real concerns.
    So they want their employees to earn a fair wage, but as 
you understand, if you bring that tipped wage up to the 
minimum, it prices them out of the market. So, again, just to 
raise the concern.
    Secretary Walsh. Yes, one of the things--and we can talk 
more about it. One of the things that we have seen in the 
restaurant hospitality industry is 11.2 percent increase in 
wages, and most of the restaurants that I have spoken to 
haven't necessarily complained about it to me. And some of them 
are small restaurants. But I will get back to you on that, and 
I look forward to getting to your district and having some 
crabs.
    Mr. Harris. Thank you very much.
    I yield back, Madam Chair.
    The Chair. I recognize Congresswoman Clark and say a thank 
you to Congressman Pocan for having Ms. Clark jump the line 
here.
    So, Congresswoman Clark.
    Ms. Clark. Thank you so much. Thank you, Madam Chair.
    Mr. Secretary, always good to see you, and thank you for 
your incredible work since you have been in your position.

            WOMEN IN THE WORKFORCE AND CHILDCARE INITIATIVES

    And I especially want to thank you for your focus on women 
in the workplace. We know that at the height of the pandemic, 
2.5 million women left the workforce, and 1 million fewer women 
in the workforce today than in February of 2020.
    And we know who these women are. They are low income. They 
are essential workers. They care for our children and for our 
parents, our seniors, our disabled family members. They are 
primarily black, brown, indigenous, and rural women. And they 
are moms, because we know there is a price to be paid in this 
country for being a mom.
    So your Secretariat finds itself at the intersection of 
another crisis that we are having for women in this country, 
and that is that we are about to see Roe v. Wade overturned and 
moving in many States to mandated pregnancies, Government-
mandated pregnancies. So as we are looking at who is most 
impacted by this post pandemic economy and, frankly, who was 
most impacted going into the pandemic, but the pandemic shown a 
light on these women and their economic forces, these are the 
exact same women, low-income moms, who are most likely to seek 
abortion care.
    So in this new world that we are entering, this new crisis 
for women, some of the work that you have done is around 
childcare, which is absolutely necessary. A recent GAO report 
that I requested found that only 11 percent of all workers have 
access to employer-provided childcare, and we know the United 
States is way behind other developed countries in supporting 
this.
    Can you tell me a little bit about the impact that you will 
see in being able to have women have jobs that can provide for 
their families if we do not do something about childcare?
    Secretary Walsh. Thank you, Madam Chair. And certainly, 
this is an issue that both of us worked on back in our days in 
Massachusetts.
    If we don't do something as a country about childcare, we 
are going to do severe damage to our economy. If we don't get 
women back into the workforce at a big level--and we are seeing 
women come back into the workforce, but we see high levels of 
unemployment--it will impact our economy, number one. Number 
two, it will impact our family structure in America, number 
two.
    I know that in legislation, a couple of pieces of 
legislation the President has filed that is in front of 
Congress now. But this is an issue--again, this is not a 
partisan issue. This is a bipartisan issue of childcare in 
America, about the cost of childcare, the availability of 
childcare, and not just childcare, high-quality childcare.
    The cost of paying folks that work in that industry also 
are predominantly women and women of color that are underpaid, 
making minimum wage in that industry. If you look at the 
numbers, across the board what the pandemic has taught us is 
that we have deficits in different parts of our economy. One of 
our deficits are certainly in job training that we saw, people 
quitting jobs at high rates, and the biggest glaring spotlight 
is on women in our economy.
    And it is not just childcare. It is paid family leave as 
well. Women, 51 percent of the women in this country are the 
leads in the family. Yet we don't respect them for that.
    So, I mean, I am certainly working across agencies with 
Secretary Cardona, Secretary Raimondo, working on how do we 
strengthen our childcare system. It is time for us as a country 
to make a major investment in childcare. That is the best I can 
say right now.

                DEPARTMENT OF LABOR SURVEY DATA UPDATES

    Ms. Clark. And speaking of childcare and moms, the data 
that came out of the Department of Labor, the most recent that 
we can find is 2018, showed that 1 out of 4 moms had to return 
to work within 10 days of giving birth. We are the only wealthy 
country that doesn't have national paid leave, which is a 
disgrace.
    But can you tell me, are you considering updating that 
information and surveys to give us new insight?
    Secretary Walsh. Let me just get my quick cheat sheet here. 
The latest data that we have is the 2020. But let me just say 
this to you. I will work with the Women's Bureau and your 
office to get updated numbers. We need to have numbers from 
2022, not from 2020, not from 2018, not from 2016. That was 
yesterday.
    I will do everything I can to get some updated numbers with 
you so we can actually see up close and personal what the real 
issues are.
    Ms. Clark. Thank you so much.
    Thank you, Madam Chair and Congressman Pocan, for your 
indulgence.
    The Chair. Congressman Fleischmann.
    Mr. Fleischmann. Thank you, Madam Chairwoman.
    Mr. Secretary, good morning, sir.
    Secretary Walsh. How are you?
    Mr. Fleischmann. Good, good. Congratulations to your Boston 
Celtics, first and foremost, for making the Eastern Conference 
finals. The Secretary and I have different views on a lot of 
things, including sport teams, but I always appreciate great 
winning. So I wish you well, sir.
    Secretary Walsh. Thank you.
    Mr. Fleischmann. I also appreciate the fact that you have 
taken the time to come back. Let us face it. This 
administration and our side have some fundamental strong 
differences in ideology and on policy, but I think we both want 
the best for the American worker, just different paths to get 
there. So thank you for your willingness to sit down and talk 
through some of the difficult issues. I appreciate that, sir.

                       EEOICP OMBUDSMAN POSITION

    Mr. Secretary, I first wanted to commend the Department for 
opening the Ombudsman position to oversee the Energy Employees 
Occupational Illness Compensation Program. This is an issue, 
albeit a little bit parochial, it is of particular importance 
to my issue and my constituents in the Oak Ridge area. Many 
employees, contractors, subcontractors, and their vendors were 
exposed to radiation, beryllium, and other highly toxic 
substances that have left them with chronic illnesses, sir.
    My first question is what is the administration's timeline 
for reviewing applications and filling the Ombudsman's 
position, and what plan of action do you hope to see from the 
new Ombudsman, Mr. Secretary?
    Secretary Walsh. Yes. Thank you very much for the question, 
Congressman.
    First and foremost, we are in the process of hiring right 
now, and we are looking at a timeline--I just got whispered in 
my ear--about 6 months we should have that position ready to 
go. And I look forward to, obviously, working with you in this 
area to make sure that people are getting the proper attention 
they deserve.

                  EEOICP TRAINEE POSITION PROTECTIONS

    Mr. Fleischmann. Yes, sir. Mr. Secretary, we are receiving 
a lot of calls from constituents who have been exposed to these 
particular substances over the years, and many of these people 
were actually trainees at the time. A little bit of a specific 
question, is the administration open to expanding the EEOIC 
program to include trainees as a covered class, sir?
    Secretary Walsh. Let me have a conversation with my office 
and get back to you on that. I am not prepared to answer that 
question at this particular second.
    Mr. Fleischmann. Understood. And getting that background, 
as I say, it covers a specific class of worker, but as 
trainees, these people were, of course, workers and exposed in 
that capacity. But understanding----
    Secretary Walsh. I don't see the challenge--I don't see the 
obstacles there. Let me just--again, before I commit to 
anything, I just want to have a conversation with the office.
    Mr. Fleischmann. Agreed. Understood.

                CONTRACTOR PROCUREMENT PROCESS TIMELINE

    Finally, sir, the Advisory Board on Toxic Substances and 
Worker Health officially requested a support contractor 3 years 
ago, sir. It is my understanding that the contract is still in 
the procurement process and has not yet been sent out for bids. 
Mr. Secretary, is this a normal timeline for the procurement 
process? When do you expect the process to be completed, sir?
    Secretary Walsh. It doesn't sound right, certainly, the 
timeline for 3 years on this. Again, I have to go back and 
check and do little bit more research on this. I wasn't 
prepared to answer, per se, this question today. So I will get 
back to you and your office right after this hearing.
    Mr. Fleischmann. Understood, sir. I know we have got some 
other hearings and issues coming up. So, Mr. Secretary, I will 
just say thank you.
    And Madam Chair, I will yield back.
    Secretary Walsh. Thank you.
    The Chair. Thank you. Congresswoman Lee.
    Ms. Lee. Thank you very much, Madam Chair and Ranking 
Member Cole, for this hearing.
    And thank you, Mr. Secretary, for being here. Good to see 
you.

RACIAL EQUITY IN UNEMPLOYMENT AND HIRING FOR AFRICAN AMERICAN WOMEN IN 
                             THE WORKFORCE

    And thank you in your testimony for being straight up, 
pretty blunt and authentic in much of what you talked, wrote 
about especially in your testimony as it relates to black 
women. And we know that black women--and you laid this out in 
your testimony--right now, the unemployment rate is at 5 
percent, and it is the highest of women by race and ethnicity. 
I think it was 6.6 percent a month ago. So it is heading in the 
right direction, but it is very concerning.
    And so I know that black women have been disproportionately 
impacted during COVID, but what in the world are you able to do 
to address this? What are you doing to address it?
    And then, secondly, with regard to your commitment to 
racial equity, thank you again for being very clear in your 
testimony about what the issue are around racial equity. And in 
fact, you mentioned that oftentimes black women, the 
intersection of racism and sexism means that black women are 
experiencing a different and more difficult recovery, but also 
how they are treated differently within these jobs.
    And so in terms of the executive order, how does that 13985 
calling for equity throughout the Federal Government, how do 
you address equity as it relates to African-American women and 
the unemployment rate? And then, secondly, you talk about we 
must embed equity into how we recruit and hire and what have 
you. But how are you doing that? How do you embed it?
    Because, I mean, I understand how structural racism works. 
So there are systems you have to dismantle before you can do 
anything to move forward to develop equity strategies. So I am 
curious as to how you are doing that and what you see in terms 
of black women and strategies to make sure they are treated 
properly, first of all, and that their unemployment rate comes 
down?
    Secretary Walsh. Well, thank you, Congresswoman. Let me 
just start by saying you talk about it, and you don't run away 
from it.
    It is no surprise to me that the black unemployment rate in 
this country is 5 percent, and we can't say--unfortunately, we 
can't say because of the pandemic it is 5 percent. Pre-
pandemic, there was a challenge with black women and employment 
in this country, and the black community as a whole in this 
country.
    We have had usually the black unemployment rate is double 
that of the white unemployment rate in this country. It has 
been historic, forever. I think some of the things that we can 
do is when we think about the Bipartisan Infrastructure Law and 
we think about opportunities and challenges that come from that 
law, I think we have an obligation to make sure--and part of 
the Good Jobs Initiative--is making sure that we have an 
equitable recovery, making sure that those investments from the 
Bipartisan Infrastructure Law, whether it is on a construction 
site or the jobs that are going to come off it, that people of 
color, particularly black people and Latino, have an 
opportunity to get access to those good-paying jobs.
    The investment in the Davis-Bacon prevailing wage, when we 
think about raising wages, in many parts of this country people 
work on Davis-Bacon prevailing wage projects. They are being 
paid lower rates. We haven't looked at Davis-Bacon in the last 
40 years. That is an opportunity to lift wages up for people.
    We passed the $15 an hour minimum wage, Federal contracting 
minimum wage. We had many people, particularly communities of 
colors, that were working on those projects that were underpaid 
and paid $7 and $8 an hour by Federal contracts and Federal 
contracting. We were able to lift that wage up to $15 an hour.
    The executive order that the President signed that you 
referenced, 13985, is across the Government. The President has 
asked all of us to look to make sure that equity is embedded in 
everything that we do as a department and how do we continue to 
move forward.
    My Women's Bureau--if you want to be more kind of granular, 
my Women's Bureau is really focused on creating opportunities 
and pathways as well. So you know, this isn't words I am saying 
to you. This is the action that we are taking in the Department 
of Labor, and we certainly have a long way to go, but--and we 
also have to measure the data. Data tells the truth. If you 
don't have the data and you don't look at the data, it doesn't 
tell the truth.
    Ms. Lee. It is too bad we don't have the data after----
    Secretary Walsh. No, no. What I am saying is measure the 
data to make sure that the investments we are making now, that 
we see in a very short period of time that the data is actually 
speaking a different story is what I meant by that.

          FEDERAL INFRASTRUCTURE PROJECT CONTRACTING STANDARDS

    Ms. Lee. Apprenticeship programs and work on the 
infrastructure project. In my district, for example, in the 
Golden State of California, historically--well, California 
eliminated affirmative action. The only type of programs that 
you can apply racial equity and gender equity to are federally 
funded programs.
    So you look around in my district, and you don't see any 
black and brown people working on these big infrastructure 
projects in the past. So how do you make sure--and you are 
going to make sure the black and brown people are on the 
infrastructure projects and what kind of a stick do you have 
for contractors to make sure they do that?
    Secretary Walsh. Well, I think the stick is you work with--
I am working with the building trades now to make sure that we 
are creating career apprentice programs into the building 
trades. I have done it in the past. As head of the building 
trades in Boston, I have created a couple different programs 
that have created pathways in there for people of color and 
women to get into the building trades. They were successful 
programs. They are proven programs that work, building 
pathways.
    I know how to do it. You don't need a stick. What you need 
to do is have conversations about equitable. And I know that 
you talked about some of the affirmative action programs that 
have gone in our country. We are way beyond, in my opinion, 
affirmative action programs. We should be doing this as the 
nature of business in this country.
    Ms. Lee. We should.
    Secretary Walsh. So, again, I feel confident in the 
conversation I have had with the building trades and the 
conversation I have had around this infrastructure law. And not 
just the infrastructure law, but private construction as well, 
to get more opportunities and more pathways into the trades.
    And not just the trades. I think when we talked with 
Chairman Cole, when we talked a little bit about apprentice 
programs, we need to make sure that all of these apprentice 
programs, when we create them--whether it is trucking or in 
other industries--we need to make sure that they are 
diversified as well going in the beginning of them.
    Ms. Lee. Thank you very much. Thank you, Mr. Secretary.
    The Chair. Ms. Herrera Beutler.
    Ms. Herrera Beutler. Thank you, Mr. Secretary. It has been 
helpful to just sit here and listen to your approach. I commend 
you. You obviously worked these issues. Not all Secretaries do, 
to be honest. You obviously work them, and I appreciate that, 
your willingness to work them with all of us up here because it 
is true that the American worker is pretty forefront on our 
minds, especially right now.

                RECOVERY OF UNEMPLOYMENT INSURANCE FRAUD

    And I wanted to ask, Ranking Member Cole talked a little 
bit about the unemployment fraud that took place during the 
pandemic. I just wanted to make sure you are aware 2 weeks ago, 
Department of Justice issued a press release that a Nigerian 
citizen pled guilty to COVID-19 unemployment fraud in 
Washington State and 17 other States. That individual was able 
to submit more than $2,000,000 in unemployment claims.
    And so I know that since then, OIG found $163,000,000,000 
in pandemic unemployment benefits could have been paid 
improperly. And I was watching our Secretary of Labor at the 
time, and she was not doing a very good job, and there were a 
lot of warnings. She has since moved on, thankfully. Although 
now she is at a Federal level, which is not a good idea. But I 
digress.
    I wanted to ask how much has DOL, have you all been able to 
recover of that fraud?
    Secretary Walsh. I don't have the exact number. I will get 
it to you. But I will tell you I meet monthly with my IG, and 
our IG is going after any fraudulent cases $250,000 or above. 
So I will get you a number.
    A lot of these cases are in court. So it is going through 
the court process. We are talking now about a year since they 
are identified. We work very closely with the Justice 
Department, but anything over $250,000, the Department of 
Labor's IG is going after. So I will get you the money that was 
recovered, and I will also get you the money that is on the 
hook that we are in court on.
    Ms. Herrera Beutler. Great.
    Secretary Walsh. So you have kind of two numbers right 
there.
    Ms. Herrera Beutler. That would be great.

               CHILDCARE INDUSTRY AND WORKFORCE SHORTAGE

    Representative Clark also spoke a little bit about 
childcare workforce shortages, and I think--so this has been an 
issue I have been working with a number of folks on the panel 
for a while.
    Childcare continues to be a top issue for folks in 
southwest Washington. Twenty-five percent of our region's 
childcare capacity completely disappeared during the pandemic, 
and it was already an issue before the pandemic, already a 
childcare workforce shortage.
    And I just wanted just a commitment from you, and I think 
you will give it pretty readily, that the Department is going 
to commit to helping us build this pipeline for childcare 
workers, quality childcare workers, as we try and address the 
shortages to free up opportunities for moms and others in this 
country.
    Secretary Walsh. No, you have my commitment on that. And 
not only that, I would love to talk to anyone that has ideas on 
it because it is a very challenging career. Because what 
happens in a lot of childcare facilities is that somebody will 
start in the childcare industry. They will work. They are 
getting paid low wages. And then, ultimately, a lot of them go 
into teaching, and they get into an opportunity----
    Ms. Herrera Beutler. Yes, they get pulled right out.
    Secretary Walsh [continuing]. And we lose that--we lose 
that infrastructure. And then--so I would love any ideas you 
have on that.
    Ms. Herrera Beutler. There are a couple of bills, and we 
will make sure to pass them your way, bipartisan bills. Some 
are bicameral. Because there is a few different things you have 
to do. Some of it is training. Some of it is making sure that 
there is physical brick and mortar places. Some of it is making 
sure that the families can afford it. So we have a few 
different bills that we will be happy to get your way. Again, 
bipartisan and bicameral.
    Secretary Walsh. Our childcare industry got destroyed 
during COVID. A lot of them, States, they were able to fund 
them for the first 6 months of COVID. And then, after the 6 
months, they went back to the old structure. But people didn't 
go back to work----
    Ms. Herrera Beutler. People went home.
    Secretary Walsh [continuing]. So they didn't get--or they 
weren't getting the money from the parents, from the families, 
or whatever, the vouchers to do it. So they went out of 
business. So that whole industry is in desperate need.
    Ms. Herrera Beutler. We have some ideas for you.
    Secretary Walsh. I would love to hear.

                   IMPACT OF PROJECT LABOR AGREEMENTS

    Ms. Herrera Beutler. On another topic, project labor 
agreements. And I suspect we won't see eye-to-eye on this. But 
I think it is important----
    Secretary Walsh. You never know.
    Ms. Herrera Beutler. I think it is important that you 
understand. You mentioned that the PLAs are welcome news for 
all workers, but that is not what I am hearing from the 87 
percent of non-union workers in construction. This 
administration's recent--their executive order on PLAs, 
mandating them, I think my challenge is, is that they limit the 
pool of qualified bidders primarily to one stream of bidders. 
And that can have impacts not just for taxpayers, but for 
people who are working, and they won't have the chance at a job 
that is a good job.
    In Washington State, the unionization rate is actually 
relatively high, at 18 percent. And Washington State is not 
exactly a red State, right? I am in no way anti-union. I have 
family members who work in the trades who are part of unions. 
That is not my issue.
    But I am pro worker and, I think, pro competition. And what 
I am concerned about is that the PLAs are going to really kind 
of disenfranchise 80 percent of non-union contractors, smaller, 
mom-and-pop industries--again, I have family who are in this 
side of the business--in Washington--and they just want a fair 
shot at competing for projects funded by the Federal 
Government.
    My opinion is this mandate is going to increase the cost of 
Federal construction projects, and it is going to curb 
competition. What are your thoughts?
    Secretary Walsh. First and foremost, the project labor 
agreements of the President's executive order is $35,000,000 or 
above, so the 87 percent of contractors that can't apply for it 
wouldn't apply for it in the beginning because we are talking 
about large construction projects that the bidding pool is 
small. That doesn't prohibit non-union, non-signatory 
contractors from bidding on that work.
    And actually, project labor agreements prove that it 
actually saves taxpayers money because there are guarantees in 
the project labor agreement that job done on time, on budget, 
doesn't have work stoppages in it, and the project labor 
agreements that I have been involved with as the building 
trades or in my time in my other roles I had in my career, 
oftentimes, those projects come in underbid, under budget, and 
on time.
    I mean, that is the reality of the situation. There is no 
question about it. And it doesn't prohibit----
    Ms. Herrera Beutler. I have to stop you there just because 
I am way, way over time.
    Secretary Walsh. I am, too. [Laughter.]
    Ms. Herrera Beutler. I am way over time, and there is a 
question about it. I have to submit that for the record. We 
differ on that one.
    Secretary Walsh. Okay.
    Ms. Herrera Beutler. But thank you so much.
    Secretary Walsh. Thank you.
    Ms. Herrera Beutler. Yield back.
    The Chair. Congressman Pocan.
    Mr. Pocan. Great. Thank you, Madam Chair.
    And thank you, Mr. Secretary. I really want to thank you 
and your staff. I think you have done a great job in the role, 
as has your staff, and I think your knowledge and your passion 
for workers is very much appreciated.
    I would like to try to get to three subjects. So let me 
start with the first one.

              WORKER ORGANIZING AND EMPOWERMENT TASK FORCE

    You served alongside Vice President Harris as the vice 
chair of the White House Task Force on Worker Organizing and 
Empowerment, which earlier released a report that had 70 
recommendations for actions the administration should take to 
empower workers' voices in their workplaces. Many of those 
recommendations call for coordinated efforts by the Department 
of Labor and other agencies such as the NLRB, which has been 
flat-funded for a decade.
    What resources do you and other agencies like the NLRB and 
the Office of Solicitor require to fully implement those 
recommendations from the task force?
    Secretary Walsh. Yes. I actually have a meeting later today 
to talk about the task force. It is our first kind of follow-up 
since the report came out. I don't have the exact number what 
we will need, but any resources you want to allocate our way, I 
will gladly take them. And that is not a snide comment. It is 
the reality of the situation.
    But let me have my meeting today, and after I get a chance 
to understand exactly what departments, what areas we need, I 
think I would love to come back to you.
    Mr. Pocan. Yes. I mean, we are in the middle of doing the 
next year's budget, so please do that.
    Secretary Walsh. Yes. Good timing.

