[Senate Hearing 118-]
[From the U.S. Government Publishing Office]




 
  DEPARTMENT OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
          RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2023

                              ----------                              

                                       U.S. Senate,
           Subcommittee of the Committee on Appropriations,
                                                    Washington, DC.
    [Clerk's note.--The subcommittee was unable to hold 
hearings on departmental and nondepartmental witnesses. The 
statements and letters of those submitting written testimony 
are as follows:]

                         DEPARTMENTAL WITNESSES

      Prepared Statement of America's Public Television Stations 
                  and the Public Broadcasting Service
    On behalf of America's 160 public television licensees, 
collectively operating 336 public television stations serving nearly 97 
percent of the American people, we appreciate the opportunity to submit 
testimony for the record on the importance of Federal funding for local 
public television stations and PBS. We urge the subcommittee to support 
$565 million in 2-year advance funding for the Corporation for Public 
Broadcasting (CPB) in FY 2025, $60 million for the Public Broadcasting 
Interconnection System in FY 2023 and $30.5 million for the Ready To 
Learn program at the Department of Education in FY 2023.
                 corporation for public broadcasting: 
              $565 million (fy 2025) 2-year advance funded
    Public television plays a key role in educating our children; 
providing job training; preserving our diverse, dynamic culture and 
democracy; and keeping Americans informed, safe and healthy. Public 
television's essential services have been critical during the COVID-19 
pandemic, as local public television stations in all 50 States have 
provided enhanced educational services and content to help support 
students, families, teachers, and schools throughout this challenging 
time.
    Federal funding for CPB, which enjoys the overwhelming support of 
the American people, is essential to making these services available to 
all Americans, including those in rural and underserved areas. At about 
$1.40 per person per year, this funding provides an enormous return on 
investment for all Americans.
    Yet these vital community-based services were level-funded at $445 
million for a decade--resulting in an approximate $100 million in lost 
purchasing power.
    Recognizing this loss, we appreciate that Congress has increased 
the forward funded CPB appropriation in each of the last 3 years.
    While public broadcasting is grateful for these increases, the FY 
2024 enacted funding level of $525 million still leaves the public 
broadcasting system about $55 million, in inflation-adjusted dollars, 
behind where the system was 11 years ago. This shortfall continues to 
present a serious challenge at a time when the system is bearing the 
costly expense of providing access to content on ever-emerging 
platforms and stations continue to offer more and more essential 
services to their communities.
    In addition, local stations are facing a growing backlog of over 
$300 million worth of infrastructure improvements we need but cannot 
afford to fund since the Public Telecommunications Facilities Program 
(PTFP) was defunded in FY 2011. The longer these improvements are not 
addressed, the more they threaten local stations' reliable broadcast 
services and public service missions.
    At the same time, public television stations are eager to make the 
transition to the new NEXT GEN TV broadcast standard, with its 
transformative potential for enhanced public service in telehealth, 
Smart Cities connections, precision agriculture, national security 
applications as well as remote learning and public safety 
communications. This transition will cost our system an additional $400 
million.
    Public broadcasting respectfully requests that Congress take 
another substantial step toward securing our current and future public 
service goals in the FY 2023 appropriations process.
    The $565 million that public broadcasting is requesting in FY 2023 
for FY 2025 will help restore lost purchasing power and help local 
stations begin to replace aging infrastructure, invest in new 
technology, and invent a future that will educate more children and 
adults, provide additional critical resources and capabilities to 
teachers and schools, further enhance public safety and expand the 
civic leadership work of local stations.
    Given the success of public media, and its potential to do so much 
more for so many, it is sound policy to increase Federal funding for 
this valuable service that provides an exceptional return on 
investment.
Education
    Public media is committed to education and service for all 
Americans. Public broadcasting allows people at all income levels and 
from all parts of the country-rural and urban-to have access to 
consistent, high-quality, diverse content for free. This educational 
programming is readily available to children, parents, teachers, senior 
citizens, those pursuing their high school equivalency degrees, and 
many others.
    Public television's educational broadcast content has helped more 
than 90 million pre-school age children get ready to learn and succeed 
in school. Beyond the iconic, proven educational programming, PBS, in 
partnership with local public television stations and school districts 
provides additional content directly to classrooms and homes through 
PBS LearningMedia--which provides access to tens of thousands of State 
curriculum-aligned digital learning objects--including videos, 
interactives, lesson plans and more--for use in K-12 classrooms and at 
home. Content is sourced from the best of public television in addition 
to material from the Library of Congress, National Archives, 
Smithsonian Institution, NASA and other high-quality sources.
    Additionally, local public television stations throughout the 
country have partnered with PBS to bring a first-of-its kind, free PBS 
KIDS 24/7 broadcast channel and live stream to their communities--
providing kids throughout the country with the highest level of 
educational programming, available through local stations any time. 
During the COVID-19 pandemic, many stations have used this expanded 
broadcast capacity to directly serve families and students from Pre-K--
12 with state standards aligned educational content and instructional 
content created by teachers. Last year, 13.5 million kids ages 2-8 
watched PBS KIDS content. Parents also looked to public television for 
educational resources, with PBS Parents users increasing by 80 percent 
during the pandemic.
    Public television stations are also leaders in adult education. 
Public television operates the largest nonprofit GED program in the 
country, helping tens of thousands of second-chance learners earn their 
high school equivalency degree. In addition, public television stations 
are leaders in workforce development, including retraining American 
veterans, by providing digital learning opportunities for training, 
licensing, continuing education credits, soft skills and more.
Partners in Public Safety
    Public broadcasting stations throughout the country are leading 
innovators and essential partners to local public safety officers. In 
partnership with FEMA, PBS WARN uses the public television 
interconnection system and local stations' broadcast infrastructure to 
support the Wireless Emergency Alert (WEA) system that enables cell 
subscribers to receive geo-targeted text messages in the event of an 
emergency-reaching citizens wherever they are.
    The February 2019 Report from the FEMA National Advisory Council on 
Modernizing the Nation's Public Alert and Warning System specifically 
recommends, ``Encouraging use of public media broadcast capabilities to 
expand alert, warning, and interoperable communications capabilities to 
fill gaps in rural and underserved areas.''
    In addition, and separate from the WEA system, local public 
television stations' digital infrastructure and spectrum enable them to 
