[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
CARING FOR AMERICA: LEGISLATION TO SUPPORT PATIENTS, CAREGIVERS, AND
PROVIDERS
=======================================================================
HYBRID HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
OCTOBER 26, 2021
__________
Serial No. 117-55
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Published for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
_______
U.S. GOVERNMENT PUBLISHING OFFICE
56-784 PDF WASHINGTON : 2024
COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California Ranking Member
DIANA DeGETTE, Colorado FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland ADAM KINZINGER, Illinois
JERRY McNERNEY, California H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont GUS M. BILIRAKIS, Florida
PAUL TONKO, New York BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York BILLY LONG, Missouri
KURT SCHRADER, Oregon LARRY BUCSHON, Indiana
TONY CARDENAS, California MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice NEAL P. DUNN, Florida
Chair JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California DEBBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware DAN CRENSHAW, Texas
DARREN SOTO, Florida JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
------
Professional Staff
JEFFERY C. CARROLL, Staff Director
TIFFANY GUARASCIO, Deputy Staff Director
NATE HODSON, Minority Staff Director
Subcommittee on Health
ANNA G. ESHOO, California
Chairwoman
G. K. BUTTERFIELD, North Carolina BRETT GUTHRIE, Kentucky
DORIS O. MATSUI, California Ranking Member
KATHY CASTOR, Florida FRED UPTON, Michigan
JOHN P. SARBANES, Maryland, Vice MICHAEL C. BURGESS, Texas
Chair H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon BILLY LONG, Missouri
TONY CARDENAS, California LARRY BUCSHON, Indiana
RAUL RUIZ, California MARKWAYNE MULLIN, Oklahoma
DEBBIE DINGELL, Michigan RICHARD HUDSON, North Carolina
ANN M. KUSTER, New Hampshire EARL L. ``BUDDY'' CARTER, Georgia
ROBIN L. KELLY, Illinois NEAL P. DUNN, Florida
NANETTE DIAZ BARRAGAN, California JOHN R. CURTIS, Utah
LISA BLUNT ROCHESTER, Delaware DAN CRENSHAW, Texas
ANGIE CRAIG, Minnesota JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington CATHY McMORRIS RODGERS, Washington
LORI TRAHAN, Massachusetts (ex officio)
LIZZIE FLETCHER, Texas
FRANK PALLONE, Jr., New Jersey (ex
officio)
C O N T E N T S
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Page
Hon. Anna G. Eshoo, a Representative in Congress from the State
of California, opening statement............................... 2
Prepared statement........................................... 4
Hon. Brett Guthrie, a Representative in Congress from the
Commonwealth of Kentucky, prepared statement................... 6
Prepared statement........................................... 8
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 12
Prepared statement........................................... 14
Hon. Cathy McMorris Rodgers, a Representative in Congress from
the State of Washington, opening statement..................... 16
Prepared statement........................................... 18
Witnesses
J. Corey Feist, JD, MBA, President and Founder, Dr. Lorna Breen
Heroes' Foundation............................................. 24
Prepared statement........................................... 27
Answers to submitted questions............................... 254
Lisa Macon Harrison, M.P.H., President, National Association of
County and City Health Officials............................... 35
Prepared statement........................................... 37
Brooks A. Keel, Ph.D., President, Augusta University............. 41
Prepared statement........................................... 43
Victoria Garcia Wilburn, D.H.Sc., OTR, F.A.O.T.A., Assistant
Professor, Occupational Therapy, School of Health and Human
Sciences, IUPUI................................................ 47
Prepared statement........................................... 49
Answers to submitted questions............................... 256
Alan Levine, CEO, President, Ballad Health....................... 52
Prepared statement........................................... 54
Stephanie Monroe, J.D., Director, Equity and Access,
UsAgainstalzheimer's, Executive Director, AfricanAmericans
AgainstAlzheimer's............................................. 64
Prepared statement........................................... 67
Jeanne Marrazzo, M.D., Director, Division of Infectious Disease,
University of Alabama at Birmingham............................ 72
Prepared statement........................................... 74
Submitted Material
H.R. 1474, the Alzheimer's Caregiver Support Act, submitted by
Ms. Eshoo...................................................... 133
H.R. 1667, the Dr. Lorna Breen Health Care Provider Protection
Act, submitted by Ms. Eshoo.................................... 138
H.R. 3297, the Public Health Workforce Loan Repayment Act of
2021, submitted by Ms. Eshoo................................... 148
H.R. 3320, the Allied Health Workforce Diversity Act of 2021,
submitted by Ms. Eshoo......................................... 156
H.R. 5583, the Helping Enable Access to Lifesaving Services Act,
submitted by Ms. Eshoo......................................... 163
H.R. 5594, the Enhancing Community Health Workforce Act,
submitted by Ms. Eshoo......................................... 165
H.R. 5602, the Bolstering Infectious Outbreaks Preparedness
Workforce Act of 2021, submitted by Ms. Eshoo.................. 167
Letter of October 25, 2021, from Peter M. Leibold, Executive Vice
President, Chief Advocacy Officer, Ascension, to Mr. Palloneand
Mr. McMorris Rodgers, submitted by Ms. Eshoo................... 181
Letter of October 25, 2021, from George C. Benjamin, M.D.,
Executive Director, the American Public Health Association, to
Ms. Eshoo and Mr. Guthrie, submitted by Ms. Eshoo.............. 183
Letter of October 22, 2021, from Orly Avitzur, M.D., President,
American Academy of Neurology, to Ms. Eshoo and Mr. Guthrie,
submitted by Ms. Eshoo......................................... 185
Letter of October 26, 2021, from Ada D. Stewart, M.D., Board
Chair, American Academy of Family Physicians, to Ms. Eshoo and
Mr. Guthrie, submitted by Ms. Eshoo............................ 187
Statement of American Association for Respiratory Care, October
26, 2021, submitted by Ms. Eshoo............................... 192
Letter of October 22, 2021, from Mark Rosenberg, DO, MBA, FACEP,
President, American College of Emergency Physicians, to Ms.
Eshoo and Mr. Guthrie, submitted by Ms. Eshoo.................. 194
Letter of October 25, 2021, from A. Lynn Williams, Ph.D., CCC-
SLP, President, American Speech-Language-Hearing Association in
to Ms. Eshoo and Mr. Guthrie, submitted by Ms. Eshoo........... 199
Letter of October 25, 2021, from Charles J. Fuschillo, Jr.,
President and CEO, Alzheimer's Foundation of America, to Ms.
Eshoo and Mr. Guthrie, submitted by Ms. Eshoo.................. 200
Letter of October 26, 2021, from Sharon L. Dunn, PT, Ph.D.,
Board-Certified Clinical Specialist in Orthopaedic Physical
Therapy,President, American Physical Therapy Association, to
Ms. Eshoo and Mr. Guthrie, submitted by Ms. Eshoo.............. 202
Letter of October 26, 2021, from Mary R. Grealy, President,
Healthcare Leadership Council, to Mr. Pallone and Ms. McMorris
Rodgers, submitted by Ms. Eshoo................................ 205
Letter of October 13, 2021, from Beth Feldpush, DrPH, Senior Vice
President of Policy and Advocacy, America's Essential
Hospitals, to Mr. Schumer, et al., submitted by Ms. Eshoo...... 208
Letter of October 26, 2021, from Jane M. Adams, Vice President,
Federal Government Affairs, and Lauren Moore, Vice President,
Global Community Impact, Johnson and Johnson, to Mr. Pallone
and Ms. McMorris Rodgers submitted by Ms. Eshoo................ 213
Letter of October 21, 2021, from Melissa B. Miller, Ph.D., Chair,
Clinical and Public Health Microbiology Committee and Stacey L.
Schultz-Cherry, Ph.D., Chair, Public and Scientific Affairs
Committee, American Society for Microbiology, to Ms. Trahan and
Mr. McKinley, submitted by Ms. Eshoo........................... 215
Letter of October 25, 2021, from 15 Independent Children's
Hospitals, to Mr. Pallone, submitted by Ms. Eshoo.............. 217
Letter of October 11, 2021, from Jerome Siy, M.D., MHA,
President, Society of Hospital Medicine, to Ms. Wild and Mr.
McKinley, submitted by Ms. Eshoo............................... 221
Letter from Jason Delamarter, Chief Operating Officer, Prestige
Care Inc., to McMorris Rodgers, submitted by Ms. Eshoo......... 222
Letter of October 25, 2021, from George M. Abraham, M.D., MPH,
MACP, FIDSA, President, American College of Physicians, to Mr.
Pallone and et al., submitted by Ms. Eshoo..................... 225
Letter of October 22, 2021, from 36 Organizations, to Ms. Trahan
and Mr. McKinley, submitted by Ms. Eshoo....................... 227
Letter of October 26, 2021, from Representative Maxine Waters, to
Mr. Pallone and et al., submitted by Ms. Eshoo................. 230
Statement of October 26, 2021, from the Alzheimer's Association
and Alzheimer's Impact Movement, submitted by Ms. Eshoo........ 236
Statement of October 26, 2021, from J. Nadine Gracia, M.D., MSCE,
President and CEO, Trust for America's Health, to Ms. Eshoo and
Mr. Guthrie, submitted by Ms. Eshoo............................ 239
Statement of October 26, 2021, from the American Hospital of
Association, submitted by Ms. Eshoo............................ 241
Report of the Government Accountability Office, ``Health Care
Workforce Federally Funded Training Programs in Fiscal Year
2012,'' August 15, 2013, submitted by Ms. Eshoo \1\
----------
\1\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF14/
20211026/114166/HHRG-117-IF14-20211026-SD018.pdf.
Letter of October 25, 2021, from Members of Congress, to
President Biden, submitted by Ms. Eshoo........................ 244
Letter of October 25, 2021, from Members of Congress, to Ms.
Brooks-LaSure, submitted by Ms. Eshoo.......................... 246
Statement from Ron Kraus, Clinical Nurse Specialist at Indiana
University Health Methodist Hospital and 2021 President of the
Emergency Nurses Association, submitted by Ms. Eshoo........... 249
CARING FOR AMERICA: LEGISLATION TO SUPPORT PATIENTS, CAREGIVERS, AND
PROVIDERS
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TUESDAY, OCTOBER 26, 2021
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The Subcommittee met, pursuant to call, at 10:30 a.m., in
the John D. Dingell Room, 2123 of Rayburn House Office
Building, and remotely via Cisco Webex online video
conferencing, Hon. Anna Eshoo (chairwoman of the subcommittee),
presiding.
Members present: Representatives Eshoo, Butterfield,
Matsui, Castor, Sarbanes, Welch, Schrader, Cardenas, Ruiz,
Dingell, Kuster, Barragan, Blunt Rochester, Craig, Schrier,
Trahan, Fletcher, Pallone (ex officio), Guthrie (subcommittee
ranking member), Upton, Burgess, Griffith, Bilirakis, Long,
Bucshon, Mullin, Hudson, Carter, Dunn, Curtis, Crenshaw, Joyce,
and Rodgers (ex officio).
Also present: Representatives Rush, Schakowsky, Latta, and
Pence.
Staff present: Shana Beavin, Professional Staff Member;
Waverly Gordon, Deputy Staff Director and General Counsel;
Tiffany Guarascio, Staff Director; Zach Kahan, Deputy Director
Outreach and Member Service; Mackenzie Kuhl, Press Assistant;
Aisling McDonough, Policy Coordinator; Meghan Mullon, Policy
Analyst; Juan Negrete, Junior Professional Staff Member; Tim
Robinson, Chief Counsel; Chloe Rodriguez, Clerk; Andrew
Souvall, Director of Communications, Outreach, and Member
Services; Kimberlee Trzeciak, Chief Health Advisor; Caroline
Wood, Staff Assistant; C.J. Young, Deputy Communications
Director; Alex Aramanda, Minority Professional Staff Member,
Health; Sarah Burke, Minority Deputy Staff Director; Theresa
Gambo, Minority Financial and Office Administrator; Seth Gold,
Minority Professional Staff Member, Health; Grace Graham,
Minority Chief Counsel, Health; Nate Hodson, Minority Staff
Director; Peter Kielty, Minority General Counsel; Emily King,
Minority Member Services Director; Bijan Koohmaraie, Minority
Chief Counsel, Over and Investigations Chief Counsel; Clare
Paoletta, Minority Policy Analyst, Health; Kristin Seum,
Minority Counsel, Health; Kristen Shatynski, Minority
Professional Staff Member, Health; Olivia Shields, Minority
Communications Director; and Michael Taggart, Minority Policy
Director.
Ms. Eshoo. The Subcommittee on Health will now come to
order.
Due to COVID-19, today's hearing is being held remotely, as
well as in person.
Good morning, colleagues. For members and witnesses taking
part in person, we are following the guidance of the CDC and
the Office of the Attending Physician. So please wear a mask
when you are not speaking. For members and witnesses taking
part remotely, microphones will be set on mute to eliminate
background noise. Members and witnesses, you will need to
unmute your microphone when you wish to speak.
Since members are participating from different locations at
today's hearing, recognition of members for questions will be
in the order of subcommittee seniority.
Documents for the record should be sent to Meghan Mullon at
the email address we have provided to your staff, and all
documents will be entered into the record at the conclusion of
the hearing.
The Chair now recognizes herself for 5 minutes for an
opening statement.
OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
In the first year of the pandemic, over 3,600 U.S.
healthcare workers died fighting COVID-19, and this is
according to the Guardian, and Kaiser Health News. And since
February 2020, about one in five healthcare workers have quit
their jobs. For those still on the job, almost all report
experiencing stress and most report being emotionally and
physically exhausted.
As a country we have responded, really, with mostly
symbolic support: ticker tape parades, ``healthcare hero'' yard
signs, and Time Magazine dedicating its cover to frontline
health workers. Congress provided Federal aid to support
healthcare institutions through the $175 billion Provider
Relief Fund, but it has been difficult to track how much of
that aid made it to the workers themselves.
On the West Coast, more than 24,000 nurses and other
healthcare workers have authorized a strike over pay and
working conditions as we meet this morning. Public health
workers, as well as doctors and nurses, also report being
physically threatened. In my district, Dr. Sara Cody, the top
Santa Clara County public health official, was stalked and
threatened over her decisions to protect public health during
the pandemic. And Asian-American healthcare workers have faced
a new wave of racial harassment in the workplace during COVID-
19.
This is the urgent backdrop as we meet in this hearing
today. We are considering seven bills, five of which are
bipartisan, focused on supporting current caregivers, as well
as rebuilding the pipeline of future workers. Three of the
bills set up loan repayment programs for the healthcare
workforce, which will directly reward future workers for their
important contributions. Two other bills, the Dr. Lorna Breen
Health Care Provider Protection Act and the Alzheimer's
Caregiver Support Act recognize that current caregivers need
stronger support to help them weather their physically and
emotionally draining work.
Our Subcommittee is honored to welcome Mr. Corey Feist and
Ms. Jennifer Breen Feist. They are the brother-in-law and
sister of Dr. Lorna Breen, who died by suicide after
experiencing the mass death of the first wave of COVID-19
patients and then contracting the virus herself. Since their
sister's death, they have dedicated themselves to addressing
clinician burnout and suicide.
What an honor to have you here with us today.
The Dr. Lorna Breen Health Care Provider Act provides grant
funding for suicide prevention and peer support at healthcare
facilities. It also makes sure that healthcare professionals
can ask for mental help without facing negative consequences in
their careers.
We are also honored to welcome back to the Congress
Stephanie Monroe, who has served as Chief Counsel to the Senate
HELP Committee during her 25-year career on the Hill. Ms.
Monroe now serves as the Executive Director of African
Americans Against Alzheimer's, and is the current caregiver for
her 84-year old father, who is living with Alzheimer's. She
will testify in support of the Alzheimer's Caregivers Support
Act, which provides grants to expand support services for the
unpaid caregivers of people living with Alzheimer's and other
dementia.
The final two bills being considered today will reauthorize
grants and fellowship programs for clinicians in medically
underserved communities--and we have so many members that
represent those communities--and volunteers for community
health centers.
This hearing, I believe, is the first step toward treating
our nation's healthcare workers as heroes. We have called them
that, but now we have to act. I look forward to today's expert
testimony that will be provided by our witnesses.
We thank you for traveling the distances that you have to
be with us and to moving these important bills through our
Subcommittee as swiftly as possible. We want this to get to the
finish line. We want these bills to get to the finish line,
send them to the President for his signature into law, and then
the words on the pages will walk into people's lives.
[The prepared statement of Ms. Eshoo follows:]
Prepared Statement of Hon. Ann Eshoo
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. The Chair now recognizes the Ranking Member of
our Subcommittee, Mr. Guthrie, for his 5 minutes of opening
statements.
OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH STATE OF KENTUCKY
And it is great to see you and be with you today.
Mr. Guthrie. Thank you, Chair Eshoo, it is great to be with
you, as well, and thanks for holding this important hearing.
And thanks to have all of our witnesses with us here today.
Today we are examining bills that aim to support patients,
caregivers, and providers. Now, more than ever, due to the
COVID-19 pandemic, our country is facing severe workforce
shortages, and the healthcare industry is no exception.
Since the beginning of the pandemic, healthcare workers
have stepped up to the plate, and have been on the front lines
fighting against this terrible virus. I want to take a moment
and thank each and every healthcare worker for their selfless
attitude as you continue to go to work and help our nation at a
crucial time in our history.
I think we all agree on the importance of increasing
recruitment and retention in our nation's healthcare workers.
However, I am concerned, and I want to point out about the
impact of President Biden's COVID-19 vaccine mandate on the
workforce. Numerous Kentuckians have told me that the
anticipated Center for Medicare and Medicaid Services and
Occupational Safety and Health Administration rule is leading
to many people to quit their jobs.
This is--there is confusion. The mandates were announced
months ago, but rules have yet to be released. Many questions
remain, including how will someone get an exemption, will prior
infection count, and is testing an alternative to comply.
Another hurdle in attracting and retaining people to the
healthcare workforce is the high cost of obtaining a medical
degree. I continually hear from constituents that the reason
for not pursuing a degree or certificate in healthcare is due
to the financial burden of tuition costs. To help alleviate
this distress, I introduced the Public Health Workforce Loan
Repayment Act, along with Representatives Eshoo, the chair,
Burgess, and Crow.
This bill, this bipartisan bill, would establish the Public
Health Workforce Loan Repayment Program to promote the
recruitment of public health professionals at local, state, and
tribal public health agencies. I believe a strong public health
infrastructure starts with health professionals at its core.
Additionally, we continue to encourage private entities and
states to create innovative solutions in order to tackle
staffing shortages in the healthcare field. For example, one of
the most vital healthcare needs confronting Kentucky is the
shortage of physicians, particularly primary care doctors
serving in community settings. I am proud to represent the
University of Kentucky's College of Medicine Bowling Green
Campus in my district and my hometown, which aims to address
this critical need.
Launched in 2018, the Bowling Green Campus has increased
the size of the UK College of Medicine by 120 students, a 20
percent increase. The school provides students two
opportunities to obtain a combined degree, whether an MD/MPH or
an MD/MBA.
Another great example is the Medical College of Georgia 3+
program that Dr. Keel will testify before us today. Arkansas--I
will leave you--leave that to explain your program yourself,
and--but I will talk about Arkansas, Maryland, and Nebraska
have launched new recruitment and retention programs. For
example, Arkansas recently created their first graduate
registered nurse apprenticeship program, and Nebraska announced
new online resources to connect with healthcare facilities with
staffing needs. As co-chair of the Congressional Apprenticeship
Caucus, I have been a strong supporter of apprenticeships, and
believe they are a great avenue for workers and employees.
Lastly, as we discuss these bills before us today, we need
to keep in mind that Congress has already authorized 5.9
trillion in funding to provide COVID assistance and relief for
Americans, including money intended to address workforce
shortages in healthcare. President Biden's $1.9 trillion
American Rescue Plan, which was signed into law in March of
2021, provided significant mandatory funding for workforce
initiatives, including 7.6 billion for the public healthcare
workforce.
I voted for all the previous, but--COVID relief. But to
make note, and to be fair, I didn't vote for the American
Rescue Plan. However, I want to point out that many states,
like my home state of Kentucky, have yet to receive much of
this funding. We need to ensure the remaining funds that have
not been dispersed are being spent effectively, and take stock
of that spending.
I want to thank all of the witnesses for being here today,
and I look forward to hearing from each of you as--on ways we
can better address and find solutions to current healthcare
workforce shortages.
[The prepared statement of Mr. Guthrie follows:]
Prepared Statement of Hon. Brett Guthrie
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Guthrie. Thank you, and I yield back.
Ms. Eshoo. The gentleman yields back. The Chair is now
pleased to recognize the Chairman of the Full Committee, Mr.
Pallone, for his 5 minutes for an opening statement.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Chairwoman Eshoo. Last week we held
a legislative hearing to examine bills that would improve the
health of children and families. And today this Subcommittee
meet to discuss a slate of bipartisan bills that seek to
strengthen America's health workforce, and support our
communities and providers.
The legislation before us now would foster a robust public
health workforce and provide support to those who fought on the
front lines of the COVID-19 pandemic. Throughout the pandemic,
physicians, nurses, scientists, contact tracers, community
health workers, and many others have worked tirelessly to
attend to the needs of patients, and to promote the health and
wellbeing of our communities. And it is a tribute to their
selfless work over the last 18 months that we are gradually
approaching a new normal, but we are not out of the woods yet.
The pandemic has stressed our healthcare system, with many
healthcare workers suffering from fatigue and burnout. And
unfortunately, some workers are leaving the workforce entirely.
Historically underserved areas, rural and tribal communities,
in particular, are suffering from a lack of access to basic
public health services and are experiencing workforce
shortages.
And there is also an alarming trend in the mental health of
healthcare professionals. An April survey from the Kaiser
Family Foundation and the Washington Post found that a majority
of frontline healthcare workers say that stress related to
COVID-19 has had a negative impact on their mental health and
that same survey found that only 12 percent of healthcare
workers receive mental health services. An additional 18
percent reported that even though they thought they needed
care, they did not seek it due to busy schedules, stigma, fear,
or financial concerns.
These issues demonstrate the need for broad investments and
support for our healthcare workforce. This includes resources
to recruit and retain talented health professionals and to
protect their mental well-being going forward. And the seven
bills before us today recognize the urgency of these issues by
addressing the mental health burden faced by frontline workers,
creating incentives and novel pathways for services to
underserved communities, strengthening workforce capacity so we
can meet future public health emergencies head on, and
incorporating the needs of caregivers for Alzheimer's patients.
I just wanted to mention the bills H.R. 1667, the Dr. Lorna
Breen Health Care Provider Protection Act authorizes grants for
mental and behavioral health training for healthcare workers.
It also authorizes grants for its programs and campaigns to
improve the mental health and resiliency of healthcare
providers. This bill was named for Dr. Lorna Breen, the medical
director of the emergency department at New York-Presbyterian
Allen Hospital, whose family is here to provide testimony on
the bill. And I would like--I want to thank them for being here
today.
Two of the bills before us aim to build a more diverse and
community-based healthcare workforce. H.R. 5594, the Enhancing
Community Health Workforce Act, would improve health outcomes
in medically underserved neighborhoods by investing in outreach
through community health workers.
And then there is H.R.--I guess it is 33520 (sic), the
Allied Health Workforce Diversity Act, that seeks to increase
diversity in the physical, occupational, and respiratory
therapies, as well as audiology and speech language pathology
professions. And this legislation would accomplish--would,
basically, authorize grants for scholarship stipends and
recruitment and retention programs for students from under-
represented backgrounds.
We are also considering bills that would provide guidance
on how to expand our pandemic response and strengthen workforce
resiliency. H.R. 3297, the Public Health Workforce Loan
Repayment Act, establishes a student loan repayment program for
public health professionals that complete a period of full-time
employment with a state, tribe, or local public health agency
for at least three years.
And then there is H.R. 5602, the BIO Preparedness Workforce
Act, that helps grow the infectious disease workforce by
creating loan repayment programs for healthcare professionals
who spend at least half of their time engaged in bio
preparedness and response activities. And they will also be
eligible if they provide infectious disease care in a shortage
designation area, underserved community, or federally funded
facility.
And then the last bill, H.R. 1474, the Alzheimer's
Caregiver Support Act, authorizes additional funding to expand
training and support services for unpaid caregivers of people
living with Alzheimer's disease.
So obviously, these are all important. We would like to
move them forward and I look forward to our discussion and
hearing more from the panel, Madam Chair.
[The prepared statement of Mr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone Jr.,
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Pallone. Thank you again, Ms. Eshoo.
Ms. Eshoo. The gentleman yields back. It is a pleasure to
recognize the Ranking Member of the Full Committee,
Congresswoman Cathy McMorris Rodgers, for her 5 minutes for
opening statement. And she is joining us, I believe----
Mrs. Rodgers. In person.