                         PERSUADER RULE UPDATES

    Mr. Pocan. Also I found it very exciting the new wave of 
organizing that we are seeing. I think you and I coming with a 
labor background have seen a lot of traditional labor 
organizing in the past, but now we are seeing it at Starbucks 
and Target and Trader Joe's and Amazon and in the video game 
industry and a lot of other industries that haven't seen it 
before.
    One campaign I am watching particularly closely is the 
quality assurance workers at Raven Software, a company in my 
district, which has faced captive audience meetings and other 
types of classic union-busting tactics. I know one of the 
recommendations in that task force report was for the 
Department of Labor to update its rules for persuader activity 
reporting.
    Can you explain how an update to the persuader rule will 
help protect and empower workers, and what resources do you 
need from this committee to make that update?
    Secretary Walsh. Yes, thank you for that.
    I can't get too much into it because we are in the 
rulemaking process right now. But certainly, I have spent 
enough time as well talking to workers in this country that are 
disgruntled, quite honestly, and we are seeing an increase in 
involvement in union organizing, We are seeing workers rising 
up. We are seeing last month I think 4.7 million people quit 
their jobs because they weren't happy in the job they had.
    So I actually think a lot of what we talked about today--
just a little off topic--the job training, workforce 
development investments, the apprenticeship--I think we have to 
do that for our economy. Because we can't continue an economy 
where people are quitting at the rate they are quitting every 
month because they just really want to earn more money. We 
actually have to create pathways for them into better-paying 
jobs.
    And that is why we are seeing a lot of this--or I think 
that is why we are seeing a lot of this organizing conversation 
going on. People saying, wait a second, union workers over 
there seem to have a better situation, better benefits, more 
money, and I want part of that.
    So I think, as a society, as an economy, as the Department 
of Labor, I think we have to work closely with Commerce as well 
on how do we create better pathways into better-paying jobs, 
whether they are union or not.
    Mr. Pocan. Sure. And as you look at that rule, I mean, part 
of that additional organizing, though, has got the additional 
pushback. And we have seen it time after time, whether it be 
Amazon, whether it be Starbucks, or in the video game industry, 
like Raven Software. So do appreciate anything you can do in 
that area.

               BLS TRACKING OF STRIKES AND WORK STOPPAGES

    Many of these campaigns also involve smaller bargaining 
units, and like let us take Starbucks, for example. I am 
interested whether this new way of organizing requires a shift 
in how we track this type of activity at the Federal level. The 
Bureau of Labor Statistics only tracks strikes and other work 
stoppages involving over 1,000 workers.
    Do we need to change the way the BLS tracks this kind of 
activity in light of these trends, and if so, are you going to 
need additional resources, or what can we do to get to that 
point?
    Secretary Walsh. Yes. I think I haven't thought of it that 
way until you just brought it up. I would have to talk to BLS, 
but I am assuming if we don't track it, they will need 
additional resources to track that information.
    I will have to get back to you on that. I honestly--that is 
a good point. I haven't thought of that.
    Mr. Pocan. Great. No, I appreciate it.
    And Madam Chair, I will yield back my 40 seconds.
    The Chair. Congressman Moolenaar.
    Mr. Moolenaar. Thank you, Madam Chair.

                           LOWERING INFLATION

    And good morning, Secretary. Just wanted to raise some 
issues that I am hearing as I travel throughout my district. 
The number-one issue I hear is inflation and the concerns of 
people's paychecks not going as far as they used to.
    I am wondering what ideas you have at lowering inflation 
because I do have concerns. Ms. Herrera Beutler talked about 
project labor agreements. It kind of defies logic to me that by 
discriminating against certain people working on projects, that 
somehow that would be a cost savings. It seems like competition 
would actually encourage more, but that is a different topic.
    But I am just wondering if you could tell me what your 
plans are to help lower inflation?
    Secretary Walsh. Yes. That is obviously a great question. I 
think inflation that the country is dealing with right now, we 
saw a little dip in it last week in inflation. It went down 0.2 
or 0.3 of a percentage point, but it is still high. One of the 
biggest things that we can do, I can do as Secretary of Labor, 
is continue to work on the supply chain issues.
    Supply chain has caused part of the problem in creating 
getting goods and services to our shelves and our stores and 
into our--into people's homes. We have worked--I have worked 
really hard over the last 8 months, along with Secretary 
Buttigieg, to really think about making sure that we are doing 
everything we can to get the ships offshore onto land and the 
product into the stores.
    Also monitoring very closely the negotiation right now in 
the L.A. ports to make sure that we are not seeing any 
disruption. There is negotiation between the carriers and the 
ILWU, ILA--the longshoremen--making sure that we don't see any 
shortages there that, again, could add to inflation further 
down the road. I feel pretty comfortable where we are in that 
situation today.
    I was out in L.A. about a week ago, week and a half ago. I 
sat down with the company. We had a conversation about the 
ports. We had about 27 ships offshore to be coming in to be 
unloaded. I was there a previous month before that, where I was 
actually in Seattle, and we had 67 ships. So we are seeing that 
alleviation of the burden.
    My concern is that right now in China, many manufacturing 
facilities are closed down. So we have about 100 ships, to my 
knowledge, offshore in China, waiting to be loaded and be 
brought to the United States. We have to make sure we have a 
system in place that moves those goods and products across the 
ocean.

               OSHA VACCINATION AND COVID TESTING POLICY

    Mr. Moolenaar. I appreciate the update on the ports and the 
ships. I think that is a big concern. I think the trucker 
shortages also seem to be a concern. As I talk to people, there 
is just a real need for more truck drivers.
    I wonder, the OSHA policy, the vaccine mandate that your 
administration pursued, the court chose not to implement that. 
Are you continuing to pursue that? Because I do think, between 
truckers trying to go in Canada across national lines, there 
was a big concern about that.
    I do feel that some of these administration policies are 
contributing to an environment where people are having to 
choose between getting a vaccine or doing their job, and I 
think it is discouraging people in the workplace. I wonder if 
you----
    Secretary Walsh. Thank you.
    Mr. Moolenaar. Are you rethinking that, or are you still 
pursuing that?
    Secretary Walsh. Well, first and foremost, the policy that 
came out of the Department of Labor was not a mandate. It was 
an ``either/or.'' It was a vaccine or testing. That is the 
policy I had. It is in black and white what we did.
    And for the most part, trucking was not going to be part of 
that because truckers drive in their truck by themselves, and 
they were covered by it to some degree, but it wasn't a 
mandate. And it hasn't discouraged one person from driving a 
truck.
    I think where we have a problem in this country with 
trucking is we haven't made investments in trucking in a long 
time, and we have people--I met with the independent trucking 
agency that was talking about how those drivers that are 
independent drivers, that own their own rigs and drive their 
own trucks, that they are undercut all the way along the way, 
and that is where the disgruntledness comes from.
    So I think in the trucking industry, the biggest thing that 
we are being able to do at the Department of Labor is working 
to shorten the time to get into a registered apprenticeship to 
48 hours. So we have over 100 companies right now that have 
signed up with the Department of Labor that actually have 
apprenticeships that we are able to limit that to 48 hours.
    They have truck drivers--I think there are thousands of 
truck drivers in the system now. We have worked with big 
companies, small companies, union companies, non-union 
companies, independent companies. So we are working with 
everybody who is interested.
    And I think bringing some faith back into the trucking 
industry. Trucking is a good career. Trucking is a good middle 
class career that gives people the opportunity to earn a good 
living. And for some way over the time, we have lost a little 
bit of that, but I feel confident as we move forward that we 
are going to meet those challenges.
    Also we have 70,000 over the last 5 years, 70,000 CDL 
veterans that have come out of the service that we have an 
opportunity to get them a pathway into trucking, and we are 
working on that now as well.
    Mr. Moolenaar. Great. Thank you, Mr. Secretary.
    Secretary Walsh. Thank you.
    Mr. Moolenaar. Thank you, Madam Chair.
    The Chair. Ms. Frankel.
    Ms. Frankel. Thank you, Mr. Secretary. Hello, good morning. 
Thanks for being here and for your work.
    First, I just want to pick up on something that Ms. Clark 
talked about, and I know you are sincere about an equitable 
economy. So I will just do a little ranting, which is this.
    If we ban abortions across this country, which it looks 
like we are about to in 26 States, there is not going to be an 
equitable economy for women if they are not allowed to make 
their own decisions about their bodies, their lives, and their 
futures.
    All right. You don't have to comment on that. I had to say 
that.

              FLORIDA STATE UNEMPLOYMENT INSURANCE PROGRAM

    All right. So, first, I want to talk to you about Florida. 
Florida, when COVID hit and there was unemployment assistance, 
our State I think was the worst, if not one of the worst, in 
getting that money out. You have asked for an increase for 
unemployment assistance. Is there any way we are going to be 
able to help States like Florida?
    I don't know if we can force them to make the system 
better. I mean, our system was designed in the way so people 
could not get unemployment because one of the Governors--I 
think it was Rick Scott--did not believe in unemployment. Okay, 
are you getting the answer from the----
    Secretary Walsh. No, no. I am asking about Florida just 
specifically so I can answer some questions you have.
    Ms. Frankel. Yes. No, just I don't know if there is a way 
to get our State government to help people when it is 
necessary.
    Secretary Walsh. Well, the question I asked them, we did 
have a tiger team in Florida. We have been able to assess and 
working on assessing the system in Florida.
    Florida is one of the States that has worked with the 
Department of Labor. I believe they have received a grant as 
well to help them implement some changes in Florida. So, to my 
knowledge, the relationship between the Department of Labor and 
Florida's unemployment office has been strong, been good, and 
we are working there.
    Now I can't promise in that particular case, as you know, 
we don't have the ability to increase benefits and the timing 
of getting the benefits out and how they institute a program. 
But what we can do is work to fix some of the shortfalls and 
make recommendations to Florida, you know, in some cases.
    I just finished a book on Frances Perkins, and there was a 
real move at one point to make the Social Security 
Administration a Federal program where we would set the benefit 
across the board. But they decided back then to make it a State 
program. We administer it, and they do it.
    So I think I have gone back and forth on, being in the 
legislature in Massachusetts and being able to push for higher 
benefits and being the Secretary of Labor. I think at this 
particular moment, I wish it was a Federal program so we could 
actually do some real improvement there.
    Ms. Frankel. Thank you.

                           IMMIGRATION REFORM

    I know you have lots of ideas on creating good-paying jobs. 
We know unemployment is very, very low in this country now. 
What is the relationship between immigration and getting us--
fixing this? It is the labor shortage. The labor shortage----
    Secretary Walsh. Yes.
    Ms. Frankel [continuing]. We want to create more good jobs. 
Does that mean there is going to more labor shortage?
    Secretary Walsh. No. Thank you very much.
    I mean, I am glad you opened the door for me, and I don't 
know if I am going to get myself in trouble on this. But the 
reality of the situation is we need immigration reform in the 
United States of America.
    I have talked to every business, and the Republicans and 
Democrats on this committee, go talk to businesses in your 
communities privately and ask them what they want. Every single 
company is going to say we need immigration reform. Big 
companies need it. Small companies need it. People need it. We 
need more workers in this country.
    We are a country that constantly depends on immigrant 
workers. We always have. My parents were two of those workers 
that came to this country.
    We are a country that if we want to continue to move 
forward as a country, we need to figure out some immigration 
laws and get some reform. Not H-2B visas, H-2A visas. Not those 
visas. That is not immigration. We need real immigration reform 
in this country for a pathway to citizenship because those are 
some of the challenges.
    Now I know I am speaking to Congress, and we could do 
something about it. I know nothing is going to happen about it, 
I will be completely honest with you. And I think it is really 
unfortunate. But talk to your employers, talk to your employers 
in your districts and the big employers in this country----
    Ms. Frankel. Okay. We can do that. I have got to get one 
more question right in here.
    Secretary Walsh. Yes. I am not filibustering. I apologize.

                           CAUSES OF INFLATION

    Ms. Frankel. No. Okay, listen, we have been talking about 
inflation. In my opinion and many, the President is being 
unfairly blamed for inflation. I would say that COVID is the 
biggest factor.
    But one of the analysis I heard had to do with supply and 
demand and versus demand for products versus supply for 
services, or demand for services. Would you comment on that?
    Secretary Walsh. Yes, I mean, the President is taking it 
for inflation, and he is the President. So, obviously, he has 
big broad shoulders. So he can take it. But I definitely think 
there are lots of challenges why we are in this economy. There 
are lots of challenges why 4.5 million people quit their job 
last month because of COVID.
    There are lots of reasons why in some cases our hospitals 
are overburdened because of COVID. We are seeing more violence 
against nurses in hospitals because of COVID. Well, COVID has 
caused a lot of concern.
    But again, we can't just blame COVID. We have to address 
the issue, and the President has a plan to address the issue. I 
was asked the question by the congressman about what am I doing 
in my little role as Secretary of Labor to deal with inflation. 
We are working on supply chain issues. Secretary Buttigieg is 
working on issues. Secretary Raimondo is working on issues.
    So this is an all of Government. I am not going to blame 
anybody for the inflation issue. What we have to do is address 
the inflation issue.
    Ms. Frankel. Thank you, Madam Chair.
    Secretary Walsh. I know what you meant.
    Ms. Frankel. But I am thanking you also.
    Secretary Walsh. Thank you.
    The Chair. Congressman Cline. Thank you, Ms. Frankel. 
Congressman Cline.
    Mr. Cline. Thank you, Madam Chair.
    Thank you, Mr. Secretary.

          INDUSTRY-RECOGNIZED APPRENTIESHIP PROGRAM ELIMINATION

    Talking about the labor shortage, I just can't grasp why, 
in light of the unprecedented labor shortage and employers' 
reports of increasing gaps in workers' preparedness, is the 
Department not supporting and, in fact, now attempting to 
eliminate industry-recognized apprenticeship programs. And I 
know you were asked this by my good friend from Oklahoma.
    But even without Federal funding, the programs were 
expanding valuable apprenticeship opportunities for workers and 
employers alike in fields that are rapidly changing and rapidly 
developing and in fields that are disproportionately filled by 
women and minorities. Can you comment on that?
    Secretary Walsh. I mean, the administration, we are 
certainly--I am certainly committed to and the administration 
is committed to expanding registered apprenticeship in 
industry-driven programs. That is how they work. That is the 
best way of doing it. Proven, flexible models that we can go 
across industry on.
    We don't need a disconnect--in my opinion, a disconnected, 
duplicative program that does not nothing but create confusion. 
That is what the IRAPs are doing. The IRAPs really haven't been 
proven. They were created, invented, whenever they were a few 
years ago, and we have a program, an apprenticeship program 
that actually works in the country.
    And they don't have to be a union apprenticeship program. 
They can be a--when I am talking about expanding registered 
apprenticeships, I am not talking about expanding union 
apprenticeships, I am talking about expanding apprenticeships 
in industries that actually are proven and work.
    Mr. Cline. And let me just say I hope that they don't 
duplicate the existing apprenticeship programs because often 
those are not working. The Federal Government spends billions 
each year on job training programs that fail to provide workers 
with education and experience that helps them to find and 
retain jobs.
    Even the gold standard evaluation, the Federal Government's 
Workforce Investment Act, which is supposed to provide training 
for in-demand services, found that only 32 percent of 
participants found occupations in their area of training, and 
the majority, 57 percent, did not believe that their training 
helped them to find employment.
    Secretary Walsh. They weren't apprenticeships. They were 
training.
    Mr. Cline. I know, I know. But moreover, individuals 
receiving the full workforce training were less likely to 
obtain health insurance or pension benefits. Their households 
earned several thousand dollars less, and they were more likely 
to be on food stamps than participants who received minimal 
services.

             STATE AND INDUSTRY-LED APPRENTICESHIP PROGRAMS

    Let us talk about Job Corps for a minute. National Job 
Corps study found that a Federal taxpayer investment of $25,000 
per Job Corps participant resulted in participants being less 
likely to earn a high school diploma, no more likely to attend 
or complete college, and earning only $22 more a week. It is 
not surprising that Federal programs, including apprenticeship 
programs, are out of touch with the needs of employers in high-
demand occupations because bureaucrats in Washington can never 
know businesses' needs better than employers themselves.
    And that is why these industry programs, these industry 
apprenticeships would be much more responsive, different than 
the Federal Government-run apprenticeship programs, and I think 
better for the economy, for the supply chain shortages that you 
are talking about. If you want a way to address the supply 
chain, supporting these industry-led apprenticeship programs 
would be a first way to start.
    Secretary Walsh. Well, thank you.
    Let me just, first and foremost, with Job Corps, I agree 
with you. I have concerns about Job Corps. I have had 
conversations with many members of Congress about Job Corps, 
about strengthening Job Corps. I have talked to mayors in 
cities that Job Corps exists to ask them to partner with us 
because, quite honestly, the mayors and the local authority has 
to be part of the solution there.
    Because right now what I see with Job Corps is independent 
kind of entities around the country. They are doing the best 
they can, but I think there is an opportunity. We have 37,000 
young people that go through Job Corps every year that we 
potentially have great job training programs right in our own 
backyard, meaning in the Federal Government. So I want to 
strengthen that, and I have talked to the caucus. And you will 
see, I think we have asked for a budget request for Job Corps 
as well.
    On the apprenticeship stuff, I wouldn't necessarily say--I 
don't know if I would describe it as apprenticeships failing. I 
think that some of our workforce development programs have not 
been as successful as they need to be. And what we have done 
and what I have tried to do at the Department of Labor is 
really change the way that we are making investments. And some 
of it we can do because we have the flexibility.
    In a lot of cases, I don't have the flexibility to change 
the workforce development program or the job training program 
because the way it comes to me through Congress and the 
investment I have to make, I have to follow the parameters of 
Congress. It is not the no strings attached investments that I 
would like to have more of.
    Mr. Cline. A one size fits all program to address varying 
degrees of need in States, right?
    Secretary Walsh. In some cases, depending on the grant. And 
we have to change that. Because the challenge is that 
employers--and I spend a lot of time talking to employers. If 
you ask the employer--I was at the Chamber of Commerce the 
other day, the national Chamber of Commerce. I probably--as a 
Democratic Secretary of Labor, I probably spend more time 
talking to businesses than probably some of my predecessors.
    And I do that because it is important. As we think about 
creating workforce development and job training programs--
again, to your comment, I am taking words out of your mouth--it 
needs to be created from the employer's side and tell us what 
they need as far as how they move forward. And that is 
historically how we have always done it. So we are working to 
change that way.
    When I think of future apprenticeships in this country, I 
think of a program that is going to be helped built by the 
business community to help us understand the needs that they 
have so that we can make the right investments. So they have, 
to Ranking Member Cole's situation in Tinker Air Force Base, 
that is--and I said this to the commanding officer down there. 
There is no point of me creating a program in the Department of 
Labor when, in fact, you understand what you need.
    I can make a program up, but it might not be sufficient to 
your needs. So my office does that. We reach out to businesses.
    Mr. Cline. We need to cut the strings, give the States more 
control, give the industry more control. I think we have to 
help them.
    Secretary Walsh. I think we have to monitor the States 
because not all States do it well either.
    Mr. Cline. I will ask you about transparency in the next 
round of questions.
    I yield back.
    The Chair. Mrs. Watson Coleman.
    Mrs. Watson Coleman. Thank you very much, Madam Chairwoman.
    Thank you, Mr. Secretary, for being here.

                          LABOR SHORTAGE CAUSES

    First of all, I have agreed with your assessment of things 
and our need to ensure that there is better inclusion and 
better jobs and that we work to put our resources into ensuring 
that those that are underrepresented have access to good 
training and to good jobs. What I am not clear on is how you 
intend to accomplish some of these things.
    The unemployment rate is very, very low. Can you tell me 
what it is again real fast?
    Secretary Walsh. Three-point-six percent.
    Mrs. Watson Coleman. The unemployment rate for black women 
is----
    Secretary Walsh. Five percent.
    Mrs. Watson Coleman. The unemployment rate for black men?
    Secretary Walsh. I think it is--it is probably in the 6--I 
don't have that number in front of me. It is probably in the 
6s.
    Mrs. Watson Coleman. So is there an employment shortage, an 
employee shortage because we don't have enough people to work 
or because we have a significant amount of people, particularly 
in the black communities, that can't work for one reason, 
either it is training or it is childcare or whatever?
    Secretary Walsh. Yes, I think the answer to that question 
is for both reasons. But there is a significant amount of folks 
in the black community and communities of color and women that 
right now are sidelined or working in jobs that they are not 
earning a living wage. And through job training programs and 
workforce development programs, we can quickly get people 
trained up to get better-paying jobs, into better industries.

            INCREASING JOB TRAINING FOR WOMEN AND MINORITIES

    Mrs. Watson Coleman. I agree with you. How are we going to 
accomplish that? What is it that your Department is going to 
do, either alone or in conjunction with other departments, to 
get more women and minorities into these training programs for 
good, marketable jobs? What specifically do you see planning 
out to reach them and then to engage them?
    Secretary Walsh. Yes. We are doing that through our 
investments in our workforce development grants, the WIOA 
reauthorization grants. I think Congress is voting on that 
today.
    Mrs. Watson Coleman. Yes, I know that the investments are 
going there. What are the mechanisms to get a better--better 
programs and better involvement for disadvantaged specifically, 
but better outreach, better supports? What is it that you are 
proposing to do that will manifest these ideals that you have, 
these new investments that we are willing to support?
    Secretary Walsh. Well, first and foremost, I would like a 
little more discretion with the investments in the grants. A 
lot of our grants, our funding, they have lots of discretion 
around them. I would like to be able to do what I would like to 
do invest in there.
    And we are working with--we have to work with and we need 
to work with States' and cities' workforce development boards 
around the country. We put the grants through them, and they 
get the programs. I think that is one way.
    And the second way, quite honestly, is continuing to meet 
with employers where they are at so we understand the 
challenges they have and create direct programs with some of 
the employers in our country, the larger employers in our 
country, and the unions. Unions have a unique opportunity here 
as well to open their doors to allow people the opportunity to 
get in there.
    So I think, in some ways, we have to I wouldn't say 
reinvent the process, but we have to do some significant 
surgically precise investments in communities.

                STAFF FOR MONITORING EMPLOYMENT PROGRAMS

    Mrs. Watson Coleman. Let me ask you two quick questions. 
Number one is do you have enough staff that will be able to 
monitor what is happening to ensure that these programs are 
moving in the direction and in a manner that you want, or do 
you need more sort of monitoring staff?
    Secretary Walsh. To be completely honest, I need more 
staff. I mean, we are understaffed at the Department of Labor, 
and we are understaffed in a lot of different places. And the 
American Rescue Plan helped us ----
    Mrs. Watson Coleman. Yes.
    Secretary Walsh [continuing]. But we are understaffed. In 
all of our offices, we could use more people.