provide State and local officials with critical emergency alerts, 
public safety, first responder and homeland security services and 
information during emergencies through a process known as datacasting. 
Datacasting uses broadcast spectrum to send encrypted data and video to 
first responders with no bandwidth constraints.
    In partnership with local public television stations and local law 
enforcement agencies, the U.S. Department of Homeland Security (DHS) 
has conducted several successful pilots throughout the country that, in 
addition to other local initiatives, prove the effectiveness of 
datacasting in a range of use cases including: flood warning and 
response; enhanced 911 responsiveness; over-water communications; 
faster early earthquake warnings; multiagency interoperability; rural 
search and rescue; high profile, large event crowd control; and 
assistance with school safety, including in areas that lack broadband 
or LTE services.
    As a result of the successful pilots, the DHS Science and 
Technology Directorate has partnered with America's Public Television 
Stations to maximize and promote datacasting technology and the 
opportunity to partner with local public television stations in 
communities nationwide.
    Additionally, stations are increasingly partnering with their local 
emergency responders to customize and utilize public television's 
infrastructure for public safety in a variety of critical ways, with 
many serving as their States' Emergency Alert Service (EAS) hub for 
weather and AMBER alerts.
Providing Civic Leadership
    Public television strengthens the American democracy by providing 
citizens with access to the history, culture and civic affairs of their 
communities, their States and their country. Throughout the pandemic, 
public television has provided essential front-line coverage to ensure 
Americans have the facts they need to stay healthy and local 
information on where they can turn for help if they need it.
    For the 19th year in a row, PBS was ranked the most trusted among 
national media institutions. That trust is more important than ever. 
Americans tune into their local public television station or view their 
online resources for trusted information that can help keep them safe.
    Local public television stations often serve as the State-level 
``C-SPAN,'' covering state government actions. As some of the last 
locally controlled media, public television stations also provide more 
public affairs programming, forums for discussion of local issues such 
as the opioid crisis, local history, arts and culture, candidate 
debates, agricultural news, and citizenship information of all kinds 
than anyone else. What truly sets public television stations apart is 
that stations treat their viewers as citizens rather than consumers.
Public Broadcasting is a Smart Investment
    All of this public service is made possible by the Federal funding 
to CPB. This Federal investment sustains the public service missions of 
public television, which are distinct from the mission of commercial 
broadcasting and will not be funded by private sources, as the 
Government Accountability Office concluded in a 2007 study commissioned 
by Congress.
    The need for Federal investment is particularly acute in small-town 
and rural America, where lower population density, a lack of corporate 
and philanthropic support, and challenging topography make the 
economics of local television and public service more challenging. As a 
result, public broadcasters are sometimes the only local broadcaster 
serving rural communities-and only with the help of the Federal 
investment.
    For all stations, Federal funding is the ``lifeblood'' of public 
broadcasting, providing indispensable seed money to stations to build 
additional support from state legislatures, foundations, corporations, 
and ``viewers like you.''
    For every dollar in Federal funding, local stations raise six 
dollars in non-Federal funding, creating a strong public-private 
partnership providing a valuable return on investment and supporting 
approximately 20,000 jobs across America.
    And yet, until 3 years ago, this critical funding remained flat for 
a decade, forcing stations to make difficult programming, staffing and 
service decisions as operational costs rose with inflation, while CPB 
funding did not. Despite this severe financial constraint, local public 
television stations have continued their deep commitments to the 
communities they serve.
    The $565 million that public broadcasting is requesting in fiscal 
Year2025 is necessary for the continued health of local stations and 
the public broadcasting system as a whole--and for long-delayed 
enhancements of the essential education, public safety and civic 
leadership services described above.
Two-Year Advance Funding
    Two-year advance funding is essential to the mission of public 
broadcasting. This longstanding practice, proposed by President Ford 
and embraced by Congress in 1976, establishes a firewall insulating 
programming decisions from political interference, enables the 
leveraging of funds to ensure a successful public-private partnership, 
and provides stations with the necessary lead time to plan in-depth 
programming and accompanying educational materials-all of which 
contribute to extraordinary levels of public service and public trust.
    Local stations leverage the 2-year advance funding to raise State, 
local and private funds, ensuring the continuation of this strong 
public-private partnership. These Federal funds act as the seed money 
for fundraising efforts at every local station, no matter its size. 
Advance funding also benefits the partnership between States and 
stations since many States operate on 2-year budget cycles.
    Finally, the 2-year advance funding mechanism gives stations and 
producers, both local and national, the critical lead time needed to 
raise the additional funds necessary to sustain effective partnerships 
with local community organizations and engage them around high-quality, 
award-winning programs. Producers and directors like Ken Burns, Henry 
Louis Gates, Jr., Jamila Wignot, Stanley Nelson and others spend years 
developing programs like The Vietnam War, Country Music, Ben Franklin, 
Rita Moreno: Just a Girl Who Decided to Go For It, Amy Tan: Unintended 
Memoir, Asian Americans, Reconstruction: America after the Civil War, , 
African Americans: Many Rivers to Cross and upcoming documentaries like 
The U.S. and the Holocaust, Becoming Frederick Douglass and Harriet 
Tubman: Visions Of Freedom. It would be impossible to produce this in-
depth programming and the curriculum-aligned educational materials that 
accompany it without the 2-year advance funding.
            public broadcasting interconnection: $60 million
    The public television interconnection system is the infrastructure 
that connects PBS and national, regional and independent producers to 
local public television stations around the country. The 
interconnection system is essential to bringing public television's 
educational, cultural and civic programming to every American 
household, no matter how rural or remote. Without interconnection, 
there is no nation-wide public media service. The interconnection 
system is also critical for public safety, providing key redundancy for 
the communication of presidential alerts and warnings, and ensuring 
that cellular customers can receive geo-targeted emergency alerts and 
warnings.
    Congress has always provided Federal funding for periodic 
improvements of the interconnection system. In FY 2018, Congress moved 
to fund interconnection for public broadcasting on an annual, rather 
than decennial, basis to enable dynamic, incremental upgrades based on 
rapid advances in technology. In addition, to the interconnection 
system, this account also provides funding for other technologies and 
services that create infrastructure and efficiencies within the public 
media system.
    Public television is requesting $60 million for interconnection in 
fiscal Year2023 to support continued investments in the public 
