[Senate Hearing 117-58]
[From the U.S. Government Publishing Office]


                                                       S. Hrg. 117-58

                    CHILD NUTRITION REAUTHORIZATION:
                   HEALTHY MEALS AND HEALTHY FUTURES

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

                                HEARING

                               BEFORE THE

                       COMMITTEE ON AGRICULTURE,
                        NUTRITION, AND FORESTRY

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             MARCH 25, 2021

                               __________

                       Printed for the use of the
           Committee on Agriculture, Nutrition, and Forestry
           
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                  Available on http://www.govinfo.gov/
                  
                              __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
45-390 PDF                 WASHINGTON : 2022                     
          
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            COMMITTEE ON AGRICULTURE, NUTRITION, AND FORESTRY


                 DEBBIE STABENOW, Michigan, Chairwoman
PATRICK J. LEAHY, Vermont            JOHN BOOZMAN, Arkansas
SHERROD BROWN, Ohio                  MITCH McCONNELL, Kentucky
AMY KLOBUCHAR, Minnesota             JOHN HOEVEN, North Dakota
MICHAEL F. BENNET, Colorado          JONI ERNST, Iowa
KIRSTEN E. GILLIBRAND, New York      CINDY HYDE-SMITH, Mississippi
TINA SMITH, Minnesota                ROGER MARSHALL, Kansas
RICHARD J. DURBIN, Illinois          TOMMY TUBERVILLE, Alabama
CORY BOOKER, New Jersey              CHARLES GRASSLEY, Iowa
BEN RAY LUJAN, New Mexico            JOHN THUNE, South Dakota
RAPHAEL WARNOCK, Georgia             DEB FISCHER, Nebraska
                                     MIKE BRAUN, Indiana

               Joseph A. Shultz, Majority Staff Director
               Mary Beth Schultz, Majority Chief Counsel
                    Jessica L. Williams, Chief Clerk
            Martha Scott Poindexter, Minority Staff Director
                 Fred J. Clark, Minority Chief Counsel
                           
                           C O N T E N T S

                              ----------                              

                        Thursday, March 25, 2021

                                                                   Page

Hearing:

Child Nutrition Reauthorization: Healthy Meals and Healthy 
  Futures........................................................     1

                              ----------                              

                    STATEMENTS PRESENTED BY SENATORS

Stabenow, Hon. Debbie, U.S. Senator from the State of Michigan...     1
Boozman, Hon. John, U.S. Senator from the State of Arkansas......     2

                               WITNESSES

Beers, Lee Savio, M.D., President, American Academy of 
  Pediatrics, Washington, DC.....................................     6
Green, Reynaldo, Vice-President, Nutrition and Family Well-Being, 
  Quality Care For Children, Atlanta, GA.........................     8
Gould, Jessica, Director, Nutrition Services, Littleton Public 
  Schools, Littleton, CO.........................................    10
Golzynski, Diane, Ph.D., Director, Office of Health and Nutrition 
  Services, Michigan Department of Education, Lansing, MI........    12
Hoffman, Heidi M., Director, Colorado State WIC, Colorado 
  Department of Public Health and Environment, Denver, CO........    13
Rodriguez, Carlos, President and CEO, Community Foodbank of New 
  Jersey, Hillside, NJ...........................................    15
                              ----------                              

                                APPENDIX

Prepared Statements:
    Beers, Lee Savio, M.D........................................    40
    Green, Reynaldo..............................................    56
    Gould, Jessica...............................................    62
    Golzynski, Diane, Ph.D.......................................    64
    Hoffman, Heidi M.............................................    68
    Rodriguez, Carlos............................................    78

Document(s) Submitted for the Record:
Boozman, Hon. John:
    FMI 2021 WIC Reauthorization Priorities......................    94
    FMI, prepared statement for the Record.......................    96
Hyde-Smith, Hon. Cindy:
    Senator Hyde-Smith, prepared statement for the Record........    99

Question and Answer:
Beers, Lee Savio, M.D.:
    Written response to questions from Hon. Debbie Stabenow......   102
    Written response to questions from Hon. John Boozman.........   103
    Written response to questions from Hon. Kirsten Gillibrand...   104
    Written response to questions from Hon. Richard Durbin.......   105
    Written response to questions from Hon. Cindy Hyde-Smith.....   108
Green, Reynaldo:
    Written response to questions from Hon. Debbie Stabenow......   109
    Written response to questions from Hon. John Boozman.........   110
    Written response to questions from Hon. Cindy Hyde-Smith.....   110
Gould, Jessica:
    Written response to questions from Hon. John Boozman.........   112
    Written response to questions from Hon. Cindy Hyde-Smith.....   114
    Written response to questions from Hon. Charles Grassley.....   115
Golzynski, Diane, Ph.D.:
    Written response to questions from Hon. Debbie Stabenow......   117
    Written response to questions from Hon. John Boozman.........   117
    Written response to questions from Hon. Patrick Leahy........   118
    Written response to questions from Hon. Cindy Hyde-Smith.....   119
Hoffman, Heidi M.:
    Written response to questions from Hon. John Boozman.........   121
    Written response to questions from Hon. Patrick Leahy........   121
    Written response to questions from Hon. Amy Klobuchar........   122
    Written response to questions from Hon. Kirsten Gillibrand...   123
    Written response to questions from Hon. Richard Durbin.......   123
    Written response to questions from Hon. Cindy Hyde-Smith.....   125
Rodriguez, Carlos:
    Written response to questions from Hon. Debbie Stabenow......   127
    Written response to questions from Hon. John Boozman.........   128
    Written response to questions from Hon. Patrick Leahy........   131
    Written response to questions from Hon. Amy Klobuchar........   132
    Written response to questions from Hon. Richard Durbin.......   133
    Written response to questions from Hon. Cindy Hyde-Smith.....   134

 
   CHILD NUTRITION REAUTHORIZATION: HEALTHY MEALS AND HEALTHY FUTURES

                              ----------                              


                        THURSDAY, MARCH 25, 2021

                                       U.S. Senate,
         Committee on Agriculture, Nutrition, and Forestry,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 9:35 a.m., via 
Webex and in room 301, Russell Senate Office Building, Hon. 
Debbie Stabenow, Chairwoman of the Committee, presiding.
    Present or submitting a statement: Senators Stabenow, 
Brown, Klobuchar, Bennet, Gillibrand, Smith, Durbin, Booker, 
Lujan, Warnock, Boozman, Hoeven, Ernst, Hyde-Smith, Marshall, 
Tuberville, Grassley, Thune, Fischer, and Braun.

STATEMENT OF HON. DEBBIE STABENOW, U.S. SENATOR FROM THE STATE 
    OF MICHIGAN, CHAIRWOMAN, U.S. COMMITTEE ON AGRICULTURE, 
                    NUTRITION, AND FORESTRY

    Chairwoman Stabenow. Good morning. I call the hearing of 
the U.S. Senate Committee on Agriculture, Nutrition, and 
Forestry to order, and welcome to all of my colleagues. I do 
understand that we are going to have some challenges this 
morning with votes. The first vote now has been moved up to 
10:45. We will continue on through the hearing but please just 
if you need to leave and vote and come back, we will keep it 
going between the Ranking Member and myself chairing the 
meeting, and making sure people have an opportunity to ask 
their questions and so on.
    I am so pleased to be here today to discuss how we create a 
healthier future for our children. I know this is something we 
all deeply care about. All parents want to see their children 
grow up to lead healthy and successful lives. One of the best 
ways to do that starts with the food on their plates. When 
those plates are empty, it is a crisis for the children, it is 
a crisis for the family, and it is a crisis, quite frankly, for 
our country.
    School meals were created because Congress recognized that 
far too many children were growing up malnourished. On the 
heels of World War II, that was a serious risk to our national 
security. The Special Supplemental Nurtrition Program for 
Women, Infants, and Children (WIC) was established in response 
to the devastating impacts of poor nutrition on moms and 
babies. Summer meals were created because children were going 
hungry in between school years. At each of these turning 
points, Congress saw a crisis and acted.
    While a lot has changed since then, we need to take action 
again today. The COVID-19 pandemic has only exacerbated the 
dual challenge of obesity and hunger. Obesity rates for 
children have been on the rise for years, again creating calls 
for action from today's military leaderships, pediatricians, 
public health experts. After the last year without recess or 
after-school sports, early evidence is showing that the 
pandemic has put more children at risk of obesity. According to 
the American Academy of Pediatrics, who we will hear from 
today, children in low-income households and communities of 
color are more at risk of both obesity and COVID-19.
    At the same time, too many children in this country do not 
have enough to eat. Think about that--too many children in the 
United States of America do not have enough to eat. One in four 
children in the United States now face hunger because of the 
pandemic.
    It is clear we are facing a child health crisis and a child 
hunger crisis. While the pandemic has created a new set of 
challenges it has also created opportunities for us to improve 
children's lives. Whether they are learning in person or 
virtually, we know our children cannot focus with an empty 
stomach. They need wholesome and nutritious breakfasts, 
lunches, snacks in order to learn and grow.
    During the pandemic, Congress gave schools new tools to 
reach more families in need, minimizing paperwork and focusing 
on creative ways to meet children where they are, whether it is 
delivering meals along bus routes, giving out a week's worth of 
meals at once, or providing a pandemic Electronic Benefit 
Transfer (EBT) card to help families purchase food in the 
grocery store. New tools helped schools reach more children in 
need.
    While we all are happy to be beginning to move past this 
pandemic, we can apply these lessons and creative thinking to 
how we reach children during the summer, on weekends, and after 
school. As we transition back to in-person learning, we have to 
use all of the tools in our toolbox to feed our kids and reduce 
burdens on schools, daycare centers, and parents.
    It is also important to make sure families have healthy 
food for their children before they reach school age. The 
successful WIC program helps pregnant moms and babies eat 
healthy food in the critical first stages of life. Key 
investments in technology and modernization, like telehealth, 
data-sharing, even something as simple as text messaging can 
help us feed more people in need.
    It has been over 10 years since Congress last made 
improvements to our critical child nutrition programs. With all 
of the challenges we face, it is time to take action on a 
bipartisan basis. Feeding kids is not and should not be a 
partisan issue. I know my partner and my Ranking Member, 
Senator Boozman, agrees. I look forward to passing a strong, 
bipartisan child nutrition bill that helps our kids get 
healthier, not hungrier.
    Thank you so much, and I now turn to Senator Boozman.