                         REENTRY PROGRAM SUPPORT

    Mrs. Watson Coleman. I am very concerned, sir, about the 
reentry programs and the opportunities for returning citizens, 
whether or not they are the youth that are really fertile for 
some new training and the older folks that need to be retrained 
or redirected and supported. And I was wondering--and they are 
trying to get jobs--what specifically are you all looking at 
doing to work with that population, which is coming back into 
our community?
    Secretary Walsh. Yes. First and foremost, the President's 
budget has several grant proposals that focus on disadvantaged 
communities. And part of that, the President is also focused on 
reentry as a major opportunity in our country.
    Listen, there are people in our prison system right now 
that are not counted as potential future workers in America, 
and if we set the right training programs up and the right job 
opportunities and meet people where they are at, we can create 
a whole new pathway.
    I have very rarely seen somebody that is incarcerated, 
comes out, gets into a good job training program and earns a 
good living, they don't reoffend. They don't go back to jail.
    Mrs. Watson Coleman. Absolutely.
    Secretary Walsh. They don't have an opportunity--and I have 
seen it up close and personal in the past. And I think that we 
have a unique opportunity right now in our country.
    We also have a couple Job Corps centers and American Job 
Centers inside prisons in America that we are working to help 
train workers up, real training, not fake training. Not giving 
them some type of certificate, but actually real training that 
is connected to a job. I think that is going to be the answer 
to the future. How do we connect folks from job training to a 
real job?
    Mrs. Watson Coleman. Thank you. I think it is very much the 
quality of training that is available and the preparation. I 
think is very important that you have the kinds of staff that 
you need to ensure that this is happening.
    Let me be a partner wherever. Thank you.
    Thank you, Madam Chair, and thank you, Mr. Secretary.
    Secretary Walsh. Thank you, Congresswoman.
    The Chair. Thank you. Congressman Harder.
    Mr. Harder. Thank you so much, Chair DeLauro, for hosting 
today's hearing.
    And thank you, Secretary Walsh, for being here.

               NATIONAL YOUTH EMPLOYMENT PROGRAM PROPOSAL

    We have an affordability crisis in our community, and much 
of it comes down to our young people, who are struggling to 
find jobs that pay enough. I spend a lot of time talking to our 
employers, as you did and do, and I hear lots of them about how 
hard it is to hire locally, how much of a shortage, labor 
shortage that they are struggling with every day.
    But at the same time, I also spend a lot of time talking to 
students right out of high school, right out of community 
college, and they tell me how much challenges they are having 
as well. More than 75 percent of youth in our area express 
concerns about whether or not they have the skills necessary to 
secure a job.
    This disconnect I think represents an enormous policy 
failure. We need to do a better job of helping our next 
generation develop the skills that they need to take those jobs 
that are right in communities like mine. There are some 
programs, TREO and YouthBuild, that are somewhat helpful on 
youth workforce training, but they are not perfect, and they 
are not nearly enough. And there is, frankly, so many young 
people who are left behind and overlooked by these programs, 
and that contributes to brain drain in districts like mine and 
also to a real crisis for our employers as well.
    I know that the President's budget request includes a 
proposal for a new program, the National Youth Employment 
Program. I would love to hear a little bit more about this 
program and how you actually envision this addressing the 
current gap in workforce development. And what else can we do 
to address this disconnect that seems pretty prevalent?
    Thank you.
    Secretary Walsh. Thank you, Congressman.
    First and foremost, I think we have a big opportunity here 
with young people in America to really create them and get them 
opportunities into innovative careers, and your district is 
part of that. For many, many years in this country, we have 
only been focused really on pushing kids into a 4-year college 
system, and we have an amazing community college system in our 
country that allows people to work and get grant processes and 
work with employers, again, on what is needed.
    And I think that we need to start being smart about our 
investments. Young people are smart about what they want their 
future to be. In some cases, they are uncertain what their 
future is, but they know they don't want to work at a fast food 
restaurant and make 10 bucks an hour or 15 bucks an hour. They 
want to do better than that.
    And a lot of these investments the President is making, 
whether it is in the proposal you mentioned or YouthBuild or 
even Job Corps, we have to create better pathways for our young 
people. And we have to, as you mentioned--I will take your 
words--meet them where they are at and really figure out how do 
we move forward.
    So I think we have to be strategic. Plus, it is an 
opportunity for us. We saw 2 months ago in the jobs numbers one 
of the biggest gains was young people that had less than a high 
school diploma. The highest number of employed people, less 
than a high school diploma, in the last 25 years in our 
country.
    So we are seeing people look for opportunities. We need to 
help them and put them on a pathway to some type of career that 
they are interested in. Now a lot of them are not sure what 
they want. That is why I think apprenticeship and pre-
apprentice is key for that generation.
    Mr. Harder. Absolutely. Well, thank you for that.
    And I couldn't agree more. More than 4 out of 5 adults in 
my district doesn't have a 4-year college degree, more than 80 
percent. So if we are telling folks that college is the only 
route to the middle class, we are certainly leaving a lot of 
people, a lot of people out.

              GRANTS FOR RURAL AND HIGH UNEMPLOYMENT AREAS

    This disconnect does feel to be more impactful in certain 
areas than others. Would the Department of Labor consider 
prioritizing serving youth in rural areas or areas with high 
levels of unemployment compared to the national unemployment 
rate when awarding these competitive grants? Because I am 
worried with a program that is already fairly small, that it 
might not be going to the places that actually need it most.
    Secretary Walsh. Yes. I mean, certainly I would love to 
work with you on that. Some of the grant proposals that we have 
are competitive, and we can't--we can't do that. In other 
areas, we have some discretionary funds that we can build our 
programs in rural America or areas that might not have been 
getting the proper attention they need.
    So I would love to work with your office on that. 
Absolutely, there is no question about that.
    Mr. Harder. Great. Well, thank you so much.
    Look forward to working in there. We are in an area with 
high unemployment just a couple hours away from an area that 
has very low unemployment, and we want to make sure that those 
workforce development programs are going where they are most 
needed.
    So thank you again for being here, and I yield back the 
remaining time I have.
    Secretary Walsh. Thank you, Congressman.
    The Chair. Congresswoman Lawrence.
    Mrs. Lawrence. Thank you so much, Madam Chair.
    Thank you so much for being here, Secretary.

        RETRAINING WORKERS THROUGH THE DISLOCATED WORKER PROGRAM

    You had the amazing good fortune, as I did, to tour the new 
ZERO factory. And walking around the factory, we saw that there 
were more robots than there were people.
    Well, in the past, it was filled with hundreds of employees 
who were working every day. But as new technology progressed, 
we now need more technicians and more computer programmers than 
we did assembly workers. So my question is about up-skilling.
    There are some people, especially in the auto industry, who 
have given almost 20 years of their life to being an effective 
and knowledgeable assembly worker. Can you explain how the 
Department can use programs like the Dislocated Worker Program 
to help retrain workers?
    I know when GM was talking about closing a plant, shutting 
it down, laying off everyone, so that they could retool it for 
new technology, which included the robots that were going to do 
the work of people, and some people lost their jobs during the 
pandemic, as we know. But how can we continue to invest in our 
workforce where we are not discounting hundreds of people who, 
by no fault of their own, are now displaced or unemployed?
    Secretary Walsh. No, thank you very much, Congresswoman.
    Let me just say this. In talking and hearing every question 
that was asked of me today, every question was in some ways 
geared towards what the future of work looks like in America 
and the challenges we have, whether it was immigration or H-2B 
visas or job training and workforce development. And I think 
that as a government, we have a unique opportunity at this 
moment in time to make investments in the American workers like 
they have never seen, whether that is in the previous 
congressman's concern about workers, young workers not going to 
college and not getting jobs and job training. When I think 
about whether it is dislocated worker investment or what have 
you, it comes down to job training.
    When I was in that factory, when we were in that factory at 
the GM facility, there was a young woman there. She was 16 
years on the job--or 14 years on the job, actually. And she was 
a UAW member, and she talked about when she sat at the job, she 
used to get dirty every day because she was working with 
wrenches and lug nuts and things like that.
    And now it is all technology. And she is still in that 
factory working, and she doesn't get dirty every day, but now 
she is a technician. And she was able to be retrained as a 
technician to work in that factory to continue her career.
    And there is no question that, as a country, we need to do 
a lot better job of creating opportunities and pathways, 
whether it is through apprenticeship programs or workforce 
development programs, or job training programs, or folks in Job 
Corps, or folks in prison, or women of color, or whoever it is. 
We have a unique opportunity at this moment in time.
    In this committee, in the appropriations that you are going 
to give us at the Department of Labor through the President's 
budget is we are going to do everything--I am going to do 
everything I can, as long as I am Secretary of Labor, to make 
sure the investments are making a difference.
    I am not going to get caught up in the politics, but I am 
going to do everything I can to make sure that I make a 
difference in people's lives, whether that is urban America, 
rural America, downtown Washington, D.C., Albuquerque, New 
Mexico, wherever it is in this country. I want to make sure the 
Department of Labor is one of those departments that people 
say, wow, they really do some great things, and we help build 
the workforce of the future so that people can raise a family, 
get into the middle class, and be proud of who they are.
    That is my goal, and that is my job. I don't know if that 
answers your question, Congresswoman. But that is--I think we 
do have a unique opportunity at this moment in time.
    Mrs. Lawrence. What I was looking for is a commitment to 
understand the opportunity that I often see is overlooked. We 
embrace new technology. We need it for so many reasons. For 
efficiency, to keep the economy going, to advance technology, 
and to deal with our climate issues. But we can't turn our back 
on those people who are going to be dislocated.

             EMPLOYMENT THROUGH JOB TRAINING CERTIFICATION

    My last concern I wanted to talk to you about are community 
college investment. Oftentimes, not only community college, but 
private companies who do the apprenticeship training--and it 
has been brought up before--at the end of that training, all 
they have is a certificate, but not a job. And so many 
employers are saying that they need certain things. How can we 
match our Federal dollars that we pay to get people certified 
will equate to them being hired?
    It is a gap there that is frustrating to no end.
    Secretary Walsh. Well, I think we have to work strongly 
with our community college system. DOL just recently announced 
a grant competition for our schools, Strengthening Committee 
Colleges Training Grants. We are going to award $45,000,000 to 
15 different community colleges.
    I have spent a lot of time--I asked my office to put 
together a list of the community colleges I have gone to in the 
last several months. I have been Trident Technical College in 
South Carolina, Kirkwood in Iowa, Montgomery in Maryland, 
Delgado in New Orleans, Lorain in Ohio--Elyria, Ohio--Thomas 
Nelson in Newport News, Virginia.
    And I spend a lot of time in our community colleges in this 
country, and I think it is really important that we continue to 
work with them. And grant programs is the best way we can help 
them, but also working with their legislatures to strengthen 
the community colleges because a lot of their money comes from 
the States. So we need to strengthen to make sure that we 
support them, to let them know they need to support community 
colleges.
    That is the best--the best networking we have in this 
country through really with job training and workforce 
development is our community college system. We have one almost 
in every district in the country. Congress has--some of you 
have more than one.
    We have an opportunity to strengthen the community colleges 
to really prepare people for the future. Again, working with 
our business community on what their needs are and also working 
with our community colleges and what their needs are.
    Mrs. Lawrence. The accountability of matching skills with 
jobs is something that I feel is a very high standard for you 
and for Congress.
    Well, thank you so much. I yield back.
    Secretary Walsh. Thank you, Congresswoman.
    The Chair. Thank you.
    I would like to ask Congressman Harris to close, and we are 
looking at an 11:00 a.m. Greek Prime Minister. So I will be 
brief, and I am going to ask you to be brief.
    Mr. Harris. I will, Madam Chair. Thank you very much.

                 Closing Remarks by Congressman Harris

    Mr. Secretary, it is good to see you again, and it is 
interesting. You know, as a physician and a faculty member, I 
should enjoy the other two parts of what this committee's 
jurisdiction are, but I enjoy your visit the most of all 
because you really do want to--I love your enthusiasm about 
making American workers first. That is it, foremost.
    In a global economy, this is not an easy job, and you are 
addressing some of the issues. The need for technical training, 
very important. Obviously, temporary foreign workers, 
important. Prison rehabilitation, huge issue. That is the way 
we solve some of our crime crisis. There is no question about 
it, and anything you can do would be appreciated.
    Obviously, legal immigration, you are right. We are not 
going to do anything, but we really should appreciate--I am the 
son of the immigrants, you are the son of immigrants--look, 
this is an important source of our workforce, and shame on 
Congress for not recognizing that.
    Look, again, we are not going to agree on everything, but I 
speak for the members on my side of the aisle, we enjoy very 
much working with you because you have a ``can do'' attitude 
about keeping American workers first, and I appreciate that.
    Secretary Walsh. Thank you.
    Mr. Harris. And with that, I yield back, Madam Chair.
    The Chair. Thank you.

                 Closing Remarks by Chairwoman DeLauro.

    And I think you summed it up in your comments about the 
future of work and the future of the American workforce, and I 
don't think it can be said more eloquently. And I am so 
delighted you were reading Frances Perkins. Frances Perkins is 
a hero, in my view.
    And just very briefly, I was once interviewed for being 
Secretary of Labor, and when I was asked the question, ``How do 
you see the job?'' I said, ``I want to be Frances Perkins.'' So 
there you go.
    But you are reincarnated here in terms of what you want to 
do and so forth. But your point is, and that is where we come 
into play here, is that we have the ability to provide the 
investments that haven't been made over the years. And that is 
what is critical.
    And working men and women have for a long time felt that 
they have been on their own and that they don't have the kind 
of support they need from Government in order to help them with 
job training, with wages, or if their wages are being stolen 
from them or if their place of work is not an environment where 
they can be safe and so forth. They have been through a tough 
time in the last 2 years, but you said it in your closing, your 
conclusion in your testimony.
    Despite all that we have been through, workers across the 
Nation are still showing up every day to help meet this moment. 
We have the responsibility to meet this moment and to help you 
to meet that moment, and we are committed to doing that. I want 
you to know that.
    Secretary Walsh. Thank you, Madam Chair.
    The Chair. Thank you for what you are doing and for your 
support of America's workers.
    Secretary Walsh. Thank you very much.
    The Chair. Oh, I have to gavel.
    [Answers to submitted questions follow:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                             Tuesday, May 24, 2022

                              MEMBERS' DAY

    The Chair. Well, it is fully virtual, so let me just 
address a couple of matters here.
    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 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 members 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 to yellow.
    I want to say a thank you to Ranking Member Cole and other 
members of the subcommittee who are here and thank all the 
Members of Congress for joining us for Member Day.
    This is a unique opportunity to gather input. We are 
focused on the Labor, HHS, Education appropriations bill, but 
it is a wonderful opportunity to hear from our colleagues on 
their district's priorities for the fiscal year. The bill that 
this subcommittee builds is the largest of all of the non-
defense appropriations bills and impacts the lives of every 
single American.
    Through the subcommittee's fiscal year 2022 bill, we made 
investments to start tackling our Nation's toughest challenges. 
We increased investments in high-poverty schools, for students 
with disabilities, to expand access to postsecondary education. 
We strengthened lifesaving biomedical research with increased 
funding for the NIH. We bolstered America's public health 
infrastructure with more resources for the CDC and State and 
local governments.
    We tackled the health crises, including maternal health, 
mental health, gun violence, substance abuse, while looking to 
reduce unacceptable health disparities. Supported middle class 
and working families with increased funding for childcare and 
development, Head Start, preschool development grants. We 
worked at sustaining good-paying jobs through investments in 
job training, apprenticeship programs, and worker protection. 
And we included community project funding requests to meet the 
needs of communities directly.
    None of the achievements would have been possible without 
the input from our colleagues. So I am glad the President's 
budget request for 2023 proposes continued investments in the 
programs that impact the lives of Americans.
    So as we begin to draft the 2023 appropriations bill, it is 
important to hear from our colleagues about your top 
priorities, as you speak up on behalf of your constituents. So, 
many thanks to all of you for being here.
    And with that, let me turn it over to Ranking Member Cole 
for any opening remarks he cares to make.
    Mr. Cole. Well, thank you very much, Madam Chair. And I 
want to thank you for holding this hearing today and providing 
a forum for our colleagues to come and present ideas to the 
subcommittee.
    I don't have a lot to say, other than I want to associate 
myself with your remarks about the good work of this committee. 
I am always pleased to point out that in the 7 years we have 
had the opportunity to work together, each in a different 
role--sometimes chair went back and forth--but the reality is 
we found common ground seven times in a row, and I am looking 
forward to doing that an eighth time.
    But these hearings are a very important part of that 
process. And I remember one occasion a number of years ago when 
one of our colleagues brought to our attention a relatively 
minor item in a program for a budget as large as ours. It was 
$12,000,000 program named after Helen Keller, but it was 
important to train teachers who were going to work with 
students that were deaf and blind. Obviously, a crippling 
condition, but one that we know the right education can do.
    And the Member came in and made a pitch for that program. I 
wasn't familiar with the program, and I happened to ask our 
chief clerk at the time could she look at that? And came back 
and said, yes, it is funded at about $12,000,000 and hasn't 
been raised in over a decade.
    And I said, well, I think we can fix that, and we did. And 
we were able to get a fairly substantial boost. We would have 
never known that probably had the Member in question not 
brought it to our attention.
    So, again, I encourage all of you that are testifying today 
to help the committee do its job. As the chair appropriately 
pointed out, we are proud of the things this committee does. It 
helps a lot of people in a lot of work.
    I again want to congratulate you, by the way, Madam Chair, 
for getting our hearing room named after our former chairman, 
Dave Obey. That was a wonderful event to be at, and I saw a lot 
of old friends there, of course, including the chairman and his 
wife, Joan.
    But again, this is a good committee that does good work. We 
appreciate it when other Members come and provide their input. 
So I look forward to working with my friend, the chair, and 
hopefully, we can bring in another good bill. And hopefully, 
that bill will be improved by what we learn today.
    With that, Madam Chair, I yield back.
    The Chair. Thank you very, very much. And let me just say 
thank you for your participation, but just being engaged and 
involved with the effort on behalf of David Obey is much, much 
really--it was really so much of a bipartisan effort. And you 
could feel the warmth and love in the room.
    And I will just add one more piece. You will recall a 
number of our colleagues coming to this subcommittee to talk 
about the issue of Down syndrome. And from that hearing, we 
have made a very significant increase in funding for research 
for Down syndrome.
    So lest my colleagues think that this is just a perfunctory 
appearance, it is not. We really are interested in what your 
concerns are and how we can really look at how we can 
appropriate funds for them.
    And I should also say that I enjoy the best of a 
relationship with the ranking member on this subcommittee, and 
we write seven bills. We are on to our eighth, and we are going 
to make it happen. So thank you very, very much.
    And with that, I have got the order here, and everybody has 
got their allotted time here. So if I can, let me recognize 
Congresswoman Mikie Sherrill from New Jersey to talk about her 
interests in the Labor, HHS appropriations bill.

  HON. MIKIE SHERRILL, A REPRESENTATIVE IN CONGRESS FROM THE 
                      STATE OF NEW JERSEY

    Ms. Sherrill. Well, thank you, Chairwoman DeLauro, Ranking 
Member Cole, and members of the subcommittee, for providing me 
the opportunity to testify today.
    I also want to extend a special nod of acknowledgment and 
thanks to my good friend and colleague from New Jersey, 
Representative Bonnie Watson Coleman, for her outstanding work 
to represent and support our State's priorities.
    This subcommittee has done crucial work to advance the 
needs of Americans throughout the country through the funding 
of community projects in fiscal year 2022 and through 
consideration of community projects for funding in fiscal year 
2023. To that end, I want to speak today about a number of 
crucial projects that I have submitted on behalf of my district 
and the communities and constituents I represent.
    First, I would like to submit to the committee the vital 
importance of funding the Community EMS Physician Response 
Expansion Initiative at RWJBarnabas Health through the Health 
Resources and Services Administration. This initiative, already 
in place with one team based in Newark, incorporates many of 
the lessons we have learned from our military's overseas 
engagements into an innovative care approach that will help to 
provide critical life-saving assistance at the scene of 
emergencies in our communities.
    The program will build on an already-successful initiative 
at RWJBarnabas to bring ER physicians on ambulances to needed 
sites of crisis. For too many Americans, including in my 
district, crucial medical interventions are not available in 
time when they are desperately needed in the aftermath of an 
emergency. This funding will improve access to this care when 
it is needed most and will improve health outcomes and save 
lives in my community.
    The proposal received broad support from Essex County 
elected officials, who attested to the significant benefits 
this project would provide.
    Second, I would like to submit to the committee my strong 
support for funding a new pilot program to help the Jewish 
Service for the Developmentally Disabled incorporate technology 
in residential group homes, day habilitation, and private 
residential settings in northern New Jersey to provide greater 
independence and accessibility to residents. This funding will 
allow more of my constituents to live independently at home in 
their communities and will also help to address the home 
healthcare staffing crisis in residential homes.
    Furthermore, this technology already has a strong record of 
success nationwide, with communities that have utilized it 
reporting a significant decrease in need for State funding of 
up to 50 percent per individual served. Adults with 
intellectual and developmental disabilities have historically 
been underserved in terms of access to funding and 
technological innovation, and this community project will take 
one step towards righting that wrong.
    This proposal received strong support from the Healthcare 
Foundation of New Jersey, the Township of Livingston, and 
impacted members of the community.
    Third, I would like to submit to the committee my strong 
support for funding to renovate and expand the Morristown 
Medical Center Emergency Department, which would replace the 
existing patient monitors and increase monitoring capabilities, 
construct additional negative pressure rooms to control 
airborne pathogens, and modernize the triage space. The 
Morristown Medical Center had over 100,000 emergency department 
visits in 2019 and is a vital lifeline to hundreds of thousands 
of families in northern New Jersey.
    However, the center's emergency department has not 
undergone a major renovation since 2011, and much of its 
equipment and infrastructure is already beyond its expected 
useful life. This investment will help improve access to 
effective, affordable medical care for so many people in my 
district and will improve quality of life throughout our 
community.
    It is no wonder that this proposal received broad community 
support from Morris County elected officials, including members 
of the State Assembly and our sheriff.
    Finally, I want to submit to the committee the crucial 
importance of funding student scholarships at William Paterson 
University to support college completion for students impacted 
financially by the COVID-19 pandemic. Over the past 2 years, 
many students have temporarily or permanently withdrawn from 
their institution of higher education, and approximately 40 
percent of William Paterson University students who have not 
returned to school have cited financial-related reasons.
    Access to higher education is a critical path to the middle 
class for millions of Americans, including so many in my 
district. But the pandemic could take away much of that 
opportunity unless we act to support students.
    This funding will be used to ensure that students can 
reenroll in the university, continue their studies, and access 
supportive services and programming. It will play an important 
role in helping to increase college attainment levels in 
Passaic County, which currently has the third-lowest rate in 
New Jersey.
    This project received letters of support from both the 
County of Passaic and from several local mayors who indicated 
the significant community impact these scholarships would have.
    These four community projects will make a crucial 
difference in the lives of tens of thousands of people in my 
district and will provide a sizable return on investment 
through improved health, reduced cost to taxpayers, and 
expanded educational attainment.
    I greatly appreciate the subcommittee's work to support 
Members' proposals, and I urge you to include these valuable 
projects in the fiscal year 2023 L-HHS appropriations bill.
    Thank you again.
    The Chair. I thank the Congresswoman for her testimony and 
the quality of the community projects that have been submitted.
    I think overall that we are very excited, given what 
happened in 2022 and our ability to fund community projects, 
and on both sides of the aisle. I know I have heard from my 
colleagues on both sides of the aisle how successful this 
effort has been in really demonstrating the community need 
because we know that there has to be documented community 
support for these efforts and not just one's own wish or hope 
or Members', that it is directly related to the community. So 
it really proving to be almost really a necessity for some of 
our local communities in order for them to address some of 
these efforts.
    Let me ask my colleagues if they have any questions of 
Congresswoman Sherrill.
    Mr. Cole. I don't, but I want to just quickly associate 
myself with your remarks again. Sometimes Members really do 
understand their district better than officials far away in 
Washington, D.C. And it is just invaluable when they come in 
and point out what the local needs are and that there is 
support for these things.
    So, again, I want to thank all our colleagues that are 
doing that today, and again, thank you, Madam Chair, for 
holding the hearing.
    The Chair. Thanks.
    And I will just add one more thing. We are going to do as 
best we can to acknowledge and be able to fund the projects. So 
much will depend--and I might add, there are increasing numbers 
coming in. Let me just put it this way, we are going to do the 
best we can to see how many that we can get done this go-around 
because we understand the value, and we understand the need.
    So thank you very, very much for your testimony this 
morning, Congresswoman. Very appreciated.
    Thank you.
    And with that, let me recognize--oh, I see Congressman Van 
Drew is not going to be joining us this morning. So then let me 
recognize----
    Oh, I didn't ask my other colleagues. Congressman Harris, 
Congressman Cline, do you have any questions?
    Mr. Harris. No, I am fine.
    The Chair. Fine. Thank you. Thank you.
    So let me ask Congresswoman Veronica Escobar for her 
testimony this morning. Congresswoman Escobar--and I see you 
have a guest.