television and radio interconnection systems and new shared 
technologies and services including: cybersecurity; data analytics and 
business intelligence; single sign on service, a content management 
system and a content delivery network.
    This funding request would help build out a suite of interoperable 
digital platforms and solutions which would effectively and efficiently 
help stations meet the growing and dynamic needs of digital audiences. 
This investment would help ensure that every public television and 
radio station, regardless of size or location, can provide its 
community with critical services and content on modern technology and 
platforms, meeting Americans where they are.
        ready to learn: $30.5 million (department of education)
    The U.S. Department of Education's Ready To Learn (RTL) competitive 
grant program, reauthorized in the Every Student Succeeds Act, uses the 
power of public television's on-air, online, mobile, and on-the-ground 
educational content to build the literacy and STEM skills of children 
between the ages of two and eight, especially those from low-income 
families.
    Through the RTL grant, CPB and PBS have delivered evidence-based, 
innovative, high-quality content to improve the math, science, and 
literacy skills of high-need children. CPB, PBS, and local stations 
have ensured that the kids and families most in need have access to 
these groundbreaking and proven effective educational resources. In 
addition to children, this outreach helps empower caregivers to help 
them understand the important role they play in their children's 
educational success.
    RTL investments have supported the production and academic rigor of 
PBS KIDS series: Elinor Wonders Why, Peg + Cat, SuperWhy!, Martha 
Speaks, Odd Squad and Molly of Denali--a curious and resourceful 10-
year-old Alaska Native girl who lives in the fictional village of Qyah, 
Alaska--and other iconic programming for children.
    But this investment does not solely rely on trusted, educational 
children's programming. CPB, PBS, and local public television stations 
employ a national-local model to reach parents, teachers, and 
caregivers on-the-ground in communities to help them make the most of 
these media resources locally. These include television, online and 
mobile apps, digital technology, mobile learning labs and on the ground 
events that provide valuable content and support to local school 
districts, county non-profits, preschools, homeschools, Head Start and 
other daycare centers, libraries, museums, and Boys and Girls Clubs, 
among others.
    The current CPB and PBS RTL grant partnership is a 5-year 
comprehensive, learning and engagement initiative called ``Learn 
Together: Connecting Children's Media and Learning Environments to 
Build Key Skills for Success.'' CPB and PBS are creating dynamic, new 
learning experiences produced by diverse media makers that will expose 
young children to career and workforce opportunities; helping them 
build vital functional literacy, critical and computational thinking, 
collaboration, and ``World of Work'' skills and knowledge.
Results
    RTL is rigorously tested and evaluated to assess its impact on 
children's learning and to ensure that the program continues to offer 
children the tools they need to succeed in school. Since 2005, more 
than 100 research and evaluation studies have shown RTL literacy and 
math content engages children, enhances their early learning skills and 
allows them to make significant academic gains, helping bridge the 
achievement gap. Highlights of recent studies show that:
  --Children from low-income households who were provided with RTL-
        funded Molly of Denali videos, digital games, and activities 
        were better able to solve problems using informational text,--
        oral, written, or visual text designed to inform--a fundamental 
        part of literacy that paves the way for future learning, 
        particularly in social studies and the sciences. After only 
        nine weeks of access, this impact is equivalent to the 
        difference in reading skills a first-grader typically develops 
        over 3 months.\1\
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    \1\ Kennedy, J. L., Christensen, C., Maxon, T., Gerard, S., Garcia, 
E., Hupert, N., Vahey, P., & Pasnik, S. (2021).
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  --Ready To Learn-funded resources from the PBS KIDS series The Cat in 
        the Hat Knows a Lot About That! increased science learning in 
        children from low-income households and had a positive impact 
        on children's understanding of core physical science concepts 
        of matter and forces--equivalent to the difference in science 
        knowledge an early elementary student develops over 5 
        months.\2\
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    \2\ (Grindal, T., Silander, M., Gerard, S., Maxon, T., Garcia, E., 
Hupert, N., Vahey, P., Pasnik, S. (2019). Early Science and 
Engineering: The Impact of The Cat in the Hat Knows a Lot About That! 
on Learning. New York, NY, & Menlo Park, CA: Education Development 
Center, Inc., & SRI International.)
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An Excellent Investment
    In addition to being research-based and teacher tested, RTL also 
provides excellent value for our Federal dollars. In the last 5-year 
grant round, public broadcasting leveraged an additional $50 million in 
non-Federal funding to augment the $73 million investment by the 
Department of Education. RTL exemplifies how the public-private 
partnership that is public broadcasting can change lives for the 
better.
    A funding level of $30.5 million is requested in FY 2023 to support 
current grantees and further enhance the discoverability and impact of 
Ready To Learn created content and the quantity and scope of local 
station outreach to the kids, families, teachers and schools that need 
it the most.
    Given the rigorous, thoughtful educational research and evaluation 
that goes into the creation of Ready To Learn content, Ready To Learn 
grants are awarded every 5 years and supported through annual 
appropriations. Funding in fiscal Year2023 would provide the fourth 
year of funding in the latest grant round. Providing $30.5 million for 
Ready to Learn in FY 2023 will ensure that CPB, PBS and stations can 
continue to create the highest quality, proven-effective kids 
educational media, meeting kids, caregivers and teachers where they are 
on a variety of platforms, while expanding local, on-the-ground 
outreach through local partners.
                               conclusion
    Americans across the political spectrum rely on and support Federal 
funding for public broadcasting because we provide essential local 
education, public safety, and civic leadership services that are not 
available anywhere else. And none of this would be possible without the 
Federal investment in public broadcasting.
    Federal funding is the great equalizer that ensures that the best 
of public broadcasting is available in both the urban centers of our 
great cities and in Native American communities in America's heartland 
and everywhere in between.
    Federal funding for CPB is what ensures that young children in 
Appalachia have the same access to the unparalleled PBS KIDS content as 
their counterparts in Los Angeles. And Federal funding is what ensures 
that all households, regardless of their ability to pay for cable or 
streaming subscriptions have access to local programming and the best 
of NOVA, Masterpiece, NewsHour, Great Performances, and so much more.
    Public broadcasters are the only broadcasters that reach nearly 97 
percent of U.S. households, and it is CPB funding that makes this 
possible.
    For all of these reasons we request that Congress continue its 
commitment to the highly successful, hugely popular public-private 
partnership that is public broadcasting by providing $565 million in FY 
2025 for CPB in addition to $60 million in FY 2023 for public 
broadcasting's interconnection system and $30.5 million in FY 2023 for 
the Ready To Learn Program.