 STATEMENT OF HON. SENATOR JOHN BOOZMAN, U.S. SENATOR FROM THE 
                       STATE OF ARKANSAS

    Senator Boozman. Well, thank you, Chairwoman Stabenow, for 
convening today's hearing, a very, very important hearing. I 
want to thank all of our witnesses for their time and their 
testimony today, and I also want to thank you for the 
incredible that you have done over the past year during the 
pandemic. Your organizations are made up of the heroes who are 
on the front line every day, ensuring children receive the food 
they need to grow and to thrive. Your innovation, your 
tenacity, and the commitment to ensuring those in need have 
access to food is truly amazing, and I think all of us on this 
panel, and I think I can speak for all of us, truly commend 
you.
    I look forward to working with Chairwoman Stabenow and the 
other members of the Committee to produce a bipartisan child 
nutrition bill this year. I have been a co-chair of the Senate 
Hunger Caucus for a number of years, so it is a priority of 
mine to see a Child Nutrition Reauthorization bill cross the 
finish line.
    This hearing is the beginning of the process, and it is 
critical that we listen to those of you who are operating the 
programs, to understand the lessons you have learned during the 
pandemic and to know what is working and where we may have 
challenges. Many times things look good on paper, but when you 
put them into practice reality demonstrates a different story. 
We need your feedback so that government is helping you with 
your mission, not getting in the way.
    It has been over 10 years since the last child nutrition 
reauthorization, and without a doubt some of the programs 
certainly need to be modernized. There are many advances in 
technology that the Chairwoman just talked about that we should 
be considering for things like the WIC community. I hope to 
hear more about telehealth, online purchasing of food items, 
and other opportunities to move WIC into the 21st century.
    We all know there are changes needed in the Summer Food 
Service Program, an issue I have been working on for a few 
years. The Summer Food Service Program needs to be modernized 
to include flexibility in the congregate meals requirement to 
better ensure that our Nation's children are getting the 
nutrition they need to succeed.
    Twenty-two million children receive free, reduced-price 
healthy meals during the school year through the Federal 
programs, but five out of six of these children are missing 
meals during the summer. The Summer Food Service Program is 
hamstrung by rules that dictate a one-size-fits-all solution, 
requiring children to travel to a central location and eating 
their meals together. However, more than 14 million low-income 
children across the country live in communities that are 
ineligible to operate an open summer meals site. In communities 
where there are sites, access is far from easy. Lack of 
transportation and extreme weather often keep children from 
sites. In rural areas where roughly three million low-income 
children live, the closest site may actually be several miles 
away. The pandemic has heightened the need for increased 
flexibility so that all options are on the table, from offsite, 
grab-and-go models to home delivery to summer EBT.
    I am also aware of the need for more streamlining across 
the child nutrition programs and between WIC clinics and health 
care professionals. When we streamline and reduce paperwork and 
duplication it simplifies the process for everyone involved. I 
hope to hear some thoughts on this also today.
    Finally, I continue to hear concerns about the school meal 
nutrition standards, and in particular the standards for milk, 
sodium, and whole grains. The Arkansas School Nutrition 
Association recently described to me the challenges they 
continue to face with these standards. When schools are facing 
the financial strain and doing their best to feed children 
during the pandemic, I find it alarming that schools would also 
be required to implement strict nutrition standards for which 
product is not available. This is a concern that needs to be 
addressed in the short term, but it is equally important to 
find a long-term solution that gives schools certainty.
    School nutrition professionals feed kids healthy, 
nutritious meals each school day. I trust them to know their 
students and what will work in their schools to ensure we are 
feeding children and not trashcans. We know the healthiest 
option for many students is to eat school meals. Our programs 
should help empower schools to serve kids rather than create a 
wedge that further decreases participation and increases 
stigma.
    Again, I want to thank all of you for your heroic efforts 
this past year. As we move forward, I am committed to crafting 
a bipartisan bill. I sincerely hope this will remain a 
bipartisan process and the Committee can work its will in the 
months ahead. We will have a better product certainly if we are 
all at the table working together, and I have no doubt that we 
will be.
    Thank you for being here, and I look forward to today's 
discussion.
    Thank you, Madam Chair.
    Chairwoman Stabenow. Well, thank you, Senator Boozman, and 
I want to thank you for your leadership over the years on the 
Hunger Caucus, and I could not agree more. I think we are going 
to have a real opportunity to do something important for kids 
and families, and do it in a bipartisan way.
    We will now turn to introducing our witnesses, who are with 
us virtually today. We thank each and every one of you for your 
expertise and being willing to spend the time with us.
    Our first witness is Dr. Lee Savio Beers. Dr. Beers is the 
President of the American Academic of Pediatrics and a 
Professor of Pediatrics and Medical Director for Community 
Health and Advocacy at Children's National Hospital in 
Washington, DC. She is the Founding Director of the DC Mental 
Health Access in Pediatrics Program and Co-Director of the 
Early Childhood Innovation Network.
    She began her medical career as a naval officer in the 
Medical Corps and has worked as a staff pediatrician at the 
National Naval Medical Center in Bethesda, Maryland, and Walter 
Reed Army Medical Center. Welcome.
    I now recognize Senator Warnock, who will introduce our 
next witness.
    Senator Warnock [continuing]. and it is great to be here. 
Thank you, Madam Chair. It is my distinct honor to welcome to 
this Committee a fellow Georgian and also to welcome a fellow 
alumnus of Morehouse College. We graduates of Morehouse College 
call ourselves Morehouse Men, and they say you can always tell 
a Morehouse Man but cannot tell him much.
    [Laughter.]
    Senator Warnock. We are grateful that Mr. Reynaldo Green is 
her with us. He is the current President of CACFP Forum and is 
the current Vice President of Nutrition and Family Well-Being 
at Quality Care for Children in Atlanta, Georgia.
    Since 2013, Mr. Green has been focused on his 
organization's administration of a child and adult care food 
program, serving four million meals and snacks to over 22,000 
children across our State every year. We are so grateful for 
their work. I applaud his work to ensure that the children of 
Georgia have access to nutritious meals and snacks, and we look 
forward to hearing his testimony. Once again, please welcome 
Mr. Reynaldo Green.
    Chairwoman Stabenow. Thank you so much, Senator Warnock. I 
know turn to Senator Bennet, who will introduce our next 
witness.
    Senator Bennet. Thank you, Madam Chair Stabenow and Ranking 
Member Boozman. Today I have an unbelievable privilege that I 
never had in the Senator, which is to introduce not one but two 
witnesses from Colorado.
    Chairwoman Stabenow. That is correct.
    Senator Bennet. Both are leaders in child nutrition who 
work to ensure that kids across our State have access to 
healthy and nutritious meals. First is Jessica Gould, who for 
six years has served as the Director of Nutrition for Littleton 
Public Schools. She is the Past President and Vice President of 
the Colorado School Nutrition Association. Jessica has 
extensive experience in school nutrition, when an emphasis in 
advocacy, menu planning, purchasing, use of commodities, and 
financial accountability. She is also a registered dietician 
and school nutrition specialist.
    Heidi Hoffman has also joined us. Heidi serves as 
Colorado's State WIC Director. She has worked in the State's 
Department of Public Health and Environment since 2017. She has 
sought to modernize WIC services and connect families to local 
farmers and food systems throughout the WIC Farmers Market 
Nutrition Program. Previously she worked as a food access 
program administrator for the City and County of Denver, and a 
health promotion manager in Mesa County. She holds an MPA from 
the University of Colorado and a nutrition and dietetics degree 
from Colorado State University.
    Thank you, Madam Chair.
    Chairwoman Stabenow. Well, thank you, Senator Bennet, and 
we really are bipartisan. You introduced a majority witness and 
a minority witness, and just for the record we do not intend to 
let this happen again.
    [Laughter.]
    Senator Bennet. I am proud of my whole State.
    Chairwoman Stabenow. No, we are very proud of your 
witnesses today. I am going to turn now to Senator Booker who 
will introduce our next witness. Senator Booker.
    Senator Booker. Thank you, Chairwoman. For I was hungry and 
you gave me food. I was thirsty and you gave me drink. I was a 
stranger and you welcomed me. I was naked and you clothed me. I 
was sick and you visited me. Many Senators on both sides of the 
aisle know that verse from Matthew 25, are animated, inspired, 
and motivated by it.
    I have the pleasure of introducing Carlos Rodriguez, who in 
all of America is one of the best exemplars of that spirit. He 
is recognized as a great and noble voice against hunger and in 
doing the actual work of addressing the needs of the poor.
    Over the course of the last 22 years, Carlos has focused on 
improving policies and delivering services to the scale needed 
to reach all the neighbors indeed. He was actually born in the 
South Bronx, where he was raised, and Carlos has had a profound 
appreciation for the impact that policy on people's lives. Much 
of hunger and poverty is a policy choice and not an inevitable 
reality.
    Now Carlos saw the light and he rose on up to move to New 
Jersey, got out of the shadow of our great State and became a 
part of it. He is the CEO of the Community FoodBank of New 
Jersey, where he focuses on bringing individuals, corporations, 
community groups, and government organizations together for a 
better future. He is responsible for serving over 1.2 million 
people in New Jersey who are struggling with food insecurity. 
His work to feed people and shorten the pantry lines involves 
increasing distribution of nutritious food while helping to 
address the root cause of hunger and connecting working 
families with resources, helping them earn a sustainable 
living. He is a noble man, a man of dignity and honor, and I am 
grateful that he is in New Jersey, but I am grateful also that 
he is here today with us.
    Thank you, Chairwoman.
    Chairwoman Stabenow. Well, thank you so much, Senator 
Booker. We very much appreciate the introduction and the 
witness.
    Now last but certainly not least, from my book, is Diane 
Golzynski, who is the Director of the Office of Health and 
Nutrition Services and the State Child Nutrition Director at 
the Michigan Department of Education. Diane, we are so glad to 
have you with us. She is responsible for USDA child nutrition 
programs, including school lunch and breakfast, summer food 
service, and child and adult care food programs. She also 
oversees USDA commodity household programs for families and 
seniors in need, and the school and health and safety programs 
to support mental, behavioral, and physical health for students 
in our schools.
    Diane is a registered dietitian and is passionate about 
health and safety for all children and their families. We 
welcome you as well.
    To all of our witnesses, we will now hear from each of them 
and then go to questions. First, Dr. Lee Beers. Welcome.

STATEMENT OF LEE SAVIO BEERS, M.D., PRESIDENT, AMERICAN ACADEMY 
                 OF PEDIATRICS, WASHINGTON, DC

    Dr. Beers. Thank you, Chairwoman Stabenow and Ranking 
Member Boozman, thank you so much for the opportunity to 
testify here today. My name is Dr. Lee Savio Beers, President 
of the American Academy of Pediatrics, or AAP, a nonprofit 
professional organization of 67,000 pediatricians.
    As a pediatrician, I see first-hand the health effects of 
food insecurity and malnutrition in my patients. I also see the 
positive impact of Federal child nutrition programs. I began my 
career as a Navy pediatrician. Many of the enlisted families I 
cared for were food insecure and eligible for nutrition 
programs, yet were not aware. I educated my patients about how 
to access these critical programs which reduced stress on the 
family and contributed to the servicemembers' readiness.
    Since the pandemic began, food insecurity has increased 
substantially, especially for households with children. Early 
in the pandemic, many of my patients had difficulty obtaining 
infant formula. While these challenges have improved, many 
families still do not have enough food to make it through the 
week. Significant racial disparities in food insecurity, which 
existed before COVID-19, have persisted during the pandemic.
    I see this in my practice, where we have been screening for 
food insecurity for several years. Food insecurity affects the 
health, growth, development, and educational outcomes of 
children, from infancy through adolescence.
    One of the most effective investments the Federal 
Government can make to reduce food insecurity and obesity in 
early childhood, improve birth outcomes, and support 
breastfeeding mothers is to increase access to WIC. The waivers 
USDA provided during the public health emergency to allow 
remote enrollment, services, and benefits have been crucial to 
helping families in need, and should be made permanent.
    I am fortunate to practice in a place where our WIC clinic 
is just across the hall. This proximity allows for better 
collaboration and more consistent communication between health 
care providers and WIC staff, and is significantly more 
convenient for patients, many of whom rely on public 
transportation.
    We urge Congress to provide direct funding from USDA to 
physician practices to support their ability to have a co-
located WIC clinic. Congress should encourage USDA to test the 
feasibility of systems and data bases that break down the silos 
that exist between WIC and physicians' offices, and allow them 
to share limited health-related information in order to 
streamline and improve patient care and enhance the participant 
experience. This would reduce duplicative medical procedures, 
such as the drawing of blood for testing, and the burden on 
caregivers to communicate health-related information to their 
child's pediatrician.
    Before the pandemic, only 51 percent of eligible 
individuals were participating in WIC. The AAP strongly 
supports the WIC Act, which would address many of the barriers 
to participating in WIC. We also encourage Congress to allocate 
funding for USDA to conduct recruitment and retainment efforts 
to reach more families.
    Preliminary data shows an increase in pediatric obesity 
during the pandemic. These findings mirror what I have seen in 
my clinic and what pediatricians across the country are 
reporting. One pediatrician I heard from saw a child who had 
gained 90 pounds in the last year, one who had gained 60 
pounds, and three who had gained 30 to 40 pounds, all in one 
day in clinic. She was in tears describing it as the most 
depressing day she has had in a long time.
    As rates of food insecurity and child obesity rise, the 
importance of healthy school meals has taken on new urgency. It 
is critical we build on the progress made under the Healthy 
Hunger-Free Kids Act to improve the nutritional quality of all 
foods available in schools so that they are aligned with the 
Dietary Guidelines for Americans and to provide schools with 
the resources they need to serve healthy school meals.
    AAP supports healthy school meals for all students, 
regardless of income eligibility. The nationwide waivers put in 
place during the pandemic have allowed every student to access 
school meals, decreasing barriers to participation and stigma, 
and should be extended beyond September 30, 2021.
    We appreciate the Committee's focus on summer meals and 
hope that Committee will increase resources for, and expand 
access to, summer feeding programs. Given how effective the 
pandemic EBT program has been, after the pandemic this model 
should be used to ensure students have access to healthy meals 
during the summer months, on weekends, and during school 
holidays.
    These elevated rates of food insecurity and obesity will 
not vanish as soon as schools open for fully in-person learning 
or the COVID vaccine is widely available. We are grateful for 
the investments Congress has made in child nutrition in past 
COVID-19 relief packages, and we support the effort to 
reauthorize and strengthen these vital programs for children.
    Thank you so much for the opportunity to be here today, and 
I look forward to answering your questions.

    [The prepared statement of Dr. Beers can be found on page 
40 in the appendix.]

    Chairwoman Stabenow. Thank you very, very much for that 
important testimony.
    Now we welcome Mr. Green. Welcome.