  HON. VERONICA ESCOBAR, A REPRESENTATIVE IN CONGRESS FROM THE 
                         STATE OF TEXAS

    Ms. Escobar. I know. I am so sorry.
    The Chair. That is fine. That is fine. [Laughter.]
    Ms. Escobar. He loves the Zoom. So my apologies.
    The Chair. That is no problem. No problem.
    Ms. Escobar. Well, thank you so much, Chairwoman DeLauro 
and Ranking Member Cole, for hosting this Member Day hearing.
    I have the honor of representing El Paso, Texas, in 
Congress, and I am so grateful to have the opportunity to be 
advocating for the needs of my community.
    This subcommittee has played a critical role in helping 
communities like mine overcome the many issues the COVID-19 
pandemic has presented us over the past 2 years, and I look 
forward to working with you this fiscal year to address the 
many challenges still facing El Pasoans.
    I would like to begin by first thanking the subcommittee 
for the $900,000 increase allocated in the fiscal year 2022 
omnibus for the U.S.-Mexico Border Health Commission. 
Unfortunately, for years, the U.S. section of the Commission 
was overlooked and underfunded. This became increasingly 
apparent at the beginning of and during the COVID-19 pandemic 
when the border region was disproportionately impacted by the 
virus.
    The funding increase this subcommittee allocated is giving 
the U.S. section the ability to again reengage with their 
Mexican counterparts, begin work on Healthy Border 2030, and 
perform basic functions like hire more staff and maintain a 
permanent office in El Paso.
    However, it is critical that we keep providing the U.S. 
section of the Commission with the resources it needs to 
continue to play a role in binational health policy. That is 
why I support the President's fiscal year 2023 request to 
increase the Commission's funding by $900,000 and urge the 
subcommittee to include this funding in your final bill.
    Next, I would like to thank the subcommittee for providing 
funding for my community projects in fiscal year 2022. These 
projects will have immediate impact on those who need it most. 
That is why I am excited to discuss the projects I submitted 
for your consideration for the fiscal year 2023 community 
project process.
    The first project is the El Paso Children's Hospital 
Pediatric Mobile Clinic. If funded, this project will play a 
key role in expanding healthcare to traditionally underserved 
parts of El Paso, like colonias.
    El Paso Children's Hospital would use these funds to 
purchase and outfit a mobile clinic, with the goal of providing 
both basic and specialty pediatric healthcare throughout El 
Paso County. It would also allow the hospital to provide 
several other services, like administering flu shots to young 
El Pasoans who are unable to visit a doctor regularly.
    The second project is the Texas Tech University Health 
Sciences Center El Paso Border Health Center. I truly believe 
the border region is a unique place that faces its own 
challenges when it comes to healthcare. Our majority Latino 
population has seen dramatic increases in chronic diseases like 
heart disease and diabetes, but because the border region is 
vast and diverse, it is difficult to keep track of these 
trends.
    The proposed Border Health Center would create a 
telemedicine and monitoring program to provide early 
interventions to slow the rise of chronic diseases while also 
conducting research to benefit Federal agencies. This 
transformational project would help change lives by trying to 
better understand the root causes of the healthcare challenges 
we face on the border.
    The final project is the El Paso Independent School 
District After School Community Learning Center. This project 
would allow the school district to expand after school learning 
programs to parts of the community that are traditionally 
underserved, like Segundo Barrio. By extending more resources 
to these parts of the city, the school district will be able to 
reach more students and give them the tools they need to 
succeed.
    I would like to once again thank the subcommittee for your 
leadership and for this opportunity and thank you in advance 
for consideration of my requests.
    And I yield back.
    The Chair. There we go. Unmute myself here.
    So I am going to ask my colleagues if you have any 
questions. Congressman Cole.
    Mr. Cole. No.
    The Chair. No. Congressman Harris.
    Mr. Harris. No.
    The Chair. Congressman Cline.
    Mr. Cline. [Nonverbal response.]
    The Chair. I want to just say--it is not a question, but 
thank you for taking such an interest. I know that this is the 
Labor, HHS Subcommittee, and these are the issues you are 
focused on. But I have watched what happens with mobile 
clinics--I think we all have--which can get around to the 
underserved areas, as you point out, and how critically 
important they are.
    I am a product of the after school program. And I say ``a 
product,'' I taught in an after school program many, many years 
ago. And it is just we don't warehouse children in these 
programs. We actually provide them with learning experience and 
art and culture, et cetera, and it is a wonderful way for 
parents who are working to make sure that their kids are safe.
    So I thank you for your focus on the health issues and on 
the education issues that are really so critically important to 
youngsters today and in a region that has an underserved 
population that we need to try to focus on.
    So thank you very, very much for your testimony this 
morning. Thank you.
    Ms. Escobar. Thank you, Madam Chair.
    The Chair. Let me now recognize Congresswoman Kim Schrier 
from Washington State, and love to have your testimony.

 HON. KIM SCHRIER, A REPRESENTATIVE IN CONGRESS FROM THE STATE 
                         OF WASHINGTON

    Dr. Schrier. Good morning. Chairwoman DeLauro and Ranking 
Member Cole, thank you very much for the opportunity to testify 
to your committee about a few issues of great importance to me 
and my district.
    Specifically, I want to address funding for the Pediatric 
Subspecialty Loan Repayment Program, funding for the Public 
Health Emergency Preparedness Cooperative Grants, and two of my 
community project submissions, Central Washington's Student 
Medical and Counseling Center air ventilation upgrades and the 
Heritage Heights Memory Care at Lake Chelan.
    So the first program I want to speak about is the Pediatric 
Subspecialty Loan Repayment Program. The goal of this program 
is to make sure that children in rural areas get the care that 
they need.
    Millions of children reside 1\1/2\ hours or more away from 
access to specialty care. This was always a problem, but the 
pandemic has increased the need particularly for mental 
healthcare, and the cost of pediatric subspecialty treating is 
steep. Few students coming out of medical school think that 
they can pay back their loans if they practice in small or 
rural communities. So we need to incentivize specialty 
providers to practice in these communities.
    This program rewards providers who practice in rural and 
underserved areas for at least 2 years. When providers train 
and start practicing in rural areas, they often become part of 
the community and are more likely to stay. And this important 
targeted investment works to address the overwhelming medical 
school debt that serves as a barrier to training in pediatric 
medical, surgical, and mental health subspecialties. And I 
respectfully request $30,000,000 in funding for the Pediatric 
Subspecialty Loan Repayment Program.
    The second program I want to discuss is the Public Health 
Emergency Preparedness Cooperative Agreement, or PHEP grants. 
This is the main Federal program that supports the work of 
health departments in preparing for and responding to all types 
of disasters, including bioterrorism, natural disasters, and 
infectious disease outbreaks.
    The response systems, personnel, and infrastructure that 
States require to respond to public health emergencies like 
COVID-19 would not exist in most States without PHEP funding. 
These grants help States swing into action in all sorts of 
disasters.
    In my home State of Washington, PHEP grants allowed the 
health department to form an epidemiology task force in 
response to a mumps outbreak, for example. And this task force 
supported local health departments with case investigation, 
disease surveillance, and risk communication activities.
    We know COVID-19 caused substantial burnout in the public 
health field, and resources are stretched thin. Substantial 
funding will allow these entities to rebuild and move forward, 
and I respectfully request that the committee provide 
$842,000,000 for this program.
    Last, I would like to speak on two community projects that 
I submitted to this committee. The first is a project to 
upgrade the Central Washington University Student Medical and 
Counseling Center medical grade air distribution.
    Central Washington University needs to upgrade their air 
filtration system. The current HVAC system has not been updated 
since the 1970s, and an upgraded air system will keep both 
staff and students safe as they await for needed medical and 
mental health appointments.
    The rural city of Ellensburg depends on the university, and 
the university depends on healthy staff and faculty and 
students to keep it running. And especially in light of the 
COVID-19 pandemic, these upgrades are necessary, and I 
respectfully request $2,000,000 for this project.
    The second is for Heritage Heights at Lake Chelan. This is 
a senior care facility in a rural part of my district that is 
converting part of their facility to memory care. Currently, 
there are no memory care facilities within 40 miles of Lake 
Chelan, and no nearby facilities accept Medicaid. This means 
that seniors with dementia and their families have few options 
in the Chelan Valley for memory care, and the conversion will 
allow for seniors who need assisted living and memory care to 
get their care close to home.
    It will make possible for them to age nearby their 
families, their doctors, and existing support systems, and I 
respectfully request $800,000 for this project.
    Thank you again for the opportunity, the opportunity to 
testify on issues that are very important to my constituents, 
and I yield back.
    The Chair Thank you.
    Let me yield to my colleague, Congressman Cole. Any 
questions?
    Mr. Cole. I actually do want to make a couple of quick 
comments.
    The Chair. Sure.
    Mr. Cole. First of all, I want to, again, thank the 
gentlelady from Washington for coming. But I want to associate 
myself with the two programmatic requests that she made.
    It is a little bit early to talk about dollars because we 
obviously don't know what our top line for the full agreement 
is, let alone our allocation by the subcommittee. It is a 
little early. But I think she puts her finger on two really 
important programs in terms of long-term preparedness.
    And I represent a district that has the same challenges in 
terms of getting specialty care into relatively remote areas, 
and I think the emphasis on pandemic preparedness, I mean, we 
shouldn't have to learn this lesson again. I think this 
committee did a lot of good work leading into the pandemic, and 
I am proud of what it did. But this is an area where we 
probably just simply need to do more.
    So, again, I think those are both excellent requests, and 
certainly, the specific community requests, again, I have the 
same issue with, for instance, constituents with dementia that 
can't get care anywhere close to where they live. So I 
understand the utility of those kinds of requests and, again, 
thank the gentlelady for coming and testifying before our 
subcommittee.
    Dr. Schrier. Thank you, sir.
    The Chair. Thank you. Congressman Harris.
    Mr. Harris. No, no questions. Thank you.
    The Chair. Thank you. And Congressman Cline.
    Mr. Cline. No, thank you, Madam Chair.
    The Chair. Thank you.
    I just want to say as well I do associate myself with the 
ranking member's comments about the programmatic requests, that 
I think they are really critical efforts. And we are right, we 
don't know about what the dollar amounts are yet, but really in 
terms of preparedness, it is we need to continue to look at how 
we support efforts and the CDC's efforts on preparedness.
    And I think I look at teacher shortage, I look at pediatric 
subspecialties here, and all of these of areas I think we do 
need to look at how we deal with loan repayment programs so 
that we can encourage people to move in.
    I just want to say this one last comment. We are really 
very fortunate in this Congress, Dr. Schrier, your background 
in pediatrics, your background in health really brings to the 
fore the critical issues that we need to--that we need to face, 
and that kind of knowledge, you make these proposals out of the 
science and the knowledge of the medical profession. And for 
that, we are really, really very grateful.
    So thank you so much for the testimony.
    Dr. Schrier. Thank you, Madam Chair, Mr. Ranking Member. We 
are very grateful for you. And a point of privilege, thank you 
for your work with the USDA to get so many of our projects----
    The Chair. Hear, hear. We are done. It is done. It is done. 
Thank you.
    Dr. Schrier. Thank you.
    The Chair. Take care.
    And with that, let me recognize Congresswoman Sylvia Garcia 
from Texas about community projects. So, Congresswoman Garcia.

 HON. SYLVIA R. GARCIA, A REPRESENTATIVE IN CONGRESS FROM THE 
                         STATE OF TEXAS

    Ms. Garcia. Thank you, Madam Chair, and thank you, Mr. 
Ranking Member and all the committee members, for having me 
here this morning to talk about my priorities for the Labor, 
Health and Human Services Subcommittee for this next year.
    Madam Chairwoman, earlier this year, the 2020 Census 
Community Survey revealed that my district, my district has the 
highest number of uninsured rate in the Nation. Madam Chair, 
this is not a number one that I sought. This is incredibly 
alarming, and that is why many of my appropriation requests 
this year revolved around healthcare and creating jobs where 
employees could attain high-quality health insurance.
    I would like to flag several of my community project 
requests for the committee. First, El Centro de Corazon, a 
Federally Qualified Healthcare Center, an FQHC, is in my 
district. We are requesting $5,000,000 in funding for 
construction and equipment costs to build an additional 10,000 
square foot healthcare facility.
    This facility will increase capacity to provide more women 
and children with accessible and affordable healthcare 
services. Services will include prenatal care, contraceptive 
management, ultrasounds, and well woman exams.
    Madam Chair, as you are well aware, women's healthcare is 
under attack in Texas. So this project will be a step in the 
right direction to put and maintain more healthcare for women 
in my district.
    Additionally, I have nearly $4,000,000 in community project 
dollars for an Access2Health SmartPods project. This community 
project seeks to address the healthcare disparity in multiple 
locations across my district through the deployment of 
innovative, award-winning Access2Health SmartPods developed by 
Baylor College of Medicine.
    A SmartPod is like a mobile healthcare facility unit. There 
will be 10 pods, half of which are equipped to provide primary 
care, and half of which are tailored to provide mental health 
services, will be deployed across 4 popular community centers 
and 1 county park. These self-contained pods cost effectively 
provide the full range of primary care and mental health 
services to areas that lack healthcare services.
    I have visited these pods. There is one or two already in 
action, and I could tell you that, firsthand, I have seen this, 
and it works. It is about taking the healthcare services to the 
underserved and hard-to-reach communities, and it will be a 
great addition to services in my district.
    Finally, Madam Chair, I will flag a project for one of my 
school districts, Pasadena Independent School District, called 
the High School to High Wage Project. This project will help 
Pasadena ISD ensure their students have access to proper and 
up-to-date equipment, resources, and training so that they are 
prepared to enter the workforce and fill employment gaps in 
high-demand, high-wage occupations.
    These are not just any jobs. These are jobs vital to the 
economic and socioeconomic success of my district and the 
greater Houston area.
    Statewide and regional data indicates that jobs in the 
healthcare industry, trades, and STEM-related fields are being 
impacted the most by the shortage of qualified employees, and 
Pasadena ISD is addressing that. The school district, working 
closely with business and industry partners, work together to 
ensure that they are preparing their graduates to fill these 
high-wage, high-demand positions. Giving our students the 
opportunity to get into high-paying, high-quality jobs means 
they are more likely to attain high-quality health insurance as 
well, which, of course, will improve our numbers.
    I am happy to answer any questions you may have. Thank you 
again.
    And I, too, think that Dr. Schrier is a great addition to 
the Congress, and I thank her and your committee for acting 
swiftly on our baby formula crisis.
    Thank you, and with that, I yield back.
    The Chair. Thank you. Let me yield to my colleague, 
Congressman Cole, for questions.
    Mr. Cole. No questions. All seem very worthy projects.
    Ms. Garcia. Thank you.
    The Chair. Congressman Harris.
    Mr. Harris. No questions. Thank you, Madam Chair.
    The Chair. Congressman Cline.
    Mr. Cline. No questions. Good to see my colleague from 
Texas.
    The Chair. Thank you.
    Again, startling, the highest rate of uninsured in the 
country, something to be concerned about. And I am, over and 
over again, just taken with the quality of the projects that 
are really bubbling up from communities, and your district, you 
know, in Pasadena Independent School District and where you 
want to go there and the health issues that you want to--again, 
these SmartPods, I would love to see one myself to see how that 
works. But any way in which we can be better delivering 
services, which is what your focus is here.
    So I think Members, including yourself, Congresswoman 
Garcia, really are focused in and work very closely with the 
local groups, with local government in trying to really ferret 
out the very specific and critical needs of your communities.
    So many, many, many thanks for your work and for your 
testimony and for the submissions. Much appreciated.
    Thank you.
    Ms. Garcia. Well, thank you, Madam Chair. And any time you 
want to come to Houston, I would certainly invite you during 
our great Rodeo Week.
    The Chair. Okay.
    Ms. Garcia. But any time would be great. I know I have 
spoken to Secretary Becerra, and he hopes to come down and help 
me bring the issue of the uninsured and sites in several areas. 
So anything I can do and certainly would welcome your help in 
decreasing that.
    Because, as I said, that is a number one I did not seek and 
I don't want to be on. So working very, very hard to turn those 
numbers around.
    The Chair. Hear, hear. I know you will.
    And with that, thank you very, very much for your testimony 
this morning.
    Ms. Garcia. Thank you so much. You all have a great day.
    The Chair. Thank you.
    To my colleagues, there are no more Members who are 
testifying. I think people being at home for this week and 
running around their districts, which is a good thing to do, 
that has had fewer Members participating. But I want to just 
say thank you for your help here this morning, and I guess we 
go on this Thursday, I believe, to listen to public witnesses 
and of which there are a number. So we will have a full 
schedule on Thursday. But thank you very, very much.
    And again, to all of us, in a very bipartisan way, I think 
people have really honed in, and it is really so reassuring to 
see the quality of the projects that people are bringing 
forward. There was so much skepticism around revisiting 
community projects, and I just feel good.
    And that is a testament to all of you here and our 
colleagues who understand, as you pointed out, the ranking 
member, that Members know their districts the best. They really 
do. And I think we are seeing evidence of that.
    So thank you all very much.
    And with that, I got to gavel. The hearing is adjourned. 
Thanks.

                                           Wednesday, May 25, 2022.