                       NONDEPARTMENTAL WITNESSES

 Prepared Statement of the Academy for Radiology & Biomedical Imaging 
                                Research
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee, I am Mitchell Schnall, President of the Academy for 
Radiology & Biomedical Imaging Research (Academy), and the Eugene P. 
Pendergrass Professor of Radiology and Chair of the Radiology 
Department at the Perelman School of Medicine at the University of 
Pennsylvania. The Academy is comprised of more than 200 academic 
research departments, patient advocacy groups, industry partners, and 
imaging societies, representing thousands of radiologists and 
researchers in all 50 States. We are the only advocacy organization 
representing the broad spectrum of the imaging research community by 
collectively advocating for robust and consistent Federal research 
funding.\1\ It is my pleasure to submit this testimony on behalf of the 
Academy. We strongly support at least $49.048 billion for the National 
Institutes of Health's base appropriation. This figure represents an 
increase of $3.5 billion over FY2022 plus the release of the 21st 
Century Cures funds. The Academy also supports a proportional increase 
to the National Institute of Biomedical Imaging and Bioengineering 
(NIBIB), resulting in at least $458.5 million for FY2023--a $33.6 
million increase over the FY2022 enacted level. Further, should the 
Advanced Research Projects Agency for Health (ARPA-H) or pandemic 
preparedness efforts progress, funding should be designated separately 
from NIH's base and should supplement, not supplant, investment in 
basic research. While the Academy is supportive of ARPA-H and pandemic 
preparedness, and acknowledges they hold significant and exciting 
potential, investigator-initiated research is the foundation of basic 
science.
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    \1\ https://www.acadrad.org/about-the-academy/.
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    Moreover, Congress must work to ensure Federal appropriations are 
enacted on time to avoid disruptive interruptions to the research 
continuum. We must avoid relying on continuing resolutions, which are 
insufficient to meet evolving needs. At the end of FY2021 and beginning 
of FY2022, we received many examples of research left unpursued because 
funding was not available because of reliance on continuing 
resolutions. Delaying otherwise meritorious research only serves to 
further extend the time until we make lifesaving discoveries that help 
patients fighting deadly and debilitating diseases. Through consistent, 
robust funding for NIH and our National research infrastructure, we can 
continue to make advancements that will improve the lives of patients. 
The Academy is extremely grateful for the subcommittee's long-running 
support of NIH and encourages you to prioritize NIH for consistent and 
dependable funding levels for biomedical research, radiology, and 
imaging science.
           imaging advancements and innovations help patients
    Imaging serves as a necessary diagnostic tool that researchers and 
clinicians of all types use to help advance our understanding of 
biology and to develop and deliver treatments. This is particularly 
evident in the research examples provided below and through discussions 
about ARPA-H. A review of the past ARPA-H listening sessions and 
discussions with Congressional offices shows the value of improved 
imaging and diagnostics in support of a spectrum of biomedical research 
advances--resulting in direct benefits to patients. By improving our 
imaging tools and techniques, we broaden the resources available to 
address many challenging medical conditions. In my own work as a 
clinician-scientist, I use state-of-the-art technologies like 
specialized magnetic resonance imaging (MRI) and 3-dimensional 
mammography to improve the diagnosis and treatment of multiple cancer 
types, including breast, prostate, and pancreatic. Imaging research 
serves many purposes and can significantly improve patient outcomes.
    Basic science advancements translate into a variety of clinical 
applications benefitting patients. Included below are examples of 
imaging applications to the Covid-19 pandemic, leveraging innovative, 
artificial intelligence technologies, and detecting and treating 
diverse types of cancer.
Detecting Covid-19 Quickly and Easily: From 0 to 1 billion+
    Launched in April 2020 and led by the National Institute of 
Biomedical Imaging and Bioengineering, the Rapid Acceleration of 
Diagnostics (RADx)-Tech program has been instrumental in the Nation's 
Covid-19 testing strategy and response.\2\ This Congressionally 
supported program utilizes a competitive system to funnel the best 
ideas quickly toward implementation. In short, RADx-Tech accelerated 
the development and availability of Covid-19 tests. In September 2020, 
there were limited testing options, accounting for fewer than 700,000 
Covid-19 tests per day for laboratory and point of care use. As of 
February 2022--less than 18 months later-there were 41 FDA-approved 
tests, including at-home, point of care, and laboratory options, 
resulting in over 1.8 billion tests produced cumulatively. That same 
month, over 5.6 million tests per day were manufactured--over 168 
million in total for the month.\3\ These tests contributed directly to 
our understanding of a devasting pandemic and put tools directly into 
patient's hands. When coupled with strong support from policymakers, 
the funneling pipeline used by NIBIB can accelerate extraordinary 
advancements.
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    \2\ https://www.nibib.nih.gov/covid-19/radx-tech-program.
    \3\ https://www.nibib.nih.gov/covid-19/radx-tech-program/radx-tech-
dashboard.
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Machine Learning Technology Improves Diagnostic Imaging and Patient 
        Outcomes
    Applying artificial intelligence and machine learning tools to the 
imaging space continues to improve our diagnostic capabilities. In my 
testimony last year, I highlighted the efforts of the Medical Imaging 
and Data Resource Center. MIDRC continues to apply artificial 
intelligence and machine learning technology for screening, detection, 
staging, and follow-up for Covid-19 patients. Throughout 2021 and into 
2022, MIDRC collected over 85,000 images and is progressing toward an 
artificial intelligence algorithm for automating image analysis to 
diagnose patients and provide a disease prognosis more quickly and 
efficiently.
    In further examples of AI/ML applications, the University of 
Washington is pursuing multiple strategies to improve mammography. A 7-
year MERIT award from the National Cancer Institute has enabled 
building AI algorithms for breast cancer analysis, building off a 
crowdsourced challenge. UW also recently launched a 5-year initiative 
funded by NIH to create an academia-industry collaboration to validate 
multiple, commercial AI algorithms for automated mammography screening 
interpretation. Like in the Covid-19 context, reliably automating the 
review and evaluation of screenings, especially as it adapts to new 
variables, could significantly improve the detection, treatment, and 
outcomes of breast cancer.
    In a final example of AI-based applications, academic-industry 
partnerships are working to optimize imaging and diagnosis using AI-
enabled Magnetic Resonance Imaging (MRI). This effort, which improves 
image quality and processes those images efficiently, is cutting exam 
times by over 30 percent. These advances are being disseminated broadly 
throughout the industry and are reshaping diagnostic capabilities and 
patient experience. Reducing the length of an examination accelerates 
the time to diagnosis and treatment, increases the efficiency of the 
imaging center to see more patients, and has a significant patient 
impact through reduced anxiety and increased satisfaction during a 
stressful time.
Better Images, Less Radiation, Faster Results
    Finally, work conducted at the University of California-Irvine is 
improving a well-known and trusted tool, x-ray technology. The new 
imaging system, x-ray-induced acoustic computed tomography (XACT), is a 
promising alternative to traditional technology. Supported by an NIH 
grant, XACT can image the human body much faster while requiring a 
lower radiation dose for the patient. Moreover, a portable model is in 
development that can reach more patients, particularly in remote areas 
that may have difficulty accessing doctors' offices and care centers. 
XACT can be used for a wide range of image-guided procedures, such as 
biopsies, placement of drainage tubes, catheters, tumor ablation, and 
injections. The improved tool generates faster diagnosis and treatment, 
lowers radiation exposure, and reaches underserved communities, all 
leading to improved outcomes across a wide range of treatment or 
imaging interventions.
                         summary and conclusion
    Sustained and robust NIH funding is crucial to advancing our 
efforts to understand and treat a myriad of diseases and disorders. NIH 
investments are also a key economic driver. In 2022, NIH funds 
generated $2.60 in economic activity for every $1 of research and 
flowed to every State in the Nation.\4\ Funding NIH's base program with 
at least $49.048 billion will provide the robust support needed to 
sustain growth and secure advancements in biomedical research.
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    \4\ https://unitedformedicalresearch.org/wp-content/uploads/2022/
03/UMR_NIHs-Role-in-Sustaining-the-U.S.-Economy-FY21.pdf.
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    Thank you for your strong, continued support of NIH, NIBIB, and all 
the Institutes and Centers working to advance our biomedical research 
efforts and to improve the lives of patients worldwide. On behalf of 
the Academy, I urge you to continue your strong support of our Nation's 
research and innovation enterprise.