Ms. Eshoo. Oh, you are here. Oh, that is great. I am
looking up at the screen.
OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON
Mrs. Rodgers. Thank you, Madam Chair. To all Americans who
work in healthcare, thank you. You are all heroes who have been
on the front lines at every stage during this pandemic, caring
for people who need you. Your sacrifices, especially during
these most uncertain times, is why we will not stop our
investigation into COVID-19 origins. We must hold China
accountable for hiding lifesaving information that could have
made your job easier.
I know you are tired. There is great frustration and
anxiety. Health care providers from my home state of Washington
are sounding the alarm. Our vaccine mandate took effect on
October 18th. According to the Washington Hospital Association,
they expect to lose up to five percent of their entire
workforce. That is up to 7,500 workers whose patients and
families are depending upon them.
I hope that the Biden Administration will learn a lesson
from these mandates that have made Washington State a difficult
place right now, and I hope that he will abandon--President
Biden, will abandon--his top-down federal mandate. This
approach, these type of mandates, only promote fear and
control. And they are making the shortages worse.
Across the country, 11 million jobs remain unfilled. It is
more expensive to purchase nearly everything, from food to
fuel. It is getting harder to get by. And ultimately, more and
more people are facing a choice to either comply with a
mandate, or lose their livelihood altogether. I have heard too
many heart-wrenching, heartbreaking stories from individuals in
eastern Washington in recent weeks. The hard-working men and
women of this country, especially our frontline healthcare
workers, our heroes, need solutions, not force and fear that is
eroding trust in public health.
I am glad that Mr. Levine is here to discuss what
challenges he is facing, and how Congress might be able to
help.
I have always been a strong supporter of existing federal
incentives to support health provider training and education,
including championing the reauthorization of the Teaching
Health Center Graduate Medical Education Program. Through the
CARES Act, Congress reauthorized the major health workforce
programs under title 7 and title 8 of the Public Health
Services Act, run by Health Resources and Services
Administration.
CARES also required a strategic plan to better inform
Congress on a framework for addressing workforce needs. This
plan was given to us last night, a month over--after it was
due. It certainly would have been helpful to have it before
last night, but we will look forward to looking at that to
better direct our legislative efforts that we are considering
today.
In addition to many existing grant programs that support
health workforce through CMS payments, the Federal Government
has spent roughly $16 billion per year on the health workforce
as of 2015. In December 2020, Congress passed legislation that
will add 1,000 new GME slots, starting in 2023.
Further, in the American Rescue Plan, Democrats, although
they went it alone, they allocated a lot of money on workforce
programs, including billions for public health programs,
hundreds of billions for more Medical Reserve Corps, National
Health Service Corps, Nurse Corps, teaching health centers, and
behavioral health workforce. In reconciliation, Democrats are
also providing almost 150 million in mandatory funding for an
unauthorized program that some are now seeking to authorize
through one of the bills before us today.
While I support the intent of this program, this is the
wrong way to legislate. We need to know what is actually
working before spending more money, and authorizing more
programs.
We should be looking at how states are leading. Governors
DeSantis and Baker gave more flexibility with staffing ratios,
including the use of personal care attendants to meet
requirements. Governor Sununu authorized military service
members and emergency medical technicians to obtain temporary
licenses as nursing assistants. Governors Hogan, Hutchinson,
and Ricketts worked to streamline licensing, by allowing nurses
from out of state to practice, waiving application fees for
nursing licenses, and removing red tape for license renewals.
States are also funding programs and working with medical
schools on long-term strategies to improve retention in
underserved areas. Dr. Keel is here today to share how Augusta
University is leading to reduce medical debt, and encourage
doctors to work in underserved areas in Georgia. I am excited
to hear about this, and how maybe it could work in my home
state of Washington.
Overall, states regulate the practice of medicine. At the
Federal level, we need to support states and share best
practices.
The healthcare workforce plays a key role in our economy,
keeps our patients healthy and safe. We owe so much to our
frontline workers, who have been at the forefront of this
pandemic. Let's hear from the states. Let's hear from those
that are on the front lines. I yield back.
[The prepared statement of Mrs. Rodgers follows:]
Prepared Statement of Hon. Cathy McMorris Rodgers
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. The gentlewoman yields back.
The Chair reminds Members that, pursuant to committee
rules, all Members' written opening statements shall be made
part of the record, so make sure, members, you get your
marvelous remarks in.
I now would like to introduce our witnesses.
First, Mr. Corey Feist. He is the founder of the Dr. Lorna
Breen Foundation. He is the brother-in-law of Dr. Breen. And
with him, seated behind him, is Jennifer Breen Feist, Dr.
Breen's sister.
Thank you for being here today, on behalf of everyone on
the committee. We are very grateful to you for being willing to
testify.
Next, Ms. Lisa Macon Harrison, she is the president of the
National Association of County and City Health Officials. And I
would like to call on Mr. Butterfield to enhance her
introduction, because she is his constituent.
So are you with us?
Mr. Butterfield. I am with you. Thank you, and good
morning, Madam----
Ms. Eshoo. There you are.
Mr. Butterfield. Madam Chair, and----
Ms. Eshoo. Good morning.
Mr. Butterfield. Can you hear me?
Ms. Eshoo. Yes, very well.
Mr. Butterfield. OK, thank you.
Ms. Eshoo. Yes.
Mr. Butterfield. Good morning, Madam Chair. Good morning to
all of my colleagues, and thank you to all of the witnesses for
your testimony today. I will be very brief, but I want to
introduce to my colleagues Lisa Macon Harrison.
Ms. Harrison is the--testifying today in her capacity as
president of the National Association of County and City Health
Officials. But she is also the health director of Vance County,
which is in my congressional district, and Granville County,
which is in the adjoining area. Ms. Harrison has worked at the
intersection of public health research and practice in my great
state of North Carolina since 1995. She has a bachelor's degree
in public health and public policy, and a master of public
health from the Gillings School of Global Public Health at the
legendary UNC Chapel Hill.
She has co-authored more than 30 peer-reviewed
publications, and is associated with both UNC Chapel Hill and
the Duke University School of Nursing. Even though these
schools are competitors in sports, they collaborate every day
in academics and other endeavors.
So thank you, Ms. Harrison, for coming today.
I will conclude by saying that she serves as a member of
the North Carolina Institute of Medicine, and is a past
president of the North Carolina Public Health Association. She
is a current president of the National Association of County
and City Health Officials, and previously represented five
southern states on its board of directors.
As you can see, our witness is well-qualified to testify
today.
Thank you very much, Madam Chair. I yield back.
Ms. Eshoo. Thank you, Mr. Butterfield. Beautiful words
about Ms. Harrison, and it is always a reminder to me of what
extraordinary Americans we have in their--whatever their
capacity is, they come here, and we are better for it.
Dr. Brooks Keel, he is the president of Augusta University,
and I would like to recognize Mr. Carter to introduce his
constituent, Dr. Keel.
But a warm welcome to you, Doctor. It is great to see you.
Mr. Carter. Well, thank you, Madam Chair and Ranking Member
Guthrie, for inviting a great witness to testify today from my
home state of Georgia, Dr. Brooks Keel.
Dr. Keel is the president of Augusta University. It is the
ninth largest medical school in the country. Georgia, as you
know--we often say there are two Georgians, there is Atlanta
and everywhere else. And of course, everywhere else is pretty
much rural. And Georgia has faced severe physician shortages in
rural areas of our state, and Dr. Keel's leadership has led
Augusta University to create a unique solution to this problem
to encourage students to open practices in medically
underserved areas. I am excited to introduce him today.
Thank you for being here, Dr. Keel, and I know we are all
looking forward to hearing more about this innovative program
that I think is going to benefit all rural areas of our
country, but particularly, in the beginning, the rural areas of
Georgia. So thank you very much for being here.
Ms. Eshoo. Thank you, Mr. Carter.
Dr. Victoria Garcia Wilburn is an assistant professor of
occupational therapy at the IUPUI School of Health and Human
Sciences.
Welcome to you, a warm welcome. Thank you for being here
with us today.
And last, but not least, Alan Levine is the executive
chair, president, and CEO of Ballad Health, a health system
serving Northeast Tennessee, Southwest Virginia, Northwest
North Carolina, and Southeast Kentucky. I would like to
recognize Mr. Griffith to introduce Mr. Levine, since he is one
of his constituents.
Mr. Griffith. Thank you.
Ms. Eshoo. So you are recognized, my friend.
Mr. Griffith. Thank you very much. I appreciate it, and I
would like to welcome Alan Levine here with us today, I have
known him for many years.
He is chairman, president, and chief executive officer of
Ballad Health, which, as you heard, serves a big chunk of area
in Appalachia. Ballad Health operates 13 hospitals in
Tennessee, 7 in my district in Southwest Virginia, including
the Lee County Community Hospital, which opened earlier this
year in Pennington Gap.
And I say opened, because it had closed and, working with
the community, they reopened it. They were able to get it
reopened about four or five years after it had originally
closed. That is fairly unusual for hospitals in rural areas
that close, particularly in rural Appalachia. So we are very
pleased about that.
Ballad employs 14,000 individuals, including 800
physicians, many of whom serve in very rural areas. His wife,
Laura, is a nurse, and they have two grown children, who also
have careers in healthcare.
So, we are very glad to have him with us today, and
appreciate him taking his time. Even though he couldn't be here
live with us in the room, he will be participating on the
video.
Ms. Eshoo. The gentleman yields back?
Thank you.
Ms. Stephanie Monroe, she is the director of equity and
access of UsAgainstAlzheimer's, and executive director of
AfricanAmericansAgainstAlzheimer's.
Thank you for being with us today. It is wonderful to see
you, and thank you for your extraordinary leadership.
Dr. Jeanne Marrazzo is a board member of the Infectious
Disease Society of America and Infectious Disease Division
Chief of the University of Alabama at Birmingham.
Thank you, Dr. Marrazzo, to you, as we welcome and
acknowledge not only all of the brilliance that you each bring
to the hearing today, but for your life's work. You have made
our country better, and you do every day.
So thank you, each one, for joining us. We look forward to
your testimony. You are probably--I don't know if you are
familiar with the lights in front of you. Green, just go for
it. Yellow, warning. And you know what red is.
So we will start with Mr. Feist for your 5 minutes of
testimony. And again, thank you for being with us.
STATEMENT OF COREY FEIST, FOUNDER, DR. LORNA BREEN HEROES'
FOUNDATION; LISA MACON HARRISON, M.P.H., PRESIDENT, NATIONAL
ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO);
BROOKS A. KEEL, PH.D., PRESIDENT, AUGUSTA UNIVERSITY; VICTORIA
GARCIA WILBURN, D.H.SC., O.T.R., F.A.O.T.A. ASSISTANT
PROFESSOR, OCCUPATIONAL THERAPY, IUPUI SCHOOL OF HEALTH & HUMAN
SCIENCES; ALAN LEVINE, EXECUTIVE CHAIRMAN, PRESIDENT, AND CEO,
BALLAD HEALTH; STEPHANIE MONROE, J.D., DIRECTOR, EQUITY AND
ACCESS, USAGAINSTALZHEIMER'S, EXECUTIVE DIRECTOR,
AFRICANAMERICANSAGAINSTALZHEIMER'S; AND JEANNE MARRAZZO, M.D.,
BOARD MEMBER, INFECTIOUS DISEASE SOCIETY OF AMERICA (IDSA),
INFECTIOUS DISEASE DIVISION CHIEF, UNIVERSITY OF ALABAMA AT
BIRMINGHAM
STATEMENT OF COREY FEIST
Mr. Feist. Thank you for having me today. My name is Corey
Feist. As you heard, I am the president and co-founder of the
Dr. Lorna Breen Health--Heroes Foundation. I am also the chief
executive officer of the University of Virginia Physicians
Group, which employs all of the physicians and most of the
nurse practitioners and advanced practice professionals at the
University of Virginia Health System in Charlottesville.
I am also the proud husband of Jennifer Breen Feist, who is
sitting over my shoulder, who is here with me today, and is
also welcome to answer any questions that you might have of
her. Jennifer co-founded the Dr. Lorna Breen Heroes Foundation
with me in June of 2020, and she is the sister of Dr. Lorna
Breen.
I want to start by thanking the chair and ranking member of
the--for the opportunity to address the committee today.
Unfortunately, the thousands of healthcare professionals who
take such incredibly amazing care of us, particularly during
this pandemic, cannot access mental health support, and it is
critical that this changes.
On behalf of the thousands of healthcare professionals, I
am here to encourage you to immediately consider passing H.R.
1667, the Dr. Lorna Breen Health Care Provider Protection Act,
which aims to reduce and prevent suicide, burnout, and mental
and behavioral health conditions among healthcare
professionals. The companion legislation to this bill, S.610,
unanimously passed the Senate on August 6th.
I would like to extend a special thank you to
Representatives Wild, McKinley, Krishnamoorthi, and Chu, along
with Senators Kaine, Reed, Cassidy, and Young for championing
this first-of-its-kind legislation.
Let me start by sharing a little bit about my sister-in-
law, Dr. Lorna Breen. This picture in front of me was taken on
March 10th, 2020, while on a Montana ski trip with our family.
That is my daughter, Charlotte, with us.
As Jennifer has said, this was the last week of normal for
our family, and for many of us across this country.
Dr. Breen was the medical director of the emergency
department at NewYork-Presbyterian's hospital, and left our
Montana ski trip to return home to take care of patients. In
the three weeks that followed, Dr. Breen treated confirmed
COVID patients, contracted COVID herself, and returned to an
overwhelming, relentless number of incredibly sick patients.
After 12-hour shifts, she and her co-workers would stay,
because the influx of patients never slowed. Yet she kept going
back until she, literally, could no longer stand. Despite these
overwhelming challenges, she pushed on, and tried to push
through.
Sharing that the entire time she was concerned that her
inability to keep up was going to end her career, by April 9th
Lorna hit her breaking point. She couldn't get out of her
chair. She called Jennifer on the phone. She was nearly
catatonic, and needed immediate help.
Lorna answered the call for her city, for her country. But
when she needed to take care of herself, she was concerned
about her job, fearing she would lose her license, or be
ostracized by her colleagues. She died by suicide April 26,
2020, 47 days after this picture was taken.
When Lorna died, we were all looking around, saying, ``Why,
how did this happen? When did it? Why did it happen?'' We were
in the news all over the world. And then something that we
found completely unbelievable happened: people started reaching
out. The families of doctors and nurses and other healthcare
providers told us their own stories about their loved ones who
had died by suicide. All total strangers.
Many doctors and nurses continue to suffer in silence with
mental health challenges, due to both cultural and regulatory
hurdles, which reinforce and often prevent them from obtaining
help, the same help that we can all get in this room.
Prior to the pandemic, the suicide rate among physicians
and nurses was twice the national average in this country. In
fact, prior to the pandemic, 400 physicians died by suicide
each and every year.
Early after Dr. Breen's death we heard about a phrase
coined the ``parallel pandemic,'' which refers to the mental
health crisis in medicine. Lorna kept telling us she was going
to lose her license, lose her job, all because she required
mental healthcare for the first time in her career. She was
mortified, fearing her colleagues would never want to work with
her again. We promised her she wasn't right. And after she
died, we learned that she was.
This is not OK. This is not normal. This is not right. We
believe Lorna died because she was a physician.
Consider the following statistics before the pandemic: 96
percent of medical professionals agree that burnout was an
issue; 42 percent were reluctant to seek mental health
treatment; 50--and then after the pandemic, 55 percent of
professionals agree that burnout is an issue; 60 percent say
that stress has harmed their mental health.
On top of these statistics, Dr. Breen's case, nearly all of
the healthcare professionals--nearly half of those
professionals won't obtain treatment. This is like sending the
entire healthcare workforce to war, and not supporting them
when they come back.
Thank you for consideration of the Dr. Lorna Breen Health
Care Provider Protection Act, and your support of our
healthcare heroes.
[The prepared statement of Mr. Feist follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you very much, Mr. Feist.
I also would like to acknowledge that there are two members
that are cosponsors of that legislation on the committee, Mr.
Upton and Mr. Griffith, and we thank you for your fine work.
Thank you for your testimony.
Ms. Harrison, you are recognized for 5 minutes.
STATEMENT OF LISA MACON HARRISON
Ms. Harrison. Good morning, Chairwoman Eshoo, Congressman
Guthrie, and members of the subcommittee. My name is Lisa Macon
Harrison, and I am president of the National Association of
County and City Health Officials, also known as NACCHO. This is
the association that represents our nation's nearly 3,000 local
health departments.
I am also the local health director of Granville-Vance
Public Health in North Carolina, serving a rural population of
approximately 100,000.
Thank you for the opportunity to speak to you today about
the critical importance of the nation's public health
workforce, and legislative opportunities to support them.
My colleagues across the country in local health
departments have been the tip of the spear in the pandemic
response. They have been the voices over the phones, the hands
in the gloves, the faces behind the masks, the arms in the
gowns, and the fingers typing away on data updates daily for
local communities to help others understand how we are getting
through this pandemic, community by community.
In my district alone, our 12 public health nurses have
delivered over 40,000 vaccines, which is over half of the
COVID-19 vaccines delivered in our counties. While we are still
in the background, contact tracing, still testing, still
educating the public, still consulting with local schools and
courthouses and businesses, so that people can feel safe.
No other healthcare partners have the same breadth of
responsibilities for communicable disease control and health-
related policy decisions the same way public health is. Our
workforce is our most critical asset. However, a decade of
disinvestment leading up to the pandemic meant that health
departments were understaffed and overworked long before this
crisis hit. Local health departments started the pandemic 20
percent down in workforce capacity, and the pandemic really
stretched thin our already lean workforce. Preliminary findings
from NACCHO's 2020 Forces of Change survey show that over 80
percent of local health departments reassigned existing staff
from regular duties to the agency's COVID-19 response. That was
certainly true in my district.
The response is taking a toll. Turnover is up across
communities, and some health department staff have actually
shrunk again during the pandemic. For some, it is the intense
polarization and threats that drive them away. Others are lured
away by better paying opportunities in hospitals or the private
sector, while still others are leaving due to the response's
effect on mental health. In fact, this past spring, CDC found
out that over half of public health workers were experiencing
symptoms of PTSD.
We expect this migration out of governmental public health
to be more acute when the pandemic ends, as many of my
colleagues have stated they are committed to staying the course
during the crisis, but will leave as soon as the threat is
abated. I have seen firsthand the turnover rate increase at my
local health department before the pandemic. Our annual
turnover was between 2 and 5 percent, annually; right now it is
closer to 12 percent. In rural areas like mine it can take
months to fill vacant positions. The public health workforce
crisis needs our attention, both now and in the future.
In order to build the public health workforce for the 21st
century, we have to focus on three different factors: retaining
the current hardworking, skilled, and experienced staff we
have; recruiting top new talent; and expanding the workforce
with more predictable, sustainable funding. That is why we are
so appreciative that you are considering bipartisan legislation
that would make a meaningful impact in these efforts, H.R.
3297, the Public Health Workforce Loan Repayment Act. Thank
you.
This bill would create a loan repayment program for public
health professionals who work at local, state, or tribal health
departments for at least three years. It is modeled after the
successful National Health Service Corps, with support from
clinical healthcare workforce, and would be the first dedicated
program to help recruit and retain top talent into public
health departments, where they are so desperately needed.
Public health loan repayment has support from health
departments large and small, as well as from over 100 public
health medical, academic, labor, and consumer stakeholder
groups. We hope it will have your support, as well.
While the Public Health Loan Repayment bill will help
recruit new staff, we must also invest in public health
infrastructure to provide predictable, sustained, and disease-
agnostic funding to bring back the positions we have lost, and
support optimal staffing levels.
Moreover, we must do better to increase salaries and
benefits for public health department staff, and offer those
already in the pipeline a career ladder to stay in the field
long-term. Federal policy plays a role here, as well, as jobs
tied to specific Federal programs at the local level often pay
so much less than a living wage.
The challenges facing the public health workforce are
incredible, but with your help we can make a meaningful impact
to support them while they support our communities. Thank you
for your attention to these issues. I am happy to answer any
questions.
[The prepared statement of Ms. Harrison follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you very much. Excellent testimony.
Dr. Garcia Wilburn, you are recognized for--oh, I am sorry.
Dr. Keel--I didn't do that on purpose, Dr. Keel. It is my
eyesight. You are recognized for your 5 minutes, and welcome
again. Lovely to have you.
STATEMENT OF BROOKS A. KEEL
Dr. Keel. Chairwoman Eshoo, Ranking Member Guthrie, and
members of the Subcommittee on Health, thank you very much for
the opportunity to speak with you today.
And thank you, Representative Carter, for your
introduction, and for the continuing service to our great state
and to this country.
My name is Brooks Keel. I am the president of Augusta
University. AU is one of four public research intensive
universities in the State of Georgia, and the home of the
Medical College of Georgia, or MCG, which is the thirteenth
oldest and ninth largest medical school in the country. We are
the only public medical school and the only public academic
health center in the state.
It is no secret that the entire country is facing a
physician shortage. Where primary care physicians are in short
supply everywhere, the lack of providers in rural settings is
especially acute. Georgia has a severe shortage of physicians,
ranking forty-first in the country in physicians per capita.
Currently, eight counties in Georgia have no practicing
physician at all.
One contributor to the physician shortage is the staggering
amount of debt incurred while pursuing a medical degree. While
MCG offers scholarships to the neediest of students, more than
80 percent of MCG students graduate with debt, sometimes
exceeding $130,000. This debt can discourage future physicians
from practicing in the very areas where their need--where the
need is the greatest, and may also dissuade medical students
from choosing a career path in primary care, as specialty
fields often prove to be more financially lucrative.
Today I want to share with you the details on a program
created at the Medical College of Georgia termed MCG 3+, which
aims to eliminate medical school tuition debt and reduce
disparities, by increasing access to care in rural and
underserved areas across the state, and begins to tackle the
extreme physician shortage that we are experiencing in one of
the top ten most populous states in the country.
First, by employing a unique and novel curriculum, the 3+
program shortens medical school from four years to three years.
Right away, this reduces medical school debt by 25 percent.
Second, we are asking first-year medical students who have
a passion for primary care, and a propensity for practicing in
rural Georgia, to commit to primary care residency in the State
of Georgia. This alone will significantly enhance the chance
that these students will continue to stay in practice in the
state once they complete their training.
And in this context, I am referring to primary care in the
broadest of terms, to include family medicine, internal
medicine, pediatrics, but also psychiatry, obstetrics,
gynecology, emergency medicine, and general surgery.
Third, if these motivated students will commit to
establishing their clinical practice in an underserved rural
area in Georgia, and will agree to practice in these areas for
at least three years after completing their residency training,
we will waive their medical school tuition. In other words,
free medical school in return for a year-for-year clinical
service commitment in rural Georgia.
I should point out that, while the primary impetus for the
3+ program was to incentivize physicians to establish a
clinical practice in rural and underserved Georgia, this
overall approach should also lead itself to tackle other vital
needs the state may have. For example, we are exploring whether
the 3+ program will allow us to address a critical shortage of
medical examiners and forensic pathologists in the state.
Additionally, as I mentioned earlier, psychiatry is one of
the seven primary care pathways identified in MCG's 3+ program.
We are, therefore, excited about how the reauthorization of
H.R. 5583, Helping Enable Access to Lifesaving Services Act,
might indeed play a role in our 3+ program.
The 3+ was implemented in the fall of 2021, and MCG has
contracted with nine first-year medical students to join this
program. We hope to add another ten next year. We recently
received a $5.2 million gift from Peach State Health Plan, a
subsidiary of Centene Corporation, in support of the 3+ rural
program. This was matched by another $5.2 million from the
State of Georgia, allowing us to establish the $10.4 million
endowment to cover the cost of tuition for these physicians.
We are aggressively seeking additional public and private
philanthropic opportunities that will allow us to support
additional students who desire to take advantage of this
program. Our goal is to create a continuing pipeline of
physicians who are dedicated to meeting the healthcare needs of
the state, both now and well into the future.
We believe that leveraging the combined efficiencies of the
accelerated three-year M.D. curriculum, coupled with tuition-
free medical education and an in-state primary care residency
experience, MCG will dramatically enhance our contribution to
Georgia's physician workforce, and significantly impact the
health and economic prosperity of all Georgians, especially
those living in our rural and underserved areas.
Madam Chairwoman and Ranking Member Guthrie, thank you once
again for your interest in Augusta University and the Medical
College of Georgia, and for allowing me to be here today. I
will be happy to answer the questions you or the committee may
have.
[The prepared statement of Dr. Keel follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you very much, Dr. Keel. That is helpful.
It is not only helpful, it is hopeful, and we all need hope.
Dr. Wilburn, it is indeed your time for your testimony.
Dr. Wilburn. Thank you.