  STATEMENT OF REYNALDO GREEN, VICE-PRESIDENT, NUTRITION AND 
 FAMILY WELL-BEING, QUALITY CARE FOR CHILDREN, ATLANTA, GEORGIA

    Mr. Green. Thank you for this opportunity to speak with you 
today. My name is Reynaldo Green, President of the National 
CACFP Forum, a leading national organization that works to 
strengthen and expand the program to underserved communities. I 
am also the Vice President of Nutrition and Family Well-Being 
at a statewide nonprofit called Quality Care for Children, a 
CACFP sponsor located in Atlanta, Georgia.
    I sincerely appreciate Chairwoman Stabenow and the Ag 
Committee's leadership and commitment to CACFP, both during 
COVID-19 and in normal times.
    We are at a critical juncture to strengthen the Child and 
Adult Care Food Program through Child Nutrition 
Reauthorization. This will allow us to continue the original 
intent of the program: to address hunger and improve the 
nutritional well-being of millions of children across this 
country.
    In 2020, CACFP connected 4.2 million children with high-
quality meals and snacks, while providing $3 billion in 
reimbursement to local communities. This program promotes early 
healthy eating habits and helps prepare children for school by 
being ready to learn.
    The program plays a vital role in improving the quality and 
affordability of child care for many families with a low 
income. However, there are thousands of child care programs 
that do not participate because the benefits are inadequate, 
the program is wrought with burdensome paperwork, and the 
losses and penalties are too detrimental to child care programs 
that already operate on razor-thin margins.
    The brunt of these barriers disproportionately impacts both 
communities of color and providers with fewer resources, 
contributing to gross inequities in child care quality and 
nutrition.
    The Forum believes equity in CACFP can be achieved through 
CNR if we remove systemic barriers that often give advantages 
to better resource programs. This is how we can do that. First, 
we recommend Congress to expand CACFP to allow a much-needed 
afternoon snack or supper for children in full day care. Right 
now, providers can receive a maximum reimbursement of two meals 
and a snack per children, per day, through the program. 
Children need this additional snack or meal to meet their 
nutritional needs if they are in care for eight hours or more. 
This act will allow the program to support the nutrition 
standards for children in full day care as specified by the 
American Academy of Pediatrics and the American Public Health 
Association.
    Another need is for proprietary child care businesses to 
undergo an annual eligibility verification process instead of a 
monthly one. The vast majority of this type of child care is 
small businesses or mom-and-pop-operated care. By switching 
this process to one time per year we not only eliminate an 
undue burden, but we also make this process consistent with 
other Federal nutrition program eligibility requirements.
    As stated earlier, burdensome paperwork has become a 
deterrent to participation. Many issues can be solved by 
streamlining CACFP processes to be consistent with the USDA 
Paperwork Reduction Workgroup's Report to Congress. One step is 
to modernize applications. We must eliminate normal days and 
hours of time on enrollment forms. Based on Federal rules, 
State agencies are penalizing program operators, resulting in 
the loss of thousands of dollars each month, simply because the 
original and signed enrollment form are not consisted with the 
changing, on-demand work schedules of families today.
    Second, allow the use of electronic data collection and 
virtual visit systems that follow all the required Federal 
CACFP standards. The pandemic has shown us that we can do this 
with efficiency without losing program integrity. This is also 
very beneficial to rural providers and their families.
    COVID-19 has exacerbated inequities in food security and 
education. Therefore, now more than ever, we need to strengthen 
and enhance access to CACFP which supports quality child care, 
good nutrition, and economic stability for families with low 
incomes.
    The positive effects of CACFP can be expanded and 
strengthened by improving the adequacy of benefit by allowing 
another meal or snack for children in full day care, making 
proprietary care eligibility consistent with other Federal 
nutrition programs by allowing yearly verification, and by 
eliminating overly burdensome and outdated paperwork.
    In the interest of time, I have focused on these key 
points, but we have a full list of recommendations with 
additional details in the written statement, and, of course, I 
am more than happy to answer any of your questions.

    [The prepared statement of Mr. Green can be found on page 
56 in the appendix.]

    Chairwoman Stabenow. Thank you so much. We very much 
appreciate your comments, and the points you raised are very 
important.
    Next we will hear from Ms. Gould. Welcome.

   STATEMENT OF JESSICA GOULD, DIRECTOR, NUTRITION SERVICES, 
         LITTLETON PUBLIC SCHOOLS, LITTLETON, COLORADO

    Ms. Gould. Thank you. Thank you, Madam Chair and Committee 
members, for the opportunity to share with you today. My name 
is Jessica Gould and I am a registered dietitian and the 
Director of Nutrition for Littleton Public Schools in 
Littleton, Colorado. My district has approximately 15,000 
students with 21 schools, all having full-service kitchens. We 
are 18 percent free and reduced.
    I want to start today by saying thank you for focusing on 
Child Nutrition Reauthorization. When the Healthy, Hunger-Free 
Kids Act became law, child nutrition operators were excited and 
anxious because we agreed with many of the changes for our 
program, and we had many challenges ahead of us. I am excited 
to share with you today that our students finally understand 
that fruit and vegetables are required to make a meal, and they 
are enjoying and eating the options that we are providing.
    We have seen this year that the waivers that eliminated 
area eligibility and allowed students to take non-congregate 
meals for multiple days have been incredibly advantageous for 
our students and families. My district has operated k-5 in 
person, secondary hybrid, fully remote, and now we are back 
fully in person, and these flexibilities helped ensure we are 
able to provide access to meals to all students.
    I know that students in every one of my schools that are in 
need, regardless of their free and reduced percentage, and I 
have not seen this taken advantage of at this time. However, 
the gratitude of my families that I am able to meet in their 
neighborhood is overwhelming. I believe as you look at CNR 
these flexibilities to ensure we are providing access to all 
students is very important.
    As a child nutrition operator, I also request that we 
maintain the current flexibilities on sodium, whole grains, and 
milk. Operators across the country are committed to serving our 
students nutritious, well balanced meals, and I believe we are 
doing just that.
    Meeting Tier two and very soon Tier three sodium poses 
serious concerns for our programs and ultimately students. How 
many of you enjoy lettuce, tomato, and pickles on top of your 
hamburger or cheeseburger? For my program to meet Tier one, we 
have had to create a vegetable serving of these three items and 
limit the pickles to only two to meet regulatory requirements. 
Our students are now used to this. However, I also see many of 
them walking across the street to a fast-food restaurant 
because they think that our food does not have enough flavor.
    Tier three sodium is incredibly concerning to me. Many meal 
staples, like a turkey and cheese sandwich on whole grain 
bread, or a salad with chicken breast and no dressing, and any 
of our scratch-made items, including our students' favorite 
marinara, would be cut. We all know that sodium is naturally 
occurring in food. After removing the roughly 125 milligrams 
just in our milk we would be left with only 515 milligrams for 
a fruit, vegetable, and an entree at our elementary level. We 
have also determined that this would eliminate protein options 
from breakfast if we are required to meet Tier three.
    This change would also have a significant impact on our 
vegetarian options that we provide. Many of these items are 
made with legumes or cheese and would have to be cut from our 
menus. Even our sun butter and jelly sandwich would not be 
allowed. Any variety and culturally diverse items would be a 
thing of the past in our programs.
    We are seeing more and more manufacturers leaving the 
industry due to the constant changes within our Program, and 
for the manufacturers that are sticking with us, yes, they can 
work on reformulation of products. However, that cost will 
eventually hit our school nutrition budgets, and we are 
critically suffering right now. Who is to say, at the end of 
the day, if that product will actually be palatable for our 
students. Our meals are not nutritious until they are in the 
bellies of our students.
    In LPS, we are at 75 percent of our grains are whole grain, 
and I request that we keep the grain requirements to 50 
percent, because it allows for regional items to be offered and 
accepted by students. From biscuits in the South to tortillas 
here in Colorado, this option allows us to continue providing 
meals our students will love and will eat. In LPS, we also use 
the waiver for our pastas. We have a few scratch-made pasta 
bakes, and whole grain pastas do not hold well. These recipes 
were brought back after the whole grain requirement was changed 
back to 50, because when I originally brought them out with 
whole grain pasta I received calls from principals, parents, 
and students, saying that our food was inedible.''
    These are just a few examples of why it is critical for our 
programs' participation and ultimately sustainability to keep 
these regulations where they are. In my district where many 
students can choose to eat with our program, I believe if 
required to implement these changes we will not survive.
    I could go on and on, and I also respect your time and my 
limit. I am happy to answer any questions from an operator's 
perspective. Thank you.

    [The prepared statement of Ms. Gould can be found on page 
62 in the appendix.]

    Chairwoman Stabenow. Thank you so much. I very, very much 
appreciate your input.
    Let me now turn to Dr. Golzynski, and thank you so much for 
your leadership in Michigan, and I appreciate your testimony.

STATEMENT OF DIANE GOLZYNSKI, Ph.D., DIRECTOR, OFFICE OF HEALTH 
   AND NUTRITION SERVICES, MICHIGAN DEPARTMENT OF EDUCATION, 
                       LANSING, MICHIGAN

    Dr. Golzynski. Thank you very much. Investing in the 
education of our children is an investment in the future of 
this great country. Reliable access to healthy foods is truly 
one of the most important investments we can provide for our 
children.
    [Audio interruption]--in the great State of Michigan. I am 
honored to be here with you today outlining priorities for that 
investment in reliable access to and education around healthy 
food.
    The child nutrition programs, including SNAP, WIC, school 
lunch and breakfast, child care meals, and summer meals provide 
an incredible safety net for families and children, yet we are 
seeing an alarming number of childhood poverty and hunger. No 
child should experience hunger, and it is our responsibility as 
the adults that care for them to design and build the strongest 
safety net possible.
    My dad grew up hungry, and I was a first-hand witness to 
the life-long effects that childhood hunger had on him, 
eventually contributing to his death. Chronic disease, high 
health care costs, and a lower educational attainment were 
preventable realities for my dad. No child chooses to be 
hungry, and we have the opportunity to continue to strengthen 
the child nutrition programs to help prevent futures for our 
children that mimic what my dad experienced.
    In 2010, the Healthy Hunger-Free Kids Act aligned our 
school meals with the strong, science-based recommendations 
from the Dietary Guidelines for Americans. We have learned a 
lot from those early days of HHFKA, and we have an opportunity 
to build on those lessons learned. We must continue to align 
all child nutrition program meals with the most up-to-date 
dietary guidelines.
    We must put the education, attainment, and future health of 
our children above all else and fund it like it is truly the 
priority that it is. Strong nutrition standards should be 
viewed as a goal that can be attained if we continue to equip 
school nutrition programs, school staff, parents, and children 
with the necessary tools and education to get there.
    Just as we have put training wheels on a bike for a child 
to learn, we must do the same with nutritious foods. From stir-
fry lines to cafeterias designed to mimic a food court, we 
should never give up on the education of a child, whether it is 
in reading, math, or nutrition.
    In Michigan, we have additional State investment of 10 
cents per meal when it includes a local fruit, vegetable, or 
dried beans. This exposure to healthy local produce has 
increased the children's acceptance and excitement to the point 
where parents are telling us that the children now request the 
produce grown by their local farmer at home.
    The school meals of today do not look anything like what 
you and I experienced when we were in school. We must do more 
to engage parents and school staff in the incredible food being 
served in today's cafeterias and the connection of those meals 
to the well-rounded education of the whole child. Everyone 
involved must understand that these meals provide invaluable 
nutrition education for what a life-long, healthy diet looks 
and tastes like, and we should never give up on that education.
    As schools begin to reopen, we expect to see the school 
meal revenue drop and unpaid meal debts soar, as families 
cannot or will not easily return to sending money to school for 
food. With the number of families struggling who have not 
experienced poverty before, we believe the stigma of applying 
for free or reduced-price meals will keep even more families 
from seeking the assistance they need. Children simply should 
not have to wonder if they are going to be able to eat while at 
school.
    We must also provide a healthy breakfast at school in a 
manner to which reduces stigma and increases the opportunities 
for children to participate. In talking with a local 
superintendent, he told me that the number of children in his 
district that qualify for free or reduced-price meals was not 
high enough for him to do the work to even offer the program. 
He has over 1,000 students in his district that qualify. That 
is over 1,000 students that have no opportunity to eat 
breakfast at school, and that does not take into account the 
additional children whose families are too ashamed to apply or 
whose incomes are just above the threshold to qualify.
    Children should also not have to shoulder the burden of 
wondering if they are going to eat when school is not in 
session. Whether it be the weekend, school breaks, a natural 
disaster, a pandemic, or the summer months, we need a child 
nutrition program that can be immediately responsive and 
provide healthy meals that strive to meet the dietary 
guidelines. Lessons learned from non-congregate meals and 
parent pickups during the pandemic should guide a future revamp 
of that program.
    As families try to regain some sense of normal, go back to 
work, get caught up on rent and other payments, we must 
continue to be that glue for our children. Mental health and 
child hunger are realities of the pandemic that we should be 
addressing now and continue that support for years after the 
pandemic officially ends.
    Thank you for your continued support of the child nutrition 
programs. Thank you for maintaining high nutrition standards 
that teach our future generations ways to meet the dietary 
guidelines so that we can continue to tackle the diet-related 
diseases that plague our country. After all, we must be 
successful in nutrition because our future cannot be successful 
without it. Thank you.

    [The prepared statement of Dr. Golzynski can be found on 
page 64 in the appendix.]

    Chairwoman Stabenow. Thank you so much, Diane. I very much 
appreciate your words and your work.
    Ms. Hoffman, welcome.