    [This statement was submitted by Mitchell Schnall, M.D., Ph.D., 
President, 
Academy for Radiology & Biomedical Imaging Research.]
                                 ______
                                 
                 Prepared Statement of Accessia Health
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Provide the National Institutes of Health (NIH) with at least $49. 
        billion and provide individual NIH Institutes and Centers with 
        proportional discretionary increases.
    --Please provide additional, distinct funding for the emerging 
            Advanced Research Projects Agency for Health (ARPA-H) at 
            NIH, which would facilitate implementation of this 
            important program without supplanting ongoing NIH research 
            activities.
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least $11 billion to facilitate timely public health efforts 
        along with proportional discretionary increases for CDC Centers 
        and Divisions.
    --Please provide $6 million for the Chronic Disease Education and 
            Awareness Program at CDC.
  --Provide the Health Resources and Services Administration (HRSA) 
        with a funding level of at least $9.8 billion.
  --Please support the development and advancement of innovative 
        payment models and efforts to effectively enhance coverage and 
        access, including through additional resources for the Centers 
        for Medicare and Medicaid Services (CMS).
_______________________________________________________________________

    Thank you for the opportunity to submit testimony on behalf of 
Accessia Health and the community of patients we serve. Chairwoman 
Murray, Ranking Member Blunt, and distinguished members of the 
subcommittee, thank you for the significant ongoing investments in HHS, 
particularly medical research and public health programs that improve 
health for patients with debilitating and life-threatening conditions. 
Please maintain this commitment and further enhance support for medical 
research and public health programs as you work with your colleagues on 
appropriations for Fiscal Year (FY) 2023. Further, please continue to 
provide resources for the development and implementation of innovative 
models for payment and care delivery that prioritize patients while 
properly managing precious resources. Thank you again.
                         about accessia health
    Accessia Health pioneered the patient assistance model for people 
living with chronic medical conditions. To date, over $1.1 billion has 
been distributed to patients throughout the country, helping them 
navigate the complexities of the healthcare system.
    We understand the patient journey and we are blazing new trails by 
leveraging our three decades of success to expand patient assistance 
support to serve today's patients and healthcare consumers.
    Our patient assistance model includes healthcare education, 
financial assistance, specialized legal services, case management, and 
more. We are committed to serving diverse populations and seek partners 
who share our belief that all people deserve access to healthcare. 
Helping people is our mission and our passion.
                                advocacy
    We advocate for greater access to affordable healthcare and 
treatment for patients with rare and chronic diseases. Working on both 
the State and Federal level, we strive to ensure patient voices are 
heard and patient assistance is protected. Accessia Health also joins 
with partner coalitions to advocate for increases funding for 
healthcare programs and for patient-centered healthcare reforms.
    We encourage you to adopt the aforementioned funding requests to 
better meet the unmet needs of patients with serious illness and to 
address gaps in care through systems innovation and scientific 
advancements. Our vision, is one where patients living with chronic 
illness, rare disease, or disability no longer struggle to access the 
treatment, and assistance they need to lead their best life.
    specialty drug carve out: one example of an area where patient 
                         protections are needed
    Third Party Administrators have reached out to employers 
advertising a new way to save healthcare resources for the company. The 
employer contracts with the administrator, then the entities work 
together to curtail the prescription drug formularies that the company 
will offer to their employees, specifically leading to cutting out 
specialty drugs from the formulary. Typically, the price point for the 
formulary cutoff are treatments greater than $350. The employer is then 
told that the administrator will work with their employees to obtain 
any treatment if needed free of charge. The employee will then receive 
a concierge advocate who will work to obtain free treatments from the 
manufacturers. The self-insured plan saves massively on their 
healthcare spending less the contracted cost of the concierge workers. 
This is explained as a benefit to the employees that they will be 
receiving their treatments for free.
    There are several problems with the sustainability of this new 
model. First and foremost, manufacturer patient assistance programs 
impose major limitations on these free product patient assistance 
programs. Historically manufacturer patient assistance programs were 
created to serve uninsured patients for a limited period time. However, 
many manufacturers will provide compassionate drugs to patients with 
commercial coverage if the product is not covered on the plan drug 
formulary. Due to the limited time, the concierge advocate will try 
additional strategies such as non-medical drug switching and/or claims 
they can import drugs from outside the United States. These programs 
also may have an income requirement to qualify. Manufacturer patient 
assistance programs are not a long-term solution for patients with rare 
and chronic conditions to obtain needed treatments and therapies. Since 
manufacturer patient assistance program are a benefit they offer, 
continuing this practice could encourage them to severely curtail 
access to these programs.
    Congress needs to engage with the Biden-Harris Administration to 
end this practice that will clearly hurt patients with rare and chronic 
illnesses who need ongoing access to life sustaining treatments and 
therapies. In 2019, 44 percent of patient did not purchase a 
prescription due to cost. This practice, which is beginning to grow in 
the United States will further limit patient access to needed 
treatments and therapies. The Department of Labor, the agency with 
regulatory authority over ERISA plans, must work with Congress and also 
issue guidance restricting this practice.
                          patient perspectives
    I was diagnosed with Fabry 6 years ago and my husband was diagnosed 
with Pompe 3 years ago. I don't know what we would do without Accessia 
Health's help--we would be bankrupt. With both of us having rare 
diseases, the bills would be astronomical. Everyone at Accessia Health 
is so helpful. I haven't met one person who isn't kind.  --Lupe and 
Duane Austin
    Accessia Health is a lifesaver. I was diagnosed with a rare genetic 
disease, Fabry disease, right after I purchased my new home. My 
treatments are over $40,000 every two weeks. I wasn't sure how I was 
going to pay my mortgage, it's only with the help of Accessia Health 
that I'm able to stay in my home and afford my treatments, medical 
bills and nursing services.''  --Lisa Wright
    Accessia Health's ACCESS program helped me receive Social Security 
Disability, which let me adopt my son Jacob.  --Randy Russell

    [This statement was submitted by Gwen Cooper, President & CEO, 
Accessia Health.]
                                 ______
                                 