                       TACKLING TEACHER SHORTAGES

                               WITNESSES

DESIREE CARVER-THOMAS, RESEARCHER AND POLICY ANALYST, LEARNING POLICY 
    INSTITUTE
LINDSEY BURKE, DIRECTOR OF THE CENTER FOR EDUCATION POLICY, HERITAGE 
    FOUNDATION
RANDI WEINGARTEN, PRESIDENT, AMERICAN FEDERATION OF TEACHERS
JANE WEST, EDUCATION POLICY CONSULTANT
    The Chair. I want to say a thank you to Ranking Member Cole 
and all the members of the subcommittee joining today's 
hearing.
    Before we begin, I want to take a moment to address a 
tragedy that occurred in Texas yesterday. I am angry, I am in 
disbelief to be here once again. Yesterday, the students and 
the teachers at Robb Elementary School in Uvalde, TX woke up 
ready to learn, they woke up ready to teach, but 19 children, 
and one teacher, and a school employee went to school, only to 
be taken from us forever. It is a senseless attack. It is 
absolutely heartbreaking, but it isn't anything new. Mass 
shootings are taking the lives of babies, of parents, of 
brothers, and sisters everywhere, and, you know, my community 
knows all this too well. A tragedy occurred at Sandy Hook 
Elementary School nearly 10 years ago. It took the lives of 20 
beautiful, innocent souls--babies--and six teachers, and it 
shook us to our very core.
    We are gathered today for this hearing to find ways to 
support our educators, but how can we begin to speak of support 
of our teachers if they are not physically safe at school? It 
is alarming and it is outrageous that so many children in 
America's schools and their parents and teachers worry that a 
senseless act of gun violence could take their lives. The 
American people and our Nation's children are waiting for us to 
take immediate action to save innocent kids and to save their 
teachers.
    In today's hearing, we will examine the root causes driving 
the teacher shortage. While we were not expecting yesterday's 
tragedy to loom over our conversation today, we must keep it at 
the top of our mind as we consider the challenges that our 
educators confront each day nationwide. So I welcome our 
witnesses today: Desiree Carver-Thomas, researcher and policy 
analyst at the Learning Policy Institute; Dr. Lindsey Burke, 
director of the Center for Education Policy, The Heritage 
Foundation; Ms. Randi Weingarten, president, American 
Federation of Teachers; Dr. Jane West, education policy 
consultant.
    It is a selfless act to choose teaching as a career. The 
Americans who choose this path go in with the admirable goal of 
educating future generations and helping students of all ages 
and backgrounds succeed. I am sure everyone here today 
remembers a teacher who inspired us along the way. Teachers can 
change the course of their students' lives, sharing knowledge 
and starting students down a path for successful futures. Good 
teachers are essential to our progress as a Nation.
    You know, as a substitute teacher early in my career, I 
bore witness to the challenging work that educators do and the 
demands that they are put under every day, something that is 
hard to grasp unless you are in the position yourself. I trust 
our teachers, and I know it is our job to provide them with the 
resources and the support that they need to thrive. The 
witnesses with us today know this well. They represent a 
diverse group focused on the wellness of our students and their 
education, but they also know that the teacher shortage 
plaguing our Nation threatens all those teachers provide to our 
students. If there are not teachers to educate our kids, the 
very foundation on which our Nation's progress is built gets 
dissolved.
    Every student deserves a high-quality education, but 
teacher shortages threaten our ability to provide that 
education. The pandemic exacerbated the existing challenges our 
Nation faced to ensure every student has access to the diverse 
and well-prepared educators they deserve. In the 2017-2018 
school year, nearly every State, including my State of 
Connecticut, experienced teacher shortages in high-needs 
subjects and in special education. In that same year, more than 
100,000 teaching positions around the country were vacant or 
staffed by people unqualified for the job. In New Haven Public 
Schools in my district today, there are over 150 vacancies for 
certified teaching positions.
    Teachers are unfortunately leaving the profession. There 
has been a significant increase in retirement and a 
dramatically-shrinking pipeline into the profession with over 
300,000 fewer students enrolling in teacher preparation 
programs over the past decade. Potential teachers struggle with 
financial concerns, with the high cost of preparation, with the 
subsequent burden of student debt and with a lack of 
competitive compensation. K-12 teachers earn 20 percent less 
than other college graduates do, further creating recruitment 
and retention issues. A Rand Corporation report found that the 
top reason for teacher departures was that pay did not match 
the stress or the risks of the job.
    Alongside these issues is a high turnover rate, a rate 
double that of other high-achieving nations. A lack of 
administration support, dissatisfaction with testing and 
accountability pressures, lack of opportunities for 
advancement, and disappointing working conditions lead teachers 
to other professions. And this was all before the pandemic 
imposed new burdens on our schools and their teachers. The 
total enrollment in undergraduate institutions dropped by 6.6 
percent, including 14.1 percent for community colleges. This 
concerns me greatly since 80 percent of our educators start 
their teaching career with a bachelor's degree, and community 
colleges that link with a 4-year institution are a unique 
source of diverse teachers.
    Tragically, as a result of teacher shortages and the impact 
of the pandemic, 55 percent of educators reported in a January 
National Education Association survey that they will leave the 
profession sooner than they had planned. These are not just 
numbers. These highlight the very real crisis impacting 
students across the Nation. The achievement gap that students 
of color, low-income students, and students with disabilities 
tragically experience is in large part due to inequitable 
access to qualified teachers. Every student and every child 
benefits from having diverse teachers, and in a Nation where 
the majority of students are people of color, a workforce made 
up of just 20 percent of teachers of color is not enough. And 
tragically, data reported to the Department of Education for 
this year projected a shortage of educators trained to meet the 
needs of students with disabilities in all but two States.
    Congress has a lot of work to do to address teacher 
shortages, and I intend to lead these efforts. Since becoming 
chair of this subcommittee, we have increased funding in a 
bipartisan way for comprehensive educator preparation programs, 
including the recently-passed fiscal year 2022 omnibus. We 
included $59,000,000 for teacher quality partnership grant 
programs to fund educator residences and other high-retention 
pathways; $95,000,000 for the IDEA Personnel Preparation 
Program to prepare special educators and higher education 
faculty, and researchers who support their training; $8,000,000 
in first-time funding for Hawkins Centers of Excellence. We are 
supporting educator training at HBCUs and at MSIs, and we 
provided $2,200,000,000 in Title II, a critical source of 
funding for the preparation and professional development of 
teachers.
    There is more we must be doing. Our witnesses lay out 
solutions to many of the problems we face. I share their view 
that proactive investments in pipeline and preparation programs 
will help us reduce shortages in the years to come. As we build 
this subcommittee's fiscal year 2023 funding bill, we must 
consider the funding and policies necessary to help increase 
recruitment and retention, improve working conditions, and 
support teacher advancement.
    Our first Secretary of Education and a woman who made the 
Department and Federal support for our teachers into what it is 
today, Shirley M. Hufstedler, said, ``To the teacher, America 
entrusts her most precious resource, her children, and asks 
that they be prepared to face the rigors of individual 
participation in a democratic society.'' As we all know, we are 
experiencing emergency-level teacher shortages. From our 
witnesses, I look forward to learning how this committee and 
the Federal Government can continue to address this crisis and 
ensure that every student has access to a well-prepared, well-
paid, diverse, stable, and supportive teacher.
    In our country, teaching has always been one of our most 
highly-revered professions, and we must do everything that we 
can to keep it that way. After all, we do entrust our teachers 
with our most precious resources and, ultimately, the future of 
our democracy.
    And now, let me turn to our ranking member, Mr. Cole, for 
his opening remarks.
    Mr. Cole. Thank you very much, Madam Chair. Obviously this 
is a difficult morning for all of us, and I want to associate 
myself with your opening remarks. I can't imagine what our 
friends and neighbors are dealing with Uvalde, Texas, this 
morning, what each one of those families are going through, 
what everybody in that school is experiencing. Obviously, we 
are most sympathetic to those who lost loved ones, but the 
trauma of an event like that for every child that was there, 
for every teacher that was there, for every parent who's, 
hopefully, child made it through but went through hours of 
wondering, I can't imagine it. So I want to express my deepest 
sympathy and just prayers, and thoughts, and sadness at this 
enormous event.
    It always touches you, but when you have a hearing like the 
one we are having this morning, I had the great privilege of 
having our teacher of the year in Oklahoma in my office 
yesterday. She actually teaches in the Norman School District, 
where I am broadcasting from, Jessica Eschbach, a terrific 
young person, went into teaching almost by accident, began a 
career in accounting. It started that way and said that really 
wasn't for her. She was going to be a teacher. She ended up 
moving to Oklahoma and getting her degrees here and has been 
just a star. And I think of somebody like that having to deal 
with, you know, what her colleagues in Uvalde are dealing with, 
or my own son who is a public school teacher as well in my home 
system in Morehead. My heart goes out to everyone involved.
    I want to thank you, Madam Chair, for calling the hearing, 
and I particularly want to thank all of our witnesses for being 
here today. I always look forward to these discussions.
    Parents, teachers, and children across the country are 
still reeling from what I believe was one of the biggest policy 
missteps of this pandemic, and that is the closure of many of 
our Nation's public schools 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 help them in a virtual environment, children 
in minority communities, and those who had a difficult time 
learning through a computer screen. But all children have 
suffered. The lasting impact of the pandemic on our students 
has been profound. We have seen concerning rates of mental 
health illness, missed preventive care, self-harm, an ongoing 
lack of engagement, not to mention the loss of academic and 
study skills.
    And the impact on teachers has been profound as well. When 
this hearing topic was first announced and I asked the staff to 
prepare some background materials on why teachers leave the 
profession, we expected to get into a list of some reasons such 
as, ``I can earn more from outside the classroom,'' and that is 
certainly true, or there is just simply too much red tape. We 
probably all agree on that, too, or even things like mask and 
vaccine mandates and pandemic exhaustion, and I expect those 
are reasons you will find in many policy papers on this topic.
    But then we started to ask the actual teachers why they 
left, or are you considering leaving, and their answers were 
very sobering and saddening. Almost uniformly, teachers from 
different parts of the country who left or who are thinking of 
leaving teaching gave some of the same reasons: ``a lack of 
respect from parents,'' ``lack of respect from students,'' 
``pressure to keep passing students who haven't mastered the 
material onto the next grade level,'' or ``students don't come 
to class, and there is no consequence,'' ``administrators don't 
understand the stressors teachers are under and just keep 
adding more to our plates.'' This sense that many teachers feel 
undervalued, unappreciated, and not understood or respected, to 
the point of choosing to leave their jobs, is deeply troubling 
to me. Teaching should be one of the most valued, most 
appreciated, and most respected professions in the country as 
teachers are laying the foundation not only to train all future 
professions, but also to foster that common bond of civility, 
understanding, and patriotism that will sustain us as a Nation 
in the next generation.
    There is no single program we can create at the Federal 
level to change this. This requires a shift in our culture. I 
don't have the answers today, but I do think we need to 
confront and talk about this very real problem. And I want to 
thank our witnesses, again, for all they have done 
professionally over the course of their career, for focusing on 
this problem, and for coming before us today and sharing their 
time and their expertise.
    Madam Chair, I want to thank you again for holding the 
hearing, and I yield back the balance of my time.
    The Chair. I thank the gentleman from Oklahoma, and with 
that, I am delighted to introduce our witnesses for their 
testimony. Our first witness today is Desiree Carver-Thomas. 
And, Ms. Thomas, your full written testimony will be included 
in the record. You are now recognized for 5 minutes for your 
opening statement.
    Ms. Carver-Thomas. Thank you. Chair DeLauro, Ranking Member 
Cole, and members of the subcommittee, thank you for the 
invitation to participate in this hearing. I am Desiree Carver-
Thomas, and I am a researcher and policy analyst at Learning 
Policy Institute. We have been deeply engaged in synthesizing 
the research on teacher diversity.
    The large body of evidence demonstrates that teachers of 
color provide cultural knowledge and role modeling that enrich 
the whole school community, with particularly strong benefits 
for black students taught by black teachers. One analysis found 
that black elementary students with black teachers had higher 
reading and math test scores than students without black 
teachers. Another showed that black students assigned to a 
class with a black teacher at least once in grades 3 to 5 were 
less likely to drop out of high school and more likely to 
aspire to go to college. In other words, the benefits of having 
a black teacher for even 1 year in elementary school can 
persist over several years. Other studies showed declines in 
suspensions, expulsions, and chronic absenteeism, and high 
rates of feeling cared for and academically challenged. And 
many of these studies suggest that other students, including 
white students, experience similar benefits.
    The share of teachers of color has increased from 12 
percent of teachers 30 years ago to 21 percent in 2017. Still, 
that share is low compared to the 40 percent of people of color 
in the Nation. Further, high turnover rates offset successful 
recruitment of teachers of color in recent years. In addition, 
student loan debt impacts teacher diversity. Research shows 
college students of color are more likely than white students 
to say that they changed their career paths because of their 
loans. Student loan debt is also much greater for black 
students than for white students, with a widening gap over 
time. Given loan debt issues, college students of color are 
less likely to enroll in teacher preparation programs than are 
white college students and more likely to enter through 
alternative certification pathways. These teachers tend to 
complete less pre-service coursework in student teaching, if 
any, and teachers who do not get comprehensive pre-service 
preparation leave at 2 to 3 times the school rates of those who 
do. Nearly half of newly-hired black teachers enter through 
alternative certification pathways compared to just 22 percent 
of other 1st-year teachers.
    Challenging teaching conditions can lead to higher 
turnover. Teachers of color most likely to teach in schools 
serving a majority of students of color, schools that often 
contend with a lack of resources and support. In addition, some 
teachers report facing discrimination and stereotyping. 
Effective school leaders can influence these teaching 
conditions. Poor school leadership, however, more than doubles 
the likelihood the teachers will turn over.
    Congress support diversity and high-quality preparation 
through the appropriations process and other legislative 
vehicles, including the $9,000,0,000,000 Road Map for the 
Workforce in the American Families Plan, and while Federal 
recovery funds are and can be used to support a diverse and 
well-prepared workforce, sustained Federal investments are 
needed. All of the existing programs I will discuss were 
created or updated on a bipartisan basis.
    First, underwriting the cost of teacher preparation can 
encourage more students of color to pursue teaching and to do 
so through a high-quality program that promotes greater teacher 
retention. Service scholarships and loan forgiveness programs 
cover or reimburse a portion of preparation costs in exchange 
for a commitment to teach in a high-needs school or subject 
area. These programs are most effective at recruiting teachers 
when they underwrite a significant portion of costs. In teacher 
residencies or district university partnerships, residents 
apprentice with effective metro teachers for a year in a high-
need school and subject while completing related coursework. 
Residents receive financial support and commit to teach at 
least 3 years in their district with ongoing mentoring. 
Nationally, about half of residents are people of color, and 
residents tend to have higher retention rates than other 
teachers.
    Congress could update Federal service scholarship and loan 
forgiveness programs, which have not been substantially updated 
by Congress since George W. Bush was President. Since 2008, 
student loan debt has grown by over $1,000,000,000,000. 
Congress can increase the TEACH grant award to $8,000 and can 
change the Teacher Loan Forgiveness and Public Service Loan 
Forgiveness programs to have the Federal Government make 
teachers' monthly loan payments until they meet the service 
requirement and retire the debts. Congress could also expand 
investments in high-retention pathways into teaching. The 
Teacher Quality Partnership Program, IDEA, Hawkins Center of 
Excellence Program, and supporting effective instruction 
programs fund high retention pathways like residencies. 
Additionally, we do not have a program dedicated to making 
high-need and advanced credentials more affordable.
    Next, mentoring and induction, including collaboration and 
coaching, can support beginning teachers of color. New teachers 
who do not receive induction supports are twice as likely to 
leave teaching as those who do. There is no Federal funding 
dedicated to this purpose. Finally, robust Federal funding for 
high retention pathways into leadership can develop strong 
school leaders who improve school conditions, which can help 
teachers of color teach for the long haul.
    In closing, research demonstrate there is an urgent need 
for a well-prepared and diverse educated workforce and a strong 
bipartisan role for Congress to play in this endeavor. Thank 
you for your focus on the issue, and I look forward to 
answering any questions members have.
    The Chair. Thank you very, very much. Let me next introduce 
our witness, Dr. Lindsey Burke. Dr. Burke, your full testimony 
will be entered into the record, and you are now recognized for 
5 minutes. And thank you for being here.
    Ms. Burke. Thank you. My name is Lindsey Burke. I am the 
Mark A. Kolokotrones fellow in education and the director of 
the Center for Education Policy at The Heritage Foundation. 
Thank you, Chair DeLauro and Ranking Member Cole, for the 
opportunity to testify today.
    We are brokenhearted about the events that transpired in 
Uvalde, Texas, yesterday at Robb Elementary School, and our 
prayers are with the families. We are here today to talk about 
teachers, and two educators died protecting our students 
yesterday. We know that is who our teachers are. In America, 
that is why we treasure and value our teachers because that is 
who they are.
    Although there has been teacher turnover as a result of the 
COVID-19 pandemic, teacher vacancies have to be considered in 
the larger context of ongoing increases and school staff hires. 
Today, teachers comprise only half of education jobs. This is 
part of a longer-term trend that Dr. Benjamin Scafidi has been 
tracking for many years. Since 1950, public schools have added 
personnel at a rate nearly 4 times that of the rate of growth 
and student enrollment. While the increase in new teacher hires 
was nearly 2-and-a-half times the increase in students, the 
number of non-teachers that is, administrative and other 
staff--increased more than 7 times that of student enrollment. 
So if school districts wants to attract more high-quality 
teachers to local classrooms, what policy should State 
legislatures and school boards pursue?
    First, they should remove barriers to entry into the 
classroom. The teaching profession is constrained by policies 
that mandate aspiring teachers obtain paper credentials, often 
at substantial cost. However, research has demonstrated there 
is little, if any, connection between teacher certification and 
a teacher's impact on student academic achievement. The absence 
of a relationship between teacher certification and teacher 
effectiveness is most noticeable and of negligible difference 
in outcomes between traditionally-certified, alternatively-
certified, and uncertified teachers. As researchers Robert 
Gordon, Thomas Kaine, and Douglas Stager found, ``To put it 
simply, teachers vary considerably in the extent to which they 
promote student learning, but whether a teacher is certified or 
not is largely irrelevant to predicting his or her 
effectiveness.'' So how can we ensure excellent teachers find 
their way to the classroom and are encouraged to stay? By 
making it easy easier to enter the profession but rigorously 
evaluating teachers once they are there.
    Second, States and districts should tackle pension reform. 
States should move from defined benefit pension plans, in which 
85 percent of public school teachers are enrolled compared to 
just 15 percent of private sector workers, to defined 
contribution retirement plans, like 401(k)s, which are popular 
in the private sector. Switching from defined benefit to 
defined contribution plans could provide retirement account 
portability across State lines for teachers, allow them to roll 
over account balances if they change jobs, and accumulate equal 
benefits even if they switched employers.
    Third, districts should eliminate last in/first out 
policies and reward excellence in the classroom. Too many 
schools continue to use the seniority-based layoffs when 
staffing decisions have to be made. These last in/first out 
policies should be abandoned in favor of staffing decisions 
based on teacher effectiveness and competence, not years in the 
school building. Finally, States and school districts should 
end the non-teaching staff hiring spree. Total inflation-
adjusted/per-pupil spending has increased 152 percent from 1970 
to 2018. Teacher salaries increased just 7.3 percent over the 
same time period. If districts want to attract and retain high-
quality teachers, they should refrain from continuing to 
increase the number of non-teaching staff in public schools 
and, instead, revamp teacher compensation systems to better 
reward those teachers who have a positive impact on student 
performance.
    Public school districts have the tools and considerable 
financial resources at their disposal to attract and retain 
quality teachers, but that outcome requires making different 
decisions than school districts have made historically. They 
can begin by eliminating certification barriers, tackling 
pension reform, ending last in/first out policies, and 
curtailing the non-teaching staffing surge.
    I look forward to answering any questions. Thank you.
    The Chair. Thank you very, very much. Let me just now 
recognize our next witness, Randi Weingarten for your full 
testimony, which will be included in the record. You are 
recognized now for 5 minutes.
    Ms. Weingarten. Thank you, Chair DeLauro, and thank you, 
Ranking Member Cole. I am Randi Weingarten. I am the president 
of the American Federation of Teachers, and I am still a 
teacher on leave from my social studies position as a high 
school teacher at Clara Barton High School in Brooklyn, New 
York.
    We are all in mourning today. It is only in America that 
parents are not assured that their kids will be safe from gun 
violence at school, and while educators had a really important 
job yesterday, they are more important today than ever.
    And I am here to talk about the staffing shortages facing 
America's public schools. I have been working on this issue for 
about 40 years or so, and about how to solve the crisis, and 
how Congress can help. And, you know, staffing shortages are 
not just a school problem. They are a national crisis. Every 
year, nearly 300,000 teachers leave the profession, two-thirds 
of them before retirement. Frankly, we have many, many, many, 
many surveys, and the pensions are one of the things that keep 
teachers in teaching. Teacher turnover is almost double that of 
any other occupation of their peers in schools that serve 
majorities of students of color, and those students who live in 
poverty experience a higher teacher turnover rate, and COVID 
has made this worse.
    So I am going to kick off four different things that I 
suggest that we do, but it all goes to the question, what would 
make you recommend a career in teaching to your own child or to 
your grandchild, particularly in public schools, and what can 
you do to help.
    Number 1, we can actually do much more in terms of 
recruitment and preparation of a high-quality, diverse teaching 
force. Over 80 percent of teachers are now white and female, 
while students of color make up about 50 percent of the student 
population. Our ranks should reflect this diversity, and so the 
Grow Your Own Programs, which educate support staff to become 
certified teachers, are really good programs, and historically 
black colleges and other minority-serving institutions will 
prepare half of all teachers of color in this country. We can 
actually fund them more.
    Number two, retaining teachers is as important as 
recruiting teachers. And so I would urge us to give educators 
the time, the tools, the trust to teach well. That means 
reducing class size to have more individual attention, and that 
means increasing planning time, which is what the countries 
that compete with us do. And it also means enabling educators 
to create teams in terms of sharing workloads. The investment 
in community schools and mental health supports will keep more 
teachers. Full-service community schools, wrapping around 
services of schools will actually help kids and help teachers 
teach, and identify the problems that we see before we see 
these kind of awful situations that we saw last night.
    Let's actually try to deal with paperwork. Last week, New 
Mexico Governor Stephanie Lujan Grisham signed an executive 
order to reduce paperwork and administrative burdens on 
educators, enabling them to focus on students. This, as well as 
salaries, is the number one issue that teachers talk about as 
well. And as a result, if we actually tried to start thinking 
about how to change the accountability systems, we can reduce 
paperwork. We need to make an accountability system that is 
aligned to what kids need to do, be able to do, and know as 
opposed to the paper/pencil system we have now.
    Obviously, compensation is important. Teachers make 20 
percent less than what they can earn in other similarly-skilled 
professions, and we are a profession. Let's find ways to deal 
with that, and there are a whole bunch of Federal programs that 
can help us do that. We can also do something in terms of 
public service loan forgiveness. As some of the other speakers 
have said, the Public Service Loan Forgiveness Program can help 