 STATEMENT OF HEIDI M. HOFFMAN, DIRECTOR, COLORADO STATE WIC, 
 COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, DENVER, 
                            COLORADO

    Ms. Hoffman. Thank you. Madam Chair Stabenow, Ranking 
Member Boozman, and members of the Committee, thank you for 
inviting me to testify today about WIC. I am Heidi Hoffman. I 
work at the Colorado Department of Public Health and 
Environment as the State Director of our WIC program, which 
serves 130,000 Coloradans each year. I am also here in my 
capacity as chair of the Legislative Committee for the National 
WIC Association, a nonprofit organization representing the 
interests of 89 State agencies and nearly 1,800 local WIC 
providers.
    As you know, WIC provides personalized nutrition education, 
healthy food, and support to pregnant and postpartum women, and 
children up to age five. The evidence is clear that WIC leads 
to healthy pregnancies and births and a healthier start for 
young children, as well as significant taxpayer savings, with 
every dollar spent returning at least $2.48 in future health 
care savings.
    WIC could have even more impact for Americans families by 
enacting long-recognized, bipartisan eligibility expansions for 
women and children who are not yet enrolled in school. The 
challenges, however, are equally clear. Before the pandemic, 
only 51 percent of those eligible were receiving WIC service, 
even fewer in my State and others, due to a variety of 
barriers, including things like reliable transportation and 
getting time off from work. There is a lot of room to modernize 
and streamline the program.
    During COVID, waivers have allowed us to safely provide 
services with phone and video appointments and to issue 
benefits remotely onto EBT cards. This has helped growing 
families and those caring for small children to put healthy 
staple foods on their table, even during multiple upheavals to 
their work, school, and home lives.
    The clearest lesson we have learned is that we cannot 
return to our prior business model, designed over 40 years ago, 
and still meet the needs of busy parents and other caregivers. 
Remote appointments allow more engagement during nutrition 
counseling, without needing transportation or additional time 
off work. As Dr. Beers discussed, sharing health screening 
information with health care providers coordinates and improves 
care. Extending certification periods ensures that benefits are 
available at critical times in a child's development.
    In order to reach all eligible families who want WIC, we 
must be able to meet the expectations of a modern generation of 
parents. Just two weeks ago, the American Rescue Plan included 
$390 million for outreach, innovation, and program 
modernization, a substantial investment that will help connect 
eligible families with WIC support.
    These resources can make a world of difference to cash-
strapped States. For example, Colorado and many others 
participate in a national marketing campaign that provides 
branding, social media content, and COVID information to create 
a consistent national brand for the WIC program. We also work 
with our State SNAP and Medicaid agencies to refer eligible 
families between programs.
    Creative outreach and data-sharing efforts are consistently 
stymied by tight budgets and limited staff capacity, both the 
result of an inflexible funding formula that routinely 
underinvests in WIC's proven nutrition, breastfeeding, and 
health benefits.
    In Colorado, we developed an online referral form for 
health care providers, food banks, and family members to refer 
people to WIC. This pre-filled information is sent directly to 
a local clinic to simplify and shorten the process for families 
to get certified. All State WIC agencies need straightforward, 
technological innovations such as this, that improve the user 
experience and make services more accessible.
    This is also clear in the shopping experience. As SNAP 
agencies scaled up online purchasing options last year, that 
conversation was just starting for WIC, which recently switched 
over to EBT cards. We must thoughtfully work with our retail 
and technology partners to develop nationwide solutions that 
will make modern and accessible shopping options available for 
WIC families, including online payment and home delivery.
    One final thought I would like to share. Colorado greatly 
values our partnership with the UTE Mountain UTE Tribe, which 
operates as one of 33 Indian Tribal organizations directly 
administering WIC services. This option empowers Tribal 
sovereignty and builds stronger government-to-government 
relationships. One way this partnership has benefited both 
agencies is when Colorado obtained approval to join the WIC 
Farmers Market Nutrition Program for the first time just this 
year. FMNP provides an additional food benefit for families to 
spend with local farmers. This is currently capped at just $30 
per person, per year. An additional investment would help 
strengthen the partnership between our local food suppliers and 
WIC shoppers.
    We are grateful that our UTE Mountain UTE Sister agency has 
agreed to help distribute these benefits to their WIC families 
living in Colorado, as we work together to serve the people and 
the food producers living within our neighboring service areas.
    Thank you again for the opportunity to testify. We 
appreciate your support of WIC and CNR this year, and look 
forward to your questions.

    [The prepared statement of Ms. Hoffman can be found on page 
68 in the appendix.]

    Chairwoman Stabenow. Thank you so much. We agree, WIC is an 
incredibly important program. Thank you so much.
    Last but certainly not least, Mr. Rodriguez. Welcome.

  STATEMENT OF CARLOS RODRIGUEZ, PRESIDENT AND CEO, COMMUNITY 
          FOODBANK OF NEW JERSEY, HILLSIDE, NEW JERSEY

    Mr. Rodriguez. Thank you. Thank you, Senator Booker, for 
the generous and kind introduction, and for your long-time 
support of the FoodBank's mission and our neighbors in need.
    Chairwoman Stabenow, Ranking Member Boozman, and 
distinguished Committee members, thank you for the opportunity 
to speak at today's hearing. I am privileged to serve as the 
President and CEO of the Community FoodBank of New Jersey, our 
State's largest anti-hunger organization that provides access 
to food and other critical resources for 15 of New Jersey's 21 
counties. For most of my career I have worked on the front 
lines of the fight against hunger, including at three different 
food banks across two States.
    I am also someone with lived experience, relying on Federal 
child nutrition programs as a child growing up in the South 
Bronx. Meals provided by the Summer Food Service Program kept 
me well fed when school was out, and nourished me to become who 
I am today.
    During the time that I have this morning, I will discuss 
how we can bolster Federal after-school and summer meals 
programs to achieve more meaningful effects on childhood hunger 
year-round. First, because I can think of no better way to 
illustrate the impact and importance of these programs, I want 
to tell you the true story of a little girl who likely would 
not have enough to eat without them.
    In December 2019, just before COVID hit, our team met 
Paige, a gregarious, eight-year-old at one of our partner sites 
that offers both the Child and Adult Care Food Program and 
Summer Food Service Program. She marched right up to us, eager 
to talk about her experience there. While enjoying a well-
balanced meal of an apple, carrots, milk, and whole wheat 
turkey sandwich, she explained that she and her two siblings 
visited the site every day while their parents were at work.
    She said one thing in particular that we will never forget. 
``We like coming here because we don't get this kind of food at 
home.'' I heard loud and clear that without the meals provided 
by the after-school program, Paige and her siblings would have 
had to contend with an empty refrigerator at home. Instead, she 
skipped off from our conversation that day to go play 
basketball with her friends, a happy and healthy child.
    For so many kids like Paige, who live in households 
struggling to make ends meet, the arrival of COVID-19 several 
weeks later made putting food on the table an even more urgent 
challenge.
    Today more children than ever, at least one in six 
nationwide, are going to bed with empty bellies. As we have 
worked to nourish the record number of children in need during 
the pandemic, we have learned valuable lessons that have been 
informed the recommendations that I have for you today.
    The goal of Federal nutrition program should be to 
consistently nourish every child's success, not just to comfort 
them in times of distress. Many of the flexibilities that the 
USDA has enabled during the pandemic, particularly with regard 
to CFSP and CACFP, should be made permanent, as they have 
improved the program significantly, allowing them to reach more 
children, more equitably.
    This year, Congress has an important opportunity to improve 
the health and well-being of millions of our Nation's children 
by passing a strong reauthorization bill that provides a 
seamless, year-round option for providers, lowers area 
eligibility for site participation, relaxes the congregate 
feeding requirement, and utilizes the efficiencies of a summer 
grocery cart. These measures would strengthen the site-based 
model for child nutrition programs by enabling the 
participation of more sites, helping food banks and other 
providers to reach more children, and reducing the 
administrative burden. They would also enable us to provide for 
more children in underserved and hard-to-reach area, meeting 
them where they are with alternative distribution models.
    The pandemic EBT program has also proven to be a powerful 
mechanism to support children and families in a situation that 
causes school closures. Our own experience in New Jersey has 
shown that even under these challenging circumstances the 
exceptions provided by the COVID-19 waivers have unlocked 
enormous potential for Federal child nutrition programs to 
yield gains in access, equity, and reach.
    We urge this Committee to take these lessons to heart, if 
the goal is to make real progress in ending child food 
insecurity and ensuring opportunity for all of our Nation's 
children.
    On behalf of the Community FoodBank of New Jersey, the 
nationwide network of Feeding America food banks, and our 
community partners and the neighbors in need that we touch, I 
thank you for your time and attention.

    [The prepared statement of Mr. Rodriguez can be found on 
page 78 in the appendix.]