Ms. Eshoo. Welcome again.
STATEMENT OF VICTORIA GARCIA WILBURN
Dr. Wilburn. Chairwoman Eshoo, Ranking Member Guthrie, and
members of the Health Subcommittee, thank you for inviting me
to speak to you today in strong support of H.R. 3320, the
Allied Health Workforce Diversity Act.
This legislation is crucial, as our nation looks to recover
from the pandemic and have an allied health workforce that
mirrors the makeup of our nation.
I want to thank Representatives Rush and Mullin for their
leadership on this bill.
I also want to thank Ranking Member McMorris Rodgers, who
has been such a champion for this bill since it was first
introduced in the 116th Congress, passing unanimously out of
the House of Representatives as part of the larger title 7
workforce program's reauthorization package.
When reflecting on this legislation, I think about how
different my life would have been if the Allied Health
Workforce Diversity Program had existed when I was on my
trajectory to becoming an occupational therapist. I would have
been provided a distinct pathway to my career, instead of
spending countless hours navigating potential college majors as
a first-generation student. I would have had improved mental
health, and perhaps my academic achievement would have been
greater with more support.
After my parents moved to Chicago--after my parents
married, they moved to Chicago for the booming industry jobs.
My father was in construction for 30 years, and my mother, who
didn't finish the eighth grade, worked in a factory at night,
while my four older siblings slept. When we were old enough,
she enrolled in cosmetology school. Her cosmetology diploma was
the first degree to ever hang in our home.
My parents strongly believed education equaled opportunity.
But as the youngest of five, my parents' ability to provide
financial support was limited. Financial support from Boston
University and Federal student loans allowed me to afford a
bachelor's degree in occupational therapy. But it is because of
the network of mentors and career counselors who became like
family at BU that I speak to you today, as a licensed
occupational therapist and member of the board of directors of
the American Occupational Therapy Association.
The Allied Health Workforce Diversity Act would provide
thousands of future students of respiratory therapy,
occupational therapy, physical therapy, speech language
pathology, and audiology with access to additional, targeted
supports beyond what I received, like mentorship and tutoring.
Students who are disadvantaged and from under-represented
communities bring a unique perspective to our healthcare
system, and improve health outcomes. If we, as a nation, want
to improve patient care and reduce health disparities, we must
increase our efforts to recruit, train, and support these
students.
The Allied Health Workforce Diversity Act creates a grant
program in title 7 of the Public Health Service Act,
administered by the Health Resources and Services
Administration. Grants would be awarded to accredited higher
education programs of respiratory therapy, occupational
therapy, physical therapy, speech language pathology, and
audiology to support efforts to increase the opportunities of
students from under-represented and disadvantaged backgrounds.
The funding the grant provides would support efforts by the
program to attract, recruit, and retain individuals under-
represented in these professions. It will fund community
outreach efforts, mentoring and tutoring program creation or
expansion, and financial support directly to the students in
the form of scholarship and stipends.
The program is modeled after a similar successful program,
the Nursing Workforce Diversity Act. According to the Bureau of
Labor Statistics data, since its creation in 1998, the
Workforce Diversity Program has doubled the percentage of
nurses from a diverse background. H.R. 3320 seeks to duplicate
the success of the nursing program, while providing HRSA with
the flexibility to continuously define which communities are
considered under-represented, to grow with an ever-changing
healthcare workforce.
While the bill cites people from ethnic or racial
minorities, or those with a disability as an example for an
individual under-represented in the profession, HRSA would have
the authority to fund programs seeking to increase the share of
students from other backgrounds, such as those from rural,
military, or agricultural communities.
A study published in JAMA in March, 2021 stated,
``Fostering a diverse, inclusive workforce is critical to
increasing access to care and improving aspects of healthcare
quality.''
The research shows two important findings. First, health
professionals from under-represented and minority backgrounds
are more likely to practice in medically underserved areas.
Patients who receive care from healthcare professionals of
their own cultural background tend to have better outcomes.
The same study shows the higher education pipeline of the
allied health professionals are less diverse than the current
workforce findings, which match an analysis of the national
college progression rates by the National Student Clearinghouse
Research Center. Between 2019 and 2020, the national college
enrollment rate fell 9.4 percent for students from high
minority high schools.
I thank the committee for the opportunity to come here
today and discuss this important issue. The Allied Health
Workforce Diversity Act as an opportunity to move our nation
along the path to recovery.
I look forward to working with you, and I am happy to
answer any questions you might have.
[The prepared statement of Dr. Wilburn follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Well, bravo. Let it be noted that the baby the
family came and testified before the Congress of the United
States of America. Bravo to you, bravo.
Next, Mr. Levine, who is the chair of the board and chief
executive officer of Ballad Health, welcome to you, and thank
you for your testimony to the committee this morning.
STATEMENT OF ALAN LEVINE
Mr. Levine. Thank you, Madam Chair, and thank you, members.
Before I begin, I would like to say that, in my opinion, I
do not believe that we, as a nation, have shown enough respect
for the nurses and frontline caregivers in a manner worthy of
the sacrifice and labor they have given us. And I am grateful
to you and to your committee for affording us the opportunity
to embark upon correcting this, and providing them with the
support they deserve, and I agree with the advocacy you have
heard from my colleagues on your panel.
My name is Alan Levine, and I have the honor of serving as
the chairman of Ballad Health, which is an integrated health
improvement organization serving the incredible Appalachian
Highlands, a non-urban and rural region of about 29 counties
the size of New Hampshire. Proudly, also the twenty-ninth best
employer for diversity in America, according to Forbes Magazine
in 2020.
The Appalachian Highlands is unique for its beauty, low
cost of living, and friendly culture. But it is not unique,
however, when it comes to an emerging national crisis. And that
crisis is the supply and resiliency of our nation's healthcare
workforce. In particular, our nursing professions.
As some of the legislation before you today thankfully
recognizes, this challenge to our workforce has a
disproportionate impact on our nation's non-urban and rural
communities, which make up 85 percent of America's landmass.
Despite the financial headwinds brought on by the combination
of the pandemic and the major investments necessary in wages
due to the shortages, Ballad Health yesterday announced a major
partnership with East Tennessee State University, making a $10
million commitment to create what we hope will be a nationally-
recognized Center for Nursing Advancement, focused on studying
and acting on the issue of nursing resiliency and supply.
As the data in my written testimony supports, the nursing
shortage was a crisis before the pandemic. But the pandemic has
now revealed the problem of resiliency and the major mental
health and behavioral aspects of the last two years. Consider
that, since 2016, the average American hospital has turned over
about 83 percent of its nursing staff. Twenty-four percent of
registered nurse turnover is occurring in the first year, which
points to the issue of resiliency. And for the first time now,
retirement is one of the top three reasons given for nursing
turnover, which is a frightening fact.
The cost of this, in terms of quality of care and
sustainability, is enormous. And as I detail in my written
testimony, Ballad Health, an important system operating on a
slim two percent margin prior to the pandemic, has now
invested, this year alone, a recurring $100 million into
mitigating the turnover issue. Once the very generous federal
pandemic support is gone, I do fear this could have a lasting
impact on our sustainability, as a rural health system.
With 180 rural hospitals already having closed nationally,
it is an obvious worry, especially given that we are now paying
fourfold for contract labor, with rates as high as $140 per
hour for med-surg nurses. Most rural health systems can't
afford to do this for very long, and in our case we have
nowhere to turn. Seventy percent of our payer mix is
government-established payment, while only twenty-one percent
is commercially market-based insured. Government payment is not
and cannot keep up with the inflation we are seeing in the
market right now, and it is further harmed by the arcane and
frustrating Medicare Area Wage Index.
Rural health systems like Ballad Health are critical to the
health and overall well-being of the communities we serve. Not
only are we serving the current disproportionately high chronic
health needs of our population and the demands of COVID-19, but
as leading providers of preventive services, health education,
social care navigation, and employment, community-led hospitals
and health systems are important catalysts for overall
community health improvement.
In Ballad Health's case, our programs aimed at helping
pregnant women combat addiction, and focusing on the needs of
pregnant women whose newborns are likely to experience trauma,
childhood trauma, rely heavily upon a skilled workforce,
including community health workers, something I hope to expand
upon during the Q&A session.
I have included numerous citations in my written testimony,
but Linda Shepherd, the chief nursing officer at our Johnston
Memorial Hospital in Abingdon, Virginia, and president of the
Virginia Nurses Association, summed up our current situation
best: ``Our nurses''--and I quote--``Our nurses are mentally
depleted, exhausted, and traumatized, experiencing pandemic-
related PTSD with little or no time to seek mental health
services. Suicide among nurses and other members of the medical
community is also on the rise.''
Clearly, many of the provisions you are considering here
today are intended to get to the heart of this problem. Ballad
Health was proud to support, for instance, the introduction of
the Dr. Lorna Breen Health Care Provider Protection Act, which
should help improve healthcare providers' mental health, and
reduce burnout. And while not on today's agenda, Ballad Health
has also been working with Congress, including many of you on
this committee, to gain passage of the Save Rural Hospitals Act
to establish a permanent national minimum Area Wage Index to
ensure our healthcare manpower is compensated fairly.
I would like to thank you, Madam Chair and the ranking
member, for the invitation to participate in today's hearing,
and I especially want to thank Congressman Griffith for his
unwavering advocacy for our region.
I would be happy to discuss Ballad Health's initiatives or
any other legislative or administrative proposals impacting
rural hospitals during the upcoming Q&A portion of this
hearing. Thank you.
[The prepared statement of Mr. Levine follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you, Mr. Levine.
Next, Ms. Monroe, you have 5 minutes for your testimony.
And welcome again, and we are all grateful to you.
Ms. Monroe. I will put myself on talk.
Ms. Eshoo. That is it. Now we can hear.
STATEMENT OF STEPHANIE MONROE
Ms. Monroe. Good morning, Chairman Eshoo, Ranking Member
Guthrie, and members of the committee. I really appreciate
being able to be here to share a little bit about my story, but
also the things I think this committee is doing excellently,
and ways that you can continue to support Alzheimer's families
and their caregivers.
So, as I mentioned--as was mentioned previously, I am a
Capitol Hill veteran of about 25 years. I am a former assistant
secretary for civil rights at the Department of Education. I
have had a lot of honors and privileges in my lifetime. This, I
would say, is the best job I have ever had. I was working in
the U.S. Senate for all of that time.
Despite that fact, and being knowledgeable, as I thought I
was, about healthcare and the needs of very vulnerable
communities, and the fact that my brother is a physician at
Vanderbilt University, and that my sister is a trained
professional educator in Baltimore, Maryland, we were all
completely blindsided when, eight years ago, my father received
a diagnosis of Alzheimer's.
Now, we shouldn't have been surprised, I guess, because
seven years before he started displaying certain symptoms. It
took us that long to get a doctor to actually tell us what was
going on. And that was lost time that we can't ever get back,
and it was unfortunate, and it was unnecessary.
So we received the diagnosis, we were given a prescription,
we were given the name of a doctor to go to see who was a
neurologist. And we were basically sent along our merry way in
a daze.
This is something that you are just not prepared to hear,
no matter how extensive your--you think your knowledge is. This
is your father. This is the man who did everything in your
household, all the electrical, the painting, even if he didn't
know how to do it, it got done by him.
So we left there, and we were like, you know, where do you
start? You know, you are given medications. What do you expect?
How do you manage this condition? What does it mean, in terms
of long and short term? What are the financial realities of
this?
My parents were working class people. They didn't have
long-term care insurance. What are we going to do, as a family?
We knew we were going to come together and make this work, but
what do we really do?
You are not given any support, you are not given--connected
to any resources that might be able to help you along this
journey, just a script and a ``good luck.''
You don't even know what questions to ask, because you
don't know what you don't know. You don't know what resources
exist, or whether they would even be helpful to you. You don't
seek caregiver support because, like a parent doesn't consider
him or herself to be a child care provider, you don't consider
yourself to be a caregiver. You are the mother, daughter,
sister, spouse of a loved one, of a father, of a mother. So you
are just lost in that moment.
So I am here today, and I know I am just one person, but I
want to let you know that I represent the 6.2 million Americans
living with Alzheimer's. The scary thing is that number is
expected to double by 2060. Thirteen percent of Americans in
the U.S. are African American. Twenty percent of persons living
with Alzheimer's are African American. Yet, unfortunately, only
three percent of African Americans are included in clinical
trials to find better treatments for everyone. So I would say
we have got a real problem on our hands that we have to
address.
So I am here today to urge consideration of the bills on
the agenda as a lifeline for caregivers who, unfortunately, are
forced often to deny their own health and well-being while
caring for others. Too often this results in physical and
emotional deprivation, sometimes resulting in the caregiver
becoming sicker and dying sooner than the loved one that they
are taking care of.
The Alzheimer's Caregivers Support Act authorizes the
Secretary of HHS to award grants to public or private
nonprofits to expand and offer training and support services
for families.
And at UsAgainstAlzheimer's, we have done surveys of
caregivers and their families to understand exactly what
mattered most to them. We found that the majority of caregivers
reported that their own healthcare provider knows that they are
caregivers, butpercent report that the doctor hasn't mentioned
anything about resources that might be available to that
person. For those who actually did receive training, about 50
percent said they did not receive it at the appropriate time,
and fewer than half felt it addressed the situations that they
actually faced.
So I would like to thank Representative Waters and Smith
for their leadership, and introducing this important piece of
legislation, and working to improve it.
I know that I am out of time, but I just have a little bit
more to say, just for a few seconds, if that would be OK.
I first want to associate myself with all of the comments
that were made by Dr. Wilburn. Having a qualified, well-
trained, diverse workforce will be essential to all that we do
in this space, as the United States continues to brown and age.
We will be the new majority, and we already are in seven
different states in this country.
Finally, I just might like to thank and mention a couple of
other bills that are before the committee, and a policy that I
hope all of you will support.
The CHANGE Act sits before the committee. That will help
ensure that we have early and accurate diagnosis for people
like my dad, where we didn't have to waste seven years.
The ARPA-H legislation that the chairman has graciously
introduced will help us understand and make sure that we have
innovation and research that we can hopefully prevent and treat
this disease, with critical innovations that are necessary.
And then the paid leave, which currently is pending before
Congress, is absolutely a lifeline for America's caregivers. I
am grateful that I live in a position--I have a position where
I am able to access paid leave, but only 77 percent--77 percent
of American workers do not have that. So I really feel like
that is an important lifeline in the strategy that we need that
will allow people to be able to take the time that they need to
care for themselves, and to make sure that their loved ones
with Alzheimer's get the support and the care that they need.
Thank you.
[The prepared statement of Ms. Monroe follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you, Ms. Monroe, very powerful testimony,
both professionally and personally. Thank you.
And I think if--the top criticism of the chairwoman of the
subcommittee is allowing both members and those that testify to
go over time, but everyone has such good things to say that it
is hard for me to lower the gavel on them. So mea culpa.
Dr. Marrazzo, you are now recognized for 5 minutes, and
thank you again for being with us, and your willingness to
testify.
STATEMENT OF JEANNE MARRAZZO
Dr. Marrazzo. Thank you, Chair Eshoo, Ranking Member
Guthrie, and members of the subcommittee. Thanks for the
opportunity to testify. I am Dr. Jeanne Marrazzo, I am the
director of the division of infectious diseases at the
University of Alabama at Birmingham. I am also the treasurer of
the Infectious Disease Society of America, and I have served on
the governor of Alabama's COVID task force.
On behalf of IDSA, I am pleased to support the bill that we
are here considering today, the Bolstering Infectious
Outbreaks, BIO, Preparedness Workforce Act, and to speak about
why this bill is needed.
I also offer support for the Public Health Workforce Loan
Repayment Act and the Dr. Lorna Breen Health Care Provider
Protection Act.
Addressing bio preparedness and ID workforce shortages is
important to me, because I have seen firsthand the devastating
effects of COVID-19, with disproportionate impacts on our most
vulnerable Alabama residents. The pandemic and recent natural
disasters have exposed insufficient bio preparedness and ID
workforce capacity at healthcare facilities across the country.
More than 80 percent of U.S. counties lack an infectious
disease physician. In Alabama, our smaller and more rural
communities have little or no access to ID care. During the
pandemic, nearly everyone who required intensive care had to go
to regional medical centers, which quickly became overwhelmed.
Most hospitals in Alabama have limited ID expertise, and rely
on informal telephone consultation with regional experts, such
as myself.
During the pandemic, I personally received phone calls from
physicians caring for people with COVID in rural hospitals,
with questions ranging from indications for monoclonal antibody
treatment, to antiviral therapy in pregnant women, to
management of antimicrobial resistance secondary infections
acquired during prolonged hospital stays for COVID.
UAB also serves as a critical hub for HIV and hepatitis
care for over 25 counties. While telehealth is an option for
many, many Alabama residents do not have reliable internet
access. ID workforce shortages limit our ability to prevent and
treat HIV and viral hepatitis, and infections associated with
opioid and other substance use. A study of the HIV workforce in
14 southern states, including Alabama, found that more than 80
percent of those states' counties have no experienced HIV
clinicians, with disparities greatest in rural areas.
Despite the urgent need for a robust bio preparedness and
ID workforce, the pipeline for ID physicians lags behind all
other specialties. In 2020, only 75 percent of our ID training
programs were able to fill, while many other specialties did
so. The average salaries for ID physicians are below nearly all
other medical specialties, and below general internal medicine,
although ID specialization requires an additional two to three
years of training. With average medical student debt of
$200,000, the ID specialty is not financially feasible for
many.
Of great concern as we work to improve our workforce
diversity, individuals from populations under-represented in
medicine are more likely to have educational debt, making
financial concerns a barrier for them to enter ID, as well.
This Workforce Act will address this problem by providing loan
repayment for these professionals, with an explicit goal of
workforce diversification.
Every community needs a strong workforce to mount rapid,
effective responses to ID threats. Trained staff develop and
update surge capacity plans, train healthcare personnel,
purchase and manage protective equipment, optimally manage
patient flow, perform infection prevention, and oversee
antimicrobial stewardship to ensure that ID treatments are used
appropriately.
For example, the availability of new COVID-19 therapeutics
was often limited, and their administration often complex.
Antimicrobial stewardship teams were critical to determine the
most effective ways to deploy these tools to fight COVID.
This workforce was also instrumental in conducting COVID-19
clinical trials. Nearly all the patients that we enrolled at
UAB into these trials were from the Birmingham metropolitan
area. These patients thus have the advantage of early access to
new treatments under study. A larger and more diverse workforce
statewide that is more distributed appropriately through our
state would expand access to clinical trials, and ensure that
these trials reflect the populations that we serve.
In addition to pandemics, bio preparedness and ID
professionals are critical in responding to natural disasters
like hurricanes and wildfires. Skin infections frequently
complicate common wounds. Overcrowding in shelters increases
spread of infection. Gastrointestinal infections occur when
sewage systems or access to clean drinking water is
compromised. And waterborne and vectorborne infections also
increase after floods.
Finally, ID physicians are essential in caring for patients
receiving transplants or cancer chemotherapy. Early
intervention by an ID physician for patients hospitalized with
serious infections is associated with significantly lower
mortality and readmission, shorter hospital and ICU length of
stay, and lower Medicare costs.
In conclusion, the bipartisan BIO Preparedness Workforce
Act will help ensure an adequate supply of bio preparedness and
ID professionals by providing loan repayment. We are deeply
grateful to Representatives Trahan and McKinley for their
leadership on this legislation.
We are also pleased to see the Public Health Workforce Loan
Repayment Act, as well as the Dr. Lorna Breen Health Care
Provider Protection Act that has been introduced.
Thank you very much for this hearing. We welcome the chance
to advance these critical pieces of legislation to ensure we
have the workforce we need for the future.
[The prepared statement of Dr. Marrazzo follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you very much, Dr. Marrazzo.
Excellent testimony across the board. OK, we will now move
to member questions, and the Chair recognizes herself for 5
minutes to do so.
To Mr. Feist, the American Rescue Plan provided $140
million to address burnout among healthcare professionals. How
does this legislation, in your view, work in conjunction with
that law to address the mental health crisis that you so aptly
described?
Mr. Feist. Thank you for your question, Chairwoman Eshoo.
This is an excellent question.
The Dr. Lorna Breen Health Care Provider Protection Act
provides the policy language that directs the distribution of
those funds from the American Rescue Plan. And in fact, this
summer, when HRSA was allocating through the grant process,
those funds, I heard from hospitals across the country, chief
wellness officers from across the country, who were interested
in applying for those funds.
It is clear to me that those funds are going to be used
soon. They will be allocated in the next 30 to 45 days, from
what I understand, and they will go a long way towards
impacting the well-being of the healthcare workforce, current
as well as the future.
Ms. Eshoo. Well, that is highly instructive to us. Thank
you very much.
To Ms. Macon Harrison, I am proud, along with Congressman
Crow, Ranking Member Guthrie, and Dr. Burgess, to put forward
the Public Health Workforce Loan Repayment Act. Obviously, it
establishes a student loan repayment program for public health
professionals, and everything that you outlined shows that, I
think, if that fund were in place now, there would be a run on
the money, because the needs are so great.
How do you currently recruit new local public health staff,
especially in rural areas? I mean, can you actually recruit?
Ms. Harrison. Yes, ma'am, thank you for the question. I
appreciate that.
It is definitely one of the main challenges of my role, as
a local health director, to--excuse me--to recruit against a
lot of the larger systems that are just an hour away.
Ms. Eshoo. Right.
Ms. Harrison. So often, across the United States, you see
individuals who are well trained and experienced in their work
travel to larger areas, where the pay is greater, and the
benefits might also be.
So recruitment is one of the issues that this loan
repayment program really will help us with, and it directs some
of that funding also to local health departments.
Ms. Eshoo. Good.
Ms. Harrison. Often times we see public health sort of
connected together to lots of healthcare workforce, and we
certainly share the responsibility with lots of healthcare
partners. But local health departments really need the help
with this in rural areas, as you mentioned. It is very
difficult to do that recruitment well.
Ms. Eshoo. Thank you very much.
The first ten years of my elected public service was on a
board of supervisors, and I chaired our county hospital's board
of directors. I must have spent 80, 85 percent of my
legislative time on healthcare, working with the public health
department, with--overall, the health department in the county.
So I know those operations well, and it is very sad to me that
they have been left behind.
So I think that there is an important Federal role to play,
and I think, as we ramp that up, that it sends a real message
to county governments, local governments, and those that are
responsible for them, that they need to jack up those budgets,
as well.
Mr. Levine, I am going to enter into the--this into the
record, but I am curious how North Carolina's and Tennessee's
refusal to expand Medicaid has affected your system's
financials.
I mean, in my view, surely, avoiding uncompensated care
would help. And there is really trusted statistics on that --on
this, that being in a Medicaid expansion state decreases by 62
percent the likelihood of a rural hospital closing. And
conversely, being in a non-expansion state makes it more likely
that a rural hospital will close.
Do you care to comment?
Mr. Levine. Well, Madam Chair, thank you. We, Ballad
Health, did support the expansion of coverage for the poor and
low-income populations. In Virginia they did do that, and we
saw that it did assist us with our programs for the low-income
populations.
In the absence of expansion, we began the Appalachian
Highland Care Network, providing coordinated delivery for
patients that are uninsured, and who suffer from diseases like
diabetes and other things to reduce----
Ms. Eshoo. But I asked you what this has done, relative to
your financials and hospital closures.
Mr. Levine. Well, certainly----
Ms. Eshoo. I am not so sure about your answer.
Mr. Levine. Well, certainly, I believe that providing more
coverage to people who currently do not have coverage would
help rural hospitals with their financial situation. That is--
clearly, that is part of why we were able to reopen a rural
hospital in Southwest Virginia.
Ms. Eshoo. Thank you. My time has expired.
The Chair now is pleased again to recognize the wonderful
Ranking Member of our Subcommittee, Mr. Guthrie, for your 5
minutes of questions.
Mr. Guthrie. Thank you very much, and thanks for everybody
being here, and particularly those sharing personal stories,
putting a name to an issue, and faces to issues that we have
here and you have talked about. It moves Congress from what we
all know we should do to what we absolutely need to do and get
done. So thanks for sharing that.
I actually want to direct a couple of my questions to Dr.
Keel, because, similar to you, we have major cities in
Kentucky, but we also have a lot of rural area, and I know we--
I wish that we could have our discussion we had yesterday when
you came by the office in public, because it is concerning.
We are trying to do things in Kentucky. The University of
Kentucky has put a medical campus in Bowling Green, where I
live, a growing town, but it is the surrounding counties and
other counties we are most worried about. And so innovation is
kind of--we are moving forward.
And going from, I guess--medical schools have been four
years since--I am 57 years old. I can't remember when it
wasn't. And I know when they went to internships and direct
residencies, that was a big controversy.
So what did you face, and how important are public-private
partnerships?