us reduce teacher debt, and that can be changed in that way. 
The TEACH Program can also do the same thing. And the last 
thing I would say is let's actually increase collective 
bargaining. Pass the Public Service Freedom to Negotiate Act. 
Give teachers the right to bargain. Make them part of the 
solution. That is what we have done in places that are moving 
forward. That is what we should do everywhere. When teachers 
have voice and agency in their work, kids thrive.
    Thank you very much.
    The Chair. Thank you, and let me now recognize Dr. Jane 
West. And, again, your full testimony will be read into the 
record, and you are now recognized for minutes.
    Ms. West. Thank you, Chair DeLauro. Thank you, Ranking 
Member Cole. Thank you, members of the committee. I am pleased 
to be here to talk about the critical shortage of special 
educators facing our Nation.
    In 1975, the Congress enacted the Individuals With 
Disabilities Education Act--IDEA--enabling students with 
disabilities to gain full access to education after decades of 
exclusion. For 47 years, the law has required a free, 
appropriate public education for every student with a 
disability, no matter how significant that disability. As a 
special educator before the enactment of the law and 
afterwards, I can tell you what a difference it makes.
    The challenge we face today is one of fully implementing 
the law. While IDEA requires its services are delivered by 
qualified personnel, that is increasingly not happening. The 
critical obstacle is the crisis of a special educator shortage 
among special education teachers, paraprofessionals, school 
psychologists, early intervention providers, speech therapists, 
specialized instructional personnel, and more. Our shrinking 
capacity in higher education to prepare special educators 
threatens the pipeline for the future. The pervasive challenges 
that other witnesses have outlined of high student debt, low 
teacher salaries, declining respect for the profession, and the 
stress of coping with the pandemic affect special educators as 
well.
    For special education, the combination of a dearth of 
fully-prepared new teachers and the high attrition rate has 
generated an urgent challenge for today and the future. The 
scope of the shortage is alarming. Forty-eight States and the 
District of Columbia report a shortage of special education 
teachers, outpacing shortages in other fields, including math 
and science. Ninety-eight percent of school districts report 
special education shortages. The proportion of uncertified 
teachers grew by 50 percent from 2014 to 2016, and that number 
continues to grow. In some States, like California, over half 
of new special educators are not fully prepared. The enrollment 
in special education preparation programs has also declined by 
16 percent in recent years for initial licensure programs, 
which does not bode well for the future. We confront this 
crisis at the same time the number of students requiring 
special education services has increased, 17 percent since 
2000-2001.
    States and districts have had to scramble to fill special 
education positions in ways that are unsustainable over time 
and will exacerbate the problem rather than solve it. Lowered 
standards for certification, an increase in the use of long-
term substitutes, and the expansion of short term programs 
which place people as teachers without the needed skills and 
knowledge will keep the schools open, but they will not 
generate the results that we want for students with 
disabilities, nor expand the qualified workforce. The shortage 
leads to larger caseloads for special educators with less time 
for students with complex needs, and stretched too thin, 
special educators burn out and students are underserved.
    We know preparation matters. Generally, teachers who are 
underprepared, such as those entering the profession through 
emergency and alternative pathways that do not offer robust 
student teaching and a full curriculum, are 2 to 3 times more 
likely to leave than those who are fully prepared. Research 
shows that comprehensively-prepared and credentialed educators 
are more likely to stay in the field and are best equipped to 
deliver results for students. Without the qualified personnel, 
student outcomes suffer. A parent recently shared with me her 
journey with her son with dyslexia, which was presenting great 
obstacles to him in learning to read, resulting in tremendous 
frustration. When he gained access to fully-prepared teachers 
with expertise in reading instruction, he blossomed. Today, at 
age 27, he is applying to a doctoral program. This is the 
difference that highly-qualified and trained teachers make.
    Multiple innovative solutions are in place across the 
country, including teacher residency programs, recruitment 
strategies for high school students, Grow Your Own programs, 
and use of teacher candidates as substitutes for part of their 
teacher training programs. We know what strategies work. A 
greater investment will enable them to meet the moment. Two, 
Federal programs have solid and proven track records in 
carrying out these solutions, and a newly-funded one will 
address the dire lack of diversity in our workforce. I urge the 
subcommittee to provide greater investments in the Personnel 
Preparation Program under IDEA, the Teacher Quality Partnership 
grants, and the Hawkins Center For Excellence programs.
    In summary, students with disabilities need access to a 
well-prepared, diverse, experienced, and stable educator 
workforce. A greater investment in these programs is urgently 
needed. Thank you.
    The Chair. Thank you, and I want to say thank you to all 
the witnesses for outstanding testimony this morning, and thank 
you. It is a struggle, I think, today for all of us and for 
those of you have been engaged been involved with the teaching 
profession and educating students, and understanding what 
allows them to learn. And I know your hearts are full, and 
thank you for carrying on. It is important. It is an important 
discussion.
    And by the way, this is the first teacher shortage hearing 
that we have had since the pandemic, so it is particularly 
important. In addressing the teacher shortage, some States are 
lowering the qualifications of becoming a teacher, for example, 
Connecticut. The State Board of Education voted to authorize 
emergency certification that allowed individuals to fill 
teaching positions for subjects in which they are not 
certified, a practice that the State ended nearly 30 years ago.
    I have two questions here. Ms. Carver-Thomas, what does the 
research say about the importance of having access to fully-
certified teachers, and, Dr. West, what is the real-life impact 
on students with disabilities and their families when students 
are faced with a person serving as a special educator who does 
not have the training or skills to teach them? Dr. West? No, 
Ms. Carver-Thompson first.
    Ms. Carver-Thomas. Thank you for the question, Chair 
DeLauro. The research is clear that teacher certification 
matters for our students and for our schools in several ways, 
and I can talk about a few of those, including student 
achievement, teacher shortages, which we are here to discuss, 
and financial costs. So when it comes to student achievement, 
there is research showing that there is an association between 
full certification and student outcomes.
    A study led by Learning Policy Institute researchers, our 
Positive Outlier study, looked at California districts and the 
relationship between teacher characteristics and student 
outcomes, and found that districts with more fully-credentialed 
teachers had better student outcomes, particularly for black 
and Latino students, and this was after controlling for a range 
of other school and teacher characteristics. When it comes to 
shortages, we know that when there aren't enough fully 
credentialed teachers to go around, districts and schools will 
turn to emergency credentialed teacher, teachers who are not 
fully prepared to teach their subject matter, and these are 
teachers who are more likely to leave that school or the 
profession entirely, creating a level of churn that creates 
instability in schools, disrupts the transfer of institutional 
knowledge, disrupts professional learning, disrupts student 
learning. And we know that that sort of churn 
disproportionately impacts students of color and students from 
low-income families who really bear the brunt of that kind of 
teacher demographics where more under-credentialed teachers are 
serving those students.
    And then when it comes to financial costs, it costs money 
for districts to recruit, hire, support, train teachers who 
they bring into the classroom. And if those teachers are coming 
in and out, having to constantly be replaced, those costs walk 
out the door with those teachers. Those investments do, and 
those are investments that could be put to better use for our 
students.
    The Chair. Thank you. Dr. West, the impact on students with 
disabilities?
    Ms. West. Thank you. You know, Chair DeLauro, I would like 
to start by reminding us who we are talking about. We are 
talking about students with autism. We are talking about 
students with intellectual disabilities. We are talking about 
students who are deaf, students who are blind. We are talking 
about students with learning disabilities. These are the 
students we are talking about. Imagine going into a classroom 
without the proper preparation and seeking to teach a nonverbal 
student with autism. These are significant skills that need to 
be acquired and developed during comprehensive and intense 
preparation. There simply is no way, no substitute for 
developing that skill set.
    I was talking to a parent yesterday who has a 6-year-old 
with Downs syndrome, and she was sharing with me that he has 
developed sort of wandering away behaviors, which is not 
uncommon in students with Downs syndrome. And the strategies 
that one might commonly use, such as being very firm and, you 
know, ``come back here, don't do that,'' particularly if it is 
a situation at home or something, reinforces behavior. And 
research shows us there are other ways to manage this behavior 
that will not reinforce it, and if you aren't aware of that, 
the behavior escalates, and that is just one example.
    I also want to point out that many students with 
disabilities, most students with disabilities, are in general 
ed classrooms most of the time. So that partnership between 
special educators with that unique skill set and the content 
knowledge of general educators is critical to the delivery of 
strong academic services and social-emotional support to all 
students. So special educators also have a great investment in 
fully-prepared, fully-credentialed educators in other fields. 
Thank you.
    The Chair. Thank you. Just a note. I mentioned in my 
opening comments that early on in my career, I finished 
graduate school and was looking for a job. And one of the 
things I decided to do while I was looking was to make myself 
available to be a substitute teacher, okay? I graduated with a 
B.A., an M.A., and, you know, not in the teaching profession, 
and I would tell you that I was called as a substitute teacher 
just about every single day. You know, in essence, you are 
trying, but, you know, you are merely trying to manage the 
classroom and keep it together and not have that. But we do 
have substitute teachers in all the time and without the 
training. There is a loss, especially if a teacher is ill and 
out for a length of time.
    I have one comment on the special ed. I went through a 
special ed class one day, and the teacher, who was well 
qualified, left the lesson, and it was around the holiday, and 
that was to make Christmas decorations from macaroni. Well, I 
am not trained as a special ed teacher. I don't know the 
balance between discipline and compassion in that sense. My 
instincts were all on the compassion side, you know. Whatever 
these children were going to do, they were going to do. I will 
just tell you that by noontime, we were almost knee deep in 
macaroni in this classroom. It is humorous, but nevertheless, I 
don't have the skills to be there, and you need to have trained 
people, to your view of using trained people, to be substitute 
teachers.
    So with that, I have gone over my time, and I yield to our 
ranking member, Mr. Cole.
    Mr. Cole. Well, thank you, Madam Chair. You are pretty good 
at keeping order among unruly students on this committee, so I 
think your earlier training did well. [Laughter.]
    Mr. Cole. Let me start with you, Dr. Burke, but any of you 
I would invite to answer. You know, we know we obviously have a 
shortage overall, but we have acute shortages in specific 
areas. Special ed obviously has been mentioned, math and 
science usually also, and yet, in most school systems, pay is 
pretty uniform. It is based on seniority and credentials 
overall. Is there merit in doing what they do at the college 
level, which is, as a guy that was a history professor in 
college, I can tell you I didn't make what anybody in the 
engineering department made or anybody in the business school 
made, and I don't begrudge them that. I don't mean that 
critically of anybody. It was just my skill was more common, 
more available than the others. So would it be worthwhile 
having pay differentials in specific shortage areas to try and 
attract more people and retain them for longer?
    Ms. Burke. Thank you, Representative Cole. That would 
definitely be worthwhile, thinking about how districts can 
differentiate pay for high-demand areas, not only for high-
demand areas, but to differentiate pay to reward teachers who 
are doing excellent work in the classroom, who are getting 
their cohorts of students to learn a year or a year-and-a-half 
worth of learning in a year's time, to really reward those 
exceptional teachers. But schools have largely made a decision 
to take existing resources, which as I mentioned earlier, have 
increased significantly over the past half century, and to use 
those taxpayer resources to fund and hire non-teaching staff 
instead of putting that into something like differentiated 
teacher salaries. So again, if we just look at the recent data, 
if you go back just to the year 2000, from 2000 to 2019, while 
the number of students and teachers in public schools just 
increased about 8 percent, the number of principals and 
assistant principals increased 37 percent, and the number of 
school district administrative staff increased 88 percent.
    So, again, this is about decisions, about choices the 
districts are making, and we can look at those overall 
aggregate numbers. To go back even further back to 1950, I 
mentioned spending increasing significantly since that time 
period. A big part of that is this increase in non-teaching 
staff. The number of students increased about 100 percent from 
1950 forward, but the number of teachers increased 243 percent. 
The number of administrators and non-teaching staff increased 
709 percent over that time period.
    So you are absolutely right. Differentiated pay is 
critically important. Rewarding excellent teachers with 
differentiated pay is important, but that will require making 
different decisions than schools have made in the past.
    Mr. Cole. Let me ask you a quick follow up, and, again, I 
would invite anybody else if they have got thoughts on this to 
participate. You know, we are the Federal Government. We can't 
and should not, in my opinion, be mandating these kinds of 
things from here. We can incentivize behavior, though, through 
programs, and we try to do that on some occasions. As you think 
broadly across the country, is there anybody doing what we are 
talking about? I mean, is there any particular system you would 
say they approach this a little bit differently than most of 
the States, and this is working better?
    Ms. Burke. Well, I think what we can point to is something 
that we saw in the wake of COVID, which is how diverse the 
delivery of instruction is becoming, and the way in which that 
has enabled individuals to enter teaching and to be rewarded. 
So if we think about something like learning pods and micro 
schools, these really innovative approaches that are on the 
ground, these options enable teachers to be paid directly from 
families. And really, you know, you can imagine a situation 
where the sky is the limit in terms of earning potential for 
these instructors. And hopefully, that is where we get to, to a 
point where these excellent in-demand teachers are rewarded 
handsomely.
    Mr. Cole. Ms. Carver-Thompson, I don't have a lot of time 
left, but let me turn to you because I couldn't agree more with 
your basic point about the importance of diversity in teaching 
and kids seeing people that look like themselves pursuing the 
profession. We know our record is not what any of us would want 
it to be in that regard. Again, is there a particular place, or 
State, or system, in your opinion, that are handling this 
better that we should look at, that these are folks that are 
aggressively recruiting for diversity or achieving this goal?
    Ms. Carver-Thomas. Thank you for the question, 
Representative Cole. Absolutely, there are programs like those 
funded by some of the programs I talked about today, the TQP, 
like teacher residencies, that have become very popular across 
the country. And there are States, like California, that are 
investing, making considerable investments in teacher residency 
programs, and we know that these programs tend to have much 
higher levels of diversity than the teacher workforce at large. 
And that is largely because it is comprehensive preparation, 
but residents also receive a stipend during their residency 
year. They receive ongoing mentoring support. They receive 
aligned clinical experience that is really deep. It lasts, 
typically, a full school year while they are also completing 
coursework, and they tend to have a much higher retention rate 
than do teachers prepared through other pathways. So it is a 
very promising model that we see being invested in.
    And, you know, in California, we are starting to see an 
uptick in teacher preparation enrollments, which really defies 
the national trend because of those considerable investments. 
But there is still quite a bit of need, and so these kinds of 
investments are still much needed.
    Mr. Cole. Thank you very much. Madam Chair, just for 
purposes of notifying you, for whatever reason, I don't see 
time on my schedule, so I am guessing I have about used up my 
time. If I have gone over, I apologize, but it might help if 
there was some way we could get that displayed on the screen. 
With that, I yield back.
    [No response.]
    Mr. Cole. I think you are muted, Madam Chair.
    The Chair. I thought I did that. In any case, Ms. 
Weingarten had her hand raised to answer your question, so----
    Mr. Cole. Oh, I am sorry. I apologize.
    The Chair [continuing]. Additional time here. Go ahead, Ms. 
Weingarten.
    Ms. Weingarten. So, Congressman Cole, I think that there 
are ways in which we can do that, and there have been various 
different collective bargaining agreements that have 
differentiated paid for shortage areas, for special needs, 
like, you know, Dr. West was talking about. We have done that a 
lot The programs that paid for performance did not work. In 
fact, they actually hurt. You know, you are seeing a slow walk 
away from all the Race to the Top pay for performance because 
what was happening is that people actually left the high-need 
schools where you actually need to have kids. You need to have 
the best and most well-prepared teachers. So the pay for 
shortage areas is a really good idea, and we have done that in 
a bunch of different contracts, but the bottom line is you 
actually have to have decent pay as the basis of it. People 
have to rely, year after year, on being able to feed their 
families and being able to rely on that kind of income, and 
that is important as well, and then you can do various 
different differentials.
    And the last thing I would say is I agree with Dr. Burke 
that there have been too many non-classroom positions that have 
been created, but a lot of that is because of paperwork and the 
Federal accountability systems. And that is part of the reason 
why we are seeking to actually change the accountability 
systems to really focus on what kids need to know and be able 
to do, and make sure that the data is there. But what has 
happened is that there is a search for data, and there is more 
and more time that is focused on data collection as opposed to 
on teaching. And that is why it is one of the number one issues 
that current teachers have in terms of saying, let me teach, 
give me the time, tools, and trust so that I can actually meet 
the needs of my kids.
    Mr. Cole. Yeah. I am shocked the Federal Government would 
generate paperwork. [Laughter.]
    Mr. Cole. Thank you, Madam Chair. I yield back.
    The Chair. Thank you. Mr. Pocan.
    Mr. Pocan. Thank you very much, Madam Chair, and thanks for 
having this hearing. I know I brought it up about 3 weeks ago 
maybe, if even that, and this is a very quick coming together 
of the hearing, so thank you for having this, and thank you to 
all the witnesses. All of you provided very concrete examples 
of suggestions of what we should do.
    Ms. Weingarten, a number of yours rung the most true, at 
least in my State, in Wisconsin. In Wisconsin, in 2010 when 
Scott Walker was governor, he did an attack on public employee 
unions and, in doing that, an attack on public employees. And 
the outcome of that, within a year or two, the UW Madison 
School of Education, one of the best in the country for a 
public university, had a drop to about 40 percent of the 
applications going to the school that they had prior to that. 
There really was a respect issue for the profession that we saw 
directly out of what happened. Right now, in Wisconsin, the 
starting teacher salary that I could look up, so this might be 
a couple years old, was as low as $26,535, and the average pay 
for starting teachers in Wisconsin is in the lowest 25th 
percentile in the country according to Zip Recruiter. Right 
now, I have fast food restaurants advertising $17 to $20 an 
hour. If you are equating teaching with a fast food job, 
certainly you are not going to have a lot of people perhaps 
looking at that as a career path.
    My own sister-in-law taught for over a decade and quit 
teaching because of the disrespect that has now happened, and 
she taught in a couple different States, through the laws in 
Wisconsin. So the disrespect for the profession, I think that 
we saw the pay issues, and then throw on top all the challenges 
of COVID and everything else, it has had a real impact in a 
place like Wisconsin. In fact, Madison School District used to 
be an unattainable school district for many first-time 
teachers. Now, they are getting two or three applications for 
some positions. That is it.
    There is a significant change, at least in my State, that I 
can look at. A lot of it resonates to what you said 
specifically. What can we do around that issue, giving teachers 
respect again for the profession within the districts and the 
respect of a salary that is not in the bottom 25th percentile?
    Ms. Weingarten. So number one, one of the first things, 
that is why I said to all of you, because there is a lot of 
common sense that is involved here and a lot of the research 
about what actually happens in schools. You cannot control for 
every single factor that happens in schools, so that is why I 
say and I asked you, what would make you as a person recommend 
a career in teaching to your child or grandchild, and it comes 
down to actually two things. Teachers, thank God, they go into 
teaching because they want to make a difference in other 
people's lives, and that is something that you can't recruit. 
That is who teachers are. But what we can do is we can make 
their lives such that they don't walk into school with a pit in 
their stomach or a pit in their throat, that they can actually 
have freedom and latitude to meet the needs of their kids when 
they see those needs. You can call that trust, you can call 
that tools, you can call that time, you can call them that 
respect, but it comes down to we are not automatons. We have to 
actually have some latitude to teach and some kind of benefit, 
a sense that we are doing is right, and have that. That is No. 
1.
    Number 2 is the preparation for it. And Dr. Carver-Thomas 
said this about how the residency programs, the Grow Your Own 
programs, really help you walk in with that preparation. It is 
both the book preparation as well as the preparation so that 
you know the circumstances you are walking into. And the second 
big thing is pay so that people can actually raise a family on 
the pay that they have.
    Mr. Pocan. So in this appropriations process, I think there 
are some very specific suggestions from Dr. Carver-Thomas that 
we could do immediately, and I appreciate that. In this budget, 
what could we do most immediately, Ms. Weingarten, that you 
think would be helpful?
    Ms. Weingarten. So there are three things you can do. You 
can increase the investments in terms of the Augusta Hawkins 
Investment Program so that we can actually really focus on Grow 
Your Own residency programs, particularly with HBCUs. Number 
two, you can really increase the amount of money that goes to 
community schools and to wraparound services so that teachers 
can actually meet the needs of kids. And number three, just 
like the ARP money, and the IDEA money, and things like that, 
these things can go into how we can increase the compensation 
of teachers.
    Mr. Pocan. Great. Thank you very much, and I yield back, 
Madam Chair.
    The Chair. Okay. I think that is where we are. Yes, Dr. 
Harris.
    Mr. Harris. Thank you very much. Thank you very much, Madam 
Chair. Thanks to everyone who is appearing today. You know, I 
don't know what is going on in Wisconsin, but in Baltimore 
County, the starting salary is $49,900, so it is probably a 
local issue, and certainly the Federal Government shouldn't be 
involved in that. That should all be negotiated at the local 
level.
    Anyway, I just have a question for Ms. Weingarten. Do you 
think that teachers should be able to strike?
    Ms. Weingarten. Dr. Harris, I think that we should have 
these kind of collective bargaining programs all throughout the 
country.
    Mr. Harris. Ma'am, I have 5 minutes. I have a lot of 
questions to ask. Do you think teachers should be able to 
strike?
    Ms. Weingarten. I think that teachers should do everything 
that they can, as we do, to----
    Mr. Harris. Ma'am, do you think teachers should be able to 
strike? It is a simple question because other public servants, 
for instance, our law enforcement, they can collective bargain, 
but they can't strike because we think their role is very 
important in the community. And as professionals, we think they 
shouldn't strike.
    Ms. Weingarten. So, sir----
    Mr. Harris. Do you believe that teachers should be able to 
strike?
    Ms. Weingarten. So, sir, I----
    Mr. Harris. It is a very simple question. It is a ``yes'' 
or ``no.'' You either believe it or you don't.
    Ms. Weingarten. So, sir, I believe that every single worker 
in America should have a path----
    Mr. Harris. Okay. Let me go on to Ms. Burke----
    Ms. Weingarten [continuing]. Should have a path to 
dignity----
    Mr. Harris [continuing]. Because you are not answering my 
question. You are not answering my question, and I understand 
why.
    Ms. Weingarten. If you would let me----
    Mr. Harris. Ma'am, you are not answering the question, and 
I understand why, because it is embarrassing that teachers go 
out on strike.
    Ms. Weingarten. I am not----
    Mr. Harris. These are professionals who are supposed to be 
some of the most important parts of our children's lives, their 
education, and they go on strikes, sometimes for weeks, without 
these children getting an education. Now, Ms. Burke--Dr. 
Burke--let me ask you, what's the history to unionization----
    Ms. Weingarten. Sir, if you would let me answer it, I would 
love to.
    Mr. Harris. Ma'am, I am moving on. I only have a limited 
amount of time. No filibustering allowed for you. Dr. Burke, 
what is the history of unionization, because it appears that we 
have gotten worse teaching over the last 50 years and, at the 
same time, unionization of teaching has increased. So is there 
a connection? Is it the inability to, I won't say weed out, but 
to discourage teachers who really aren't good because, for 
instance, merit pay is discouraged where if you teach better, 
you get paid more instead of just a negotiated salary scale? 