    Chairwoman Stabenow. Thank you very, very much. We will now 
turn to questions, because of votes I want to remind colleagues 
of a couple of things. We are going to really try to stay to 
the five-minute rounds on questions. If you are virtual, please 
put on a stopwatch or something so we are going to try to stay 
to that. We will get through this and make sure that colleagues 
who are virtual know at what point they will be in the line for 
questioning.
    First let me say, Dr. Golzynski, you noted that schools and 
communities are likely to face some challenges as schools 
transition back to in-person learning and more traditional 
school meal service. That just makes common sense to me that 
there are going to be some challenges.
    What are some of the ways that we can make sure children 
are not left behind as this happens?
    Dr. Golzynski. Thank you, Chairman Stabenow. I believe that 
we need to do outreach to parents and communities and school 
leaders to assure that they know and understand the changes in 
the program as we transition to whatever our new, better normal 
is. We can look at expanding community eligibility, maybe 
eliminating the reduced-price category. We need to make sure 
that our food service directors and their staff know and 
understand how to prepare the healthy foods, and we need to 
make sure that our food supply chain has those products 
available so that our programs can offer those to the students.
    We need to also remind the students--we heard Jessica say 
that her students know and understand that a fruit or vegetable 
is required with all of the meals. We need to remind the 
students, as we go back to school in person, that that is still 
a requirement, even though they may not have seen that with 
parent pick-up meals during the pandemic.
    We need to look at our districts and not see them as a free 
or reduced-price percentage but see them as students who are 
there to learn and need to have the tools necessary in order to 
learn.
    I am looking forward to doing some additional outreach, 
some additional training for our staff, and making sure that as 
everyone starts to come back to this new, better normal that we 
have really provided everyone with the tools necessary to be 
successful.
    Chairwoman Stabenow. Thank you so much. Now Ms. Hoffman and 
Dr. Beers. First, Ms. Hoffman. In your testimony, you discussed 
the need to modernize WIC, and some of the work that Colorado 
is doing to reach more moms and babies. Can you elaborate on 
the areas where innovation is most needed, and how some of the 
coordination between programs and health care providers helps 
WIC families? Then I would ask Dr. Beers, from your 
perspective, as a physician, could you also speak to why this 
coordination would strengthen outcomes. Ms. Hoffman?
    Ms. Hoffman. Absolutely. Thank you, Senator, for the 
question. We are excited about the potential for innovation in 
the WIC program. One promising practice is creating closer 
coordination between SNAP, Medicaid, and WIC. We need to build 
in referral policies and assure buy-in from all three programs, 
and we need sustained funding to help us with data security and 
outreach.
    As WIC works closer with health care providers, we need to 
be able to share information, like iron tests, growth charts, 
and developmental assessments, to ensure the best possible 
outcomes and ease the burden on families.
    Our technology and data systems were built years ago, to 
deliver program benefits and ensure compliance, but not to 
share, collaborate, or innovate. We need updated regulatory 
flexibility and additional funding to modernize the program and 
serve as a functional partner to our health care and other 
programs.
    Chairwoman Stabenow. Thank you. Dr. Beers?
    Dr. Beers. Yes. Thank you for that question, and I would 
very much agree with everything that was just said and would 
even elaborate on some of those things. I think, you know, we 
really are seeing, as I mentioned, in our offices that 
children's nutrition is really suffering right now, and as 
pediatricians we want to use every tool in our toolbox to help 
address that, and good communication with WIC is one of those 
things. If we can really be communicating well with our WIC 
partners, and as I mentioned, co-locating WIC is honestly one 
of the most important and best ways to do this, you know, for 
me to be able to walk across the hall and poke my head in the 
office of the WIC nutritionist is just--I cannot even tell you 
how much that contributes to patient care. I think that is one 
really important piece.
    You know, the other thing that we have seen with our WIC 
partners is that they can be great partners with us in terms of 
education and in helping us to connect with families who have 
been lost to care. That is another really important area for 
coordination and collaboration together. I appreciate that 
question, and I guess the last thing I would add is that the 
electronic communication has been very, very helpful, and I 
have been hearing from pediatricians that that has been a real 
plus.
    Chairwoman Stabenow. Thank you very much. Finally, my last 
question. Mr. Rodriguez, during COVID pandemic, EBT and meal 
delivery and pick-up were very, very helpful to make sure that 
children got the meals they needed when they were not in 
school. Could you speak about how these tools help to fill the 
gaps that we see in summer and other out-of-school times after 
the pandemic ends?
    Mr. Rodriguez. Absolutely. Thank you for the question. 
Flexibility was the key to being able to respond during this 
pandemic, and just a few kinds of key examples. First, on the 
whole concept of creating a seamless, year-round option for all 
sponsors. I think it is important to realize how much 
administrative burden and kind of bandwidth it takes away from 
some of the same providers that are providing both programs, to 
be able to stop and do a training that they just had a couple 
of months earlier and kind of re-engineer very nuanced policy 
changes to be able to administer the program. This streamlining 
option, I think, can help us bank that effort to do more 
outreach and focus on child enrichment programs.
    I think specifically, in terms of what we can do with 
flexibility, I share with you the story of an experience that 
we had in Woodbine, a small South Jersey community, where 
approximately one in five families were living in poverty 
before COVID, and yet they would not have met the area 
eligibility requirement to be able to provide a summer meal 
prior to. In fact, we did not have any summer meal sites there 
prior to COVID. Yet, because of the flexibilities afforded over 
this last year, we did have that, along with 20 new sites 
throughout the State during this much-needed time.
    Because this is just one of many concrete examples of how 
the program flexibilities introduced during the pandemic help 
us create access needed for meals for children.
    Chairwoman Stabenow. Thank you very much, Mr. Rodriguez, 
and I will turn to Senator Boozman.
    Senator Boozman. Thank you, Madam Chair, and again, thanks 
so much to the panel and all you represent. Nobody has done a 
better job during the pandemic than you all have, and before 
the pandemic. We really do appreciate your service.
    Ms. Gould, you are a registered dietitian responsible for 
planning your menus to ensure your school meals meet the 
nutrition standards. If all grains have to be whole grain-rich 
and target three sodium restrictions take effect, how does that 
affect your ability to plan your weekly menus, is there an 
impact in terms of the variety of options available for 
students, and cost impact to your program? Please tell us more 
about what this means for you in the local school to implement 
the final nutrition standards from the January 2012 rule?
    This is something, you know, as I visit my schools, that 
really is at the top of the list regarding concerns going 
forward.
    Ms. Gould. Thank you, Senator. I appreciate the question 
and I am happy to answer. As I stated in my testimony, most all 
of our scratch-made items would be eliminated. When a 
manufacturer processes an item they have the ability to process 
out the sodium. However, when we are making a scratch-made item 
we cannot process out that sodium. Many of the items that we 
are so proud of right now would be eliminated from our menu. 
Protein at breakfast would be another big thing. Egg items 
typically have more sodium in them than those regulations would 
allow for. Even a half cup of baby carrots, which we all love 
baby carrots, right? A half a cup of baby carrots has 50 
milligrams of sodium.
    Every little bit starts ticking down on where we can really 
fall in line, and our variety would really be diminished. Any 
of our salads, we would not be able to offer salad dressing. 
The luncheon meat that is on top of those salads, that would be 
gone. Cheese items would be eliminated. Marinara would be 
eliminated, whether it is home-made or it is a processed item.
    The impact would be devastating to our programs, and again, 
even if something is formulated, will it be accepted by our 
students? I think that is the biggest question as well. I am 
already seeing, in a low free and reduced district, those kids 
can walk away and go to a convenience store or a fast-food 
chain, or their parents will bring in items. This opportunity 
we have had through summer food service has actually allowed us 
to really increase the amount of our quote/unquote ``paid 
families'' to eat with us, maybe even more so our reduced 
families are eating with us a lot more, and they are loving our 
food. We want to keep that participation going, and I know that 
if we have to get to Tier three, especially, we will 
significantly have decreased participation.
    Senator Boozman. Thank you.
    Ms. Gould. I just want to give a little bit on the 
manufacturing side. The cost there, it is about $15,000 for a 
pre-existing item to be reformulated, and if it is a new item 
it would be about $30,000. That is if they do not have to buy 
new equipment.
    Again, those are costs that they can deal with, but it 
always ends up hitting the school nutrition budget, and that 
is, I think, something we need to think about as well.
    Senator Boozman. Right. Thank you very much. Ms. Golzynski, 
I would ask you the same question. Have you looked at how to 
plan a menu that incorporates Target 3 sodium with 100 percent 
whole grain-rich items? If you can answer it fairly quickly, or 
the Chairwoman will yell at me.
    Dr. Golzynski. We do not want that to happen.
    Senator Boozman. Since you are from her State she will 
probably cut us a little bit of slack.
    Chairwoman Stabenow. I have to apologize that I actually 
broke my own rule by going over just a little bit.
    Senator Boozman. Well, this is such an important thing. It 
is good.
    Chairwoman Stabenow. It is. It is really important.
    Senator Boozman. Ms. Golzynski? I am sorry, Dr. Golzynski. 
I apologize.
    Dr. Golzynski. No worries. The Target 3 sodium is a very 
strict level of sodium. It does meet the dietary guidelines. It 
is a goal that we can attain. We have to work toward getting 
there, and it is going to take us a bit. If you or I were 
trying to immediately drop our sodium levels, we would need to 
gradually get there in order to make it be a sustainable 
change.
    As Jessica was talking about bread, cheese, luncheon items, 
yes, those are all processed items that are high in sodium. We 
can work on cutting those back slowly. We can work on replacing 
those with healthier items. Naturally occurring sodium 
certainly makes sense, but that is going to be in some of our 
products. As we work to increase our fruits and vegetables, as 
we work to provide healthy whole foods for our children, with 
less processed foods, we will start to get there.
    We just cannot give up. Our children are not something that 
we should ever give up on, and it is something that we should 
just continue to work on, even if we have to lengthen the 
amount of time it takes to get there, so our manufacturers can 
catch up and our children can have access to those products at 
home as well, so they are seeing them in both places.
    Senator Boozman. Thank you very much. Thank you, Madam 
Chair.
    Chairwoman Stabenow. Thank you very much. Next up we have 
Senator Brown and then Senator Fischer.
    Senator Brown.
    Senator Brown. Thank you so much, Madam Chair, for holding 
this, and thank you to all the witnesses and the wisdom and 
knowledge and insight and passion you----
    Chairwoman Stabenow. Senator Brown, we are not hearing 
volume. I am not sure if that is on your end, but we can barely 
hear you.
    Senator Brown. If I talk louder does that work?
    Chairwoman Stabenow. It does work. We can hear you better.
    Senator Brown. I like to talk really loudly, as you know, 
Senator Stabenow. Senator Fischer is laughing at me, which is 
understandable.
    Chairwoman Stabenow. We can hear you.
    Senator Brown. Thanks. Dr. Beers, Ohio is, unfortunately, 
41st in the country in infant mortality rates. About 10 percent 
of babies born in Ohio were born before the 37th week of 
pregnancy. I have been working with a number of stakeholders on 
this issue. There has been some improvement but not nearly 
enough. Ohio, in fact, has seen a marked decline in 
participation in WIC over the past five years, even during the 
pandemic.
    If you, Dr. Beers, would take to us about the role that WIC 
could play in helping the Nation lower infant mortality rates 
and reduce the rate of premature births, what steps should this 
Committee take to improve participation rates?
    Dr. Beers. Yes, Senator, thank you so much for that, and I 
agree, this is an incredibly important issue. You know, as 
pediatricians we often think about the fact that our care of 
families really starts prenatally and ensuring that pregnant 
women have adequate nutrition. The access that pregnant women 
have to WIC services is incredibly important.
    I think some of the general improvements that we have 
recommended to the WIC program will help with enrollment. I 
think it is also going to take some really targeted community 
outreach and outreach through, just in the same way that we 
work with pediatrician' offices, through obstetrician offices 
as well.
    I think it is also a moment to really think about the 
postpartum time for pregnant women, particularly when you are 
thinking about pregnancy intervals. Extending automatic 
eligibility for WIC for children up to age two is an important 
strategy to make sure that the family is still connected with 
WIC, and needs that connection as they may be moving toward 
inter-pregnancy, you know, thinking about the next pregnancy.
    I think a final thing, which is not specific to this 
Committee but the work that has been happening in extending 
postpartum Medicaid eligibility to 12 months is incredibly 
important, and I think that is something that we would like to 
see continue as well.
    Senator Brown. Thank you. Thank you very much, Dr. Beers.
    Dr. Golzynski, I appreciate your State's and the Chair's--
Chairwoman Stabenow sings your praises far and wide--your 
State's leadership in increasing the amount of locally grown 
fruits and vegetables in school meal programs. How have you 
been able to do this? What more can this Committee do to help 
local growers sell more products to school districts?
    Dr. Golzynski. I know farmers are the lifeblood of our 
program. They really are so important to helping students to 
recognize the healthy foods as well as recognize how it is 
grown and where it is grown. Our 10-cents-a-meal program has 
been critical for improving that. We are able to have that 
State investment to encourage the purchasing from local 
farmers. We do the education. The farmers come in and talk to 
the students, or we do field trips, prior to the pandemic, of 
course, field trips to the farms so that the children can see 
where it is grown and how it is grown. It does not just come 
from the shelves of the grocery store.
    I think that one of the things that we can do is to--we 
have the Buy American provision, which requires that food 
products are grown and processed in America. What can we do 
regionally to allow for increased purchasing from those local, 
regional farmers, of the healthy products, so that they are not 
traveling across the country prior to their ripeness, they have 
the most nutrition available to them? Can we do something where 
we can incentivize farmers to connect with schools, and can we 
take away some of the paperwork around purchasing of those 
products, and make it easier for our food service directors to 
be able to incorporate that into their menus that they are 
planning?
    Our distributors could increase the number of local 
products that they are slotting, and label it as such so that 
our directors can prioritize that when they are purchasing. 
They can prioritize a local, State-grown, or even a regional-
grown product.
    We also need to be aware ourselves of what is grown and 
processed in our own States and in our own regions. In a global 
economy, it is easy to lose sight of what is actually grown 