      Prepared Statement of the Ad Hoc Group for Medical Research
    The Ad Hoc Group for Medical Research is a coalition of nearly 400 
patient and voluntary health groups, medical and scientific societies, 
academic and research organizations, and industry. We appreciate the 
opportunity to submit this statement in support of strengthening the 
Federal investment in biomedical, behavioral, social, and population-
based research conducted and supported by the National Institutes of 
Health (NIH) through a recommendation of at least $49.1 billion for 
NIH's base program level budget in FY 2023.
    As a result of the strong, bipartisan vision of the House and 
Senate Labor-HHS-Education subcommittees over the last 7 years, 
Congress has helped the agency regain some of the ground lost after 
years of effectively flat budgets. That renewed investment in NIH has 
advanced discovery toward promising therapies and diagnostics, 
reenergized existing and aspiring scientists nationwide, and restored 
hope for patients and their families. As the subcommittee has 
recognized, to remain a global leader in accelerating the development 
of innovative prevention strategies, advanced diagnostics, pioneering 
treatments, and life-changing cures, , and in this time of 
unprecedented scientific opportunity, it is essential that Congress 
sustain long-term robust increases in the NIH budget.
    In FY 2023, the Ad Hoc Group for Medical Research supports at least 
$49.048 billion for the NIH base program level budget, which would 
represent an increase of $4.1 billion over the comparable FY 2022 
funding level (an increase of $3.5 billion or 7.9 percent in the NIH 
appropriation plus funding from the 21st Century Cures Act for specific 
initiatives). Importantly, the Ad Hoc Group strongly urges lawmakers to 
ensure that any funding for the new Advanced Research Projects Agency 
for Health (ARPA-H) supplement our $49 billion recommendation for NIH's 
base budget, rather than supplant the essential foundational investment 
in the NIH. This funding level, supported by nearly 400 stakeholder 
organizations, would provide real growth in the base budget above 
inflation, expanding NIH's capacity to support promising science in all 
disciplines. In addition, the coalition supports the president's 
proposal to supplement NIH's budget with additional mandatory funding 
to speed the pace of pandemic response and readiness.
    Importantly, we also recommend a funding allocation for the Labor-
HHS-Education subcommittee in FY 2023 that allows for the necessary 
investment in NIH and other agencies that promote the health of our 
Nation. We believe that science and innovation are essential if we are 
to continue to meet current and emerging health challenges, improve our 
Nation's physical and fiscal health, and sustain our leadership in 
medical research.
    NIH: A Partnership to Save Lives and Provide Hope. The partnership 
between NIH and America's scientists, medical schools, teaching 
hospitals, universities, and research institutions is a unique and 
highly productive relationship, leveraging the full strength of our 
Nation's research enterprise to translate this knowledge into the next 
generation of diagnostics, therapeutics, and cures. More than 80 
percent of the NIH's budget is competitively awarded through nearly 
50,000 research and training grants to more than 300,000 researchers at 
over 2,500 universities and research institutions located in every 
State, Washington, D.C., and U.S. territories. The Federal Government 
has an essential and irreplaceable role in supporting medical research. 
No other public, corporate, or charitable entity is willing or able to 
provide the broad and sustained funding for the cutting-edge basic 
research necessary to yield new innovations and technologies of the 
future.
    NIH has supported biomedical research to enhance health, lengthen 
life, respond to emerging health threats, and reduce illness and 
disability for more than 100 years. For patients and their families, 
NIH is the ``National Institutes of Hope.'' The following are a few of 
the many examples of how NIH research has contributed to improvements 
in the Nation's health.
  --NIH-funded basic research laid the groundwork for the novel mRNA 
        vaccine technology used in the first two FDA approved SARS-CoV-
        2 vaccines. Vaccines continue to be one of our most cost-
        effective public health tools with every $1 spent on routine 
        childhood vaccinations estimated to save $5 in direct costs, 
        and $11 in broader costs to society.
  --In 2020, the gene editing tool CRISPR was successfully used to 
        treat the inherited blood disorders sickle cell anemia and 
        beta-thalassemia, only 8 years after the primordial bacterial 
        immune system was harnessed for therapeutic use in the 
        laboratory.
  --Following nearly three decades of NIH-funded research into novel 
        mechanisms of drug action, breakthroughs in the treatment of 
        depression came in 2019 with two new FDA-approved drugs--one 
        for treatment-resistant depression and the first ever treatment 
        for postpartum depression.
  --In 2007, induced pluripotent stem cells (iPSC) were discovered when 
        adult cells were re-engineered into early non-differentiated 
        versions of themselves. In 2019, the National Eye Institute 
        launched a first-in-human clinical trial to test the safety of 
        a novel patient-specific iPSC therapy to treat the most common 
        form of Age-related Macular Degeneration, and the leading cause 
        of vision loss in the age 65+ population.
  --NIH-supported researchers continue to work toward strategies to 
        better prevent, identify, and treat pain and substance use 
        disorders through the HEAL (Helping to End Addiction Long-term) 
        Initiative. HEAL aims to support research into new, non-
        addictive medication and to establish public and private 
        partnerships to develop best practices in communities.
  --Today, treatments can suppress HIV to undetectable levels, and a 
        20-year-old HIV-positive adult living in the U.S. who receives 
        these treatments is expected to live into his or her early 70s, 
        nearly as long as someone without HIV.
  --The death rate for all cancers combined has declined in adults 
        since the early 1990s and since the 1970s for children. The 
        cancer death rate for men and women combined fell 32 percent 
        from its peak in 1991 to 2019, the most recent year for which 
        data were available.
    Sustaining Scientific Momentum Requires Sustained Funding Growth. 
The leadership and staff at NIH and its Institutes and Centers have 
engaged the broader community to identify emerging research 
opportunities and urgent health needs and to prioritize precious 
Federal dollars to areas demonstrating the greatest promise. Sustained 
robust increases in NIH funding are needed if we are to continue to 
take full advantage of these opportunities to accelerate the 
development of pioneering treatments and innovative prevention 
strategies.
    One long-lasting potential impact of investments in NIH is on the 
next generation of scientists. Sustained increases in NIH funding over 
the last 7 years have allowed NIH to more than double the investment in 
early stage investigators (ESIs). In 2015, NIH only funded about 600 
grants for ESIs and the career outlook for early career researchers 
seemed grim. In FY 2021, NIH was able to fund more than 1,500 grants 
for ESIs, reinvigorating the spirits of researchers in the biomedical 
workforce. Sustained increases are needed to allow NIH to continue 
support of new talent and innovation in medical research.
    Even with recent investments in NIH, nearly 4 of every 5 research 
ideas that are proposed to NIH every year cannot be funded. Additional 
funding is needed if we are to strengthen our Nation's research 
capacity, ensure a medical research workforce that reflects the racial, 
gender, and geographic diversity of our citizenry, and inspire a 
passion for science in current and future generations of researchers.
    NIH is Critical to U.S. Competitiveness. Our country still has the 
most robust medical research capacity in the world; however, other 
countries have significantly increased their investment in biomedical 
science, which leaves us vulnerable to the risk that talented medical 
researchers from all over the world may return to better opportunities 
in their home countries. We cannot afford to lose that intellectual 
capacity, much less the jobs and industries fueled by medical research. 
The U.S. has been the global leader in medical research because of 
Congress's bipartisan recognition of NIH's critical role. To continue 
our dominance, we must reaffirm this commitment to provide NIH the 
funds needed to maintain our competitive edge.
    NIH: An Answer to Challenging Times. Research supported by NIH 
drives local and national economic activity, creating skilled, high-
paying jobs and fostering new products and industries, and catalyzes 
increases in private sector investment. A $1 increase in public basic 
research stimulates an additional $8.38 investment from the private 
sector after 8 years. A $1 increase in public clinical research 
stimulates an additional $2.35 in private sector investments after 3 
years. According to a United for Medical Research report, in FY 2021, 
NIH-funded research supported more than 552,000 jobs across the U.S. 
and generated more than $94 billion in economic activity.
    The Ad Hoc Group's members recognize the tremendous challenges 
facing our Nation and acknowledge the difficult decisions that must be 
made to restore our country's fiscal health. Robust funding of the NIH, 
and strengthening our commitment to medical research, is a critical 
element in ensuring the health and well-being of the American people 
and our economy. Therefore, for FY 2023, the Ad Hoc Group for Medical 
Research recommends that NIH receive at least $49.048 billion in base 
funding to advance the foundational research NIH supports and continue 
the momentum in our Nation's investment in medical research, and that 
any funding for ARPA-H supplement our $49 billion recommendation for 
NIH's base budget, rather than supplant the essential foundational 
investment in the NIH.
                                 ______
                                 