And then what barriers when you say, ``We are going to go
to a three-year medical school?''
And then how did you ensure that people are adequately
trained?
And what barriers did you say to say, ``We can still train
these people in three years, and get them to where they need to
go''?
So you just share your story a little bit.
Dr. Keel. No, that is a great question. And, as you would
imagine, that is one of the first questions I get asked. When
you say we are going to be reducing medical school from four
years to three years, it gives the impression that we are
short-cutting, or we are short-changing the physician training,
and nothing could be further from the truth.
Most traditional, four-year medical schools, including ours
just a couple of years ago, that fourth year is used almost
entirely for electives that the students choose. And a lot of
it is used for preparation for interviews for residency
programs throughout the state, and throughout the country. The
vast majority of the actual core, the curriculum core that
prepares the physician, is--it takes place in those first three
years, even in traditional environments.
What we have done, then, is removed the summer experience
that a lot of those students have, so they go through the
summer. That gives us several months to be able to continue
this education in the three-year period of time.
We are using small-group sessions, which provide students
with a greater opportunity to have interaction with faculty to
learn the material.
We are putting them in the clinics at a much earlier stage.
The first-year medical students actually--not just standardized
patients, which provides good training, but they get their
hands on real patients at a very early stage in their career,
and that helps them matriculate what they learn in the
textbooks, and apply it directly to that.
Now, for those students that want to go on to a more
specific residency program, like dermatology or neurology or
orthopedic surgery, they can use that fourth year to get
additional training, going to those residencies. But an
individual that wants to go into primary care can go straight
from that third year straight into a residency program.
Mr. Guthrie. Great. Well, I know innovation does come up
from the states, and we appreciate that.
Mr. Levine, I am really interested in value-based
agreements, and how we enter those into--and how we pay for
healthcare. In the context of hospitals, instead of fee-for-
service, how would supporting value-based agreements instead of
fee-for-service with healthcare providers encourage a stronger
workforce?
Mr. Levine. Well, that is actually a great question, sir.
We have put that to practice.
We began doing these value-based arrangements three years
ago. And since then, we have reduced the number of avoidable
hospital admissions by 16,000 per year, which, number one, has
saved taxpayers and payers and employers about $200 million a
year in reduced healthcare costs. But imagine if we had 16,000
more admissions to our hospitals that we had to contend with
during the pandemic. We couldn't have staffed for it.
So the combination of the value-based arrangements, and the
partnerships we have with the primary care physician workforce
has really helped better manage patients and reduce the cost of
healthcare, taking the burden off of our team members.
So we encourage, and Ballad Health will certainly continue
to lead the way in trying to lean into these risk-based and
value-based----
Mr. Guthrie. OK, thank you.
And I have a question, Mr. Monroe. I am concerned, as you
say, that we don't get enough minorities in our studies, in our
tests. And I know that I went to a Pfizer study in Bardstown,
Kentucky, and one of the people who set up the test--I
understand, and I believe that, setting up the tests, we
absolutely have to focus on that as we set up the test--and
they were trying to get more minorities into the testing, and
had a substantial minority population in that area. They just
were having trouble recruiting and getting people to come to
the test.
So I know we have to set them up and recruit minorities to
get into the test. But how do you--what do we need to do to get
more minorities to be more acceptable to come into the testing?
Ms. Monroe. Well, one of the things that has been
interesting to me, I have traveled to 27 cities, talking about
recruitment, and mentoring different sites about how to employ
strategies. When we have surveyed over 30,000 people, about 80
percent of minorities said that they had never been asked. And
so that is the first step, is to ask.
Mr. Guthrie. Absolutely, I agree with you.
Ms. Monroe. Not be embarrassed about past things that may
have happened, or your fear that they are going to say no. Give
them the opportunity.
But I think the workforce issues are important, too. If you
go into a place that you don't know, you don't necessarily feel
welcome, there is no one who looks like you there, you speak
Spanish, no one there speaks Spanish, those are things that put
a barrier before you even get to the place where you are ready
to roll up your arms and take a test.
But the National Institutes of Health, I was privileged to
serve on their strategy for recruitment and inclusion, and they
came up with wonderful suggestions, in terms of what sites can
actually do to bring more minorities to the door.
Mr. Guthrie. And you saw success in that?
Ms. Monroe. If implemented, we would see success. But we
also need--we need, I think, a series of carrots and sticks.
Right now we just have sort of the goodwill of entities wanting
to get higher numbers.
But again, if you are coming in at three or four percent,
and that drug is allowed to go to market to everyone, without a
label that discloses the lower percentage points, I think that
is a challenge. And I think we should be looking to see if FDA
would make some kind of an allowance when that happens, or
require a commitment for a phase four trial that will be really
focused on getting minorities engaged.
Mr. Guthrie. Thank you. I have expired my time.
Thanks for being indulgent, and I appreciate it.
That is a great answer. I appreciate it. Thank you.
Ms. Eshoo. The gentleman's time has expired. The Chair now
recognizes--Mr. Pallone is not here--Mr. Butterfield of North
Carolina, the gentleman from North Carolina, for your 5
minutes.
Mr. Butterfield. Thank you, Madam Chair. Again, thank you
so much for this important and informative hearing today. I
have listened to all of the witnesses, and they are so
resourceful. I thank all of you for your testimony. Let me
begin with Ms. Harrison.
Ms. Harrison, you shared with us that public health
departments across the country have been hemorrhaging
employees, and that it has been difficult to retain and
actually hire new staff. My staff is informed that your
department here, in North Carolina, has a turnover rate of some
10 to 12 percent for the past two years. I don't know if that
is accurate or not. You can correct the record, if it is not.
But could you discuss some of the unique challenges that
rural public health departments face in attracting and
retaining employees?
Ms. Harrison. Yes, sir, thank you for the question, and
thank you for that kind introduction, it is always nice to see
you.
I, unfortunately, have experienced about a 12--even over
the last few weeks that has increased a little bit more--
percentage of turnover that really rarely happens in local
communities that are rural. We are fortunate that we do have a
lot of staff from our local area, and they are incredible.
I think the challenges we face are low salaries, and salary
bands that are not updated frequently at the state level.
I do believe that these loan repayment program
opportunities will help us with recruitment, because they are
better targeted to local public health, in particular. And as
you know, it is sometimes assumed at the Federal level that all
the money that you all approve gets to the local level. But
that is not always the case.
Mr. Butterfield. So you are----
Ms. Harrison. There are state budgets that don't always
pass----
Mr. Butterfield. So you are supportive of loan forgiveness
programs, is that right?
Ms. Harrison. Yes, sir.
Mr. Butterfield. All right. Let me move over to Dr.
Marrazzo.
Thank you so much for your testimony, as well. Duke
University Medical Center--which is in North Carolina, we all
know that--operates two infection prevention and antibiotic
stewardship networks. These are designed to help community
hospitals prevent superbugs and hospital-acquired infections.
Most of participating hospitals do not have an infectious
disease-trained clinician on their own. This shortage was a
problem before the pandemic, but COVID and the strains it
placed on the--on community hospitals simply laid bare the
problems that can occur without this type of expertise, with
inappropriate antibiotic use and increased hospital infections.
Experts in North Carolina are concerned that hospitals not
connected to networks like Duke's are faring even worse.
And so, Doctor, are the challenges that physicians in North
Carolina experience, are they similar to the challenges that
you face in Alabama?
And how will the BIO Preparedness Workforce Act helps
smaller hospitals address infectious diseases?
Dr. Marrazzo. Mr. Butterfield, thank you very much for that
excellent question. You describe a very, very similar situation
to what we are experiencing in Alabama.
And indeed, we have some smaller programs that are able to
do that, but nothing that really can meet the need of the
state. So very much echoing, I think, what--your experience and
what many states across the country are experiencing.
The BIO Preparedness Workforce Act will help by expanding
the necessary bio preparedness and ID workforce, and
incentivizing these providers to work in these underserved
communities, so you can actually make it worth their while to
get out there and do the service in the places that really need
it.
Mr. Butterfield. Thank you. Let me move over to Dr. Monroe.
Thank you as well for your testimony. In waiting my turn to
ask questions, I researched your bio, and you have impeccable
credentials. And just thank you for your years of service.
Dr. Monroe, 10,000 Americans turn 65 every day. Seventy
percent of these individuals will need long-term care. However,
since March of 2020, senior living facilities have lost over
380,000 caregivers, and 96 percent of assisted living
communities currently face shortages. And so do you think the
legislation before us goes far enough to address the caregiving
shortages in long-term settings, such as memory care and
assisted living?
If not, what additional efforts should we consider?
Ms. Monroe. Well, that is a great question. I think we need
to do much more than we are doing. I am not sure exactly what
it will take, but certainly these are extremely hard-working
individuals. They are not necessarily well-trained. Many of
them are just receiving minimum wage, and that is a challenge.
In fact, I can tell you, from personal experience, even as
of last week, at the independent/assisted living facility that
my parents reside in, my mom has had to, on a weekly basis,
turn away the professional caregivers that come in, because
they are unvaccinated.
Mr. Butterfield. Thank you. It looks like----
Ms. Monroe. And there has not been a----
Mr. Butterfield. Thank you, Ms. Monroe, thank you. The
Chair has been very patient with us, but I think we had better
yield back.
Before yielding back, Madam Chair, let me ask unanimous
consent to enter a statement into the record from a new
healthcare organization, qualified health center organization,
called Advocates for Community Health. I would like to get that
into the record, and my staff will send it over to you. Thank
you, I yield back.
Ms. Eshoo. So ordered, Mr. Butterfield, thank you.
[The information appears at the conclusion of the hearing.]
Mr. Butterfield. Thank you.
Ms. Eshoo. A pleasure to--and he yields back--to recognize
the ranking member of the full committee, Mrs. McMorris
Rodgers, for your 5 minutes of questions.
Mrs. Rodgers. Thank you, Madam Chair. I too want to thank
all the witnesses for being here and sharing your insights. I
especially want to recognize Mr. Feist, and appreciate you
sharing the story of Dr. Lorna Breen. It highlighted, I
thought, what you said about the parallel pandemic of mental
health and suicide, which is so important for us to be focusing
on, also.
Dr. Keel, I wanted to thank you for being here, and sharing
about your innovative novel curriculum that is improving the
pipeline of practicing primary care physicians in Georgia. I
wanted to ask, do you think that this is a model that could be
replicated in other states, an accelerated three-year
curriculum?
And what else can we be doing, as policymakers, to
streamline career training for health providers to help reduce
that debt burden?
Dr. Keel. No, that is a--and thank you for the question.
I certainly believe this is a model that any state in the
Union could take advantage of, not only from reducing medical
school from four years to three years, which takes quite a bit
of work, as you might imagine. There are some 20, from what I
am told, medical schools across the country already that have
some form of an accelerated MD program, although I don't
believe it is that the scale at which we are doing it, not the
entire incoming class that we are doing, but certainly that
would be one aspect of it.
But this is the problem, or putting physicians in rural
health--this--what we are doing is not--that is not going--that
is not the silver bullet that is going to completely solve
everything. We know that. It is going to take support from the
individual states, just like we were able to match a major a
contribution towards this program by state funds. That the
state appropriated it in order to do that certainly will--goes
towards that.
But I think the states themselves are going to have to step
up, and the local communities themselves are going to have to
step up, as well, to try to participate in this. It is not just
eliminating the debt, but it is also finding ways to cover the
cost of setting up a practice in a rural area that--I think
that gets to the more local aspects of what might take place.
So this can clearly be implemented in any state, and we
will be happy to talk with anyone about what we are doing, and
how we are doing it. But it is going to be a program that is
going to require a tremendous amount of work across the board.
Mrs. Rodgers. Thank you, thank you.
Mr. Levine, CMS provided flexibilities during the global
pandemic related to staffing through the 1135 waivers. Some
flexibilities help expand access to an array of skilled nurse
aides for nursing homes. Some helped waive requirements from
NTALA to ensure flexibility in screening and delivery of care
while hospitals were overwhelmed during surges, while others
helped ensure access to lifesaving telehealth, so our doctors
could more easily meet the needs of their patients during the
worst of the pandemic.
I think that we should be looking also at the impact on
patient safety, and if there is any flexibilities that should
remain in place during--or after that pandemic. And would you
speak to the ways that the pandemic flexibilities helped Ballad
Health, and then which ones should be considered for permanency
after the public health emergency ends?
Mr. Levine. Well, thank you, Representative. First of all,
what I would start with, going back to something you said in
your opening comments, you are 100 percent right, that states
really did lean into this at the state level, and the
flexibility that started with the states by deploying the
National Guard, and some of the other things they did to assist
us, were extremely helpful.
One of the things I think CMS did that I think particularly
helped us was the expansion of the use of telemedicine. Here,
in a rural or non-urban region of the country, the use of
telemedicine is important if you are going to bring services,
particularly children who suffer from health issues, and--as
well as adult addiction. So the flexibilities with
telemedicine, particularly if we can get broadband deployment
in non-urban communities in America, that will help.
And I do think some of the flexibilities with staffing,
particularly--and something that was said earlier--as the
pandemic subsides, when we get in the rearview mirror, we are
going to see a lot more turnover. And, as we see more turnover
amongst our staff, we need the flexibility of other healthcare
professionals, like paramedics, EMTs, nursing assistants in
ways that perhaps in the past we haven't used them before----
Mrs. Rodgers. Yes.
Mr. Levine [continue]. Flexibilities would help.
Mrs. Rodgers. Thank you. As a--I also wanted to note that
in your testimony you discussed the increases in the diseases
of despair, such as substance abuse disorders and suicides. Can
you further elaborate on what you think maybe are some
strategies that we can be using to help address the diseases of
despair?
Mr. Levine. You know, I will speak first to the non-urban
and rural parts of America, which, of course, is 85 percent of
our land mass. And, you know, they are facing economic
challenges.
You look at the--pre-pandemic, you look at the unemployment
rate, and then you look at the workforce participation rates,
and you really have to recognize that there is a lot of despair
in our region of the country, where we have lost the coal
industry, and nothing has replaced it. And so economic despair
is one of the big drivers for--poverty and economic despair are
the drivers for those types of behavioral--and so I would lean
very heavily on economic growth, and find ways to help these
regions expand and grow their local economy and, therefore,
workforce opportunity.
Mrs. Rodgers. OK, thank you. Thank you, everyone. I yield
back.
Ms. Eshoo. The gentlewoman yields back. The Chair is
pleased to recognize the gentlewoman from California, Ms.
Matsui, for her 5 minutes of questions.
Ms. Matsui. Thank you very much, Madam Chair, for convening
this very important hearing, and I want to thank the witnesses
for being with us today.
Today's discussion around healthcare workforce needs is
particularly timely, as the pandemic has exacerbated mental
health challenges for people of all ages, especially our
nation's youth.
As with COVID-19 and other health conditions, when it comes
to behavioral health we know that people of color, including
children, face disparities in vulnerability and access to care.
Coming out of the pandemic, we have an opportunity to save
lives by bolstering Federal resources that support community
mental health and substance use services. That is why I
encourage this committee to consider my legislation that
extends and expands the CCBAC Medicaid demonstration program.
My bill supports clinics that hire and train more staff
that make it possible for people to receive timely and high-
quality care under a comprehensive primary and behavioral
health treatment model.
Moreover, we know that we need to take a multifaceted
approach to responding to the growing and unique needs of our
communities.
I am deeply concerned about the shortage of over four
million behavioral health service providers we have seen across
the country, so I am pleased that we are discussing legislation
today that would extend funding for critical provider education
and training programs.
Dr. Keel, I would appreciate your perspective on the need
for and benefits of these programs, particularly as you share
that psychiatry is one of the seven primary care pathways in
your program that aims to address provider shortages.
Dr. Keel, you note in your testimony that the behavioral
health workforce education and--program is particularly
important to students at your public academic medical center.
How does this program assist in your students' field placement
clinical experience?
Dr. Keel. And thank you very much for the question. We have
not had an opportunity to study the--that particular
legislation well enough to be able to comment on that at this
time. We most certainly will do that.
But if I can speak to the issue of mental health,
especially as it relates to campuses, we are seeing an
extraordinary increase in the need for mental health services
on our university campuses. I know this won't be a big surprise
to you, as well.
Ms. Matsui. Right.
Dr. Keel. And clearly, anything that can be aimed towards
not only providing educational opportunities for students to
understand that, if they are having issues, they need to reach
out to get those services, but also how we, as universities and
as--and how we, as health systems, can provide those sort of
services to the individuals that need it the most, whether it
is our student population, who are very vulnerable, or whether
it is to the rural and underserved areas, and also the minority
populations of our community, who also find themselves in a
position where they just don't have access to that.
Ms. Matsui. Dr. Keel, I want to ask you about another
program that you highlighted, a pilot program that enables
medical residents and fellows to practice psychiatry in
underserved community primary care settings.
In your experience, do integrated services like those made
possible by training demonstrations and the CCBAC help
strengthen the state's mental and behavioral health service
capacity?
Dr. Keel. Absolutely. And as you may recall from my
testimony, one of the residency programs that we are--one of
the specialties that we are emphasizing in this 3+ program is
psychiatry.
I am told that, of the 159 counties in Georgia, nearly half
of those do not have a psychiatrist in that particular county.
Ms. Matsui. Right.
Dr. Keel. It provides an incredible lack of access, again,
especially in the rural and underserved areas, for an
incredibly much-needed service. So we are certainly hoping that
some of the legislation has been proposed that would emphasize
not only behavioral health counselors and that sort of thing,
but also would emphasize the training of psychiatrists, we can
incentivize those individuals to go to the areas in which they
need it the most, as well.
Ms. Matsui. Certainly. Thank you very much, Dr. Keel. I am
going to talk about workforce diversity. My colleagues and I
have been working on numerous proposals to help diversify the
healthcare workforce, and I am pleased we are considering
several of these today.
In fact, many of the proposals in our package, the Build
Back Better legislation, would also help to increase diversity
in the provider pipeline, including proposals related to
perinatal and maternal workforce development, health
professionals opportunities grants, and graduate medical
education.
Dr. Wilburn, the Allied Health Workforce Diversity Act
would allow HHS to continuously define which communities are
considered under-represented. Why is this important when it
comes to training new health professionals?
Dr. Wilburn. Thank you so much, I am happy to elaborate on
that.
It is important for the community to match the community in
which it serves. So in some areas of our country, under-
represented includes racial minority groups. And for others of
our country that might be rural and military families. We all
know that we have better health outcomes when our providers
match the demographics of their community.
Ms. Matsui. Well, thank you very much, Dr. Wilburn.
I yield back, Madam Chair.
Ms. Eshoo. The gentlewoman yields back. The gentleman from
Virginia, Mr. Griffith.
Mr. Griffith. Thank you very----
Ms. Eshoo. For 5 minutes.
Mr. Griffith [continue]. Much, Madam Chair.
Mr. Feist and your wife, I am so sorry for your loss. I
don't have any questions, but I was appalled at the conditions,
and we are going to do our best, which is why I was proud to be
an original cosponsor of the bill. So thank you very much for
being here.
Dr. Keel, I want to talk to you on another date. I have
some crazy ideas about residency reform, as well, but I love
the 3+ program. I think that that is a step in the right
direction, and I appreciate your innovation there. All right,
now I am going to go to Alan Levine from down my way.
As I mentioned in my introduction, Ballad recently was able
to reopen a hospital in Lee County, Virginia. The community had
gone--and I shortened it up, because when you are dealing with
it, sometimes time goes. It was actually eight years that it
was closed. And when the hospital originally closed down in
2013, it cited two reasons: reimbursement and recruitment
challenges.
So, Mr. Levine, recruitment challenges predate the
pandemic, don't they?
Mr. Levine. Yes. Yes, sir, they do. And they absolutely
did, and it is worse now.
Mr. Griffith. Yes. And at this point in time, Ballad has
not imposed a vaccine mandate on its staff. I am correct in
that, am I not?
Mr. Levine. Yes, sir, that is correct.
Mr. Griffith. And my estimate--you tell me if you agree or
disagree, or have some number, but my estimate is that you
could lose as many as 15 percent of your healthcare workers if
you implemented a vaccine mandate. Am I pretty close to the
mark?
Mr. Levine. We have had some concern about that. And, you
know, 63 percent of our team members and 90 percent of our
physicians are vaccinated. But, you know, a lot has been said
here about the cultural differences in the delivery of
healthcare. And cultural differences don't----
[Audio malfunction.]
Mr. Levine. We are in a part of the country where, for a
lot of various different reasons, people have differing
viewpoints on vaccines. And so we have tried very hard to lean
heavily into educating people, being a resource, a source of
truth for the community on it. And we are going to continue to
lean into doing that.
Of course, with the mandates that may be coming down from
Medicare, that certainly will change our perspective, because
we certainly, with 70 percent of our----
[Audio malfunction.]
Mr. Levine [continue]. Government, we can't afford to lose
that reimbursement.
Mr. Griffith. Right. And the problem is, if you get a
mandate from Washington, DC--and sometimes in our area--and
people don't realize it--and you mentioned the cultural
differences--we actually see some of these things coming out of
Washington to be kind of cultural colonialism by Washington,
DC. And there is a resistance to the Federal Government, no
matter what, in our area.
I am often reminded of the song, Rocky Top, which is
actually the anthem of one of the colleges there, in Tennessee,
where it says once two strangers went up Rocky Top, looking for
a moonshine still. Strangers ain't been seen again, guess they
never will. I paraphrased that a little bit, but that is--you
know, there is just a resistance to the folks coming in from
outside trying to tell everybody what to do.
And I am concerned that there will be a lot of people, a
lot of healthcare professionals, who will just say, ``Forget
it, I will go do something else.'' And in this time, where we
have--we still have a lot of unemployment in some sections,
particularly in the coal fields, but in other sections of where
you serve, there is an employee shortage. Isn't that also true,
for all kinds of things, not just healthcare?
Mr. Levine. That is correct, sir. And I think the concern
we have--again, a one-size-fits-all approach doesn't always
work. The difficulty in recruiting--if a team member leaves--
and we, right now, have openings for 700 nurses--if a team
member leaves, getting a new one to replace him is very
difficult in a rural region. And so we have been a bit hesitant
to impose a mandate, while we continue to try to work with and
educate our team members.
We certainly are for them getting vaccinated. But the
issue----
Mr. Griffith. Yes.
Mr. Levine [continue]. Of a mandate pushing them away is--
obviously, has been a concern for us.
Mr. Griffith. Well, I think my attitude reflects it. I am
vaccinated, but it reflects the area that I represent. I will
never vote for a mandate, because that is just going to make
more resistance to the vaccine, and more distrust of the
Federal Government.
How much has Ballad relied in the past on traveling nurses,
and how much are you relying on them now?
Mr. Levine. It is--you know, I have served as a secretary
of health in two states through hurricanes, the pandemic, H1N1,
and the oil spill in Louisiana. And you know, I know attorneys
general, generally, will prosecute and go after organizations
that gouge consumers in the aftermath of a disaster, like
supplies or gas.
Here we sit, where we are now paying $140 an hour for
contract nurses. I have got a nurse at one of my hospitals in
Johnson City from Vanderbilt----
[Audio malfunction.]
Mr. Levine [continue]. Nurses here, four hours away, is
because they could get three times more money from contract
agencies.
And so we are getting--right now we have 400 contract
nurses in our system. That is helping to offset the 700 need
that we have. But I think this is going to get worse----
[Audio malfunction.]
Mr. Levine [continue]. After this. And I am very concerned
about the impact--the incremental cost and the impact on
quality an over-reliance on contract agencies has, and I do
hope somebody can look----
[Audio malfunction.]
Mr. Griffith. I appreciate it. My time is up, and I yield
back.
Ms. Eshoo. The gentleman, well, yields his time.
I would just like to state a factoid here. At Tyson Foods,
96 percent are vaccinated, 60,000 people vaccinated, thanks to
their requirement.
I don't know if--I have to tell you, if I went to Stanford
University Hospital, which is a couple of miles away from me,
as a patient, I wouldn't want any doctor, any nurse, anyone
coming near me that was not vaccinated. I don't go to the
hospital to become infected, so I just--I wish that we were all
on the same page, because I think this back-and-forth on
vaccinations, it is--at the end of the day, I think it is
holding us back. Honestly, it is hurting us in our country.
If we were all one, we would march forward, and put this
pandemic behind us. Instead, we are going back and forth, back
and forth, back and forth, and it is--we are here, we are doing
all this wonderful work with these bills, and yet we can't be
sensible enough to listen to those that know what they are
talking about.
We want to train more of them. We want to train more of
them. We want more in the pipeline, and then we are going the
other way.
So excuse my two cents here, but I guess you get to do this
every once in a while, as--chairing the committee.
I am pleased to recognize the gentlewoman from Florida, Ms.
Castor, for her 5 minutes of questions.