nearby, and the kids are so excited to have met the farmer that 
grows the apple that they are going to eat, that they go home 
and tell their parents whose apple they want to eat.
    Senator Brown. Well said. Thank you. In the interest of 
time, for Mr. Rodriguez I have a question I will for the record 
about summer feeding programs, his thoughts about enrolling 
Medicaid participants in WIC and what we should be doing there. 
I will submit those questions.
    Thank you, Madam Chair Stabenow.
    Chairwoman Stabenow. Thank you very much, Senator Brown. 
Senator Fischer?
    Senator Fischer. Thank you, Madam Chair. Dr. Beers, I agree 
that we should do everything we can to ensure children across 
our country who are in need have access to free breakfasts and 
lunch. You mentioned in your testimony the Community 
Eligibility Program, CEP. Congress created CEP to provided 
targeted assistance to low-income communities. Many schools in 
Nebraska utilize CEP, but the number of eligible schools that 
are not utilizing CEP, that is a much larger number.
    We know that CEP increases participation and reduces 
administrative burdens. In the past, I have heard it that CEP 
was too complex or there were too many unknowns. I understand 
different localities and States could face unique issues, but 
in your opinion, what are some of the remaining barriers to the 
adoption of CEP?
    Dr. Beers. Yes, that is a great question and thank you for 
that. Here in the District of Columbia, where I live and 
practice, we also have CEP, and I know that it has been very 
successful in schools. You know, a lot of this--and this is the 
case for lots of the programs we are talking about today really 
comes back to decreasing the barriers to participation and 
enrollment and increasing the education around these programs.
    I think for CEP, in particular, we have seen it be 
incredibly successful in making sure that children have access 
to healthy meals at school, and in the schools where it has 
worked well I think it has been a really powerful tool. I think 
we talked about this a lot. I mean, more of my patients who 
need school meals and other nutrition supports do not access 
them than do, oftentimes. Really working to increase the 
education and decrease the regulatory barriers I think is a 
critically important strategy.
    Senator Fischer. Thank you. Dr. Golzynski, I wanted to give 
you the opportunity to respond to this question, to hear it 
from a State perspective. What barriers to adoption of CEP do 
you see and what, if anything, should we be looking at as we 
work on the Child Nutrition Reauthorization?
    Dr. Golzynski. That is a great question and I greatly 
appreciate you asking it. We have traditionally tied 
eligibility to free and reduced-price meals to so many 
different education side programs that we cannot even 
disentangle it when we try to offer all meals for free to a 
child in a district under the CEP program.
    In a CEP district, now those families still have to fill 
out some kind of household information survey to demonstrate 
what their household income level is at, so that their child or 
their district can qualify for at-risk funding, title funding, 
other educational types of programs. Families do not understand 
that. If I am getting free meals, why I am filling out 
something about my income level? The connection is not there.
    On the school administrator side, there is a stigma. There 
is a great stigma because CEP means we are a needy district, 
and not everyone wants to be seen in their community as this 
needy district. Any way that we can disentangle the eligibility 
for meal programs from the eligibility for education programs 
will help our districts feel better in offering that for their 
students. It does reduce the burden, the paperwork burden, 
tremendously. It does help families tremendously. It has been a 
wild success in our State, and I would love to see that 
expanded so that other districts have the opportunity.
    Senator Fischer. Very important. Thank you so much.
    Mr. Rodriguez, the impacts of rural hunger is felt in a 
State like mine, and some of the flexibilities, you know, that 
have been discussed, like the non-congregate feeding, have 
taken on a sharper focus in the last year during COVID. I 
commend our food banks in Nebraska who, like yourself, have met 
this challenge head-on.
    What are some of the examples of granted flexibility and 
how you have gotten food in the hands of children during this 
season that may be replicated as we think about broader rural 
needs during this reauthorization?
    Mr. Rodriguez. I think the key word, and it has been stated 
here by so many of the panelists, is flexibility. Flexibility 
to understand that our communities are diverse, they are 
different, and they have different access to resources and 
programs, throughout our State and throughout our country. Many 
examples, many of them listed in the written testimony, really 
point to how these flexibilities were able to reach communities 
that previously we could not touch.
    I gave earlier an example of a small community in south 
Jersey that pre-COVID we had a number of different families in 
poverty, yet they did not meet current eligibility guidelines. 
With the waivers, however, we immediately started feeding them 
this summer, and we will continue to feed them.
    This is true, I think, across urban, suburban, rural 
communities. There is always one barrier or another. I think if 
we take the approach to streamline, align where it makes sense 
and put gradual process to changes, I think what we get left 
with is a bank of time and energy that can be focused on 
outreach, that can be focused on further innovation. I think 
what was stated, I think, by so many of the speakers is we can 
focus on having children really not only get access to the food 
that they need but an appreciation for the healthy food that 
is, in many times, unfortunately, foreign to them.
    Remember Paige, her favorite food is a salad, and she did 
not know what that was primarily before we were able to 
introduce it to her.
    Chairwoman Stabenow. Thank you so much. Thank you, Senator 
Fischer. Thank you. We will turn to Senator Smith.
    Senator Smith. Thank you so much, Madam Chair Stabenow and 
Ranking Member Boozman for this Committee hearing, and thank 
you to all of you for the work that you have been doing over 
this last year.
    In preparation for the hearing today I reached out to 
Second Harvest Heartland, which is a food bank in Minnesota, 
just to get their thoughts and input. One of the staff members 
said to me, and this is a quote, she said, ``We learned that 
lost opportunities to receive school meals causes overwhelming 
food insecurity. When schools close, the community has to step 
up immediately to provide support.''
    I just wanted to take a moment with this in mind to think 
about the work that food banks, like Second Harvest Heartland, 
as well as school nutritionists and school cafeteria staff, all 
of these folks across the country have done so much to lead the 
way and to try to help families and students and people who are 
experiencing food insecurity in this moment.
    I am blessed to serve on the Agriculture Committee and I 
also serve on the Health Committee and the Indian Affairs 
Committee, and with that in mind I would like to just focus in, 
for a bit first, on the issues around child nutrition and 
Native communities, and what we can do better around outreach 
and consultation there.
    Just consider this. One in four Native Americans is food 
insecure. Anemia in Native American infants and children is 1.5 
times what it is for white children. Indigenous adolescents in 
America are 30 percent more likely than non-Hispanic white 
adolescents to experience obesity. Currently, 66 percent of 
Native children--66 percent of Native children under the age of 
six are enrolled in SNAP.
    I would like to ask all of the witnesses here, we all see 
that this is completely unacceptable inequity. Could you talk a 
bit about what best practices you have seen, what we know about 
what kind of outreach and education and consultation works with 
Native communities, both Tribal nations as well as in the urban 
indigenous community.
    Any takers?
    Dr. Beers. I can go ahead and start. I will say a few words 
and I know others have much to add. Thank you for raising this 
issue. It really is incredibly important. As a global statement 
I would recommend to you, actually, the American Academic of 
Pediatrics, just last week, released a new statement on caring 
for children from Native American communities, and it is very 
well done, so I would recommend that to you.
    I think that from our perspective there really are two key 
things. One is really fully funding the supports to our Tribal 
communities. I think that is an incredibly important thing for 
us to do. They have been under-supported for many, many years, 
as I know you know. I think the second most important piece, 
from our perspective, is really involving families and 
communities in those efforts and in terms of outreach, as well 
as accessing services and the cultural appropriateness of the 
nutrition and other health services that we are offering. Thank 
you.
    Senator Smith. Thank you so much. Would anyone else like to 
add anything?
    Ms. Hoffman. I would add something from the WIC 
perspective. We believe that Tribal health and the Tribal farm 
economy can be enhanced with WIC support by creating and access 
to health care and the market for rural vendors and farmers. We 
need options for delivery and funding to support local young 
stores and farms, and FDPIR eligibility should automatically 
make families eligible for WIC. The health benefits of WIC, 
such as reducing overall health care costs, decreasing pre-term 
births, supporting chronic conditions, and improving readiness 
for school can honor and benefit all Native communities.
    Senator Smith. That is great. Thank you. Thank you so much.
    I am going to actually use that as a little bit of a segue. 
The second thing I wanted to talk about, in just the brief 
second I have left, is as we focus on school nutrition and 
serving nutritious meals, a lot of times we forget that schools 
do not actually have the equipment--the refrigeration 
equipment, the other equipment--to make healthy food. I have 
come to appreciate how important this is for schools in 
Minnesota. We do a good job in Minnesota. Ninety-three percent 
of our school districts are serving healthy meals with a strong 
nutrition standard. The need for equipment is a really big 
need.
    I am excited to be, having just reintroduced my legislation 
with Senator Collins, the School Food Modernization Act, to 
help schools modernize their equipment, and as you were saying, 
it links directly then to the ability to participate in farm-
to-school programs to get farms and students and nutrition all 
moving in the same direction.
    Chairwoman Stabenow. Thank you very much, Senator Smith. 
Such important issues. I hear both the same in Michigan.
    A vote has been called. We are going to continue moving 
forward. I know we have many members that want to ask 
questions. This is such an important topic.
    Senator Thune is next, and then Senator Gillibrand.
    Senator Thune. Thank you, Madam Chair. Ms. Gould, in your 
testimony you highlighted the importance of maintaining 
flexibility for sodium, whole grains, and milk in school meals. 
I have heard similar feedback from child nutrition directors in 
South Dakota who are concerned that further regulation will 
create additional meal procurement challenges. This is 
particularly concerning for rural South Dakota schools that 
already face procurement challenges.
    Could you briefly describe the importance of sodium, whole 
grain, and milk flexibility and what challenges would schools 
face if this flexibility is not preserved?
    Ms. Gould. Absolutely. Currently, there are not those 
products to meet Tier two and Tier three readily available for 
us. I think with COVID we have been faced--our manufacturing 
community and just distribution, in general has faced major 
hurdles, because of the multiple different service models that 
we have been offering. It will be incredibly difficult for us 
to transition at this time.
    Now, in a few years would there be more products readily 
available? Most likely. However, again, Tier three is 
incredibly concerning just because of the limits and the very 
vast reduction of sodium that we are looking at. Manufacturing 
right now has not created those products. Your schools 
currently will struggle to get that product in, and in the 
future it will be a struggle as well.
    Senator Thune. Ms. Hoffman, in South Dakota we have two 
Indian tribal organizations, or ITOs, that support the needs of 
our Native American population. How do geographic special 
supplemental nutrition programs for women, infants, and 
children, the WIC programs, and ITO State agencies, partner to 
efficiently deliver WIC services and reach eligible families, 
and do you have any suggestions for how we can improve those 
WIC partnerships?
    Ms. Hoffman. Thank you for that question. I think it is a 
great opportunity for WIC programs, whether they are geographic 
States or Indian Tribal organizations who are doing WIC 
services for their communities to partner together. In Colorado 
we have, as I mentioned, the great benefit of having a sister 
agency in the UTE Mountain UTE WIC program, but we also have an 
informal partnership with the Southern UTE Tribe that we 
provide services. They do not have their own WIC program.
    I think that depending on where WIC agencies are, and 
depending on the other resources in their community, you can 
work together, either formally or informally, to make sure that 
families can access the services that they want, in the places 
that they want. Some people would rather do that in the 
community where they shop or where they work. Some people would 
rather do that in their home community. I think that there are 
opportunities to do that, both in soft ways, meaning just 
building stronger partnerships that honor the needs of the 
communities, but also in some more traditional ways, like 
outreach and technology sharing and data sharing, and things 
like that.
    Then, of course, example of working together for the 
Farmers Market Nutrition Program is unique and another 
wonderful opportunity for WIC programs to work together.
    Senator Thune. Dr. Golzynski, Ms. Gould, and Mr. Green, 
given the experience you each have in operating child nutrition 
programs, are there administrative challenges you have 
encountered when working to comply with program regulations 
that this Committee should seek to address through legislation 
to reauthorize these programs, and have you experienced any 
redundancies?
    Dr. Golzynski. Yes. I would say that one of the biggest 
challenges that we have seen is every program has its own meal 
pattern, its own set of regulations, its own set of 
requirements. When we went into the pandemic, we went to one 
specific meal pattern that was not what the kids were used to 
seeing during the school year, and then some of those 
regulations continued, from the National School Lunch Program, 
even though they were not regulations in the Summer Food 
Service Program, which is what we were seeing for children.
    Streamlining of those regulations and those requirements 
across programs so that one sponsor, who might offer multiple 
programs, does not have to try to train their staff as to which 
program they are serving that meal in, that day, so that they 
know what meal pattern or what paperwork requirement is tied to 
that specific meal.
    Senator Thune. I see, Madam Chair, my time has expired. 
Thank you.
    Chairwoman Stabenow. Thank you very much, Senator Thune. We 
will now turn to Senator Gillibrand, and then Senator Marshall.
    Senator Gillibrand. If not----
    Senator Gillibrand. They just let me in. I am sorry. It 
took them a while to get on my computer.
    Chairwoman Stabenow. Not a problem.
    Senator Gillibrand. I apologize.
    Chairwoman Stabenow. Welcome.
    Senator Gillibrand. Well, thank you to all the witnesses 
today. I am extremely grateful to all of you for your work, 
your advocacy. We have covered really important pieces of 
legislation this morning, and I am grateful.
    One piece is the Summer Meals Act, which I have long 
championed with Senator Murkowski. That has created historic 
investments in improvements to the summer nutrition programs 
and addressed longstanding operational barriers based by summer 
food sponsors and sites in serving more meals and connecting 
services to more youth. Without the existing structure of the 
summer nutrition program in place ahead of this pandemic, 
community-based organizations would not have been able to 
mobilize and organize in unique and new ways to continue to 
serve meals, scale meal service operations quickly, and 
maintain the critical community connection our Nation's school-
aged youth need now more than ever.
    Mr. Rodriguez, what role have you seen the traditional 
congregate meal sites and sponsors play in providing non-
congregate meal service options to help the most in need during 