Could you just run through the history of unionization?
    Ms. Burke. Sure. So unionization, it has been with teaching 
profession for a long time, borne out, in part, in the early 
20th century as an effort at teacher professionalization. 
However, to your point, that has really worked into something 
entirely different. We see capture of institutions, like 
colleges of education, which if we want to talk about ways to 
reward effective teachers and lower their costs of entering the 
teaching profession, union-supported policies, like rewarding 
teachers for getting a master's degree, forces teachers to go 
into college of education and take on more debt than they 
otherwise would have, while we know at the same time that has 
no impact on their ability to be an effective teacher or 
increase student outcomes.
    If you look overall at the American wage and salary 
workers, union membership rates are about 10.3 percent overall. 
However, among public school teachers, that rate soars to 70 
percent. It is the highest unionization rate of any employment 
sector, and so that means millions of members are paying tax 
exempt dues, revenue to the National Education Association, the 
American Federation of Teachers annually. And that matters for 
the conversation because, generally speaking, unions end up 
opposing many of the reforms that actually hold promise for 
attracting qualified teachers, the reforms that I mentioned 
earlier: removing certification barriers to entry, addressing 
unfunded pension liabilities, providing merit pay for 
exceptional teachers, et cetera.
    So, and I would add, and I think many would agree, that 
many of these union policies really exacerbated teacher 
frustration during the pandemic by forcing schools for nearly 2 
years to remain closed, and forcing educators to engage in 
emergency remote instruction. And so many of these policies 
that have really plagued public education for over a century 
now are rooted in policies that are supported by special 
interest groups.
    Mr. Harris. Sure. And just on the pension reform, is the 
lack of pension reform an impediment to mobility of teachers 
between districts?
    Ms. Burke. Not necessarily between districts, but it is 
between States, an impediment to their mobility to move State 
to State, or to consider if they want to exit the profession 
and find other employment to do that. And that could weigh on 
your mind ahead of time if you are considering entering the 
teaching profession, not having that flexibility.
    Mr. Harris. Thank you very much. I yield back.
    The Chair. Sorry. Ms. Clark.
    Ms. Clark. Thank you, Madam Chairwoman, and thank you to 
all the witnesses for being here today. I just want to echo the 
comments of some of my colleagues about just how horrifying it 
is to watch what happened, and to underscore that we are not 
powerless to act. And we haven't been powerless, but we have 
failed our students. We failed our teachers by not acting to 
reduce gun violence in this country. School massacres are not 
freedom. Shooting children and their teachers in their 
classrooms is not some extension of a constitutional right. We 
have to do better, and we will.
    I want to talk to you about another issue that is facing 
our country and will not allow us to recover and address this 
teacher shortage issue fully if we don't tackle the lack of 
childcare. And when we look at early educators, the median 
hourly wage in this country is $12.24, not enough to raise a 
family on. And one-third of Head Start positions are unfilled, 
citing compensation as the number one reason why they are not 
taking those jobs. So my question for Ms. Weingarten, and it is 
good to see you, is, can you speak to why a reliable childcare 
system and the availability of childcare benefits is an 
important tool for teacher recruitment and retention, and how, 
as we are working to raise compensation and benefits for 
teachers, we can also focus on early educators, and why that is 
so important?
    Ms. Weingarten. So thank you, Representative Clark. I just 
also want to say, you know, I grew up in a system with the 
Taylor Law where did not have the right to strike. The right to 
strike should only be a last resort. It should never be a 
first. It should only be a last resort, and that is what most 
teachers do, and I just wanted to make it clear that, you know, 
I would have said that to that answer.
    In terms of childcare, one of the things that all of you 
were working on in the child tax credit, childcare, is how do 
we actually in, you know, America reduce the cost for families 
so that people can actually do the kind of work, deal with the 
kind of things that they want to do? You know, unfortunately, 
in America, you know, if you are wealthy enough, you know, 
childcare is not an issue. If you are not, childcare is a huge 
issue. And so that is an issue, you know, when you have jobs 
that are anything, you know, outside of being an investment 
banker or a, you know, equity manager, or things like that.
    So incoming jobs for a teacher, whether it is, you know, 
the $50,000 to $60,000 that you see in Baltimore, or it is the, 
you know, substandard wages in early childhood, if you don't 
have childcare, how are some going to be able to do that? And 
so it is how you drive down these costs. In Western Europe, 
there is a package of things that happen for workers so that 
they don't have to think about paying for that that way. They 
don't have to think about healthcare. They don't have to think 
about childcare. They don't have to think about retirement 
security. They just live on those kind of wages. So cutting 
costs, whether it be student debt costs or whether it be 
childcare costs, are hugely important.
    Ms. Clark. Thank you for that. And to Ms. Carver-Thomas, I 
also want to ask, as we are looking at trying to increase our 
amount of teachers and early educators so that we can help 
solve this childcare crisis and have the robust public schools 
that we want, what are you seeing as some of the key barriers 
that are keeping interested students from entering the teaching 
profession?
    Ms. Carver-Thomas. Thank you. I would say that one of the 
key barriers is affordability of comprehensive preparation. We 
know that student debt has increased in the past couple years, 
and yet our programs that are designed to help college students 
afford those costs, like the TEACH grant, have not been 
substantially updated by Congress since 2008. And so those 
barriers are even higher for potential teachers of color, who 
research shows are more sensitive to debt and potential wages.
    Ms. Clark. Thank you so much. I see my time has expired. I 
yield back.
    The Chair. Mr. Moolenaar.
    Mr. Moolenaar. Thank you, Madam Chair. Dr. Burke and all 
the members of the panel, thank you for joining us, and, Dr. 
Burke, I had a question for you based on your research. Where 
are you seeing more interest in aspiring teachers? Is it a 
geographic issue? Are there certain fields of study that you 
are finding there is more interest or less interest in being 
teachers?
    Ms. Burke. Well, I think it might actually be the type of 
school that teachers can teach in. We are seeing a real 
renaissance in classical education. In particular, we are 
seeing a growth in the classical charter school movement, and 
we are seeing, as a result of that, that classical charter 
sector is actually working to create their own teacher 
education pipeline for entering those schools. And I think that 
is partly in response to the fact that we are seeing so much 
interest in that particular sector.
    Mr. Moolenaar. And how are they creating that pipeline? One 
of the things that strikes me is, often, you will have 
students, and I am sympathetic. We have heard a lot about the 
debt that students have as they finish their preparation for 
teaching and the length of time. What kinds of innovations are 
you seeing in that area that is making it easier for people to 
transition into teaching?
    Ms. Burke. So within the classical sector, some of these 
schools are partnering with existing colleges of education at 
universities where they are philosophically aligned in terms of 
the pedagogy, the curriculum, et cetera. But then some of these 
K-12 schools, classical schools, are working really in-house to 
educate and prepare teachers to enter into their classroom. At 
the undergraduate level, you know, if you have the foresight to 
end up majoring in education, you can enter the teaching 
profession relatively easily. However, if you decide later on 
and after getting your bachelor's degree that you want to enter 
the classroom and become a teacher, for most people then that 
means going back to school, going to get a master's degree, 
spending $40,000, whatever it might be, to earn that master's 
and 2 years of time commitment, and that is untenable for a lot 
of people.
    So, again, it really does come back to reducing those 
barriers to entry across every type of K-12 education sector, 
whether it is the classical charter sector or public/private 
charter, et cetera, and making sure that those new career 
professionals, in particular, who would be excellent educators 
have the ability to do so without spending a lot of time and 
money to obtain paper credentials.
    Mr. Moolenaar. You know, I am sensitive to the role of the 
Federal Government versus the State government, and local 
school boards, and everything. What role would the Federal 
Government have into making those kinds of innovations, that 
kind of flexibility more widely available?
    Ms. Burke. Well, one really good option would be allowing 
flexibility with all existing Federal education dollars. It is 
always important, of course, to remember that the Federal 
Government is a small, small stakeholder, in overall K-12 
financing, 8.5 and 10 percent overall K-12 financing in a given 
year. And so these reforms, both from a spending perspective 
and just a good constitutional governance perspective, largely 
have to happen at the State and local level. But the Federal 
Government should provide flexibility with that small slice of 
funding that it currently does provide through the taxpayer 
purse and allow States to put those existing education dollars 
toward any lawful education purpose under State law. So if a 
State wanted to take those funds and use it to revamp future 
compensation, or advance education choice options for students, 
or focus on reading achievement, whatever a State might want to 
do in conjunction with districts, they should be able to do 
that with those existing funds.
    Mr. Moolenaar. Thank you. Ms. Weingarten, I wonder if you 
could respond. You know, I hear a lot from people in Michigan, 
concerns by parents who feel like in public schools, that their 
values are being undermined and their voices are not being 
heard. Are you hearing that message, and, if so, what can be 
done to restore the confidence that parents have in our public 
education system?
    Ms. Weingarten. So thank you for that question, 
Congressman. What I hear a lot is a lot of frustration. 
Teachers and parents want more of a voice in terms of, you 
know, what is happening in terms of the day-to-day basis, and, 
frankly, what I am hearing this year is that a lot of people 
wanted more of a way for us to meet the needs of kids. You 
know, kids came back with an awful lot of needs, and so we 
wanted to try to figure out how to meet those needs. So I have 
heard a lot of we don't have enough guidance counselors, we 
don't have enough nurses, we don't have enough of these kinds 
of things. But what we are also seeing, and this is part of the 
reason why the AFT is pushing our Reading Opens the World 
Program, is that we really need to get back to the basics of 
focusing on reading, focusing on the kind of community school 
work that Chair DeLauro has really championed, and focus on how 
we create the pathways to, you know jobs, into colleges.
    Mr. Moolenaar. Thank you, and, Madam Chair, I see I have 
overextended my stay here, so I yield back.
    The Chair. That is okay. The discussions are good. And with 
that, Ms. Bustos.
    Mrs. Bustos. Thank you, Madam Chair. Quickly before I get 
to my questions, I do want to want to briefly echo the 
sentiments that many of my colleagues have shared about the 
horrible shooting and at the school in Texas. And, you know, 
obviously all of our hearts are broken, those of us, you know, 
who are moms or grandmas, or dads and grandpas. You know, there 
is really nothing worse than learning about these terrible 
incidents that we have got to do something about. That is my 
call to action to everybody. We have got to do something 
legislatively and play a role in helping to get our Nation in a 
better place. Lots of ideas out there, but we need to take that 
up as well.
    Thank you, Chair DeLauro, thank you to Ranking Member Cole 
as well, for holding this hearing. I know on a very personal 
level how important the topic of teacher shortage is. We have 
done a series of these rural economic roundtables across the 14 
counties that I serve in this congressional district in 
Northwestern Illinois. And at every single one of them, I kid 
you not, at every single one of them, we heard about teacher 
shortages. And, you know, obviously when we have got something 
that is so important, this foundational profession of teaching, 
and that we are having trouble attracting and keeping educators 
across the country, that is why this hearing is so important.
    In the State of Illinois, we have about 4,100 unfilled 
teaching positions, paraprofessionals, other staff. So 4,100, 
and, you know, so obviously, you know, there are a lot of 
factors that lead into that. But when you get down to it, and 
Randi Weingarten, I know you know this probably as well as 
anybody, if not better than anybody on this Zoom. You know that 
we are asking a heck of a lot of our teachers and our staff 
while paying them too little.
    So we have got a bill that creates incentives for teachers 
to stay in the profession. One of them that I am part of, it is 
called the Retaining Educators Takes Added Investment Now Act--
we call it the RETAIN Act--that would give fully-refundable tax 
credits for teachers in Title I schools. So the credits would 
start at $5,800 and ramp up two $11,600 to retain staff. So, 
Ms. Weingarten, can you talk a little bit about why incentives 
like those under the RETAIN Act are really important, and maybe 
even essential, if we are going to bring teachers into the 
workforce and really incentivize them to stay in the workforce?
    Ms. Weingarten. So thank you, Congresswoman. Look, so let 
me just say we have a shortage task force that will present its 
findings and will do a big focus on this as part of our 
convention in July. Some of what I talked about today is some 
of what we are bringing forward. But what you just focused on 
is so important because what happens is teachers are better 
their third year than they are in their first year. Dr. Burke, 
I started as a lawyer before I was a teacher. I was one of the 
alternatively-credentialed teachers. I wish I had a residency 
program. I was not a good teacher, in my judgment, my first 
year. I needed the support that I got from other people. And so 
by my 3rd year, my 4th year, I was a much better teacher.
    Those retention bonuses, when people are deciding are they 
going to stay in teaching or not, teaching is a high attrition 
field. That kind of retention bonus is really important, that 
kind of retention bump is really important, because then we can 
keep people in the profession, and they can raise their family, 
and live in communities, and teach. So that kind of work that 
you are doing, Congresswoman, is really important in terms of 
giving us the funding to be able to retain people in their 3rd, 
4th, 5th, 6th, 7th, 8th, 9th, 10th year.
    Mrs. Bustos. So if we can kind of keep along these lines in 
my questioning, of the 14 counties that I mentioned, 11 of the 
14 are very, very rural. In fact, 85 percent of the towns in 
the congressional district that I represent have 5,000 
residents or fewer in the towns, and 60 percent are 1,000 or 
fewer. And so we are seeing these shortages in rural areas in a 
really big way. I am wondering if you have any thoughts about 
are there different ways that we should tackle this problem in 
rural areas versus more urban settings?
    Ms. Weingarten. Yes, there are, and we are starting to 
think about that. Look, you and I have had the conversation 
around what we did in Peoria and having that kind of housing of 
a career tech ed facility that ended up being used for several 
rural counties and rural areas. We had to deal with the 
transportation issues and things like that, but you can then 
figure out how to cluster magnets together so that we have the 
expertise of a physics teacher, or, you know, of a teacher of 
calculus. We have been doing that, frankly, in McDowell County, 
West Virginia, where we, with Gayle Manchin, have been running 
a public/private partnership adjacent to the school district 
about how we make sure that we have expertise so that rural 
areas do not have this kind of deficit. We need to get great 
teachers who are deeply knowledgeable about these things.
    Mrs. Bustos. Thank you, Ms. Weingarten. My time has 
expired. With that, Chairwoman DeLauro, I yield back. Thank you 
so much.
    The Chair. Thank you. Thanks very, very much. And 
Congressman Cline.
    Mr. Cline. Thank you, Madam Chair. I want to thank the 
witnesses for being here today on this hearing. You know, 
according to the Virginia Department of Education's Annual 
Report On Critical Shortage Areas, the top 10 shortage areas 
this year are special ed, elementary, pre-K through 6, then 
grade 6 through 8, then career and technical education, and 
math grade 6 through 12. You know, it is our priority to ensure 
that students get a good education, and that stems from good 
teachers. We need to address the issue head on and find a way 
to help our States to get students back on track after the 
closure of schools for almost 2 years.
    Virginia had an especially aggressive shutdown under our 
Democrat-led governor and General Assembly, and Virginia 
schools are struggling as a result according to a new report 
presented to our current governor. The data demonstrates lower 
student achievement and reading in math, wider achievement 
gaps, reduced transparency, and eroding parent confidence in 
the Commonwealth's public schools. Our governor mentioned that 
the significant lowering of expectations, the lack of 
transparency with data, the weak accountability for these 
results, that ends today. So I am hopeful that our new governor 
will help us get in the right direction.
    Let me ask, Dr. Burke, how would you define a teacher 
shortage? Is there a national definition or is this more of a 
State and local nuanced issue?
    Ms. Burke. Thank you, Representative Cline. I think it is 
just that, a local nuanced issue, as you put it. We see, you 
know, differences across the country, State to State. It is 
certainly not a national problem that needs to be addressed by 
Congress. And, again, I would point to decisions being made by 
local public school districts and States across the country. If 
we look just from 1992 to 2014, we saw per-pupil spending 
increased 27 percent, inflation adjusted, while teacher 
salaries actually fell 2 percent over that same time period. So 
public schools have really chosen to fund a non-teaching 
staffing surge rather than direct these ever-increasing 
taxpayer-funded dollars to higher teacher salaries.
    Mr. Cline. Absolutely. I saw in your testimony the 
statistics. Inflation adjusted per-pupil spending from 1992 to 
2014 increased by 27 percent, but teacher salaries fell by 2 
percent because public schools chose to fund a non-teaching 
staffing surge rather than direct ever-increasing taxpayer-
funded spending to higher teacher salaries. And I am sure that 
that problem is worse in some States as opposed to others. Some 
States are probably doing better. It just goes to show why we 
should encourage States to address the problem, as needed, as 
opposed to imposing a one-size-fits-all requirement. Can you 
talk about how the COVID-19 mandates contributed to the loss of 
teachers?
    Ms. Burke. Sure, and, Representative Cline----
    Mrs. Watson Coleman  [continuing]. And encourage them. So I 
think unions are vitally important to the education of our 
children, and I am glad that the NEA, and AFT, and every other 
union is standing up for them. Thank you, Madam Chair. I yield 
back.
    The Chair. Thank you. Congresswoman Lee. Oh, wait a minute. 
Hang on a second. I am being told here--excuse me--
technological difficulties appear to have arisen. We can't 
proceed with a fully-virtual hearing until the livestream is 
working. Unlike a situation where one or a couple of remote 
members who are unfortunately left out of participating in a 
hybrid hearing because the equipment in the hearing room breaks 
or their equipment at a remote location breaks, having a 
virtual hearing with no livestream breaks House and committee 
rules that have no flexibility apparently.
    Voice. It is working.
    The Chair. Is it working now? Give me a break here. Come 
on, guys, with this technology, all right? We are done. We can 
move on.
    Congresswoman Lee, go ahead.
    Ms. Lee. Thank you, Madam Chair. Thank you, Chairwoman 
DeLauro and Ranking Member, for this hearing. Boy, what a day. 
Let me also thank all of our panelists for being here today, 
especially, and for your tremendous work and leadership in 
securing the future, and that is what you are doing. And let me 
associate myself with all the remarks about the tragic, 
horrific massacre yesterday. Gun violence is continuing to kill 
students, teachers, and staff. It is an epidemic. It is a 
public health epidemic, and it has got to stop. And I am 
getting so worried that this trauma is settling in and people 
are becoming numb to this.
    And I am wondering now, just in terms of a barrier to the 
teaching profession, how are teachers now viewing the epidemic 
of gun violence in terms of wanting to go into the profession? 
I mean, this is heartbreaking, and so we have got to move 
quickly on legislative solutions, which my colleagues have 
cited. So let me just ask Dr. Carver-Thomas a question 
following up with Congresswoman Bonnie Watson Coleman, and good 
to see my sister from Oakland, California, who is doing a 
phenomenal job with regard to students of color and teachers of 
color, and being able to not only relate to these students, but 
also to teach a curriculum that empowers students to learn and 
makes it more interesting in terms of reading.
    I did not have one black teacher until I got into college, 
and it was awful because there was no connection to, for 
example, black history and the curriculum, or African history, 
no connection to who I was as a human being, which really 
created a lot of trauma for not only myself, but most black 
people who are my age. And so can you talk about just the 
relationship between teaching one's history also in the context 
of having teachers of color being able to teach one's history 
within the context of each and every one.
    And then secondly, with regard to the Augustus Hawkins 
Centers of Excellence, I had the privilege to work with 
Congressman Ron Dellums and knew Gus Hawkins very well. I spoke 
at his memorial. I cannot believe that this is just the first 
time we put $1,000,000 per grantee into the program. This 
committee did. So can you just tell us what we need to do, 
given the importance of HBCUs, as it relates to teacher 
education and our young people, because HBCUs really train, 
what, 50 percent of the Nation's black teachers.
    Ms. Carver-Thomas. Thank you, Representative Lee. Yeah, I 
want to reiterate the importance of teachers of color as 
cultural translators that teachers of color are able to connect 
what their students are experiencing to what they are learning 
in the classroom, and that is, you know, important. We see from 
other research the importance of culturally-responsive to 
pedagogy or essentially disconnecting students' experience to 
new information that they might learn that has an impact on 
students' ability to achieve. And we see that borne out in the 
research that those practices lead to better academic outcomes 
for students, which can go a long way toward addressing some of 
the longstanding disparities in student opportunities and 
outcomes that we have seen for decades.
    And, you know, HBCUs, and also tribal colleges and 
universities, and other minority-serving institutions play an 
important role in developing teachers who will go into 
classrooms and serve that important role. And as you mentioned, 
HBCUs disproportionately prepare teachers of color. They are 
preparing more teachers of color, you know, by proportion than 
other kinds of institutions. And so it is incredibly important 
that they have the resources they need to be able to create 
high-quality programs, like residencies and other kinds of 
high-quality teacher preparation programs, that offer the kind 
of rigorous coursework, closely-aligned clinical practice in 
schools, mentoring from expert mentor teachers, and that 
experience in the kinds of schools where teachers will 
ultimately teach
    Teachers of color are more likely to teach in schools 
serving mostly students of color, and it is important that they 
are able to have experience teaching in those settings so that 
they feel confident and well prepared when they enter the 
classroom and am more likely to stay for the long haul.
    Ms. Lee. Can I ask Randi, real quickly before my time is 
up, to comment on the gun violence and how that is affecting 
young people entering into the teaching profession?
    Ms. Weingarten. So, thank you, Congresswoman. Look, all 
morning long, as you can imagine, my phone has been ringing off 
the hook. ``What can we do? ``How do we move through this?'' So 
teachers across the country are thinking about two things at 
the same time. Number one, they are thinking about grandmothers 
in Buffalo and kids in Texas. Number two, they are thinking 
about grandmothers in Buffalo and kids in Texas. And then 
number three, they are thinking about how do we create a safe, 
welcoming environment for all of us. That is why I leaned into 
in this hearing the whole issue about community schools and 
wrapping around services.
    Schools are relational. If we create the trust and we 
connect in terms of relationships, particularly in a post-COVID 
era, that is going to be really, really helpful, and that is 
what teachers are thinking about, not hardening schools, not 
arming themselves, but how we can create a safe, welcoming 
environment.
    Ms. Lee. Thank you, and thank you, Dr. Carver-Thomas, very 
much, both of you for your response.
    The Chair. Ms. Frankel.
    Ms. Frankel. Madam Chair, thank you for this hearing. Thank 
you to all the panelists today, and I am going to follow up 
with something Ms. Weingarten just said. Look, I am going to 
express, of course, my just heartbreak for the brutal murders 
we saw yesterday in Texas and also across this country just in 
the last several weeks. What we are seeing is not just 
proliferation of guns. We are seeing a proliferation of hate.
    I come from Florida. We have a big teacher shortage. It is 
predicted to be about 9,000 teachers next year. We call 
ourselves the Sunshine State. It is the sunshine State except 
in the classroom. We have had two policies that the governor 
and the legislature have just enacted, Ms. Weingarten, and I 
would like your opinion on them. There is a bill that bans any 
classroom discussion on gender identity, sexual orientation, in 
grades K through 3, and bans discussion that any parent might 
find inappropriate in grades K through 12. It has been called 
the Don't Say ``Gay'' bill, but obviously it is much more than 
that. And then there is the Stop WOKE Act, which limits 
workplace and classroom discussions on race, gender, and 
oppression, stifling education and dialogue about race, 
diversity, inclusion, and truths in America's founding. In 
other words, I mean, they banned something like 40 math books 
because they actually asked the question in one of them, how do 
you feel about math. So you don't have to understand what 
children are feeling, respecting their family life.
    And I am just wondering if you have thought about how these 
restrictions can contribute to recruitment challenges and 
driving teachers out of the workforce.
    Ms. Weingarten. So, Congresswoman, as you can imagine, of 
course I have, but part of what has happened over the course of 
generations is that when there is uncertainty in communities, 
there is fertility for a culture war in schools. You saw that 