             Prepared Statement of the Afterschool Alliance
    As you begin work on the Labor, Health and Human Services, and 
Education, and Related Agencies Appropriations bill for fiscal year 
2023, the Afterschool Alliance is joined by the organizations signing 
below in thanking you for increasing funding for the Nita M. Lowey 21st 
Century Community Learning Centers (21st CCLC) (Title IV Part B of the 
Every Student Succeeds Act) in fiscal year 2022, allowing an additional 
30,000 students to access quality afterschool, before-school and summer 
learning programs. The pandemic has shown how important robust 
afterschool and summer learning programs are to working families and 
our most vulnerable students, and how vital resources are to support 
these programs to ensure they are available and effective for the 
children who need them. With this in mind, we request that you support 
a funding level of $500 million for the 21st CCLC program in fiscal 
year 2023.
    Through the 21st CCLC initiative, which serves about 1.8 million 
students in all 50 States and the American territories, local school 
and community-based organizations provide students in kindergarten 
through 12th grade with a safe and supportive environment where they 
participate in academic enrichment opportunities, get excited about 
learning new things, and connect with caring mentors before school, 
afterschool, and during the summer months. 21st CCLC programs serve 
students attending high-poverty, low-performing schools, and prior to 
the COVID-19 pandemic, these programs were a vital source of support 
for underserved communities. Now, with students back in-person at 
school after having spent significant amounts of time out of the 
classroom since March 2020, feeling isolated from their teachers and 
peers, and in need of additional enrichment and learning opportunities, 
21st CCLC programs are more essential than ever.
    We are grateful that the American Rescue Plan Act (ARPA) included 
set-aside language allowing comprehensive afterschool and summer 
learning and summer enrichment programs to be eligible to receive 
emergency Covid-19 relief funds to help student recover missed 
instructional time; however, increased staffing and program costs as 
well as unprecedented demand for local afterschool programs have pushed 
programs to the brink. The most recent America After 3PM report from 
the Afterschool Alliance found an all-time high of 24.6 million 
children were unable to access a program, with cost and program 
availability as the leading factors.\1\ Additionally a fall 2021 survey 
of 1,000 afterschool program providers found that 54 percent had 
waiting lists, a significantly greater percentage than in the past.\2\ 
While ARPA funds for out of school time programs are focused on the 
specific challenges related to the pandemic and are primarily directed 
to local school districts; community based providers including 
nonprofit, faith-based, park and recreation, library, and other non-
school providers serving a wide range of vulnerable students continue 
to struggle to access the funding resources they need, with only 19 
percent of providers surveyed reporting the ability to access Federal 
Covid-19 relief funds.\3\
---------------------------------------------------------------------------
    \1\ America After 3PM, 2020 http://www.afterschoolalliance.org/
AA3PM/.
    \2\ Afterschool in the time of Covid-19 tinyurl.com/362ff68f.
    \3\ Ibid.
---------------------------------------------------------------------------
    Federal 21st CCLC formula grants to States enable rural, urban and 
suburban communities to leverage local resources by providing 3-5 years 
of funding to support local partnerships among community-based 
organizations, faith-based partners, private industry, and school 
partners (public, private, and charters). This funding infrastructure 
provided by 21st CCLC is foundation of afterschool and summer 
programming and enables communities to attract other partners and 
resources for students including access to mentors, new learning 
opportunities, nutritious snacks and meals, as well as helping address 
student mental health programs. Funds also are used for training, 
evaluation, and assistance to ensure quality programming is offered. 
While reflecting the needs of local communities, 21st CCLCs expand 
student access to activities and services designed to reinforce and 
complement the regular academic program, such as hands-on learning, 
physical activity, workforce development opportunities including 
gaining knowledge and skills in science, technology, engineering, and 
math (STEM), drug and violence prevention programs, counseling 
programs, the arts, and more.
    In addition, the outcomes of 21st CCLC funded afterschool and 
summer learning programs are undeniable. Over a span of 20 years, 
researchers have built an evidence base for quality and effectiveness 
by studying afterschool programs across the Nation. An independent 
report published in March 2019 and supported by the Wallace Foundation, 
reviewed research from 2000 to 2017 and found programs improved a wide 
range of outcomes including student attendance, achievement in 
mathematics and English; grade promotion and graduation rates, and 
student health and fitness. This research spans the country, all age 
groups and a wide variety of indicators of well-rounded student 
success. Furthermore, the most recent Department of Education national 
annual performance report found that 70 percent of students increased 
their rates of homework completion and class participation while 63 
percent of students improved their classroom behavior. Increasing 
funding for this proven program will continue to reap benefits in the 
communities where the 10,500 21st Century Community Learning Centers 
currently thrive.
    We thank you for your continued support of afterschool and summer 
learning programs, and for your work on behalf of children and working 
families. We ask that the Labor, Health and Human Services, Education, 
and Related Agencies subcommittees ensure that the Nita M. Lowey 21st 
Century Community Learning Centers Program remains a vital resource to 
students and families moving forward. Contact Information: Erik 
Peterson, Afterschool Alliance [email protected].