this pandemic, and what role do you envision them to continue 
to play as frontline workers in both combating hunger and 
supporting and strengthening social and emotional well-being of 
our Nation's school-aged youth as we start to shift toward 
recovery?
    Mr. Rodriguez. Thank you for the question, Senator. 
Congregate meals have played an important part to the response 
of the pandemic, and I think what we have learned is with more 
flexibility we can even do more. We would have had, even 
despite the tremendous growth in programs we have seen, and so 
many of our partners across the country have seen with the 
pandemic, we know we could do more. Just by adopting something 
that we know works.
    Let's take what happens in school meals, for example, in 
actual school settings, as an example of what could work. 
Schools operation one national school lunch program, and it is 
a seamless transition from the school year into the summer 
years. We are asking for something very similar so that our 
providers, many of which are nonprofits with very limited 
resources, can make the same transition. If we do that, we can 
have both congregate meals, we can innovate more in terms of 
outreach, and really focus on leveraging with other 
streamlining efforts, just making more sites available.
    It has been said quite a few times today, most recently by 
Dr. Golzynski, how much the transition, how much duplication 
there is, and even just training. We have to train the same 
staff in October, and then very quickly again right before the 
summer meals, make nuanced changes to meal packs and menu 
guidelines. If we streamlined the whole process and banked that 
effort to reaching more children, or perhaps opening up more 
sites, we would have overall greater reach and more impact for 
the children that we are trying to reach.
    Senator Gillibrand. Thank you. This question is for Dr. Lee 
Savio Beers. The National School Lunch Program is one of the 
most far-reaching and effective food security programs for 
school-aged kids that we have. Thirty million students are 
eating school meals nationally, every day. For some students, 
those school meals may be the only meal that they get that day, 
and over the past year, during the pandemic, we have seen just 
how important these school meal programs are for absolute well-
being and nutrition.
    National universal school meals for all students is a 
fundamental education and health equity issue. Research out of 
Syracuse University shows universal school meals subsequently 
increase in school meal participation and lead to increase in 
students' academic performance.
    Dr. Beers, how do you anticipate universal free school 
meals would further impact both children and their families, 
and can you speak about how universal school meals will 
positive impact the health of children?
    Dr. Beers. Thank you for this question, Senator, and, you 
know, as I noted during my testimony, food insecurity really is 
at quite high rates in this Nation, one in six children, even 
before the pandemic even began. We also know that good 
nutrition is one of the most important things we can offer our 
children in terms of helping them with a healthy lifetime.
    I think, you know, in my experience, and the data shows 
this, far more children are not able to access Federal programs 
in school meals who need them than are, and so offering 
universal school meals would really, first, increase and open 
up those opportunities for children experiencing food 
insecurity in their households to have access to meals. It 
would also decrease stigma around school meals and increase 
access further. You know, it is not an easy thing for a child 
to come into school and admit that perhaps their family does 
not have enough to eat, and so they may turn down the free 
school meals because of that. I think that is another important 
reason that universal school meals would be so effective.
    Senator Gillibrand. Thank you, Madam, and thank you, Madam 
Chairwoman.
    Chairwoman Stabenow. Thank you so much. We are now going to 
turn to Senator Marshall and then Senator Bennet.
    Senator Marshall. All right. Thank you, Madam Chair. It is 
great to be back here in an Ag Committee, talking about things 
that are so important to me, nutrition. My first question is 
going to be for Ms. Gould, if you do not mind.
    Ms. Gould, we have a generation of children and young 
adults who have not drank milk, and that is because we try to 
serve them some imitation milk, fatless milk, that tastes like 
water with powder in it. As an obstetrician-gynecologist I am 
very concerned about osteopenia and osteoporosis, that in 20 
years from now those young adults, children, never reach their 
peak of their bone density, and no matter what medicines I give 
them, when they reach menopause, the women, we will never be 
able to keep their bones strong. I think that is a great 
example of Washington, DC, trying to legislate, or trying to 
tell nutritionists in schools what to serve children.
    I am equally concerned about the Tier three specs, and I 
know other folks have talked about this. I just want people to 
realize that a Tier three pizza is basically a piece of 
cardboard without cheese on it. What will happen is--and that 
is, I guess, my question--which is going to be worse for a 
young child, to eat all of a Tier two meal or eating a fourth 
of a Tier three, because I just do not think kids are going to 
eat Tier three diets. How hard is that going to be to implement 
in the school system?
    Ms. Gould. Thank you for your question. I think you nailed 
it. It is going to be incredibly difficult, and ultimately we 
want nutrition going in our students' bellies. We want them to 
actually eat the meals and get the nutrition into them. We know 
that if they do not like it, if it is too restrictive, they 
will choose to not eat it. I think that is the balance we need 
to be considering, because we are also in the limits of Tier 
three. We are eliminating many culturally diverse items from 
students' menus.
    We have got to think about the whole child. I do not think 
one nutrient is the premise for if they are going to be obese 
or not. I think we have got to look at the overall meal and 
ensure that there is nutritional quality in that meal, and it 
is getting into their stomachs.
    Senator Marshall. Thank you. I have just got to put an 
exclamation mark on the whole milk part of this, that the whole 
milk has fat in it, which allows people to absorb vitamins A, 
D, E, and K, and that is especially important, of course, in my 
pregnant patients, how important it is to absorb those 
vitamins. There is such a thing as good fat.
    I want to talk about meatless Mondays, and Ms. Gould, I am 
sorry, but this question is going to come to you as well, since 
you are from Colorado, another example of government trying to 
tell people what is nutritious. I would put meat, especially 
beef, in that same, right beside whole milk, as healthy and 
nutritious. The meat industry has spent decades researching, 
fine-toothing, making sure that this is a nutritious protein 
source. It just drives me crazy, to be honest, for folks to 
falsely attack the meat industry, when really the evidence says 
it is a very healthy food when served properly, especially with 
all the lean meats we have today.
    I think about raising children. I did three sports myself 
in high school, raised four kids doing sports, and nowadays, 
today's varsity athletes in high school typically are lifting 
weights for an hour and a half in the morning, then maybe they 
have a P.E. class, and then they have two hours of practice at 
night. My boys, specifically, would eat two meals, buy two of 
the school lunches, and we still could not keep weight on them.
    The thought of taking a proteins source like beef out of 
the menu is crazy, okay? I think it is crazy. How can you get a 
protein source? How much tofu would a high school football 
player need to eat to be able to maintain his weight? You know, 
it certainly would apply for the girls who are practicing 
volleyball in the morning and lifting weights and then playing 
basketball in the afternoon. How would that go over, not having 
any protein, I mean, real protein like beef or pork or chicken, 
on your meatless Mondays? How did that go, or how is it going 
to go?
    Ms. Gould. I think it is important to remember, and it is 
important to educate our students that all food should fit into 
a healthy diet. When we start specifying that they should not 
be eating certain types of food we can really start getting 
into the psyche of just how they interact with food. It is 
important that in my district we are very adamant that all 
foods fit, maybe some a little bit more than others.
    I think that is something that would be important to be 
educating, and we do not want to take any protein sources away. 
I think that is a personal opinion for families.
    Chairwoman Stabenow. Thank you so much, and thank you, 
Senator Marshall.
    I am going to turn to Senator Bennet.
    Senator Bennet. Thank you. Thank you, Madam Chair, and 
thank you again to both witnesses from Colorado. We are very, 
very grateful that they are here.
    Actually, my first question is for Dr. Savio Beers. I 
cannot resist asking her this because of her role as the 
president of the American Academy of Pediatrics. Dr. Beers, in 
the American Rescue Plan that we just passed we made 
substantial changes to the child tax credit that is going to 
result this year in a glut of childhood poverty in this country 
by almost 50 percent. There is a lot of effort now to try to 
make that permanent.
    I wonder if you would take a moment to share with the 
Committee what the implications for pediatric medicine and for 
young children's health care is if there are lifted out of 
poverty.
    Dr. Beers. Thank you so much for that question. Yes, you 
know, as I mentioned earlier, nutrition is one of the most 
important contributors to a child's long-term health and well-
being, and actually probably the most important contributor to 
a child's long-term health and well-being is their economic 
stability and whether or not they live in poverty, because 
that, in so many ways, determines their ability to access and 
receive any wide variety of supports, including nutrition, good 
education, stable housing, all of these things that we know can 
help children be successful and thriving members of our 
society, and through a lifetime.
    That is not something that we can just do in one year. It 
really takes a child's entire childhood. By decreasing 
childhood poverty, as the child tax credit does, I think this 
is an incredibly important strategy and one that we would 
really hope to see continue as one of the most important things 
we can do for our children in this generation.
    Senator Bennet. Thank you, and we would love to have this 
be bipartisan as we make it permanent. It is an interesting 
thing, because half of the kids are going to be lifted out of 
poverty, but 90 percent of America's kids are going to benefit 
from this. There is going to be, I think, broad support across 
the country.
    I then had a question for Heidi Hoffman, which is about 
WIC. As you know, WIC reduces infant mortality and low birth 
weight, and it also improves the rates of regular medical care 
and timely immunizations and strengthens intellectual 
development among children. In short, we know that WIC works, 
and the American Rescue Plan works to build on the strengths of 
WIC.
    For instance, the plan increases the fruit and vegetable 
allotment that is part of the tailored food package families 
receive. It also increases WIC's capacity to do outreach to 
expand the program's reach to more eligible families. With all 
of these changes over the next several months, each person on 
WIC will receive $35 to spend on fresh produce each month, 
instead of the usual $9 to $11. These temporary investments 
build on the nutritional strengths of WIC while boosting the 
program's ability to draw more eligible families into the 
program and address food security.
    What would it mean, Ms. Hoffman, for Colorado WIC and the 
families that it serves if these types of investments were made 
permanent?
    Ms. Hoffman. Thank you for this question, Senator Bennet. 
We are very excited about the opportunity to offer more fruit 
and vegetable benefit to WIC families. One of the nice things 
about trying it for these four months, at $35 per person, per 
month, is to really gauge the interest that we have been 
hearing from people for a long time about wanting more access 
to fruits and vegetables, and really overall increasing the 
value of the food package for WIC.
    I think that is going to benefit our families, definitely 
and directly, but I also think that it will make the WIC 
program, and participation in it, more attractive to families, 
and hopefully retain them longer on the program, so that all of 
those benefits that you mentioned can really be recognized by 
anyone who chooses to be a part of the program.
    We are looking forward to seeing what the USDA will do with 
that additional funding to modernize the program and provide 
more outreach, but we know that $35 will have an immediate and 
beneficial impact for our families.
    Senator Bennet. Thank you. Thank you, Madam Chair, or Mr. 
Chair, Chair.
    Senator Boozman. [Presiding.] Well, thank you.
    Senator Bennet. Thanks.
    Senator Boozman. Next we will hear from Senator Braun.
    Senator Braun. Thank you, Chair. My question will be the 
same question for three individuals, and it will be for Drs. 
Beers, Golzynski, and Ms. Hoffman. Try to keep the answers 
roughly a minute apiece, or maybe a little over that.
    As much money as we spend on child nutrition, and as 
important as it is, I think it is clear that we have devoted 
resources to it. In running a business over the years, whenever 
I would invest in something, to me the most important part 
would be the metrics. Is the money that you are spending 
actually getting the job done?
    I would like each of you to address what you think of the 
progress that we have made, and how specifically we have 
measured it? Because I think we minimally need to see what we 
might do differently, and I am just curious as to the metrics, 
because in my opinion, whenever you do make an investment in 
something, that is the other side of the equation.
    Dr. Beers, would you start, please?
    Dr. Beers. Yes, absolutely, and you are exactly right. If 
we are investing resources in something, we want to make sure 
that it is effective, and childhood nutrition and hunger is one 
of the most important things that we really can be targeting.
    I would say, as a broad statement, because I know I only 
have about a minute, that these programs really have been very 
effective at reducing childhood hunger. There is still more for 
us to do, but we certainly have seen tremendous effects. We 
know, you know, families who are enrolled in WIC, children have 
higher birth weights. Their children have better nutrition.
    We also know that we have seen great improvements in health 
and nutrition through the changes in our school meal programs. 
We have many more children who are accessing regular food and 
meals. What we have seen, as pediatricians, is that these 
programs have made a tremendous difference. There are still 
things to work on, but we are heading in the right direction.
    Senator Braun. Thank you. Dr. Golzynski.
    Dr. Golzynski. Yes, thank you for the question. I would say 
that these investments have been critical to introducing the 
healthy foods to children and assuring that they have an 
opportunity to try them and continue to practice eating those 
foods. Our metrics can and should be not only participation in 
the program and the financial health of our school and 
nutrition programs, but long-term metrics we should be looking 
at include things like graduation attainment, attendance at 
school. We have a State Strategic Education Plan where we are 
looking specifically at those metrics, in addition to the 
shorter-term metrics, such as eating breakfast at school and 
how many children have access to breakfast at school.
    Senator Braun. Thank you. Ms. Hoffman?
    Ms. Hoffman. Yes, thank you. Not to be duplicative to what 
was already said, I would echo all of those things. I would 
also guide you to a recent report by the Center of Budget 
Policy and Priorities that collected all of the data that shows 
how WIC works.
    In addition to the things that have already been mentioned, 
there is a higher rate of breastfeeding among WIC families. 
Children whose mothers participated in WIC scored higher on 
their assessments of mental development at age two, so they are 
better prepared to start school. There are healthier food 
environments within homes, within neighborhoods, within 
communities, regardless of whether the people are themselves on 
WIC or not. Kids that are in families that one child receives 
WIC typically have a better and healthier diet.
    The conversation we had earlier about health between 
pregnancies, preparing for future healthier births, which then 
not only have all the benefits for that child and that mother 