back in the Scopes trial, you know, years and years ago on the 
issue of evolution versus Bible studies. And I say this as 
someone who is married to a rabbi and very religious. You see 
this now in terms of the anxiety that parents have, and it is 
fertile ground because we have to make sure that we help kids 
recover and thrive in the aftermath of COVID. It is the 
aftermath of COVID as opposed to all the other things. We all 
tried to do the best we could. In fact, parents get this. The 
last NPR poll showed that 88 percent of parents thought that 
teachers did the best they could.
    So what we need to do is create an environment in schools 
where kids are free to dream, and free to think, and to be 
themselves. And that is why the Don't Say ``Gay'' law is so 
negative because if a child says something in a class that is 
under, you know, grade 3, what is a teacher supposed to do? And 
it hamstrings the relationships between teachers and kids. And 
in terms of history, I am a history teacher. We have to teach 
honest history. There are people right now who can't figure out 
how to teach about what happened in Buffalo because there are 
things they can't say. We have to trust our kids and make sure 
parents know what we are doing to actually make sure that kids 
feel the relationships, the agency, the empathy, so that we can 
be a more perfect union. We got to trust people to be able to 
do this.
    Ms. Frankel. Yeah, thank you. And, you know, we don't know 
yet what the motive was for yesterday's shooting. We do know 
that some of these other shootings these past several weeks 
were definitely racist in nature, and we have seen, you know, 
for the past several years, I mean, certainly mental health 
issues. But just getting back to this Florida law, you know, it 
seems to me if teachers have to be on pins and needles that 
they can't say anything that would make somebody uncomfortable 
because they talk about racism is just an idiotic law and 
really is going to cause more racism, more hatred, more 
violence in this country.
    And with that, I thank you all again for being here today. 
I yield back.
    The Chair. Thank you. We are going to be able to have a 
second round, and I know that Congresswoman Lee is there. 
Congressman Cole, I believe, is still on. So if there are 
others, just please let us know. But with that, let me ask, and 
this is a question to Ms. Weingarten. I am concerned, and I 
know you are, and there was a question about parents and 
teachers working together earlier. I am, frankly, concerned by 
a lot of the false narratives that are out there by opponents, 
quite frankly, of public education, pit educators and parents 
against each other, make the conditions much more difficult 
now. And, you know, the efforts to scapegoat, target teachers, 
I think, are counterproductive. They don't reflect, in my view, 
but I want to test this, how parents actually feel about their 
children's teachers and schools.
    There was recent data from Hart Research that finds that 72 
percent of parents say their school provides excellent or good 
quality education. Seventy-eight percent endorsed the quality 
performance of their teacher. And, Ms. Weingarten, you 
represent many members of the communities that are the first 
responders to the societal issues, like poverty, grief, 
children's mental health challenges. How have you seen parents 
and teachers working together to support student learning and 
to support their success?
    Ms. Weingarten. Look, I don't disagree. I actually agree 
that hybrid learning was one of the worst things that happened, 
and many of us, and I think my record--I can speak for myself--
was pretty clear from April 2020, wanting to see how we could 
get schools reopened. I served on the Cuomo task force to get 
schools reopened in New York. I wrote endless numbers of op-eds 
about it, and safety was one of the ways that we did it in a 
very, very uncertain time.
    So the question really becomes, how can we create the 
parent-teacher partnership that is absolutely essential for 
kids to thrive? And we do it in lots of different ways and lots 
of different places, but schooling is one of the only places 
that government gives to parents to actually help their 
families. This is part of the reason why, Chair DeLauro, your 
bill for, you know, full service community schools is so 
important because we can get the Title I coordinators the money 
to wrap services around, to have 25,000 of these community 
schools. And Jeff Canada has taught about this, too, in terms 
of the charter sector. If we can actually do this, we have an 
infrastructure by which parents can always feel comfortable in 
a school, always get answers in a school, have the kind of 
childcare that Representative Clark was talking about. Those 
are the kinds of things we need to do. We need to make sure 
that the parent-teacher relationship is one that is open and 
one that is really respected. And what we see is that schools 
that work have that, and that is what we are trying to do all 
across the country.
    The Chair. I am excited to hear you talk about the 
community schools because, as you know, we put in $75,000,000 
for community schools for 2022, which is about a $45,000,000 
increase, and it is my intention, anyway, to increase that 
effort. I volunteered, again, when I was unemployed, in the 
community school. I watched the school open at 6 a.m., close at 
9:00 or 10:00 p.m. I watched parents, grandparents, kids 
interacting with each other, you know, all through the day, and 
it was an environment in which parents were deeply involved 
with their youngsters and what was happening. So I think we are 
on a track to move back on that. The other piece of that as 
well, if you might just talk about, isn't it true, I mean, 
elected school boards in this country, aren't parents 
represented on elected school boards so that they have a role 
in what is happening in the classroom with their kids? And they 
are on the board, but their kids are in the same school.
    Ms. Weingarten. Look, I am a big believer in local 
governance of schools, and, you know, I have worked in many 
systems. I worked with Mayor Bloomberg, who had mayoral control 
in New York City, and, yes, the two of us actually raised 
salaries--he is very proud of this--43 percent for 
schoolteachers, and it did actually hugely reduce the number of 
uncertified teachers in New York City. And, Dr. Burke, it 
actually did hugely raise scores the next year after we did 
some of that work.
    But what happens is that when you have local boards and you 
create trust, every parent has issues that they are struggling 
with. Every teacher has issues. It is a tough time in America 
right now, but it creates trust to have local boards elected by 
people in the community, and trust is what we are going for. 
And we see that opponents sometimes say, like Christopher 
Wolfel and others, that they are trying to create distrust to 
actually, you know, disconnect people from public schooling. 
But public schooling is something that Republicans, and 
Democrats, and Independents really think is important in 
communities, and the boards and locally-elected boards help 
create that trust.
    The Chair. Thank you. Congressman Cole.
    Mr. Cole. Thank you very much, Madam Chair, and, again, 
thank all of our witnesses. This is a really good discussion.
    Let me go to COVID first, and I want to do this without 
pointing fingers at anybody because I think we were dealing 
with an unprecedented situation, and people basically did the 
best they could wherever they were at, and, you know, we have 
learned some things. My personal view, shutting down schools 
was probably a big mistake, and we have in my State two 
different examples because the two largest school systems in 
Tulsa and Oklahoma City did shut down, but most of the rest did 
not. They shut down early in, you know, right at the end of the 
school year in 2020, but most of them reopened in the fall of 
2020 and remained open under difficult circumstances. And they 
seemed to have better results, honestly, in terms of their kids 
and all the social problems that we have explored at length in 
this committee.
    So I am just going to ask each of you, if you had one or 
two lessons learned out of COVID, I would be very interested in 
what we should think about going forward should we ever 
confront something like this again, and hopefully we don't. 
This was a once-in-a-century event, so we may even, in some 
ways, be overthinking it right now. But we know we are going to 
be dealing with it on this committee for a long time, and we 
know in your school systems you are going to be dealing with it 
because the aftereffects of this thing has a very long tail to 
it.
    So let me start, Ms. Weingarten, with you, and then anybody 
else on the panel. If you had a couple of suggestions or things 
we ought to think about, lessons learned from COVID, I would 
love to hear them.
    Ms. Weingarten. So No. 1, and thank you for the question, 
Congressman Cole. Number one, we need real consistency, to the 
extent possible, in what the public health positioning is. 
People were very confused. Yes, you know, COVID changed and the 
rules changed, but to the extent that we could have real 
consistency coming from all quarters that would have helped 
create trust, would have been very, very helpful, because we 
believe that safety and resources were the way to reopen 
schools. And there are many other people on this committee that 
I had many conversations with about how we create both safety 
and in-person learning. That is number one.
    Number 2, we learned how to trust teachers a lot at the 
beginning of this pandemic. There were no real platforms in 
lots of different places. There had been lots of virtual 
learning beforehand. The former Secretary of Education pushed 
it really hard, but we learned how to trust teachers a lot. 
Let's not stop trusting teachers now that we are back in 
person. They were ingenious. They were creative. So were bus 
drivers. So were food service workers. Let's actually trust 
them the same way we did when we were in an unprecedented 
pandemic.
    Mr. Cole. Thank you. Ms. Carver-Thomas.
    Ms. Carver-Thomas. Thank you.
    Mr. Cole. ``Doctor,'' I should say. I am sorry.
    Ms. Carver-Thomas. It is ``Ms.'' Thank you.
    Mr. Cole. Oh.
    Ms. Carver-Thomas. So I think something that we learned 
from the pandemic was that there is sort of a distinction 
between short-term and long-term solutions to shortages and all 
of the staffing issues that we have been dealing with during 
the pandemic. And, you know, the teacher shortage far predates 
the pandemic and was really exacerbated by the pandemic. And so 
I think it is important, moving forward, to think about what 
are those long-term solutions that can be enacted now so that 
we are not looking for short-term solutions when we are in 
crisis mode that really undercut the ultimate outcomes that we 
want to see for our students.
    Mr. Cole. Thank you very much. Dr. Burke.
    Ms. Burke. Thank you, Representative Cole. The number one 
lesson that we should take away from COVID is that we should 
fund students and not systems. That was a big part of the 
reason parents did not have educational continuity for their 
children is that dollars go to school districts and not 
students themselves. And so when schools shut down, they had 
very few, if any, choices to make sure their children did have 
access to in-person instruction. And so that is a really 
important lesson moving forward is that every single dollar 
that we spend should go directly to families to allow them to 
select into learning environments that work for them, reflect 
their values, and are open for instruction, and safe and 
effective long term.
    Mr. Cole. I am out of time, but, Dr. West, if you could 
quickly respond. I think the chair is always generous with the 
gavel.
    The Chair. Please, take your time, Mr. Cole.
    Ms. West. Thank you, Mr. Cole. I appreciate that question. 
I think, just to echo what Desiree said, our shortage in 
special education has been with us for, you know, as long as I 
have been doing this work, at least 40 years. And like with 
many situations, COVID exacerbated what was already there, so 
we were able to really see this, and these long-term solutions 
are really important. I would also point out that there are 
many students with disabilities with significant health 
conditions for whom a return to school posed an accelerated 
threat. So I think that is important to think about when we 
think about these public health kinds of situations. Clearly, 
it is preferable to be at school in person. Delivering 
something like speech therapy online or if you need one-to-one 
assistance is very challenging to do virtually. Thank you.
    Mr. Cole. Thank you very much, and thank you, Madam Chair, 
for your indulgence on time. I yield back.
    The Chair. Absolutely. Thank you. And Congresswoman Lee.
    Ms. Lee. Thank you very much. Madam Chair, let me just say 
I helped found a community school and worked in a community 
school. It was the Black Panther Party Community School, and, 
Ms. Carver-Thomas, you know the history in Oakland. But the 
kids who went to this community school soared for all the 
reasons we know. They had teachers who cared about them, 
teachers who looked like them. There was a curriculum that they 
could relate to. They exceled in math, and science, and music, 
and it was unbelievable. And so I think community schools are 
really effective, as long as they are public. I don't support 
vouchers or any of the privatizing of public schools, but I 
think community schools really are a very interesting and 
excellent structure for low-income kids, and especially kids of 
color, you know.
    And having said that, I actually worked, when I was in 
California legislature, I worked a lot, and now in Congress, on 
suspension and expulsion of black boys. A couple of years ago, 
there was a study that was done. Like, 40 percent of African-
American babies were expelled and suspended from preschool, and 
we have asked the Department of Education to get a handle 
around this. And also, in California, in the day, kids were 
kicked out or expelled from public schools because the code was 
so vague, that there were no real guidelines on what to do if 
there were issues with children. And, of course, there were no 
resources for alternatives in terms of truancy and making sure 
teachers had a path to, you know, some support system for 
children that, for whatever reason, they thought, you know, 
needed to be expelled.
    So I am wondering now, Ms. Carver-Thomas, if in California, 
have we helped tighten that up so kids have and teachers have 
alternatives so they could teach and so they don't have to be 
mental health counselors, so they don't have to be public 
safety officers? And then secondly, if anyone knows what is 
happening with these young black boys in preschool and are they 
still being expelled like they were few years ago.
    Ms. Carver-Thomas. Yes, thank you, Representative Lee, for 
the question, and there are quite a few different pieces. And 
the first I will say is that one of the studies that I 
mentioned, an LPI study, on positive outliers looked at student 
outcomes that included things like suspension and expulsions, 
disciplinary rates, and showed that teacher certification 
matters for that. And there is other research showing that when 
students have more new teachers, novice teachers, they are also 
more likely to be suspended or expelled, or experiencing 
exclusionary disciplinary practices. And so both of those sort 
of ideas suggest that comprehensive preparation really matters 
for making sure that teachers are prepared with the 
instructional strategies that they need to be able to teach 
without suspending students. The research shows that when 
students of color have more teachers of color, they also have 
fewer rates of suspensions, and expulsions, and chronic 
absenteeism.
    And so it is clear that there are instructional practices 
that make a difference, and having that access to comprehensive 
preparation really matters for students' experiences in the 
classroom. I couldn't speak to the preschool rates of 
suspensions. It is troubling, but I will say that preparation 
can make a difference as far as we know.
    Ms. Lee. Randi, can you, or Jane, or anybody can respond to 
that issue with regard to black boys, black babies?
    Ms. West. Just a quick point on that. We do know that 
students with disabilities and students of color are 
disproportionately suspended from school and have 
disproportionately experienced this rejection from school that 
does not help them advance. We also know that students of color 
are disproportionately included in special education, 
particularly black boys, and it goes back to the skill and 
expertise of the educators being able to work with them in a 
research-based way and their knowledge.
    Ms. Lee. Ms. Weingarten.
    Ms. Weingarten. It is a problem, Congresswoman Lee, and it 
is part of why data is collected to make sure that we change 
this. And one of the ways of doing that is all the restorative 
justice programs plus ensuring, as Dr. West, just said that 
people actually are trained to meet the needs in a culturally-
competent way of all kids. And it is kind of why we are, you 
know, getting at it in a lot of different ways. How do you have 
a more diverse teaching staff? How do you actually deal with 
all issues? How do you create more play time in schools? How do 
you make sure that teachers are prepared?
    Ms. Lee. Thank you. Ms. Burke, would you like to respond?
    Ms. Burke. I don't have any hard data to respond to you, 
Representative Lee, but we do know that when you control for 
behavior, that some of those differences do shrink, but I don't 
have hard numbers that are----
    Ms. Lee. Okay. Thank you. Thank you, Madam Chair. Very 
important hearing, again, the day after such a tragedy. It is 
kind of overwhelming to be here with all of you, and you have 
lifted our spirits and remind us how much work we have to do. 
But we have got to stop the gun violence on campuses.
    The Chair. I would just say, Congresswoman Lee, I think a 
Yale Child Study Center has done a lot of work in this area. 
Dr. Gilliam has, you know, worked on this. I could put you in 
touch with them about what they have found in terms of research 
and data of what is happening to, you know, preschool 
youngsters, et cetera, and expulsions. We at one point did a 
briefing on that issue, and it may be that we can, you know, 
work on something like that again----
    Ms. Lee. I would like to do that. We have got to get this 
under control because we have written a lot into our approps 
bills direction, you know, appropriations, you know, language 
to address this report. We haven't gotten many reports back 
from the Department of Education. I mean, this goes back 10 
years, you know, that I've been working on this here. So that 
would be very helpful, and maybe from this point on, we can get 
a good grasp on what we need to do. Thank you, Madam Chair.
    The Chair. Thank you. Let me ask Congressman Cole, Tom, if 
you want to make any closing remarks, and then I will wrap up.
    Mr. Cole. I will quickly, Madam Chair. First of all, thank 
you again for the hearing, and I marvel at my colleague, Ms. 
Lee from California, because it is 4 hours earlier out there. 
And so when you get up early to participate----
    Ms. Lee. No, I am here, Mr. Cole. [Laughter.]
    Mr. Cole. Well, okay. Well, I still marvel at your stamina 
anyway.
    Ms. Lee. Thank you.
    Mr. Cole. But kudos for anybody that is out West that 
managed to tune into our hearing for any length of time. But is 
a very important hearing, and I want to thank each of you 
witnesses for taking the time. It has been a difficult day, and 
we have all acknowledged that. But like my friend from 
California, I appreciate the fact that you do give us some 
optimism about where we are headed and what our potential is 
and without shortchanging any of the problems that we do have.
    I sometimes think, you know, we try to do too much at the 
Federal level, and I am not talking in terms of money. You 
know, I have often thought we just have too many programs and 
not enough money. We would be better off to focus, narrow down 
on a number of programs and spend the same dollars that we do 
today rather than spread ourselves quite as thin as we do, but, 
you know, that is probably the subject of another hearing.
    And I also do think that we have a larger cultural problem 
right now. I mentioned in my opening remarks, and I probably 
should have pursued some of that in questioning, but it is 
amorphous. But I do think the profession has lost a lot of 
respect, and I regret that. As I said, my son is a public 
school teacher. When I began my career, it was to be an 
educator, certainly not to be a politician. I think it is one 
of the most noble professions that there is, and the fact that 
we have people literally leaving out of discouragement, I mean, 
part of that is there is greener pastures and other 
opportunities. But I think part of it is just exhaustion, and 
we need to rethink, you know, some of the burdens we put on the 
teachers.
    Ms. Weingarten talked about just the sheer paperwork with 
which we excel at the Federal level. You know, we never give 
you money for free, and we always send a list of requirements, 
and reports, and what have you, and that is something we ought 
to think about ourselves. There is a certain level of trust. 
You either trust people at the local level to make good 
decisions or you don't, and I am not talking here about normal 
safeguards in terms of making sure money is not 
misappropriated. But at the end of the day, I like Ms. Burke's 
idea of money following students and empowering students and 
their families to make good choices. There is a lot of merit in 
that, I think, and it puts the decision making and the dollars 
closer together, and that usually works out better, I think, in 
the long run. But regardless of that, I appreciate everybody's 
participation. It was a lively discussion. I thank Mr. Pocan, 
Madam Chair, for suggesting it to you, and I thank you for 
following up so quickly and giving us this opportunity today.
    With that, again, I look forward to continuing to work with 
my friend, the chair, on these issues, and I yield back.
    The Chair. Thank you very, very much. I, too, want to say 
thank you to Mr. Pocan. I know he isn't on, but in the course 
of the last hearing, he suggested this. And, quite honestly, as 
I said earlier, this is the first hearing that we have had on 
the shortage of teachers since the pandemic, but two things let 
me just say. I mean, this has been such a really elevated 
conversation, and I really appreciate the richness of it and 
the discussion.
    Something that the ranking member said is that, you know, 
always revered in our society were teachers, you know. Most 
families in, you know, another generation, you know, wanted you 
to, you know, pursue teaching. That was the thing to do, and 
especially for women that was very true. And I think that Ms. 
Weingarten's, you know, comment about how would you advise your 
child or your grandchild to go into the teaching profession, 
how would you want to give them that sense of the nobility of 
the profession, and we have lost a lot of that recently. And 
what I think is that what we focused here on today is that our 
teacher shortage is a national crisis. It existed before the 
pandemic, and it was exacerbated by the pandemic.
    Retaining teachers is a crisis and we need to try to do 
that. So how do we address that? I mean, I think, again, the 
richness of this conversation has been the suggestions that we 
have had from witnesses: comprehensive preparation, service 
scholarships, teacher residencies, mentorships, induction 
support, improve teaching conditions, Grow Your Own programs, 
dual certifications, more planning time, reduce class size, 
improve teacher pay, special education. How do we train more 
people to be special ed teachers? Teachers of color, that is a 
big issue today. Expand access to collective bargaining, 
community schools. I am so proud that we are having a 
resurgence of the importance of community schools. We did that 
a number of years ago, and then they just shut down, and they 
were vital and dynamic, and then creating that atmosphere for 
students, children, families, academics, you know, teachers 
coming together in the place; mental health support, investing 
in critical preparation programs.
    I mention all those because I want to say, and this is 
encouraging, that we are looking at the Federal level recently, 
and this committee has really made some investments, and that 
is in teacher quality partnerships, which we increased about 
$60,000,000. The Hawkins program, my colleague, Congresswoman 
Lee, it is $8,000,000. This is the first time we moved in this 
direction with the Hawkins Centers of Excellence. IDEA, 
personal preparation. I mentioned community schools, the 
$75,000,000. School-based mental health, you know, which we are 
investing in.
    A number of these suggestions that you all made come under, 
you know, these categories up. We have an opportunity to make 
the investments at this time in areas that have really been 
either flat funded or underfunded for years, understanding the 
breadth of the problems that we face today. And the fact is we 
need to prioritize these investments and understand their value 
in terms of the system that educates our young people, provides 
them with the opportunities for their future, gives them the 
path to success.
    And there is no more noble calling, there is no more 
greater achievement. Everyone here, parents told them to get an 
education. If you get an education, you can succeed, and that 
is what you are all in the business to do. The biggest 
increases have been for HBCUs and MSIs. I only say that because 
I feel good about that we are on track. I want us to be able, 
you know, to do more. And when I think about what happened 
yesterday and how we go forward, because we have to go forward, 
that we have to reassure. We are not talking here today about 
gun violence, but we need to address that and the Congress 
needs to address that in a very serious way.
    But we need to assure teachers that they are safe and their 
families know that they are safe. In the Sandy Hook tragedy, a 
young woman named Victoria Soto, she, protecting her students, 
was shot and killed. It may be the same circumstances for the 
young woman yesterday who had, what, I mean, 15, 17 years of 
teaching. Talk about an experienced teacher. So we have to 
assure teachers and their families that, yes, they are safe, 
and we respect them, and we respect what they do, and put aside 
those who want to just foment dissension amongst our teachers 
and our parents.
    For our students, what can we all say? I went to school. I 
went every day. We all did. Never for a moment did either my 
parents or I felt I wasn't going to return home that day, and, 
today, it lives with each one of our kids, and it lives with 
their parents. This is a moral responsibility that we have to 
address this issue, and to the extent that we can provide the 
moment not only to solace, not only to thoughts, not only to 
prayers, but addressing the situation.
    And I will speak for myself, and I don't know about 
everybody else, but that we cannot ban assault weapons in this 
country is pretty much something that I cannot abide. But we 
need to provide also the kinds of mental health, kinds of 
efforts that can reassure people, and the kinds of things that 
we assure people, that our schools are a safe environment for 
their youngster and for the people who teach our youngsters, 
because after parents, teachers have the most time with our 
children, spend the most time with our children. And we cannot 
ever forget that, and we cannot ever understand the commitment 
that they make.
    We want to work with you. We are willing to address these 
issues in terms of, you know, the various shortages and gaps in 
the current system that we have. We are trying, but we can try 
harder, and with all of your help, we can succeed. So thank you 
so, so much for giving your lives to this profession and making 
sure that kids our kids are well educated and can realize their 
dreams and their aspirations. Thank you so much for today.
    Ms. West. Thank you, Madam Chair. Thank you, Ranking Member 
Cole.
    Ms. Weingarten. Thank you very much.
    The Chair. We will bring it to a close. Thank you very, 
very much.
    Ms. Carver-Thomas. Thank you. Pleasure to be here.
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
                          [all]