Ms. Castor. Well, thank you, Madam Chair, and I agree with
you. We have a safe and effective vaccine, and we are so
fortunate that--to live in America, where we have been able to
distribute it widely. And it is an unnecessary debate, that has
cost lives.
But I want to thank our witnesses, especially, for sharing
your expertise here today. The frontline healthcare workers,
the doctors, the nurses, the therapists have been nothing less
than heroic throughout the pandemic. And the burnout in the
stress is very real, though.
I--one of my best friends, back home in Tampa, is a long-
time nurse at Tampa General Hospital. She has worked there for
about 30 years. And it was the first--this summer was the first
time I ever heard her say she didn't want to go to work. And
then, when we had our very preventable COVID surge this summer,
in August, September, when Florida led the nation in the COVID
death rate, she just shared she was so tired of seeing people
die unnecessarily.
And then I was heartened, though, because another very good
friend, who is a mental health therapist, said, ``You know,
Tampa General has just hired me to go in and talk to the
healthcare workers, and be there for them, and counsel them.''
And I think this was even before the HRSA money out of the
American Rescue Plan was distributed. So what a godsend to
those frontline heroes.
So, Corey and Jennifer, thank you very much for your
testimony, and turning your grief into action that will help
other healthcare heroes on the front lines. During your
advocacy work in speaking to frontline providers about the need
for better mental health recognition and services, what do you
hear most often from them?
What are the common barriers you hear from those frontline
workers on seeking healthcare, mental healthcare service?
Mr. Feist. Excellent question. This answer requires a look
at regulatory barriers, as well as just the culture of medicine
and the operations.
On September 9th we published an article in U.S. News and
World Report that summarized six of the barriers that we had
heard for the last 18 months from the health--mental health--
sorry, the healthcare workforce around some of the things that
prevent them from getting mental health treatment: those we--
those are state licensure questions that go above the Americans
with Disabilities Act, hospital credentialing application
questions, commercial insurance questions, malpractice
application questions, medical plan design, or hospitals that
require their mental health treatment for patients to come to
their own hospitals.
And then, something that completely boggled my mind, which
is that physicians' mental health medical records can be
subpoenaed in a malpractice lawsuit in many states, and those
are not protected from disclosure during a malpractice lawsuit.
So those are just six of the areas. But this is a--this is
something that is so incredibly pervasive across the industry.
You know, Dr. Breen was convinced she was going to lose her
license to practice medicine in New York, but she was
incorrect. The licensure law in New York doesn't even ask
questions about mental health past. She was incorrect, but that
thought is pervasive across the healthcare industry, which is
why one of the things that we did this year, in honor of
National Physician Suicide Awareness Day, on September 17th,
was to ask every hospital in this country to publish for their
own workforce just what the what the facts are in their own
institution and in their own state. Those that one group of
regulatory barriers that I just identified for you need to be
all knocked down.
In addition, we have got tons of cultural issues about just
healthcare workforce looking out for themselves and their
colleagues, because they go into the business looking out for
patients first.
Ms. Castor. That is kind of unbelievable to me, that there
are so many barriers. So did Dr. Breen--did you--would you say
that again, that she may not have sought help because she was
afraid of something involved with her license?
Mr. Feist. Absolutely. Not only that, though, but once she
received help for the first time ever in her career, after she
was discharged from the inpatient unit at the University of
Virginia, she was convinced beyond any doubt that she was going
to lose her license to practice medicine, and she ultimately
took her life only a handful of days later. And she--and New
York State doesn't even ask that question. But the thought of
loss of licensure is incredibly pervasive.
I will give you one other example. Every year, new
residents come out of medical school and they start their
residency in the summer. We have heard from many residents
across the country that, as soon as they start their residency,
they stop taking their anti-depressants. They stop taking
medications. They stop going to see a therapist. They will pay
in cash. They will use a pseudonym, all because of this stigma
and these regulatory issues.
And I will give you one last example. We heard from a
physician in Oregon who received mental health treatment for
the first time in her career because she had a reaction to an
allergy medicine that created a mental health condition for
her. It took her ten years of fighting to get her license back
after that one issue.
This is just incredibly widespread. Now that we have spoken
about this issue, others are coming out, and they are talking
about it all over the place.
Ms. Castor. Thank you very much. I yield back.
Ms. Eshoo. The gentlewoman yields back. The Chair
recognizes the gentleman from Florida, Mr. Bilirakis, for his 5
minutes of questions.
Mr. Bilirakis. Thank you so much, Madam Chair. I appreciate
it. And thanks to the witnesses for their testimonies today.
While I appreciate the intent of this hearing to focus on
workforce issues within our healthcare systems and, in
particular, the inclusion of a bill that I have cosponsored,
the Dr. Lorna Breen Health Care Provider Protection Act, I do
want to speak to some of the broader significant challenges we
have been seeing during the pandemic amongst our hospital
systems, nursing homes, assisted living facilities, and other
providers.
And I wonder if we are missing a real opportunity to do
more to address these challenges. For example, the Florida
Hospital Association and Safety Net Hospital Alliance of
Florida recently commissioned a report with projections from
the healthcare workforce in my home state of Florida, which
found that, if the current trends hold up, by 2035 the state
will be short of supply by more than 65,000 registered nurses
and 26,000 licensed practical nurses. And that was using the
2019--actually, year 2019 as a baseline, not counting the
potential worsening effects of COVID-19, the pandemic.
Even now, one of my local Tampa-area hospital systems,
Advent Health's West Florida Division, has told me that they
currently have 1,022 RN openings, and it is not getting any
better.
Unfortunately, it is not unique to the hospitals alone, as
other providers are also seeing their demand pushed, while
their supply is stretched extremely thin. In the mental health
space, SAMHSA has estimated an over four million-provider
shortage of behavioral health services across the country. Very
unfortunate.
Amongst our nursing homes, 94 percent nationwide are
currently facing staffing shortages, and the problem is only
being exacerbated, as you know, by the pandemic.
We must continue to do what we can to ensure we are
supporting clinical education and training, increasing facility
faculty, of course, and clinical sites for nursing programs,
and allowing for additional flexibilities in our current
workforce incentive programs across the system. I believe this
is all a non-partisan issue. We all agree on this.
In that vein, I was very glad to see Governor DeSantis sign
legislation this summer that created a personal care attendants
program, with new entry-level position opportunities for these
types of caregivers to count towards nursing assistant
requirements in long-term care facilities, along with a path
towards certified nursing assistant careers.
This is thinking outside the box. This is what we need,
flexibility. We need innovative ideas such as this to ease the
burden to our industry by making it attractive for individuals
to enter into the workforce with a robust support system to
grow our labor supply.
Another way we can ease this burden is by reducing the
demand. So I have a question to my friend from this--well,
originally from the State of Florida, and did an outstanding
job as the Department of Health head under Governor Bush, very
innovative ideas, and we did a lot together. I served for eight
years in the legislature, while he was there doing an
outstanding job on behalf of the great people of the State of
Florida.
So Alan, Mr. Levine, you mentioned in your testimony the
importance of deliberately working towards admitting fewer
patients and lowering inpatient hospital admissions by moving
towards outcomes-based care at Ballad Health. I could not agree
more that we should be promoting value-based care centered on
outcomes, which is what Medicare Advantage does so well.
Can you tell us more about the ways you think we can not
only increase the supply of the workforce, but also
specifically reduce the demand for these services?
Mr. Levine. Well, I--Congressman, it is great to see you
again, my friend, and I want to go back to one quick thing that
Congressman Griffith said earlier. He was referencing Rocky
Top. I do want to point out I am a Florida Gator.
So--but your question is right on target. All of these
movements towards value-based, risk-based payment to our health
systems incentivizes us to provide a lower-cost way of
delivering care. For instance, Ballad Health was just approved
for our new Hospital at Home program that we are going to trial
with CMS, because we learned during the pandemic, if we were
able to take care of people at home, based on certain criteria,
we kept them out of the hospital, and this took the burden off
the nurses at the hospital. And that happens with telemedicine
and the use of technology. We are going to be moving in that
direction.
So anything we can do to avoid going to a hospital is
helpful in reducing the burden on nursing staff in the bedside
setting. It doesn't diminish the need for healthcare and
healthcare settings, but it does diversify the healthcare
manpower----
Mr. Bilirakis. Very good. Thank you. And it is great to be
a Florida Gator. I appreciate that, and I think we have a shot
against Georgia this weekend. I know it is a stretch, but I am
always confident. I am the eternal optimist.
With that, I will yield back. Thank you.
Ms. Eshoo. You always are, Mr. Bilirakis. OK, the chairman
of the full committee, Mr. Pallone, you are recognized for 5
minutes for your questions.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Chairwoman Eshoo. I wanted to start
out with some questions of Ms. Harrison.
I know your members are local health departments who are
often the first and last resort for our local communities. You
know, they are on the ground, setting up the vaccination
clinics, and all the things that are so important.
The Public Health Workforce Loan Repayment Act is designed
to make a significant impact in repairing the public health
workforce--well, and I would say in repairing a broken
healthcare system, you know, trying to help with the workforce,
capture new talent who might not have pursued these careers
before the pandemic. So I wanted to ask some questions about
that legislation to you in that vein.
We have heard today from witnesses on the shortages of
providers in several specialties. There are two workforce areas
which we know are expecting workforce gaps, due to burnout or
leaving for higher-paid positions in the private sector. So--
and if you could tell me, just in a yes-or-no response, would
the Public Health Workforce Loan Repayment Act be helpful to
address public health nursing shortages, yes or no?
And then what about computer science, or IT professional
shortages? Yes or no, because I have more questions of you.
Ms. Harrison. Yes, sir. On both counts, yes.
The Chairman. OK. So let me ask this. There are differences
in the authorization levels between the House and Senate
versions of this bill. So, in your view, what is the
appropriate authorization level needed to have a successful
program?
Ms. Harrison. Thank you for that question----
The Chairman. That is not a yes or no.
Ms. Harrison. Thank you, yes, sir.
So the House bill, in my understanding, authorizes 100
million for the first year, and then 75 million after that,
whereas the Senate bill authorizes a full 200 million. And so,
I think, you know, speaking on behalf of nearly 3,000 local
health departments across the United States, in this case more
is more, and each dollar goes toward supporting new
opportunities to have recruited high-level staff in local
health departments.
And so, you know, even with that $200 million, that would
support approximately 6,000 staff at the local level. That is
just two people, or approximately two people for most local or
state health departments. That would not even do the trick, but
close.
The Chairman. So we, obviously, have to go for the higher
amount, at a minimum, is what you are saying.
Ms. Harrison. More is more. Yes, sir.
The Chairman. OK. So then the last question I have of you--
and then I want to ask another question of Mr. Feist--we have
heard from some that investments made in the American Rescue
Plan should be sufficient to address public health workforce
concerns. So how would the--and I am not saying I agree with
that, but how would the Public Health Workforce Loan Repayment
Act complement the one-time workforce-directed funding that was
provided by this committee in the American Rescue Plan?
Ms. Harrison. Yes, sir. Thank you for that.
The difference is long-term versus short-term funding. So
when we have the shorter-term funding that comes down in
American Rescue Plan Act, it is very prescriptive, once it gets
to the local level, about what we may and may not use that
funding for. And it is also very short-term. So it doesn't make
a lot of practical sense for us to hire new individuals into
our agencies, if we know that money is going to run out.
And I think the more sustainable infrastructure building
workforce supportive approach is this loan repayment plan,
which is more long-lasting.
The Chairman. All right, thank you. Now I want to go to Mr.
Feist.
In the--again, going to the American Rescue Plan, in the
American Rescue Plan Congress provided funding to support key
areas included in the Dr. Lorna Breen Health Care Provider
Protection Act. So some view the ARP, the Rescue Plan funding,
as sufficient in addressing the mental health needs of the
provider community, and I view the Lorna Breen Act as the
roadmap for sustained investments to ensure the success of
these endeavors.
So sort of the same question. In your view, why is this
legislation even needed, even with the investments that we made
from the Rescue Plan?
Mr. Feist. We are thrilled that the American Rescue Plan
included the monetary provisions of the Lorna Breen Act. But as
you just said, sir, the Lorna Breen Act will not only create
the policy for the distribution and allocation of those funds,
but it will also create a future roadmap for us, with a
comprehensive study provision that really addresses the root
cause of these issues, and it creates a road map of this--to
take care of the healthcare workforce, now and in the future.
Mr. Pallone. All right, thank you so much.
Thank you, Madam Chair.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the gentleman from Indiana, Dr. Bucshon, for 5
minutes of questions.
Mr. Bucshon. Thank you, Madam Chairwoman. While I support
many of the proposals we are discussing today, I must ask one
important question: Where is the support for physician
providers right now?
My friends in the majority are planning to spend trillions
of dollars, yet nowhere in their spending package is their help
for our providers facing looming reimbursement cuts in the
Medicare physician fee schedule set to take effect at the start
of next year, as well as sequester cuts and PAYGO cuts that
could result in up to a ten percent reimbursement cut--and
decreased access to care, by the way.
Just last month, here in this committee, I offered an
amendment during the reconciliation markup that would have
alleviated most of these looming cuts for one year to provide
our heroes on the front lines with some relief, as we work in
Congress to find a long-term solution to better value their
work. However, the amendment was rejected.
So I ask: If not today, when is the right time?
This hearing is focused on supporting providers, which I am
all in favor of, providers across the spectrum. How are we not
focusing on one of the key issues facing doctors at this time,
an issue that will force more early retirements, and continue
the trend of our best and brightest students choosing other
professions with more financial promise, all of which is
leading to physician shortages, especially in rural America?
We all keep hearing from our providers that this will have
grave consequences, and directly threaten access to care. To my
friends and colleagues, let's work together to make this a
priority for this committee--this subcommittee, also--so we can
better support our providers.
Also, I want to voice my strong opposition to the HHS rule
on surprise billing, and my disappointment that there is not
strong opposition from the majority committee leadership. The
rule, in my view, does not reflect congressional intent, and
may, in fact, violate the law. I urge all of my colleagues to
stand up on behalf of Congress and our ability to write the
laws and a two-year bipartisan process.
So now, switching gears, Dr. Keel, I want to applaud the
work you are doing at the Medical College of Georgia with the
accelerated three-year medical school program. I was a
cardiovascular surgeon, so I did four, and four, and seven
years of residency for primary care--critical shortages in
rural Indiana, of course. I know firsthand that the length of
medical school and the student loan debt students leave is a
major factor for why our best and brightest students are
choosing different professions. In fact, my three adult kids
aren't doctors, and my wife and I both are.
In your experience, do you think more colleges can offer
accelerated medical programs like you are doing at yours?
And have you looked at accelerated programs like this for
other medical specialties, as well, including surgeons?
Dr. Keel. Absolutely. As I mentioned earlier, I think this
program that we have put together in Georgia can be implemented
in just about any state in the Union that is willing to take
the time and effort to change their curriculum. And I think
that is certainly something that should be considered.
I think to try to eliminate that debt for the reasons that
you pointed out just a few moments ago is critical, because--to
encourage these individuals to go into the primary care
disciplines because of the reasons that you just alluded to----
Mr. Bucshon. Yes.
Dr. Keel [continue]. In terms of the opportunity to really
earn an income and help pay off that particular debt.
We have used the term ``primary care'' very broadly, to
include not only the things that you would recognize right
away, the members would recognize right away: family medicine,
internal medicine, pediatrics. But we have also included OB/
GYN, emergency medicine, psychiatry, and general surgery.
We have right now a rotation that physicians--in some of
the more rural parts of our state--take a surgery rotation in
those areas, so they can understand what it is like to be a
surgeon, a general surgeon, in some of those greatest--areas of
greatest need.
So yes, I think this can be applied broadly, and we
certainly hope to be able to expand it to many other areas,
based on what the need is----
Mr. Bucshon. Right.
Dr. Keel [continue]. In a particular area of the state.
Mr. Bucshon. Right.
Dr. Keel. Thank you, sir.
Mr. Bucshon. Personally, I support a six-year medical
program, and working with colleges to combine the medical
school and college education that eliminates unnecessary,
duplicative courses, which--I love--I was a chemistry major. I
love biochemistry, but I didn't need to take it twice. And
genetics, the same thing. So other countries can do this. The
question of whether or not people are properly trained really
wouldn't be a problem.
Mr. Levine, I have a question for you to finish up here.
Has any staff infected a patient at Ballad Health, that you are
aware of, with COVID-19?
Mr. Levine. No, sir, not to my knowledge. Our staff are
required to wear universal precautions. Whether you are
vaccinated or not, you are wearing PPE, and you are doing
everything you can to protect our patients.
Mr. Bucshon. Great, thank you. I yield back.
Ms. Eshoo. The gentleman yields back. The gentleman from
Vermont, Mr. Welch, is recognized for his 5 minutes.
Mr. Welch. Thank you very much, Madam Chair.
Senator Sanders and I--Senator Sanders convened a workforce
roundtable with the leaders in our healthcare system in
Vermont, including the University of Vermont Medical Center,
which is our largest. And just to recite the incredible
challenges we have in our small rural state, 3,900 nursing-
related job vacancies; 70 primary care provider vacancies; 571
long-term care facility vacancies; 386 home health nursing
vacancies, and a big turnover, about 28 percent.
The cost of this is brutal. You know, we are a small state,
but traveling nurses, which has been the go-to place, is $50
million at the University of Vermont. In a small community,
Rutland, which is a really vibrant, but not rich community, $25
million.
And a concern I have is actually--I don't know who owns
these nursing--traveling nurse agencies, but it is like now a
business model, where there is incredible profiteering, and it
creates the dynamic where nurses who are, for instance, on
staff at the University of Vermont go on a per diem, and then
go down 90 miles the road to Dartmouth-Hitchcock as a traveling
nurse, and make a lot more money, and there is no benefit to
the community. And I would really welcome thoughts on how to
deal with that.
But Mr. Levine, I want to ask you, because in your
testimony you discussed how extensive the nursing workforce
shortage is, especially aggravated with COVID. And the faculty
issue is a real challenge, particularly with the pay gap. So
can you be very specific as to the steps we can take--and this
is bipartisan--to bolster our dwindling nursing force?
And how can Congress help get at the root cause of the
dynamic for long-term and sustainable change for our patients?
Mr. Levine. Well, thank you, sir. I would start by agreeing
with the advocacy for the Lorna Breen Act, because nursing
resiliency is one of the most critical issues we are facing
right now. And the reality is, you know, the East Tennessee
State University Center for Nursing Advancement that we just
created yesterday, they are going to be an eager applicant for
those grant funds to study what causes these issues, and how do
we intervene before we end up losing a nurse from the bedside.
The second thing is--you said it when--you just said that--
--
[Audio malfunction.]
Mr. Levine. We--our nurse--the data that I have seen in
2019, I believe, tens of thousands, as many as 80,000
applicants for nursing school were turned away because there is
not enough space in the nursing programs.
I think we have got to lean in to create programs to
identify high school students with a propensity towards being
successful in the sciences, and get them exposed to nursing as
a career where systems like ours would gladly employ them as
unlicensed workers, so they could get a--they could graduate
high school with some kind of a certification, and then go into
a nursing program and come out with a job.
There are----
Mr. Welch. OK, thank you. I am almost out of time, but
thank you very much for that.
I would like to ask Ms. Harrison about this incredible
challenge of the traveling nurses. How can we deal with that?
How can we make--I mean, part of it is making the nursing
profession more financially competitive, but we can't compete
with the traveling nurse, where, essentially, it is a stickup,
and a lot of that extra charge goes to, probably, hedge funds.
Ms. Harrison?
Ms. Harrison. Yes, sir. I wish I had a good answer. I think
this is a struggle across private-versus-public opportunities
to do healthcare delivery. It--they are very different models,
and it is a real struggle to work against that, for sure.
Mr. Welch. So nothing to say about that?
Ms. Harrison. I don't have a good answer for how to
eliminate that sense of loss from the public sector to the
traveling nurse----
Mr. Welch. You know, the dynamic with the traveling nurse
is this. You have got hospitals, some of them non-profit, some
for-profit. But essentially, their ability to serve people is
based on taxpayer contributions for Medicare and Medicaid
employers, who are employer-sponsored healthcare. And there is
a captive market.
And then the hedge funds, essentially, create this dynamic,
where it is incredibly attractive to a nurse, understandably,
to go from Burlington down to Hanover, New Hampshire. But we
can't sustain that cost.
I mean, is that a topic of concern among your community?
Ms. Harrison. Well, in rural areas we don't experience that
as much. And you know, we have such a short bench, not many
opportunities for hiring and retaining nurses, whether it is a
local hospital or a health department, in a rural area. So we
don't have that dynamic as much as they have in larger
metropolitan areas.
Mr. Welch. All right, thank you.
Ms. Eshoo. The gentleman yields back. It is a pleasure to
recognize the gentleman from Pennsylvania, and that he is, Dr.
Joyce.
Mr. Joyce. Thank you for yielding, Chair Eshoo, and Ranking
Member Guthrie, and our incredibly distinguished panel of
witnesses today.
Even before the onset of COVID-19, we were facing multiple
crises in our rural health systems, especially in my district
in South Central and Southwestern Pennsylvania. Shortages of
physicians, nurses, physical therapists, occupational
therapists, other health professionals limited what services
were available, and often would force patients to travel to
Pittsburgh, or even to Philadelphia for care.
COVID-19 has only further stressed a workforce that was
already in crisis. Burnout has contributed to an uptick in
retirements and providers leading the field--leaving the field.
These have had negative impacts, negative impacts on staffing,
and especially in these rural communities.
In my community at health facilities like Windber Hospital
and Excela Health, they have been forced to contract with
nursing agencies that sometimes double, even quadruple the cost
for hourly rates, just to stay operational and staffed to be
able to take care of post-op patients.
A misguided vaccine mandate that makes no attempt to
account for natural immunity is also driving more and more long
and committed professionals out of their fields. This path that
we are on is not sustainable, and will not result in better
patient outcomes for the long term.
In order to address parts of this crisis, I worked to
introduce the Enhancing Community Health Workforce Act that
would reauthorize funding for community health workers to help
improve the care coordination in underserved communities.
Mr. Levine, and then Ms. Harrison, what impact do you think
a bill like this could have, especially in rural settings?
And I will ask Mr. Levine to answer first.
Mr. Levine. Well, we--thank you, sir. We are actively using
community health workers now in several programs that we have
implemented throughout the region, as a health improvement
organization.
One of the things that we are focused on is, as I mentioned
earlier, avoiding hospitalization. So we identified social
determinant issues. It could be anything from somebody who is
homeless, or can't afford their medications. We deploy our
community health workers out to assist them. So anything that
is done to enhance and solidify their role in the system, I
think, would be very positive, and we would strongly support
it.
And I applaud you on your statement about the contract
nursing agencies. What they are doing is not only financially
destroying some of these hospitals, but they are also
distorting the market for nurses, and it is not helpful, what
they are doing.
Mr. Joyce. Thank you for your answer.
Ms. Harrison, would you please address the same?
Ms. Harrison. Thank you. Yes, sir. So I am not as familiar
with the particular program, but recognize the importance of
any bill that gets more opportunities to work with community
health workers at the local level, especially in rural areas.
We do work with local community health workers, and they have
been wonderful, especially these last few months.
I think it is important to note that the intent of the
grants do seem really helpful, in that they are disease
agnostic. So much of the funding that comes to us is very
specific. And so I can appreciate what I understand is true
about that level of flexibility to address healthcare needs
that might vary community by community. Certainly, COVID funds
are critical to address COVID, and there are also many other
public health issues that still will need to be addressed,
moving forward.
So hopefully, you know, one program will not be accountable
to the other. I think we need them all.
Mr. Joyce. And do community healthcare workers provide that
ubiquitous care that is so necessary?
Ms. Harrison. Yes. And originally, also, public health
workers were our original community health workers. We
definitely need both.
Mr. Joyce. Thank you.
Mr. Levine, in your testimony you spoke at length regarding
workforce shortage issues, and I have heard from several people
who run health systems in my district of the challenges of
maintaining a workforce, especially in this economic climate.
What should we be doing, as policy-makers, to ensure that
rural healthcare workers want to stay in these critical roles?
Mr. Levine. Well, one of the first things that really has
disadvantaged rural hospitals and non-urban hospitals
throughout America has been the Medicare Area Wage Index. The
Save Rural Hospitals Act that has been filed, I think, would
help solve that.
When 80-plus percent of the counties in the country are
below the index of--clearly, there is an imbalance. And that
imbalance keeps rural hospitals from being able to compensate
their nurses in a competitive way, with the larger neighboring
counties, where the wage index is higher. To me, that is the
first thing that ought to be done.
Mr. Joyce. Thank you for illuminating that imbalance,
because we certainly see that throughout my district in
Pennsylvania.