but also reduce future health care costs are also very well 
demonstrated for WIC.
    Senator Braun. Thank you.
    Chairwoman Stabenow. [Presiding.] Thank you very much, 
Senator Braun. Senator Lujan, and then Senator Hoeven.
    Do we have Senator Lujan? If I am not hearing from Senator. 
Lujan, Senator Hoeven.
    I am sorry. I guess we are back to Senator Lujan. This is 
the world we are in, the virtual world we are in.
    Senator Lujan, welcome.
    Senator Lujan. I appreciate that last decision, Chair. It 
is good to be with you all. Thank you so much to the panel for 
being available today for this important conversation. I am Ben 
Lujan. I am a Senator out of the State of New Mexico.
    I wanted to start here by just reminding everyone that one 
in four children in New Mexico were considered food insecure 
prior to the pandemic. Tragically, due to the pandemic, now one 
in three children in my State do not receive enough food to 
support a productive, healthy, lifestyle.
    Dr. Beers, yes or no. Should Congress use the upcoming 
Child Nutrition Reauthorization as an opportunity to address 
childhood food insecurity?
    Dr. Beers. Senator, thank you for that question. That is an 
easy one. Yes, absolutely. I think there are tremendous 
opportunities to build on and strengthen our Federal nutrition 
programs to address food insecurity.
    Senator Lujan. Dr. Beers, yes or no. Should Congress use 
Childhood Nutrition Reauthorization to improve childhood well-
being?
    Dr. Beers. Yes, absolutely. Thank you, Senator, for that.
    Senator Lujan. Yes or no. Should Congress maintain strong 
nutrition standards and support nutrition education technical 
assistance for operators and updating of food service equipment 
to help kids consume healthier foods?
    Dr. Beers. Yes, I believe that we should do that as well, 
and really look to our experts to help us guide that.
    Senator Lujan. Ms. Gould, as I noted before, a third of the 
children in my State are considered food insecure. However, the 
challenges faced by New Mexico children are not unique. 
Nationally, food insecurity is also on the rise among Hispanic 
and Latino communities and African American communities.
    Last summer, 47 percent of Latino households with children 
reported trouble accessing food. Since more than 40 percent of 
WIC participants are Latino and nearly 25 percent of National 
School Lunch Program children are Latino, I believe the 
Congress can strengthen child nutrition programs to address 
this challenge in New Mexico and across the country.
    Can you quickly touch on how the pandemic worsened food 
insecurity?
    Ms. Gould. Absolutely. I believe the biggest challenge was 
that our students were not coming to school, and that is where 
we typically have access to them. The flexibilities that were 
provided have given us a big opportunity to give more food to 
those families, but we are still, if they are home-schooling, 
many of those families might be learning from home still, even 
if they were able to go to school. Some families just had the 
ability to opt into a distance learning program, and that is 
very difficult for us to still sometimes access those families.
    Senator Lujan. Ms. Gould, let me followup there. What do 
you think the Committee can do to expand access, remove 
participation barriers, and improve quality of access for mixed 
status or Spanish-speaking families from being negatively 
impacted due to lack of accessible resources?
    Ms. Gould. I believe continuing the flexibilities that have 
been offered during this time period would be essential to 
ensuring access, and then we are actually getting that 
nutrition to those students. That would be the biggest 
recommendation I could provide.
    Senator Lujan. As far as healthy food for kids, I 
understand the advocacy here, that they are saying, you know, 
while you look at the standards of the quality of food and 
processed food, we also know how that contributes to health 
challenges as well. I want to make sure folks are getting food, 
that they get tasty food, food they are going to eat, but I am 
on the side that does not consider pizza sauce a vegetable. I 
think it has got too much of the sugar and all the other stuff 
that goes into it. If I make it at home I throw some blenders 
and some garlic and whatever else I can find in a blender, and 
I try to make it as good as I can. I know what is in it.
    Now, I am not here to preach to anyone about being 
healthier. I need to be healthier myself. What can be done by 
working with food distributors, folks that are working with 
schools, to make sure, No. 1, they are getting the best price 
for the food that they are buying, No. 2, that they are getting 
quality food. Are there standards with food processors, food 
distributors across America that have contracts with schools, 
and how can we make sure schools are not getting taken 
advantage of when they are entering into contracts for these 
agreements? I would ask anyone to jump in on that one.
    Ms. Gould. I am happy just to jump in quickly. I believe 
that with providing--we are providing nutritious foods for our 
students. We have seen that. I think we will continue to 
provide healthy foods for our students. Making scratch food 
does have sodium in it, so I think that is where I am really 
coming from there. Because we do not want all processed items. 
We want to be able to still continue our scratch-made items.
    We need to just have better and more open communication 
with our manufacturers and distributors to really talk about 
expectations.
    Senator Lujan. I appreciate that.
    Chairwoman Stabenow. Thank you so much.
    Senator Lujan. Chair, just thank you for the time and I 
look forward to following up.
    Chairwoman Stabenow. Thank you so much for the questions. 
We have Senator Hoeven and then Senator Warnock.
    Senator Hoeven. Thank you, Madam Chair. I appreciate it.
    Ms. Gould, for you. Given that school meal participation is 
already low due to distance learning, if the current 
flexibilities on sodium, whole grains, and milk were to end 
this fall, what impact would loosening those flexibilities 
have, or reducing them, on student meal participation, in your 
opinion?
    Ms. Gould. Absolutely, and thank you for the question. We 
are trying to, at this time, really encourage all students to 
eat with us. It reduces any stigma, and the last thing we want 
to do is all of a sudden change the items that we are providing 
them to something that they are not used to, they are not 
prepared for, and they do not want to eat. We want to be able 
to keep with what we are currently doing, the nutritious meals 
that we are currently offering, and if we were to be able to 
have those waivers extended, that would amazing, because then 
we can continue to reduce stigma and ensure that every student 
has access to healthy meals.
    Senator Hoeven. I appreciate that. Also, in terms of that 
flexibility, which is needed for the schools, and this is about 
healthy meals, but it is also on making sure students eat the 
meals, and, you know, obviously appreciate that they are good 
and wholesome and healthy but also tasty. You know, I think 
about meals we get around here or anywhere else. Everybody 
wants those meals to be tasty as well in order to eat them.
    In terms of the sodium, the whole grains, and milk, not 
only from the consumer side, from the student side as far as 
eating them, but then what about from the industry side, being 
able to make those foods and supply them to you, so that they 
are still, you know, something you can afford and available, 
and again, so that they are tasty. I mean, we need that 
flexibility for those reasons too, don't we?
    Ms. Gould. Absolutely. Our manufacturing industry has been 
up and down with the constant changes in our regulations. I 
think the best thing we could do right now is to remain 
consistent so they can really focus on ensuring that we will 
have the quality products that we currently are providing. 
Especially during COVID there have been challenges with 
manufacturing. Let's just get them back on their feet so they 
can ensure that we have the products that we need, when we need 
them.
    Senator Hoeven. Do you have any concern about whether or 
not those meals will be healthy if you have that flexibility? I 
have got to tell you, I am just not a fan, in a country of 320 
million people, that one size fits all in every situation, all 
across the country. I think people are smart and capable and 
you have got to trust them and give them some flexibility.
    Do you have any worry that if that flexibility is there 
that these meals will not be healthy and good for our kids?
    Ms. Gould. Absolutely not. As I have stated, I am a 
dietitian. In my district, even though our whole grain 
requirement is 50 percent, we are at 75. We are constantly 
striving to meet higher and better nutritional needs for our 
students, but we also have to make it work, and we have to 
ensure that those students are eating it. Just like you said, 
if it is going into the trashcan, that is not providing any 
nutrition to our students. We think it is incredibly important 
that we have the ability to make our meals, and make our menus, 
based on what our students want, will eat, while we constantly 
strive to increase our quality of nutrition and quality of 
items served.
    Senator Hoeven. Well, I think that is really well said. 
Thank you for what you are doing out there for our kids. I 
think any time we can empower somebody like you out there, we 
ought to do it, rather than tell you exactly what you have to 
do and when you have to do it and how you have to do it. I am a 
big fan of flexibility, and I think you just epitomized what it 
is so important that we have flexibility out there for the 
professionals, like yourself, who are out there every day, 
making sure those young people not only have meals but that 
they are nutritious and healthy and tasty.
    Thank you for that work. I appreciate it so much. You 
represent many, many, many, many other nutritionists that care 
about those young people and are doing a whale of a job taking 
care of them.
    One other quick question I have for Mr. Rodriguez. It is 
just on in terms of any of the reforms as far as the food 
service programs, streamlining the programs. What would be the 
biggest thing that you think would really help in terms of 
those community food banks?
    Mr. Rodriguez. Well, thank you for the question. I think 
flexibility is just a common theme here. I would add to that 
that strengthening the site-based model by allowing community 
providers to operate with one program year-round makes a lot of 
sense. We have talked about that continuously.
    One thing I have not mentioned as often is lowering the 
area eligibility threshold to serve more children. Doing 
something as simple as just looking at what other eligibility 
thresholds already exist. For example, our 21st century Title I 
program is 40 percent. Just doing simple things like this would 
not only create alignment but it also creates simplification in 
how we administer programs and how we do outreach and target 
populations.
    The other thing, I think, that we really need to look at is 
how do we allow alternate program models in underserved and 
hard-to-reach areas. You said it best, Senator. Three hundred 
twenty million and that many more communities, very diverse in 
what they have in terms of infrastructure and capabilities. We 
learned during the pandemic that relaxing the congregate 
feeding requirement worked, utilizing the efficiencies of a 
summer grocery card, and we have seen that during pandemic EBT, 
also worked, and created opportunities to reach underserved or 
not-served-at-all areas.
    Senator Hoeven. Right. Again, thank you, Mr. Rodriguez. 
Thanks to all of you for what you are doing to help feed people 
that need it, and it is a really important program and we 
appreciate very much all that you do. Thank you, Madam Chair.
    Senator Boozman. [Presiding.] Thank you, Senator Hoeven.
    Senator Hoeven. No, Mr. Ranking Member. Excuse me.
    Senator Boozman. Senator Warnock.
    Senator Warnock. Thank you very much. I am not going to 
make that same mistake. It is good to be here with you, and I 
want to thank you and Chairwoman Stabenow for this opportunity. 
It is great to be here to discuss a topic that will hopefully 
generate increasing bipartisan consensus.
    We all remember the painful images of long lines at food 
banks as the COVID-19 pandemic sent food insecurity rates 
soaring. Those lines are still with us. Some of the folks who 
were passing out food a year ago found themselves in those 
lines. The cars in those lines are getting nicer and nicer, an 
indication of how food insecurity has impacted so many 
families.
    Dr. Beers, in your testimony you discussed some of the 
barriers to accessing WIC, and specifically you noted that 
Congress and the USDA should look for ways to align WIC 
eligibility with other Federal programs like Medicaid and SNAP, 
in order to combat declining enrollment in these programs.
    The American Rescue Plan included similar incentives as the 
Affordable Care Act, to encourage 12 remaining States, 
including my home State of Georgia, to finally expand Medicaid. 
We were able to get $2 billion in the American Rescue Plan just 
for Georgia, more than enough for Georgia to finally expand 
Medicaid.
    Studies have shown that when States expand this critical 
safety net program there is a decrease in prevalence of severe 
food insecurity--so we get 500,000 people, in the case of 
Georgia, nearly 500,000 people, out of the Medicaid gap so they 
get health care--but the studies also show a decrease in 
prevalence of food insecurity.
    Georgia has yet to expand Medicaid. We are at yet another 
turning point. We have got $2 billion on the table, over 
400,000 Georgians in the Medicaid gap. The ball is in the court 
of the legislature.
    Dr. Beers, what impact does the lack of Medicaid expansion 
in a State like Georgia have on hunger, and how would Medicaid 
expansion help to reduce barriers to nutrition assistance 
through other programs, such as WIC, and would expansion help 
families free up household funds so that they can be less food 
insecure?
    Dr. Beers. Senator Warnock, thank you so much for that 
question, and yes, you know, Medicaid expansion is an 
incredibly important priority for us at the AAP because we know 
that children and families who have access to good quality 
health care, that they can access without worry, is an 
incredibly important thing that improves outcomes. It will 
address food insecurity in a number of ways.
    It allows, for example, my own clinic, we screen families 
for food insecurity, and we are a really important touch point 
for families in being able to connect them to both Federal and 
community resources. We do this at every well visit. We do it 
at other visits as well.
    You know, I will also add it is also a really important 
strategy in addressing the increasing rates of poor nutrition 
and obesity that we are seeing, which is also the other end of 
the spectrum that we are seeing right now during the pandemic. 
I mentioned my colleague's patient who had gained 90 pounds. I 
will say that my colleagues daily are seeing kids who have 
gained 30 to 40 pounds over the course of the pandemic, and we 
know that just simply, you know, advising them to eat healthier 
is not going to be enough. Being able to access the whole range 
of services that families can access when they are insured and 
can access good quality health care will be really important.
    We are also seeing an increase in eating disorders, because 
of the emotional impacts of the pandemic, and that is very 
complex medical care, and even Medicaid is an important 
strategy in ensuring that kids have the ability to access that 
health care as well.
    I appreciate your comment and your tying this issue to the 
larger issue of access to health care. Thank you.
    Senator Warnock. Food insecurity, lack of access to health 
care, particularly in States that have yet to expand Medicaid, 
larger issues around health, including obesity, all part of a 
network of care that we address by expanding Medicaid.
    Thank you so much.
    Senator Boozman. Thank you, Senator Warnock, very much.
    On behalf of myself and Senator Stabenow, who had to run 
and cast a vote--that is the only thing we absolutely have to 
do around here--we want to thank the panel. I think this was a 
very, very good hearing, very helpful in the sense of helping 
us to craft a way forward. These are difficult things, and 
again, you all have been more than helpful.
    The other thing, too, on behalf of myself and the entire 
panel, thank you all for all you do, being on the forefront, 
fighting the battle. As always, we appreciate the staff that 
works so hard to put these things together.
    With that I would say that in addition the record will 
remain open for five business days for members to submit 
additional questions or statements, and the hearing is 
adjourned.
    [Whereupon, at 11:40 a.m., the Committee was adjourned.]

      
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