Madam Chair, thank you, and I yield the balance of my time.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the gentleman from California, Mr. Cardenas, for
his 5 minutes of questions.
Mr. Cardenas. Thank you very much, Madam Chair, and also
Ranking Member Guthrie, for having this important hearing on
these very important topics.
I want to start with H.R. 1474, Alzheimer's Caregiver
Support Act. Alzheimer's disease and other forms of dementia
are truly disabling, as patients eventually are no longer able
to eat, sleep, or care for themselves. There are more than
five-and-a-half--approximately five-and-a-half million
Alzheimer's disease patients in the U.S., and approximately
600,000 of those are in California.
Family caregivers suffer terribly trying to care for loved
ones who no longer recognize them, and the role is often like
that of a full-time parent doing a hard and thankless task out
of love. This legislation would help train and support family
members and other important, but unpaid, caregivers in their
often unrecognized work caring for Alzheimer's patients.
Ms. Monroe, can you help explain what this legislation
would do to help the situation?
Ms. Monroe. Yes, thank you for that question. Absolutely.
This legislation would help caregivers who are trying to do
what is best for their loved ones to be able to access
resources as they need them in their community.
There is not a sole source that you can currently go to to
find out what exists. We do have some agencies like area
agencies on aging, and sometimes--although we hear now it is
only about 30 percent of doctors that are connected to
community resources. But families absolutely need that. That is
a prescription for their health, and their well-being over the
long haul.
When I, for example, have to take my dad to the doctor, I
have to do that because I am his voice. So it is important for
me to have access to that information, so I can make sure that
he does, as well.
As I mentioned earlier, we see caregivers who not only need
linkages of services for their loved one, but they themselves
may need mental health supports, and respite, and other
healthcare supports for themselves, as this is a daunting,
often very physical issue. And----
Mr. Cardenas. Thank you.
Ms. Monroe [continue]. Find that caregivers are getting
sicker and dying before the people that they are actually
taking care of, because----
Mr. Cardenas. Thank you.
Ms. Monroe [continue]. You are making a choice sometimes
between work----
Mr. Cardenas. Thank you. Thank you, Ms. Monroe.
Ms. Monroe. Thank you.
Mr. Cardenas. Thank you very much. In the interest of time,
I would like to ask a question regarding H.R. 3297, Public
Health Workforce Loan Repayment Act.
The COVID-19 pandemic has really shined the light on what a
shortage we have in this country of healthcare workers, even
though the ones that we do have have been heroes, always, not
just during this pandemic.
This bipartisan legislation helps ensure we have
professionals in place to keep us safe, so we are prepared for
future pandemics and the everyday life of caregiving.
Ms. Harrison, what was the public health workforce capacity
and infrastructure like before the pandemic?
And with COVID-19, what have been the effects?
And also, how would this legislation help?
Ms. Harrison. Thank you so much for the question. The--over
time, the recessions and the dips in funding that has come to
public health really crippled the workforce capacity, even
prior to the pandemic. So we were already at a deficit. And
then the pandemic hit, and we were expected to, of course, make
sure we could continue to do more and more.
This Loan Repayment Act will help tremendously, with at
least being able to recruit and retain over the long haul for
the public health infrastructure, and make up for some of those
losses.
The de Beaumont Foundation and the Public Health
Innovations Committee has actually done a research study that
requests 80,000 new full-time equivalents to public health at
state and local levels; 54,000 of those need to come to the
local level to just shore up regular functions and capabilities
of public health, community-to-community. And so I believe this
loan repayment program is a start to fill that gap.
But certainly, our workforce is tired, and we are losing
them to burnout. Their cups are empty after 20 months of this
level of intense and protracted work during the pandemic. So we
need to make sure that we are addressing our appreciation----
Mr. Cardenas. Thank you.
Ms. Harrison [continue]. For the current workforce, and
recruiting new ones. This will help.
Mr. Cardenas. Thank you so much. Thank you.
I would like to, with the remaining time, just say thank
you for all of us who are supporting 1667, the Dr. Lorna Breen
Health Care Provider Protection Act.
And to Mr. Feist and your family, thank you so much for
putting your time and energy into making sure that such a
tragedy does not come upon other individuals and caregivers and
their families. So thank you so much for being here with us,
and thank you for all that you do.
With that, I yield back.
Ms. Eshoo. I thank the gentleman for his beautiful words,
and he yields back. The Chair is pleased to recognize the
gentleman from Utah, Mr. Curtis, for your 5 minutes of
questions, the patient Mr. Curtis.
Mr. Curtis. Thank you, Madam Chair and Ranking Member
Guthrie, not only for this hearing and for hearing my bill
today, but for putting these hearings together in a tough
environment, with COVID, with votes, and all of our other
responsibilities. And so thank you for your patience, which we
don't always recognize.
The Helping Enable Access to Lifesaving Services Act, or
the HEALS Act, is my bill, and I am very proud of it. It
reauthorizes the grant program established by the 21st Century
Cures Act, something that happened before I came here to
Congress.
Funding within the grant would be used to help eligible
groups to recruit, educate, and provide learning opportunities
for behavioral healthcare students, including substance use
disorders, specialties, psychiatrists, psychologists, and
social workers, just to name a few.
The HEALS Act is especially important to me, because Utah,
unfortunately, has seen significant increase in demand for
behavioral healthcare services throughout the COVID-19
pandemic, not unlike our nation. As a matter of fact, the
nation has seen an overdose rate increase by 30 percent, year
over year.
Dr. Keel, I don't have a question for you, but perhaps a
comment and--to you and some of the other panelists. I have
watched over the last few years my son, who is now practicing
psychiatry, go through medical school. And you might all enjoy
that I visited him once, while he was going through medical
school, and he had his water heater turned off, and he was
trying to save money to lower his student debt, right, when he
came out the other side.
And I know firsthand the difficulty and the sacrifices
these healthcare workers make. My wife is a physical therapist,
and does home healthcare visits. Dr. Wilburn, you are smiling
behind the mask, and I have seen the impact on her firsthand,
as well.
So thank you for your testimonies today, and for all that
you are doing.
Mr. Levine, I am curious how your doctors have been dealing
with the increase in demand for behavioral healthcare services
since the beginning of the pandemic.
Mr. Levine. Well, it has obviously been a huge concern for
us. Right now we have expanded our Employee Assistance Program.
We are leaning in to every hospital. We have 21 hospitals, we
are leaning in every hospital to make it available. And based
on what has been said here, I agree, convincing people that it
is not only necessary to seek help when you have it, it is a
sign of strength, not weakness.
Mr. Curtis. Right.
Mr. Levine. And we are doing a lot of education to try to
get our physicians and our frontline caregivers with the
physicians to take advantage of these opportunities.
Mr. Curtis. If you are familiar with the HEALS Act, are you
able to comment on how that would help your situation?
Mr. Levine. I am not familiar with all of the relevant
details of the HEALS Act, but I can tell you that we would
definitely be among those that would apply for these brands
because we think, incrementally, it can help us link further in
with our physicians.
Mr. Curtis. You will smile when I say that my district is
about 80 percent rural. A lot of you here will understand what
that means. Although I do like to tease my colleagues here from
the East Coast. I think we have different definitions of rural,
and we are really rural out in Utah.
It won't surprise you that telehealth was really critical
before the pandemic, and has been even more important during
the pandemic.
And Dr. Levine, again, as it relates to audio-only
telehealth services, can you share how Ballad Health,
specifically, has been dealing with that, in context to
behavioral health?
Mr. Levine. It has been a huge opportunity for us. Right
now we are--six schools throughout our rural region. Many areas
are very, very rural, and so we have got several behavioral
programs that we deploy that way, and the audio is really
important.
Obviously, we would like to have bandwidth to be able to do
full video. And frankly, during the pandemic, some of our
largest physician practices, our very large cardiology group,
were able to keep up with the patients, purely because of the
telemedicine and because of audio.
So I absolutely agree that that opportunity is something we
would want to continue to expand and take advantage of.
Mr. Curtis. Do you have any suggestions for Congress, as we
think about the long-term cost benefits of expanding the audio-
only telehealth behavioral services with Medicare patients and
others that promote this reliable access to quality care?
Mr. Levine. I think the payment mechanisms that could
institutionalize that would be helpful in making them more
permanent and predictable. I think that it would help create
more investment into the growth of those mechanisms. And
certainly, I would always advocate for more broadband to help
with getting beyond audio.
Mr. Curtis. Yes, broadband is clearly an issue for rural
districts.
I have got just a few seconds left. I don't know if anyone
else wanted to comment.
Yes, Ms. Harrison, in just a few seconds, please.
Ms. Harrison. Thank you. I just want to mention that my
brother is a nurse in rural Utah----
Mr. Curtis. Oh, great.
Ms. Harrison [continue]. And works in a school system. So I
would just add to the importance of including schools in your
bill for mental health, behavioral health services, and
telemedicine.
Mr. Curtis. Thank you for the exclamation point on my
comments.
Madam Chair, I am out of time. I yield back to you.
Ms. Eshoo. The gentleman yields back. I especially
appreciate your sharing the story about your son training to
become a physician, what your wife does. I think it is so
important for the American people to hear that we, too, are
very human. So thank you.
The Chair now is very pleased to recognize the gentlewoman
from California, Ms. Barragan. Five minutes.
Ms. Barragan. Thank you, Madam Chairwoman Eshoo, for
holding this important hearing today. I want to thank all of
our witnesses for their testimony, and my colleagues who have
shared.
You know, the investments in our caregivers are personal to
me, to my constituents, and the American people. My mother is
80 years old, has Alzheimer's, and it has been a struggle, not
just in understanding the disease and what to expect, but in
finding reliable caregivers for her.
So, you know, we come from a Latino culture background,
where we never spoke about this, and we really didn't know
where to go for help. So it has been incredibly challenging.
And so to hear the stories here today is something I can relate
to. But it is something that the American people, especially
low-income Americans, maybe those who have cultural
differences, have, you know, certainly a hard time navigating
our system.
I--just this week I had to take a red-eye here, to
Washington, DC, to help make sure I was there to provide care
overnight. And so it is not easy, and I have to continue to
educate myself, and navigate my way through our fragmented
health and caregiving system to understand what resources are
available.
One of them, of course, is the in-home care program that we
are trying to expand under reconciliation, and make sure people
can stay in their homes.
And when you hear about the stories of the more than 16
million people who serve as unpaid caregivers, I know
firsthand, whether I am one of them, whether I have other
family members that are, it does take an enormous toll, and it
is--you know, it takes time, and emotionally is hard, as well.
So I am supportive of the legislation before us today to
provide that grant money and availability for that. You know,
we need to show compassion to those in need, and invest in our
public health workforce and care economy. And so I support the
bills today.
Ms. Monroe, I found your testimony to be so powerful, you
know, particularly on the lack of culturally appropriate
resources for dementia diagnosis. We need to use every
available resource available to fight this disease.
We also need to continue to work on getting treatments for
Alzheimer's as soon as possible, and I hope we can continue to
support the accelerated approval path for medicines to treat
serious or life-threatening conditions.
There is a lot of important legislation out there, but what
would you say is the most important thing that Congress can do
to help advance the fight against Alzheimer's?
Ms. Monroe. Excellent question. Gosh, I wish I could come
up with just one. I think there are probably, I would say, two.
The first would be to make sure that we have timely,
accurate, early diagnosis of this disease that will give people
the ability to plan, and take better care of their loved ones.
I would also like to see us adopt a national prevention
strategy, because we know that 40 percent of Alzheimer's could
be prevented by us addressing a lot of the comorbidities that
go along with it. And we have been writing letters, and hope to
have that national strategy implemented with some teeth to it.
But, you know, recruiting all communities into clinical
research will be really important to make sure that we know
that all the medicines and the therapies work well for all
people. I think that is a great priority for us because, as we
become a majority-minority country, we will be serving the new
majority when we do that, and we have just a few years under
our belt to get ready to do that.
Ms. Barragan. Well, thank you for that, and thank you again
for all your work.
Mr. Keel, in your testimony you spoke about the need for
future physicians to practice in rural and underserved
communities. Can you speak to the importance of community
health centers, and how your program encourages graduates to
practice in these types of care environments?
Dr. Keel. No, actually, I am afraid I can't comment on that
at this time. We rely mostly on academic centers, health
centers within our community-based campuses to help us
implement that.
Ms. Barragan. OK, got it.
Ms. Macon Harrison, putting your local public health
official hat on for a second, what role do you--do community
health workers play in local health districts, such as yours in
Granville, North Carolina?
Ms. Harrison. Thank you for that question. In Granville and
Vance Counties, we do have one local federally-qualified health
center. It is called Rural Health Group, and we work
collaboratively with them. We have enough need for the safety
net for primary care services that half of the local health
departments in North Carolina do full-scale primary care to
complement those federally-qualified health centers and
community health centers that do exist that are so critical
across rural North Carolina.
Ms. Barragan. Well, thank you all again for your work and
your testimony.
Madam Chairwoman, I yield back.
Ms. Eshoo. The gentlewoman yields back. It is a pleasure to
recognize the gentleman from Texas, Dr. Burgess, for 5 minutes.
Mr. Burgess. I thank the Chair, and I apologize for being
in and out of the hearing today. Trying to stop a friend from
writing a $5 trillion bad check, and it has just not been easy.
Let me just address something with you all, and this has
concerned me for a long time, and that is the repetitive
provider cuts that are coming the way of our physicians. It
happened last December 31st, it almost happened with the last--
we kept them from going over the falls. The same thing is
happening this year. It is an almost ten percent aggregate cut.
And I know people say we will fix it before the end of the
year, but it is a risky strategy. Because if you don't, then
the very people that we have all been describing as our heroes,
and the people that we have depended upon to deliver the care
in the worst possible situations, they are going to get hit
with this.
And kind of off to the side, we have the agency working on
a very, very bad interpretation of our surprise billing rule,
which is going to render doctors almost powerless against the
big insurance companies.
So there is a lot on the plate of the practicing physician
right now, and we have not had a single hearing about how to
deal with that, how to deal with these cuts. It is a
misguided--in my opinion, it is a misguided approach.
Now, in an effort to be bipartisan, Bobby Rush and I have a
temporary solution that is H.R. 5613, for anyone keeping score
at home, that would waive the budget neutrality requirement
from the physician's fee schedule, and then we can offset with
unobligated funds that still remain in the provider relief
fund.
But again, I would just stress it is so risky to wait until
the last minute, because if something distracts us--and you may
have noticed that there are a lot of things that can distract
us--then the provider cuts go into effect.
And this is not a partisan issue. The basis of--for
hearings on that, I think, could and should be bipartisan.
Let me pose a question for Mr. Levine. And again, bearing
in mind what I just said about the end of this year, the
provider cuts in Medicare reimbursement, there are solutions we
can consider that will ensure providers are paid a reasonable
amount, such as the bill I just referenced, 5612, that would
waive the budget neutrality adjustments under the physician fee
schedule.
But do you have in mind what else we could do to ensure
that our docs and nurses, their healthcare providers' pay is
competitive, in order to recruit and retain healthcare
professionals, and not burden them so severely?
Mr. Levine. Yes, Dr. Burgess, these cuts couldn't happen at
a worse time, because they are happening right at the same time
we are facing the major pressure----
Voice. Alan?
Mr. Levine [continue]. The major market pressure on nursing
salaries. These cuts to the physician community, particularly
in rural and non-urban America, are devastating. And for those
who are concerned about more vertical integration in terms of
antitrust, this is going to lead to more vertical integration.
These physicians, particularly in rural areas, if they get
cut, they are coming to the hospitals, and it is going to be--
and that is going to happen more and more, which a lot of
people are concerned about, rightly so, as are we. So I think
that is issue number one.
Of course, the Area Wage Index that I referenced earlier
severely harms the majority of America's hospitals.
I think those two things can help, though, both with
nursing salaries, as well as with physician pay.
Mr. Burgess. Well, thank you for that, and I agree with
you, the private equity folks are waiting on the sidelines, and
are eager to pounce when our providers despair, and are driven
into the arms of someone else.
Let me just ask you a question of your health center. You
don't have a mandate for the vaccine there. It is my opinion
that the vaccine is a miracle, but mandates are toxic, and
drive oppositional behavior. How are you handling that?
Mr. Levine. Our position up to this point has been to
promote vaccines, educate our team members. We have got about
60 percent of our team members that are vaccinated, 90-plus
percent of our doctors. We have started--actually, I have had
some resignations already, just in anticipation of the Medicare
mandate that is coming down. So our position has been not to do
the mandate, but to educate.
Obviously, that position will likely change with the
impending Medicare rule that is being----
Mr. Burgess. Yes, I think that would be a big mistake. But
thank you, everyone, for your participation this morning. It
has been a very informative hearing.
I will yield back.
Ms. Eshoo. The gentleman yields back. It is a pleasure to
recognize the gentlewoman from New Hampshire, Ms. Kuster, for
her 5 minutes of questions.
Ms. Kuster. Thank you so much, Madam Chair. The discussion
we are having today on healthcare workforce and caregiver
support is critically important in New Hampshire, where we are
experiencing a COVID surge right now.
I am consistently hearing from healthcare providers in my
district about the current workforce crisis. Even before the
pandemic, New Hampshire was experiencing an urgent healthcare
workforce shortage, especially in the rural communities in my
district. The pandemic has exacerbated this issues--these
issues, and there simply are not enough clinicians to meet
current demands.
One hospital leader told me recently they are facing a
clinical crisis. Cases of COVID are rapidly increasing and
overwhelming medical providers. Hospital staff are stretched
thin, and patient care is suffering. So I agree that we must
examine and support ways to grow, diversify, and strengthen the
clinical care and health workforce.
But we also need to think about ways we can immediately
support the providers who cannot meet the current labor demands
necessary to care for our communities, especially underserved
areas. Our frontline providers have experienced relentless
physical and emotional strain over the last 20 months, and they
need immediate assistance.
Dr. Keel, in addition to investing in provider mental
health and wellness, can you go into more detail about what
Congress can do to sustain the healthcare workforce now and
mitigate the immediate ramification of the existing provider
shortage?
I am sorry, that was addressed to Dr Keel.
Dr. Keel. Yes, OK. Could you repeat that question for me
real quick? Sorry, I couldn't hear that.
Ms. Kuster. Oh, I am sorry. In addition to investing in
provider mental health and wellness, can you go into more
detail about Congress--what Congress can do to sustain the
healthcare workforce now, and mitigate the immediate
ramifications of the existing provider shortage?
And if you would address telehealth, if that is one of the
solutions?
Dr. Keel. Yes. No, I think you have hit on an excellent
potential solution. We have been utilizing telehealth
extensively for the last several years--in fact, more than a
decade--dealing primarily with stroke. Initially, we had a
telehealth stroke program, a hub and spoke program, where we
are attached through telehealth to some 12 or 13 hospitals in
some of the more rural areas of our state, and it allows us to
be able to address that very serious issue on an immediate
case.
One thing COVID has taught us, though, is that the use of
telehealth is now more important than ever. And some of the
roadblocks that have been in place in past years I think are
now coming down. We need to make sure that those roadblocks
stay down, so that we can begin to implement telehealth on a
more widespread case.
This allows us to--especially in the rural hospitals, it
allows us to keep the patients in the rural hospitals if they
don't need to be transferred to a more tertiary care or
quaternary care unit like we have. And the telehealth certainly
does allow us to do that. It provides the opportunity for the
patient to stay in the hospital. That is financially
advantageous for the local hospital, certainly, but it also is
advantageous because that is where the families are located,
and it contributes greatly to the overall care that the
patients receive.
So I am fully convinced that we will see more and more
telehealth. And I think the more that we can do to try to make
telehealth more readily available and easier to do, and more
cost effective to do, it is going to help address the rural
health problems we have in this country.
Ms. Kuster. Great, thank you.
Now, Mr. Feist, from your work on the Dr. Lorna Breen
Health Care Provider Protection Act, have you learned of any
unique challenges or experiences faced by providers working in
predominantly rural or underserved communities?
Mr. Feist. Apologies, bio break after a three-hour tour.
[Laughter.]
Ms. Kuster. No problem.
Mr. Feist. Would you mind repeating that very quickly?
Ms. Kuster. Did you hear that, Mr. Feist? I am asking about
whether you have learned about unique challenges or experiences
faced by workers in predominantly rural or underserved
communities.
Mr. Feist. Absolutely, absolutely.
Ms. Kuster. And what would you recommend we do?
Mr. Feist. Absolutely. The Dr. Lorna Breen Health Care
Provider Protection Act provides funding for the current
workforce, as well as the future workforce, irrespective of
where they are, rural or urban.
The issues that we have on the workforce are ubiquitous,
regardless of where you are in medicine. And so we need to
bring programs right now to the workforce to support their
well-being, whether those be peer support programs, or that is
redesigning that healthcare delivery system so that it doesn't
burn out the workforce in the process.
If we have heard from one physician or nurse, we have heard
from a thousand, ``Don't just give me another meditation app. I
need you to help me redesign the healthcare delivery process so
that I am not burnt out in the process.''
Ms. Kuster. Right. Regretfully, my time is up. I didn't get
to discuss Alzheimer's, which is near and dear to my heart, but
I will follow up with the committee. Thank you.
I yield back.
Ms. Eshoo. The gentlewoman yields back. The Chair
recognizes the gentleman from Oklahoma, Mr. Mullin, for his 5
minutes of questions.
Mr. Mullin. Thank you, Madam Chair, and thank you for
holding this hearing today.
Dr. Wilburn, I would like to start with you. Can you
provide just specifics on how the grant program that allowed
health workers--Allied Health Worker--Health Workforce
Diversity Act would further benefit American Indians and Alaska
Native communities?
Dr. Wilburn. Thank you so much for that question,
Representative Mullin. This is such an important point, since
American Indian and Alaska Native communities have been hit so
hard by COVID.
The Indian Health Services faced a severe health workforce
shortage prior to the pandemic, a problem that has only gotten
worse. This legislation would provide an opportunity for
Northeastern State University, where 20 percent of its student
body is American Indian/Alaskan Native, to apply for grant
funding to support efforts to recruit more individuals from the
community into all of the higher education programs for all of
the professions in this bill.
According to the Post-Secondary National Policy Institute,
only 17 percent of American Indian/Alaskan Native high school
students continue on to higher education, compared to the 60
percent in the U.S. population.
Mr. Mullin. Thank you. Based on the projected increase for
the need for healthcare professionals, obviously, there is
going to be an increased need on that, and we all know that,
moving forward. How important is it to understand the under-
represented individuals that we need to recruit? And then how
do we retain those?
Dr. Wilburn. Thank you again for that question. Recruitment
and retention is really synonymous, and so the best thing for
us to do is to be able to support individuals by affinity
groups, academic counseling, tutoring, and pipeline programs.
Mr. Mullin. So when you start talking about recruiting
those individuals, is there a program that we have put out
there yet that we are thinking about a tool to help recruit
them?
I know, for instance, Oklahoma State University, they have
paired with Cherokee Nation to have a program designed to go
into high schools, and specifically start recruiting people as
early as freshmen to say, ``Hey, do you want to enter the
healthcare profession? How do we start working with you?''
And then they actually opened a medical hospital, and--
partners with Cherokee Nation in Tahlequah, which is,
obviously, an underserved area that is represented by, you
know, a large population of Native Americans.
Dr. Wilburn. So that is an excellent point, and I agree
that recruitment begins, really, in middle school.
This program would allow individuals to see themselves in
those professions already. Financial implications can seem
insurmountable. So what this program would do is really come
alongside individuals, and give them a pipeline for financial
support, which we know is often the biggest barrier to academic
achievement.
Mr. Mullin. Well, thank you for that.
In closing, Madam Chair, I would like to echo the concerns
among many of my colleagues that said--regarding the Biden
Administration's vaccine mandates. As this committee knows, and
as you know, all the last year, through the beginning of the
pandemic, my son was in a clinic for traumatic brain injuries.
And the individuals that worked with him every day, they showed
up understanding the protocols that they had to follow,
understanding the work that needed to be done with individuals
that had to have rehab to be able to continue to function on
their daily life. And they did it in a safe manner.
We have had a workforce that we depended on with our
frontline healthcare workers that we depended on every day,
that we cheered them, and we thanked them for what they were
doing. And they were good enough to take care of it in the
heart of the pandemic. Why are we forcing these individuals
now, that worked all last year without a vaccine? Now we are
saying that wasn't good enough, even though you were safe, and
you protected your patients, now we are going to say that you
have got to have the vaccine, when we already are running a
shortage, or we are already running short on healthcare
providers and medical professionals, as we are, as it currently
stands.
And so I would like to echo my colleagues and say why are
we doing this? I think this committee has the opportunity to
make a strong ask to the Administration to relook at this
mandate, because they are running out good people when we
shouldn't be losing anybody right now.
With that, I yield back.
Ms. Eshoo. The gentleman yields back. I appreciate your
comments. Just a very quick reflection. You--we all prayed for
your son, knowing the condition that he was in, and thank God.
You know, it is a good news story.
We didn't know about Delta a long time ago. It is called
the novel coronavirus because that it is. We keep learning
about this virus. Remember when they told us, ``Don't touch
your face''? We don't hear that anymore.
So--and over 700,000 American souls have been lost, over
700,000. So this is about saving lives, not losing lives. And I
don't find this--I just don't think it is menacing. But you
know what? There are people that don't agree with me, so they
don't agree. But I would place myself in the company of those
that know so much more than I do, the very people who we want
more to come into the system, those that have studied for a
decade or more, to take care of us. They know what they are
talking about, in my view, I think they know what they are
talking about.
Thank God we have the vaccines. And, you know, as I said to
a constituent, do you think that, if I had polio, that I have
the right to infect you? I don't think so. OK.
The Chair recognizes the gentlewoman from Delaware, Ms.
Blunt Rochester, for her 5 minutes of questions.
Ms. Blunt Rochester. Thank you, Madam Chairwoman, and thank
you so much to you and the witnesses for this very important
hearing on some very vital bills. And particularly, I want to
thank the families for their testimony today, as well, as you
honor your family members.
Investing in our infectious disease workforce is not only a
matter of pandemic preparedness, but a matter of health equity.
Today there are 1.2 million people living with HIV in the U.S.,
and racial and ethnic minorities make up the majority of new
HIV diagnoses, people living with HIV disease and deaths among
people with HIV.
Furthermore, a large proportion of new HIV diagnoses occur
in the South, as well as other rural areas, often in places
where there has either been a disinvestment in healthcare or
natural attrition of providers due to other factors. Given that
Black and Latinx Americans account for nearly 70 percent of new
HIV diagnoses in the U.S., I am particularly concerned about
ensuring that there is a diverse and culturally competent
infectious disease and HIV workforce that reflects the
populations most impacted.
My bipartisan bill, H.R. 2295, the HIV Epidemic Loan-
Repayment Program, otherwise known as the HELP Act, which I am
leading with Congresswoman Barbara Lee, would address that
issue head on, by helping to make it possible for HIV
professionals to live and work in underserved communities. I am
really proud of the fact that this was led by our late friend
and colleague, Congressman John Lewis, and we are proud to
carry on his legacy.
Dr. Marrazzo, can you share more about how the BIO
Preparedness Workforce Act will help to recruit diverse
clinicians to the ID HIV field, and how this bill will advance
health equity?
Dr. Marrazzo. Well, thank you very much for that excellent
question, which is near and dear to my heart, as an ID
physician based in Alabama, which continues to experience very
high rates of HIV incidence, as you are aware.
I agree with you, that having a workforce that reflects the
populations most heavily affected by HIV and other infectious
diseases has to be a top priority. We are able to reach the
patients who are affected because we look like them, and we
really care about them, and that is really important.
The bill, I think, is going to be able to help address
health disparities by reducing some of the financial barriers
that I mentioned before to the populations that are most under-
represented in medicine, particularly when you factor in the
challenge that many of these individuals have with paying some
of the considerable loan balances that have already been
mentioned. Hopefully, that will really incentivize people not
only to do HIV and ID, but to work in these underserved
communities.
Ms. Blunt Rochester. Thanks. And just as a follow-up, I
know we have had a lot of conversation about attracting people
to rural areas. Can you talk about how this bill would help to
ensure that more providers go into HIV care, where they are
most needed in these rural areas?
Dr. Marrazzo. So again, I think part of the challenge with
going into rural areas for people doing specialty care is
feeling isolated, feeling like they don't really have a
community not just to support their work, but who even
recognize their expertise.
Again, this bill would support the creation of a network of
people, and a network of interdisciplinary team providers,
which you know, especially for HIV, is really critical. You
need everything from dentists, to social workers, to infection
prevention people. So creating this kind of interdisciplinary
opportunity for people to go into this field could really make
a big difference in making people feel welcome in these
communities, and like they really want to be there and provide
the care we need for the populations who most need it.
Ms. Blunt Rochester. All right, thank you so much. And I
just want to shift to the nursing shortage, and especially
during the COVID-19 pandemic.
We know that hospital-based nursing programs provide a
desperately-needed pipeline of highly-skilled nurses to
hospitals, nursing homes, and community settings. Hospital-
based nursing schools act as both an employer and educator,
delivering successful student outcomes, and nurses who are
ready to enter the professional healthcare workforce because of
the experiential education they receive and that they provide.
Yet these programs are facing drastic cuts because of the
technical glitch and oversight from CMS that will lead to a
recoupment of millions of dollars.
My bipartisan legislation, H.R. 4407, the TRAIN Act, would
fix this administrative error, and prevent Medicare payment
cuts to these critical nursing education programs.
Mr. Levine, I am going to have to ask if you would follow
up with me afterwards, because my time has expired, but I would
love to hear you speak to the impact of these cuts to nursing
programs.
Mr. Levine. Yes, will do so.
Ms. Blunt Rochester. OK, thank you so much.
And Madam Chair, I yield back.
Ms. Eshoo. The gentlewoman yields back. It is a pleasure to
recognize the gentleman from Georgia, Mr. Carter, for his 5
minutes of questions.
Mr. Carter. Thank you, Madam Chair, and thank all of you
for being here. I know it has been a long hearing, and we
appreciate your diligence in staying here.
Dr. Keel, I want to ask you. I am very proud that you are
here today, very proud of what we are doing and what you are
doing, specifically, in the State of Georgia, in the sense of
your 3+ program that shortened medical school from 4 years to 3
years. I know--as you know, I am a pharmacist, and I have a
Bachelor of Pharmacy degree, and it was a three-year degree
after our prerequisites were met.
And we always--we were always concerned that we only got a
bachelor's degree, even though it took us three years, as
opposed to other people, two years. So what they do, they added
on a year, and gave us a doctor of pharmacy degree that took
four years. But you are doing just the opposite, and this is
good. I just want to ask you about it, and to elaborate upon
it.
So let me--how do you condense it? Did you condense
anything that--exactly how does it work?
Dr. Keel. That is a great question. One of the things most
traditional four-year medical schools do is that that fourth
year is aimed at providing students with electives and
opportunities to interview for residency programs in the
disciplines that are not considered primary care. That is
really--they are so competitive to get into dermatology,
ophthalmology, neurology, those sorts of things.
We have compressed the program, the core curriculum, into
three years by eliminating the summers that the students would
typically have off, and focusing on the core curriculum at that
point in time. For those students that need that fourth year
for the electives, they can certainly do that. But for those
students who really are aimed at trying to serve in rural and
underserved Georgia, they get to go right into their fourth
year, and start their residency in the primary care at that
point in time.
So we are not shortchanging the education of these students
a bit. We are just accelerating the opportunity for them to get
out and get to practice.
Mr. Carter. In medical school, before you can become
licensed, you still have to pass the boards. So it is not as if
you are not as qualified as someone else. I mean, you still got
to--I know we had to pass the pharmacy boards, as well, after--
even if you got a degree. We had some people who had a degree
that didn't have a license, because they couldn't pass boards.
Dr. Keel. Absolutely. And these students really haven't
been in the program long enough to really have any hard data to
show you, but these students in the three-year program are
every bit as successful passing boards as those in the four-
year program. And we certainly will--we are going to keep a
close eye on that.
There have been other programs in the country that have
exercised accelerated programs, and they have shown that the
opportunities to pass boards are not diminished at all.
Mr. Carter. As you and I know also well, we struggle in the
rural parts of our state, in rural parts of our country, and in
South Georgia, in particular, with attracting physicians to our
communities. And this is a way that--I understand the financing
for it is a way that we can get some of the students to locate
to some of these rural areas that are underserved.
Dr. Keel. Absolutely. It eliminates the debt before they
ever accumulate it, and that gives them opportunities to really
focus on staying in the state, and practicing in those rural
and underserved areas, without being strapped with upwards of
$130,000 in debt.
Mr. Carter. Right. And it is such an important part of the
rural community because, you know, when people look to go to a
community--and businesses, especially--you know, they want to
know about the education, they want to know about healthcare.
And that gives these communities the opportunity to address
those issues there.
Dr. Keel. Absolutely. One of the things we have--and
rightly so--focused on today is the need for healthcare in
those rural areas, and the need to put physicians there so that
they can provide that healthcare.
But one--the other important aspect about this is there is
a huge economic development contribution that this program and
other programs like it are going to have, as well, for the
reasons that you just mentioned. This is an industry, when they
choose to locate in an area, regardless of whether it is rural
or not, they want to know how is the education system, the K
through 12 system, and how readily accessed is healthcare to
their employees.
And so providing physicians incentives to practice in these
rural and underserved areas is not only going to help the
health disparities that we see, but it is also going to help
the economic prosperity.
Mr. Carter. What disciplines does it cover? Because, as you
know, we are really struggling with primary care physicians, we
are really struggling with psychiatry, and a number of
different disciplines to try to get to the rural areas, right?
Dr. Keel. And we are focusing on what the greatest needs
are in our state, not only the more classical primary care
disciplines, the family medicine, the internal medicine,
pediatrics, but we are also offering this to emergency
medicine, psychiatry, OB/GYN, and general surgery, as well,
because it is not just the need for a physician; some of these
counties have very specific needs for specialties, and this is
going to help address that, as well.
Mr. Carter. Just very quickly, what about financing? How
are you handling this, as far as scholarships or whatever go?
Dr. Keel. Right. We were fortunate to get a $5.2 million
gift from Peach State Health Plan, a subsidiary of Centene.
That was matched by the State of Georgia to give us an
endowment that will serve--serves as the basis for these
scholarships, and we hope to raise more money that can also be
matched by the state to adjust this, as well.
The communities are going to be--have a great need to chip
into this process, too, because it is in their best interest.
Mr. Carter. Absolutely. Thank you very much, and I yield
back.
Dr. Keel. Thank you, sir.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the gentlewoman from Washington State, Dr.
Schrier, for her 5 minutes of questions.
Ms. Schrier. Thank you, Madam Chair, and thank you the
witnesses for testifying at this really important hearing
today.
This pandemic has stressed and maxed out our healthcare
system in ways we have not seen before, in ways that we will
see even after the pandemic is behind us.
Mr. Feist, first, thank you for coming today and sharing
the story of your sister-in-law. I am so, so sorry for your and
your family's loss, and I want to also thank you for sharing
those harrowing facts about provider burnout, and mental health
strains, and physician suicide, and how many physicians are
thinking about leaving their profession that they trained so
hard for years to enter.
In my state of Washington, 19 months into COVID, our
providers are exhausted. I heard from a provider at Central
Washington Hospital in my district that COVID rates are still
high. The average approximately--this is a rural hospital--
approximately 40 COVID patients each day, about 28 percent of
their overall census. At any given time, 10 to 15 of those are
in the ICU. And the nurses, the respiratory therapists, the
doctors are tired, and they are also demoralized, especially
since most of these hospitalizations could have been prevented
with a simple vaccine.
They have about 150 open nursing positions throughout
Confluence Health, which is almost a 20 percent vacancy rate.
And this prolonged high-intensity work, combined with
understaffing, can take a huge toll on mental health.
Mr. Feist, you mentioned in your testimony that Dr. Breen
expressed concern about losing her license if she sought
psychiatric care, and it is absolutely devastating. As a
physician, I absolutely relate to that sentiment. We are
trained to put ourselves on the back burner, to work 36-hour
shifts, don't ever show weakness, know everything, postpone
relationships, don't even think about having a family. And so
it is no surprise to me at all that Dr. Breen felt that way.
And I want to just say here on the record for all my fellow
providers in Washington State and elsewhere that seeking help
should not put your career at risk.
I am proud that the Washington Medical Commission in my
state encourages any practitioner in need to seek help, and to
develop a support plan to address any needs they may have,
because nothing about seeking mental health treatment or other
medical treatment risks the license of a Washington physician
or PA.
Mr. Feist, in a perfect world there would be no stigma. But
in the meantime, do you know of any physician-led or provider-
led efforts to create a more supportive environment for
providers who are going through what Dr. Breen went through?
Mr. Feist. It is an excellent question. What we have heard
from the healthcare community through nationwide surveys,
particularly because of this stigma, is the number one-thing
that the healthcare workforce wants right now are scalable peer
support programs. The military has used these type of programs
in the past, battle buddy programs or peer support programs.
Physicians, like others, nurses, like others, want to speak to
someone who has walked the walk a mile in their shoes, and
those are the things that we have heard repeatedly from the
workforce themselves.
And what we have also heard are there are health systems in
this country that are stepping up, and they are delivering
those services to the workforce. They are not delivering them
fast enough, but those are just one significant thing that the
healthcare workforce is stepping up to do to support them.
The other big piece of this, though, as I mentioned
previously, is that we--is that there are systems that are also
working on trying to figure out how to redesign healthcare
delivery so that it doesn't burn out the workforce in the
process. And there are systems. Probably not enough, certainly
not enough right now that are making inroads to redesign the
healthcare delivery so that it doesn't burn out the workforce
in the process.
Ms. Schrier. I appreciate those comments. You know,
sometimes it is--it just helps to know that you are not the
only one. And so those peer programs sound phenomenal.
I just want to add to your list that Washington Physicians
Health Program is one program that provides behavioral health
support to physicians in Washington State.
I have very few seconds remaining. I just wanted to turn to
Ms. Harrison.
Thank you for coming today. Can you talk a little bit about
the pay of public health providers who simply don't get paid
enough?
We need to have the ability to surge public health needs if
another pandemic or some other thing comes along. I was
wondering if you had some ideas about how we can boost salaries
and incentivize students to join the field.
Ms. Harrison. Thank you for that question. And salary is
one of the most pressing issues that we deal with in
recruitment and retention. The last two people I have lost out
of my health department have been pulled away for similar jobs
at more than $10,000 a year of an increase in their salary, and
we just don't have the budget to compete with that.
I do think that these loan repayment programs will help
alleviate a little bit of that to give an alternate benefit for
individuals to come to a local health department. But I do
think we need to do a better job addressing salary bands and
ranges across the board for public servants that are dedicating
so much of their time and energy pre-pandemic, and certainly
even more during the pandemic. Thank you for that question.
Ms. Schrier. Thank you. I yield back.
Ms. Eshoo. The gentlewoman yields back. I am pleased to
recognize the gentleman from Texas, Mr. Crenshaw, for his 5
minutes of questions.
Mr. Crenshaw. Thank you, Chairwoman Eshoo, and thank you,
Ranking Member Guthrie, for holding this hearing. Thank you all
for being here. It is an important topic, and I want to echo
many of my colleagues in thanking the tremendous work done by
our healthcare workforce over the course of this pandemic. It
has been a hard strain on them, to be sure.
But also, it is worth noting that the shortage of
physicians has been occurring for quite some time now, and
there is a lot of factors involved in that, which we are
talking about today. I think some of these bills are an
excellent start to dealing with some of those problems. But a
lot of them don't get really quite at the core of the issues,
and one of which was just mentioned.
People need basic incentives to be able to deal with the
work that they are doing. One of those incentives is, of
course, pay, pay that is proportional to the hardship that they
are enduring. And the other is workforce environment. Are they
dealing with endless amounts of red tape and regulations that
make their daily job just insufferable? And these are things
that maybe we could affect, here in the Congress.
One I want to dive into specifically, which is the ever-
changing cuts to reimbursement that comes down from CMS. Any
time that we might be trying to save money in Medicare, we
often make cuts to physician reimbursement. And that, of
course, is a strain on the workforce.
This question is for Mr. Levine. If we simply continue
adding more benefits and requirements on a system that is
indeed antiquated without adding structural changes, how will
that impact a health system like yours, which is beholden to
this centrally-planned set of fee schedules and payment
systems?
Mr. Levine. Well, that is the core of the problem,
Representative. A good example is, as fast as wages are rising
with--for nurses and other healthcare professionals right now,
70 percent of our payer mix is Medicare, Medicaid, and
uninsured. The payment system is not keeping up with the
market.
So, on the one hand, we have a government pricing model
downstream, where we are trying to go deal with the free market
in employment--we are dealing with two competing systems. One
does not support the other. And so my advocacy would be to,
again, deal with the Medicare Area Wage Index issue, and move
more towards a market-based model, where the market can keep up
with the labor costs.
And I am telling you, this is going to be a massive crisis
for rural and non-urban hospitals, because the Medicare payment
system cannot keep up with how fast the market is moving, in
terms of the cost of labor.
Mr. Crenshaw. Do you anticipate losses and--in physicians
in this country?
I mean, do you anticipate--and what does that look like? I
mean, can you paint a picture for us?
Mr. Levine. Yes, sir----
Mr. Crenshaw. A little bit more specific?
Mr. Levine. Yes, it is already happening. The expected cuts
to physicians that is forthcoming, I have already got
physicians coming in saying either I employ them, or they have
to leave, which would be devastating to our rural region.
And listen, I mean, if you look at just two years ago, I
paid--for the third quarter that just ended, contract labor
cost--the quarter that just ended, $23 million for contract
labor. And we put $100 million into wage adjustments in the
last year. We only generate a two percent operating margin. So
that is almost triple our operating income that we put into
wage adjustments this year that the Medicare system is not
keeping up with.
Mr. Crenshaw. So in Houston we are seeing more and more
physicians flock to the direct primary care model of medicine,
so that they can see less patients for longer, and actually do
what they got into medicine to do, which is treat patients.
I love this model, it keeps patients out of the emergency
room, gets doctors back to that direct relationship with
patients. It is affordable for patients. I mean, we are talking
between 50 and $100 a month for this, what is total access to a
primary care physician. It doesn't solve the insurance problem,
but it sure helps us solve the insurance problem.
Do you imagine that a program like direct primary--or model
like direct primary care, or other models of direct contracting
could increase the number of physicians in the workforce,
especially in the primary care area, where we really see a
shortage?
Mr. Levine. Yes, sir. I could tell you, with the move to
value-based models, for the first time we are seeing primary
care doctors, pediatricians, and OB/GYNs who are earning more
money, because it has moved to a market-based model, where, if
they are able to reduce avoidable admissions, they share in the
savings of that.
So five years ago, a pediatrician might make--might have
made $150,000 a year. Some pediatricians now can make as much
as $300,000 or $400,000 a year, and it actually cost the system
less, because they are now are now partnering with us in
reducing wasted inpatient utilization and other high-cost types
of care.
So yes, I think those are the right models.
Mr. Crenshaw. I appreciate that. I am out of time. I yield
back, Madam Chairwoman.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the gentleman from Maryland, Mr. Sarbanes, for his
5 minutes of questions.
Mr. Sarbanes. Thank you very much, Madam Chair. Thanks for
this hearing today.
As has been testified to today, we know that a well-trained
workforce is absolutely critical to supporting high-quality
healthcare delivery, and every other dimension of our
healthcare system. These issues have, obviously, only become
more important over the past year-and-a-half during the
pandemic. It has added some pressures. It has laid bare and
given transparency to pressures and challenges that were
already there, of course.
And we have heard a lot of important testimony today about,
particularly, the toll that the pandemic has taken on our
healthcare system and our healthcare heroes, as we have come to
call them. We have got to make sure that we put more than just
phrases behind their efforts, that we put real work and
resources behind them, as well.
These are issues, the healthcare workforce issues, that I
have been privileged to be working on for a number of years. I
was able to work into the Affordable Care Act the establishment
of a National Health Care Workforce Commission. We are still
working on getting the funding in place to support that, but
the idea was to evaluate these workforce needs across the
country, and then be a resource for us, as policymakers in
Congress, in making some decisions about how to address the
shortages.
And we know how important it is to do that. It is estimated
there will be a shortage of between 18,000 and almost 50,000
primary care physicians by 2034, and a shortage of between 20
and 75,000 physicians in non-primary care specialties.
Dr. Keel, can you speak to what the value of a national
perspective on addressing these healthcare shortages, health
workforce shortages could be, in terms of evaluating where we
are, and making sure--because I know, for example, during the
pandemic we saw this situation of healthcare workers traveling
the country to meet shortages. And at some point there was a
kind of robbing Peter to pay Paul dimension to this.
So speak to the value you think, if you do believe it
offers value, bringing a kind of national perspective, and
getting that kind of a commission in place.
Dr. Keel. Well, I--it is really hard to place a value on
the importance of providing local healthcare in some of our
most rural and neediest parts of the state. These--we have
eight counties in the State of Georgia that has no physician,
whatsoever. I am told that, up until this past year, we had
three counties in the State of Georgia that had no EMS service,
and that is a very sobering statistic.
So the--we aren't going to be able to address this issue of
healthcare disparities, especially in rural parts of the state,
until we can tackle the problem of how we incentivize
physicians to go there and practice, to start off with, which
is what our 3+ program is really intended to try to do.
As I mentioned previously, the economic prosperity of these
areas is also critically dependent upon the availability of
quality healthcare, whether it is a regional or local hospital,
or whether it is a----
[Audio malfunction.]
Dr. Keel. [continue]. What it means to this country for us
to finally get a hold on this issue of providing healthcare at
the local level.
Mr. Sarbanes. I appreciate it very much. Obviously,
figuring out how we design the pipeline so they get to the
places that need these healthcare workers the most is
absolutely critical. And I imagine, as well, thinking about, in
particular--in moments of particular need, how you triage the
workforce, and bring it to bear with certain intensity in key
places that have that need.
Mr. Feist, real quickly, comment, if you would--I have got
a bill I have worked on for years called the Primary Care
Physician Reentry Act, which is to get retired physicians to
come back into the practice of medicine to help us with these
workforce needs.
Could you speak to how incentivizing that, to bring those
physicians back in the workforce, could help with the burnout
and some of the mental health challenges that you have been
talking about today?
Mr. Feist. Sure. Briefly, we have a workforce shortage
right now in healthcare across all fields and all specialties.
And so the more workforce that we can bring to take care of the
patients that we have, the better.
What we also need to do, at the same time, is we need to
redesign the healthcare delivery at the same time, not just
throw more people at the problem, if you will. But that would
be a significant step towards helping this workforce right now
get out of this pandemic.
Mr. Sarbanes. Thank you very much. I yield back, Madam
Chair.
Ms. Eshoo. The gentleman yields back.
Next we will--I will recognize the gentlewoman from
Massachusetts, Mrs. Trahan, for 5 minutes for your questions.
Mrs. Trahan. Well, thank you, Madam Chair. Thank you to the
families and the witnesses for giving us their time and their
expertise today. Also, I just want to thank Chairman Pallone
and Chairwoman Eshoo for holding this important hearing.
This hearing is so timely, as the COVID-19 pandemic has
exacerbated workforce issues that were already present, pre-
pandemic, across the healthcare continuum. You know, I am
pleased this committee recognizes that, and is highlighting
legislation that aims to address these issues, including my
bipartisan bill, the Bolstering Infectious Outbreaks
Preparedness Workforce Act, or the BIO Preparedness Workforce
Act, which I introduced with Congressman McKinley.
Madam Chair, I would love to offer a stakeholder letter of
support for the BIO Preparedness Workforce Act for the record.
Ms. Eshoo. Ordered.
[The information appears at the conclusion of the hearing.]
Mrs. Trahan. Thank you. As many of my colleagues have
expressed today, COVID-19 has highlighted longstanding health
disparities in the U.S.
In addition to COVID-19, other infectious diseases like HIV
also disproportionately impact people of color, and people of
color face greater barriers in access to healthcare. At the
same time, Black, Latinx, indigenous, and other communities of
color are under-represented in medical professions.
The BIO Preparedness Workforce Act authorizes HHS to
consider geographic equity, and ensure that contracts help to
increase the number of under-represented minority individuals
serving as bio preparedness health professionals or infectious
disease health professionals.
I am concerned about the disproportionate impact of COVID-
19 and other infectious diseases on underserved populations,
including our communities of color, and it is important to
increase access to culturally competent healthcare,
particularly during a pandemic or another public health
emergency.
Dr. Marrazzo, you mentioned to my colleague, Congresswoman
Blunt Rochester, how you believe the BIO Preparedness Workforce
Act would help diversify the bio preparedness and infectious
disease workforce. But could you elaborate on why a more
diverse infectious disease workforce is important to advancing
health equity?
Dr. Marrazzo. Yes, thank you so much for that question,
Mrs. Trahan, and I am really grateful that the bill that you
are sponsoring specifically gives the Secretary of HHS
discretion to award loan repayment contracts in a way that
increases the diversity of our workforce.
As I mentioned before, financial challenges probably pose
an even greater barrier for individuals from underserved
communities to pursue careers in infectious diseases and in bio
preparedness. A more diverse workforce really addresses the
need for a culturally competent workforce.
We know, as I mentioned before, that we do better, we
resonate stronger with providers and people who look like us
and who understand our specific health challenges. So getting a
more equitable distribution of ID professionals, not just
geographically, but also across these different strata of
society, is really going to be critical to reach the patients
that we need to reach.
Mrs. Trahan. Thank you for that. And in addition to
physicians, many other health professionals are critical to bio
preparedness and infectious disease care. I mean, many of these
professionals, including our clinical lab professionals, our
advanced practice nurses, and others are also struggling with
workforce shortages and burnout.
Dr. Marrazzo, can you also elaborate on the types of bio
preparedness and ID healthcare professionals, including their
roles, their recruitment challenges, and how the BIO
Preparedness Workforce Act would help them?
Dr. Marrazzo. Absolutely. I don't think anything has
illustrated the need for a team approach more than this
pandemic. We have all felt it very, very urgently.
So in addition to physicians, you need a team of healthcare
professionals, and those include clinical laboratory
professionals, infection preventionists, ID-trained
pharmacists, advanced practice nurses, and physician's
assistants. All of these folks are really critical to staff the
sort of workforce that we need to deal with these things. And
very importantly, all of these professionals are included in
the BIO Preparedness Workforce Act.
These people are already in short supply. Twenty-five
percent of healthcare facilities have a vacancy for an
infection preventionists position, with more than half of long-
term care facilities, which have experienced incredible COVID
challenges, as we know, having experienced a loss of an
infection preventionist in the last 24 months. These shortages
are likely to grow more in the future, as 40 percent of the
infection preventionists workforce is expected to retire in the
next ten years.
The other area is laboratory personnel. There is a very
high total vacancy rate for clinical microbiologists, just over
ten percent. And also, that is a field that is aging. Probably
about 17 percent of them are going to retire in the next five
years.
And then finally, pharmacists. We work very closely with ID
pharmacists to make sure people are safely treated with many
infectious disease agents, and they are very much in short
supply. A 2018 survey of the acute care U.S. stewardship
workforce found that pharmacists and physician staffing ratios,
particularly in places in the country like ours, are well below
recommended levels for stewardship to be optimal.
Mrs. Trahan. Thank you so much for that detailed response,
and I yield back. Thank you.
Ms. Eshoo. The gentlewoman yields back. The Chair is
pleased to recognize the gentlewoman from Texas, Mrs. Fletcher,
for your 5 minutes of questions.
Mrs. Fletcher. Thank you so much, Chairwoman Eshoo, and
thank you for holding this hearing, of course.
Thank you to our witnesses for joining us today. We
appreciate all of you taking time from your practice,
classrooms, and family rooms to join us and share the
insightful testimony that you have today.
Certainly, as many of my colleagues have noted throughout
the hearing today, the last year-and-a-half of this pandemic
has really inspired a renewed sense of gratitude to our
healthcare workforce, and the possibility of a normal post-
pandemic reality could not be realized without the tireless
work of all of the healthcare heroes across our country. And I
am proud to represent so many of them, so many healthcare
providers living and working in my district in Houston, in and
around the Texas Medical Center. We are so fortunate to have
just this incredible care in our community coming from Houston,
which is the most diverse city in the country.
We also know that--and as your testimony highlights, Dr.
Wilburn--that our healthcare workforce is lacking in diversity,
and studies have highlighted the alarming under-representation
of people of color, mostly Black, Hispanic, and Native
American, in the healthcare field. Obviously, we just talked
about this in the context of Congresswoman Trahan's questions,
and I think it matters, you know, across the spectrum, in terms
of provision of healthcare.
So, in light of those disparities, in infection that we
have seen over the last year-and-a-half, the health outcomes
that we have learned more about, and seeing, as well as, you
know, longstanding disparities in chronic illnesses, this issue
is just so, so important.
So Dr. Wilburn, I wanted to ask if you could describe the
lack of diversity in allied health professions in terms of what
groups are most under-represented, and in what fields, and then
maybe follow up with talking a little bit about what the
barriers that students of under-represented backgrounds face in
their pursuit of a career in the healthcare workforce.
Dr. Wilburn. Absolutely. Well, as I stated in my testimony,
the JAMA results were not promising for the allied health
professions. Disparity is large among all of our allied health
professions. As a reminder, that includes physical therapy,
occupational therapy, speech language pathology, respiratory
therapy, and audiology.
And so what this does is that, when under-represented
groups are not represented in healthcare, we really miss the
mark, and we are not able to provide culturally competent or
culturally humble care. And when that occurs, it is a
devastating effect, not at the individual level, but at the
community level, as well. So this could really have great
devastation among many areas.
For example, during COVID, urban areas were hit hard, very
large, and those areas are a very large representation of
minority groups. So passing this legislation would be key. It
would give us a pipeline. It would provide supports. It would
give first-generation students like myself an opportunity to
see a pathway for a clear trajectory in healthcare.
Also, thank you, coming from the great State of Texas. My
parents retired there.
Mrs. Fletcher. Oh, terrific. Well, I have to say that very
recently I have been working with--in my own family situation,
a lot of folks in occupational therapy, and it is so incredible
to see the quality of care, and the patience, and the
dedication of our healthcare workforce. It really is
incredible, what you all are able to do, able to accomplish,
all of our healthcare professionals, and it is so important to
the patients and to the families.
And so I was hoping, with the little bit of time that I
have left, that maybe you could just--I appreciated the
thoughts that you shared in your testimony, and how your path
to occupational therapy would perhaps have been different if
this bill, H.R. 3320, would have--when you were starting your
career. And so, with that in mind, I would just like, with the
time we have left, maybe you could talk about a little bit more
from your professional perspective now, what benefits are
associated with an increase in the diversity of the allied
healthcare workforce for prospective students and patients.
Dr. Wilburn. Sure. So what I could imagine is, really, a
spark of innovation. Under-represented groups largely go back
to the communities in which they came from to serve. So that--
we know those communities best, and we live in those
communities, we grew up in those communities. And what we can
offer are perhaps areas of innovation that, you know, non-
majority populations that serve us, or majority populations
that serve us, haven't thought of yet.
So really, I see this as an opportunity for a pipeline of
talent that has not yet gone noticed. This would really improve
health outcomes. We know, when our providers look like us, when
they come from the same cultural backgrounds as we do, we have
improved attendance rate, we have improved compliance with
interventions, and we are an essential part of the inter-
professional and inter-collaborative teams.
Mrs. Fletcher. Terrific. Well, thank you so much for that.
I am out of time, but very grateful, Madam Chair, for
hosting this hearing. And with that, I will yield back.
Ms. Eshoo. The gentlewoman yields back.
You know, with each member that speaks and asks the
questions, it is a reminder all over again what an
extraordinary subcommittee this is. And you can see what our
attendance--I mean, you have been here since 10:30 this
morning. But to--the attendance of all of the members, and
their diligence, their work, what they care about is all on
display, as your testimony is. So I just wanted to say that.
And we now have members that would like to question that
are not members of the subcommittee, they are members of the
full committee. And so they are waiving on, and we welcome
them.
And the Chair recognizes the gentleman from Ohio, and that
he is, very much a gentleman. His father served in the
Congress, as well.
Mr. Latta, you have 5 minutes. Welcome to the subcommittee.
Mr. Latta. Well, Madam Chair, thank you very much for
allowing me to waive on, and I always appreciated the time that
I spent on this subcommittee.
And again, I want to thank the witnesses for you being here
today, for your testimony, because it is so important for us to
hear from you, because the only way we can enact good
legislation is by hearing from you all.
You know, over the last year-and-a-half, the COVID pandemic
has tragically taken the lives of hundreds of thousands of
Americans, and fundamentally changed the way we view the world.
In the beginning, millions of Americans closed their businesses
and paused their lives in an attempt to slow the spread of the
virus. Through it all, our frontline healthcare workers, even
with PPE shortages and no vaccine, stepped up to the plate to
serve.
Prior to the public health emergency, our country was
already facing a shortage of qualified labor and industries
across the entire economy. The pandemic has only exacerbated
this labor crisis, with burnt-out workers and early
retirements. I don't know how the situation can get any worse.
But unfortunately, when the President announced his vaccine
mandate--which I believe is unconstitutional--for all Federal
workers and 17 million healthcare workers.
I have seen this across my district, as I have traveled
across it during the pandemic. I heard from staff in numerous
hospitals and from other healthcare facilities about their
concerns with being short-staffed, and it is a great concern. I
was told at several hospitals that, due to the state vaccine
mandates in other states, their employees from these other
states were coming into Ohio, because there were no mandates.
One healthcare provider stated that it could lose almost 30
percent of their staff to the vaccine mandates. If this is
true, there is no doubt that patient care and access will
suffer, and possibly result in up to 50,000 patients in need of
finding other facilities.
And that is why I introduced the Health Care Workforce
Protection from Mandates Act. While--the legislation would
prohibit the HHS Secretary from forcing the mandatory COVID-19
vaccination of workers employed by participating entities in
the Medicare program, unless the Secretary certifies in writing
that this mandate would not result in staffing shortages.
Mr. Levine, if I could start my questioning, we acknowledge
the importance of educating our employees about the vaccine
with real-world data and de-politicized science. Given this,
isn't it true that hundreds of your staff, including critical
frontline nurses, could or would lose their--leave their
positions or be fired if you have to enact the COVID-19
mandate?
Mr. Levine. Sir, I haven't yet seen the rule come out of
Medicare, but my presumption is that that could be the case, be
vaccinated or be fired. I suspect that there would be some loss
of some of our frontline employees.
Mr. Latta. Now, just out of curiosity, because, again, as
I--what we saw from--happening in Ohio, with individuals coming
in from Michigan to Ohio, especially because my district
borders the southern boundary of Michigan, that we did see
people crossing the state line to work in Ohio.
You know, when you would look at the--you know, you haven't
really--you said they haven't really looked at the specific
numbers, but have you had any people that have come to you
saying that they might even leave the healthcare profession?
Mr. Levine. I have, and I have had some resignations, just
from the fact that we are even considering the mandate. We had
a very public resignation last week.
We are--and I just want to be clear, I know you have got
limited time, but no organization has been more invested in
trying to educate people on why it is important to be
vaccinated than Ballad Health has. And we think everyone should
be vaccinated.
But we also have an obligation to take care of people who
have heart attacks and strokes who come into our hospitals. In
a rural region, everybody we lose, it is, right now, very
difficult to replace them.
Mr. Latta. Well, you know, you bring up a point, because I
know that, you know, as I go through my facilities and
hospitals in my district, and also the different colleges and
universities that I have, you know, we have got--we are trying
to get more and more individuals engaged in the healthcare
profession. We already knew we were going to have a shortage
because, even before the pandemic, especially when we were
thinking about individuals out there who are Baby Boomers, as
we all age, that we are going to need more folks out there, not
less.
But, you know, in your opinion, are the mandates the
appropriate route for the Federal Government to approach this
right now?
Mr. Levine. You know, we mandate MMR, we mandate polio, we
mandate other types of vaccines for team members. I do think at
some point, when there is more certainty and more data and--
about the longevity of the vaccine, there would be an
appropriate time to mandate it.
Right now we believe, right now, that we are leaning
towards education and being examples. I will say if Medicare
mandates as a condition of participation, we certainly have no
choice but to comply with the Medicare mandate.
Mr. Latta. Well, thank you very much.
Madam Chair, my time has expired. And again, I want to
thank my friend for allowing me to waive on today.
Ms. Eshoo. It is wonderful to have you at the subcommittee.
I can't help but think that, if someone is unvaccinated,
that they are highly susceptible to contracting the virus. They
contract the virus, and they are unvaccinated and working in a
hospital, they can pass it on to the patients. So this is--I
just don't get this.
Anyway, the gentleman from Illinois, Mr. Rush, is
recognized for 5 minutes.
And it is wonderful to have you waive on. I keep having to
look around the hearing room, but remember to look at the
screen.
Is Mr. Rush with us?
If not, then we will go to recognize Mr. Pence, the
gentleman from Indiana, for your 5 minutes. Welcome to the
subcommittee.
Mr. Pence. Well, thank you very much, Chairman Eshoo and
Ranking Member Guthrie. Thanks for letting me come on today,
and thank the witnesses today for being here.
You know, I am encouraged that this committee is taking
steps to address healthcare workforce shortages affecting
Hoosiers and all Americans. The pandemic highlighted that our
nation's overburdened healthcare system is on an unsustainable
spending path, leading to higher costs and less care,
particularly in rural America.
While the bipartisan bills before us today are approaches
to address workforce challenges, I am concerned that we are not
conducting the necessary oversight to figure out the root
causes of this systemic problem. Across Indiana's 6th district,
the workforce shortage in our hospitals and critical care
facilities is leaving patients with fewer options and longer
wait times. Hospitals are struggling to meet the financial
obligations necessary to adequately staff their facilities.
In Indianapolis, St. Vincent needed to bring in the Indiana
National Guard. At King's Daughters' Health in Madison, nurses
are making double, sometimes triple what they were making in
2020, as well as in my hometown hospital, Columbus Regional in
Columbus, Indiana. Some directors of nursing have reported to
me personally that their nurses are either burnt out from
battling the pandemic, or finding new employment as much higher
traveling nurses (sic).
Meanwhile, vaccine mandates from the Administration are
compounding this problem, pushing even more nurses out of the
industry, as told to me by these directors of nursing.
Unfortunately for rural patients in my district, this trend is
disrupting available care and treatment.
Dr. Keel, this August, Governor Eric Holcomb put together a
commission to look at the State of Indiana's health
infrastructure, including the nurse and workforce shortage.
Like your state of Georgia, Indiana faces challenges in
maintaining health systems in rural areas.
In your experience dealing with nursing workforce
shortages, what will be the long-term impact on rural hospitals
if this shortage and incredible growing cost continues?
Because, as I have talked to hospitals, their revenues are
now projected to be 50 percent down, simply because of payroll
costs in the next rolling 12 months. And that is unsustainable,
even for the profitable hospitals.
Sir?
Dr. Keel. Thank you very much for that question. And yes,
it is a great concern for our health system. We are facing the
exact same shortages that you have alluded to, and those
shortages are due almost entirely to an increase in payroll
costs. The--and a lot of that is due to having to pay travel
nurses.
Yes, nurses are leaving other positions and coming to our
system as a travel nurse. We have nurses from hospitals that
are, literally, across the street from us that are quitting
their positions there, only to fill the travel--the nurse
shortage that we have in our facility due to travel nurses. So
it is a great concern.
One of the--but beyond that, the concern that I have is
what are we going to do down the road? We cannot sustain the
cost of the travel nurses at this current rate, and we are
certainly not going to be able to sustain this once we get
beyond COVID.
Mr. Pence. And Dr. Keel, I also serve on a community
college that--we have a nursing program. Just last week I was
told that two of the professors that teach the reduced
applicant student body have just left to become traveling
nurses. Because, if you do the math, at $150, $190 an hour that
the traveling nurses are getting paid in Indiana, that is
$300,000 or $400,000 a year. What can we possibly do? I guess
we are going to have to pay nurses $300,000 or $400,000 a year.
Dr. Keel. I--that is not sustainable.
Mr. Pence. No, sir.
Dr. Keel. I know you would appreciate that. You know, we
have had a nursing shortage that goes back well before the
pandemic.
And to your point, the primary reason for the nursing
shortage is, at least from my perspective, is not a lack of
classroom space, or lack of positions, or an enrollment cap.
Quite the opposite. It is having the ability to hire nurse
faculty, when they can go into private sectors and make a lot--
--
Mr. Pence. Yes, and if I may, as I--as in my opening
remarks, I am very concerned. We really need to get a handle
on--you know, you got--you can't fix a problem until you
identify a problem, and I think we have really got to figure
out what we need to do to have nurses, because rural hospitals,
without nurses, the doctors can't get anything done.
And thank you for letting me on. I yield back.
Ms. Eshoo. You are always welcome to waive on. I understand
that Mr. Rush is going to join us.
Are you there, the gentleman from Illinois, Mr. Rush?
Mr. Rush. Madam Chair?
Ms. Eshoo. Four, three, two----
Voice. I hear a voice.
Ms. Eshoo. Where are you?
Mr. Rush. Can you hear----
Ms. Eshoo. I can--I can't see you, and I--your voice is not
very loud.
Mr. Rush. Can you hear me, Madam Chair?
Ms. Eshoo. Just--you need to turn the volume up, because we
can't hear you very well.
[Pause.]
Ms. Eshoo. He is not on camera. Does he have to be on
camera?
Mr. Rush. I am on camera.
Mr. Butterfield. He is on camera.
Ms. Eshoo. All right, the gentleman is recognized. We don't
see you on our screen, but I believe you are on--oh, there you
are. OK.
Mr. Rush. Can you hear me?
Ms. Eshoo. Yes, and we can see you.
Mr. Rush. All right, wonderful.
Ms. Eshoo. Begin.
Mr. Rush. Hey, technology has come through, once again.
I want to thank you, Madam Chair, for allowing me to
participate in today's very important hearing, and I am
grateful that you chose to include my bill, H.R. 3320, the
Allied Health Workforce Diversity Act, which I introduced in
this Congress with Representative Markwayne Mullin, and the
last Congress with the ranking member of the full committee,
Congresswoman McMorris Rodgers.
The lack of diversity in the fields of physical therapy,
occupational therapy, respiratory therapy, speech and language
pathology, and audiology is very troubling to me and to others.
Many of these professions, Madam Chair, have been pivotal in
helping individuals recover from COVID-19, which makes our
legislation needed now, more than ever.
Even prior to COVID-19, this lack of diversity was
extremely problematic. Research shows that this lack of
diversity leads to less access to these specialists in
underserved in rural areas, and worse outcomes are attended to
every--these patients. That is why I was compelled to introduce
the Allied Health Workforce Diversity Act, H.R. 3320.
This bipartisan piece of legislation would authorize
funding to, in fact, recruit and retain students who are racial
or ethnic minorities, or who are from disadvantaged backgrounds
to enter and complete programs in these professions.
And I want to thank you, Dr. Garcia Wilburn, for your
appearing before the committee today. Your story is inspiring,
and I hope that you and your family are very proud of what you
have accomplished and will continue to accomplish.
As you know, Dr. Garcia Wilburn, the Allied Workforce
Diversity Act is based on the highly-successful Title VIII
workforce development program. Can you explain why that program
was so successful?
What best practices or lessons should allied health
professionals take from the Title VIII program?
Dr. Wilburn. Thank you so much, Representative Rush. I
really appreciate your question, and giving me the opportunity
to answer your question.
First, the funding provided higher education program
support to focus on recruitment and retention, which we have
talked about numerous times today for individuals from under-
represented groups. By funding community outreach programs,
higher education programs were able to show that these under-
represented communities--that the profession has a realistic
option and pipeline to those healthcare professions. It showed
that communities--the program would be partners to these
individuals, with both moral and financial support, as they
pursued their degree, which is key.
Second, the success of the Nursing Workforce Development
Act--although cliche, success breeds success. And I know we
have some hurdles to currently overcome in the nursing
profession, but we cannot negate the fact that the nursing
profession is more diverse than ever. As programs were able to
see more people from under-represented communities graduate and
go back to their communities to practice, the idea of pursuing
nursing as a career became more mainstream at all degree
levels, from associate to doctorate.
These programs were used to fund the grant programs, to
build resources within the programs to help future classes of
students, in time to see the real benefits of diversity to the
profession. High school students, middle school students,
beyond saw people with a similar culture, racial group,
ethnicity from their own background in a respected profession,
inspiring those communities long beyond grant funding.
So this is what led to the Nursing Workforce Diversity Act,
and its program has nearly doubled in diversity since then, and
we are hoping to see the same success among the allied health
professional programs.
Mr. Rush. Thank you.
Madam Chair, my time has expired. I yield back the balance
of it.
Ms. Eshoo. The gentleman yields back, and we want you to
know you are always welcome at our subcommittee, Mr. Rush.
Mr. Rush. Thank you.
Ms. Eshoo. Thank you.
The Chair now recognizes another member, last but not
least, who is waiving on, the gentlewoman from Illinois, Ms.
Schakowsky, for your 5 minutes of questions. And I think that
will be it.
Ms. Schakowsky. Well, thank you so very much, once again,
for allowing me to waive on to this wonderful subcommittee, and
the great job that you are doing, Madam Chair.
I want to say, as the co-chair of the House Democratic
Caucus on Aging and Families, that the importance of caring for
America's seniors is, you know, right at the top of my list.
We know that two-thirds of unpaid family caregivers are
women. And one in three caregivers are themselves senior
citizens. And we also know that one in four Americans are in
the sandwich generation, meaning they are taking care of
children, as well as elderly parents, so they are very busy as
caretakers.
My--but most disturbing is that, according to a 2020 report
from the Center for Disease Control and Prevention, nearly 31
percent of family caregivers feel alone in their caregiving,
and report serious consideration of suicide. I mean, this is a
real mental health challenge that we have right now, and that
is because family caregivers continue to be left on their own,
just trying to figure out how to address this.
We have never had a real long-term care policy in this
country, so I wanted to ask Ms. Monroe--are you here, still,
Witness?
Ms. Monroe. Yes, I am here.
Ms. Schakowsky. OK, there you are. OK. I wanted to ask you
this. I found your testimony so incredibly compelling, and
really disturbing, that you were somehow completely blindsided,
that--the seven years to get your father diagnosed, that the
basic message that she got was--that you got was ``good luck.''
And here you are, as you described yourself, as someone who is
so credentialed, so informed.
So really, what I need to know from you, how--can you shed
light on exactly what type of guidance and training has to be
built-in right away, that people have to understand that they
are going to get the information, and that the help that they
need?
And as Bobby Rush was talking about, you know, there is
disparate results, as well, especially communities and people
of--in low-income communities are really, really on their own.
So what do we need to do?
Ms. Monroe. Well, I would say one of the biggest, I think,
helps would have been--so my mom lives with my dad full-time,
and she is 88, and he is 84. So having us understand----
Ms. Schakowsky. Does she also have Alzheimer's, or no?
Ms. Monroe. No, she does not, at least not diagnosed. But,
you know, we are having to support her, one who is there 24/7
with him, which is a lot of a different feeling than we have,
from--I am an hour away, my brother is about--you know, he is
down in Nashville, and my sister is about 15 minutes away. So
we are trying to do a construct, where we have three siblings
working together to try to be a caregiver, but my mom is there
27/7.
And the stress on her, and her not really understanding the
disease, thinking that, you know, we--she knows it is a
disease, but a lot of times she thinks he is just ``crazy''--
and not being able to get help--help, right now, for my
parents--and I hate to use an anecdote--would be for my dad
probably to be in assisted living. But there is no room at the
inn. And caregivers are not being--you know, are not reliable,
in terms of being there.
So we will often get a call, very last minute, saying,
``The caregivers didn't show up this morning, I can't get your
dad dressed.'' One of us has got to get in the car and drive to
do those kinds of tasks. So, you know, reliable services that
can be there, having facilities that have built-in care
structures, even on an emergency basis, that you can call upon
because you are, you know, paying 5,000 or $6,000 a month for
the purpose of being--having access to these services.
Helping my family, my siblings and I, plan, come up with a
timetable, a work plan for how we are going to manage what this
looks like, who is going to be in charge of the medication, who
is going to be in charge of the meals, who is going to take the
parents to the doctors' visits, just someone to really help us
do a work plan for what that looks like.
And how do you determine at what point you need to step up
care, and then where do you go for that?
Ms. Schakowsky. All right. Thank you so much for that.
And I also know that, even in your opening statement, you
talked about the legislation that is being considered. And I am
very proud to be a cosponsor of the Alzheimer's Caregiver
Support Act. And all the other bills that you talked about is
something we need to do. So thank you very much for your
testimony, for being such an incredible witness.
And thank you to all the witnesses, and I yield back. Thank
you.
Ms. Eshoo. The gentlewoman's time has expired.
This concludes our hearing today. On behalf of all of the
members of the committee, to each one of you that have
testified, you have our lasting gratitude. You have been highly
instructive on the bills that are before us, and given us a--
well, you have given us very direct answers to our questions,
which really enhances our understanding of each of the issues
that are before us. So thank you. And to those that had to
travel, you took on an additional burden to be here, and we
thank you.
Now, Members, as you know, have ten business days to submit
additional questions for the record. And witnesses, your work
is not done, because, as members put their questions together
and submit them to you, we ask that you, as promptly as
possible, answer those questions. And we know that you will.
So at this time I request unanimous consent to enter the
following documents into the record. There are 27 of them, and
I would love to have the ranking member----
Mr. Guthrie. We have reviewed the list, and we accept the
list, as you presented it.
Ms. Eshoo. That is wonderful. So, with that consent, we
will enter into the record the 27 documents that we have
received on the bills.
[The information follows:]
Ms. Eshoo. And with that, I think we can adjourn the
subcommittee. Thank you, everyone.
[Whereupon, at 2:31 p.m., the subcommittee was adjourned.]
[The information appears at the conclusion of the hearing.]
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