Signed:
    Afterschool Alliance
    After-School All-Stars
    AlphaBEST Education, Inc.
    America SCORES
    Boys & Girls Clubs of America
    Camp Fire National
    Children's Defense Fund
    City Year, Inc.
    Collaborative for Academic, Social and Emotional Learning (CASEL)
    Committee for Children
    Communities In Schools
    Council of Administrators of Special Education
    EDGE Consulting Partners
    Every Hour Counts
    Food Research & Action Center
    Forum for Youth Investment
    Foundations, Inc
    Girls Inc.
    Institute for Educational Leadership
    integrate opportunity, LLC
    KP Catalysts, LLC
    MENTOR
    National AfterSchool Association
    National Alliance for Public Charter Schools
    National Association of Elementary School Principals
    National Association of School Psychologists
    National Association of Secondary School Principals
    National Girls Collaborative
    National Summer Learning Association
    National Urban League
    National Recreation and Park Association
    Outward Bound USA
    Public Advocacy for Kids (PAK)
    Save the Children
    Search Institute
    UnidosUS
    YMCA of the USA

State and Local Organizations
Alaska Afterschool Network AK
Alaska Children's Trust AK
California School-Age Consortium CA
A WORLD FIT FOR KIDS! CA
EduCare Foundation CA
MENTOR California CA
California Teaching Fellows Foundation CA
California AfterSchool Network CA
EDMO (Edventure More) CA
Minga Education Group CO
Onward! CO
MENTOR Colorado CO
Scholars Unlimited CO
Sims-Fayola Foundation CO
YMCA of Metropolitan Denver CO
Academy of Arts and Knowledge CO
Riverside Educational Center CO
Brady High School CO
Project Dream with the Lake County School District CO
School Community Youth Collaborative CO
WeldRE5J--Milliken Elementary CO
Pagosa Arts Initiative CO
Boys & Girls Clubs of Pueblo CountyCO
EdAdvance CT
Prime Time Palm Beach County FL
Communities In Schools of Georgia GA
Georgia Statewide Afterschool Network GA
Voices for Georgia's ChildrenGA
We Love Buford Highway GA
Parents And Children Together HI
Iowa Afterschool Alliance IA
Girl Scouts of Silver Sage Council ID
After School MattersIL
ACT Now IL
Brighton Park Neighborhood CouncilIL
Chinese American Service League IL
Fight Crime: Invest in Kids, Illinois IL
ReadyNation, Illinois IL
AYS--At Your School IN
Boys & Girls Clubs in Indiana, Inc. IN
Indiana Alliance of Boys & Girls Clubs IN
Kentucky Out of School Alliance KY
Covington Partners KY
Kentucky/West Virginia Alliance of YMCAs KY
Maryland Out of School Time Network MD
Maine Mathematics and Science Alliance ME
KYD Network MI
Youth Development Resource CenterMI
Michigan Afterschool Association MI
Michigan's ChildrenMI
MENTOR Minnesota MN
YouthPrise MN
MENTOR North Carolina NC
Girls Inc. of Santa Fe NM
New York State Network for Youth Success NY
Ohio Afterschool Network C/O PAST Foundation OH
The Opportunity Project OK
Tula Public Schools OK
MENTOR Independence Region PA
North End OutreachRI
MENTOR Rhode Island RI
ALPHAS RI
South Carolina Alliance of YMCAs SC
South Dakota Afterschool Network SD
United Way of West Tennessee TN
Girls Incorporated of Kingsport TN
Greater Kingsport Family YMCA TN
United Way of Greater Kingsport TN
United Way of Wilson County and the Upper Cumberland TN
Memphis Music Initiative TN
MENTOR Memphis Grizzlies TN
Tennessee Afterschool Network TN
United Ways of Tennessee TN
Backfield in Motion TN
Nashville After Zone Alliance/Nashville Public Library TN
Nations Ministry Center TN
YMCA of Middle Tennessee TN
YMCA Y-Quest TN
Dallas Afterschool TX
BEACON Afterschool Program UT
Utah Afterschool Network, Inc. UT
Virginia Partnership for Out-of-School Time (VPOST) VA
MENTOR Virginia VA
MENTOR Vermont VT
Vermont Afterschool VT
Mentor Washington WA
FuturesNW WA
Empowering Youth Mentor Program WA
Communities In Schools of Washington State WA
Joyce L. Sobel Family Resource Center WA
Change the Narrative WA
Mentor Washington WA
Lopez Island Family Resource Center WA
Big Brothers Big Sisters of Southwest WA
Hey MentorWA
Youth Development Executives of King County WA
School's Out Washington WA
Youth in Focus WA
Circle Faith Future WA
Youth Rise of Washington WA
     
                                 ______
                                 
                Prepared Statement of The AIDS Institute
    Dear Chairwoman Murray and Members of the subcommittee:
    The AIDS Institute, a national public policy, research, advocacy, 
and education organization, is pleased to offer testimony in support of 
domestic HIV and viral hepatitis programs in the FY 2023 Labor, Health 
and Human Services, Education, and Related Agencies (L-HHS) 
appropriation measure. This year's L-HHS bill is more important than 
ever, as it will set up critical funding streams to help rebuild and 
reinvest in programs combatting HIV and viral hepatitis. As you craft 
the FY 2023 L-HHS appropriations bill, we urge you to significantly 
increase funding for core public health programs that treat and prevent 
HIV and viral hepatitis in the United States, as well as fund newer 
programs that seek to end the HIV and viral hepatitis epidemics. These 
programs, many of which are a part of the safety net health system, are 
key to ending these epidemics and protecting our Nation from future 
infectious disease pandemics.
                        hiv in the united states
    Approximately 1.2 million people are living with HIV in the U.S. 
Since the height of the epidemic, there have been tremendous 
advancements in HIV treatment and prevention. Today, HIV can be treated 
as a chronic health condition, and when that treatment is successful, 
it renders HIV untransmissible. People living with HIV who are able to 
get and stay in treatment can live a near normal life span, despite the 
impact of the virus. The toolbox for HIV prevention has grown 
substantially, with daily and now long-acting pre-exposure prophylactic 
(PrEP) medications in addition to traditional prevention techniques, 
such as condoms and syringe service programs. Despite these advances, 
progress toward ending the HIV epidemic has plateaued, with 
approximately 38,000 new infections each year since 2013.
    The progress made to date has been inequitable, as demonstrated by 
the fact that three quarters of new HIV infections now occur among 
people of color. Federal programs to prevent and treat HIV must address 
the racial and ethnic disparities that contribute to this greater risk, 
and Congress must invest new resources in innovative and effective 
prevention and treatment programs to end the HIV epidemic as a matter 
of racial justice.
    Congress must invest new resources in innovative and effective 
prevention and treatment programs to end the HIV epidemic. These new 
resources must support programs in communities that bear the greatest 
risk and impact of HIV. Ending the HIV epidemic has become a matter of 
racial justice.
                   ending the hiv epidemic initiative
    The Ending the HIV Epidemic Initiative (EHE), which began in 2019, 
is focused on reducing new HIV infections by 90 percent over 10 years. 
In the last 3 years, your Committee provided $260 million, $404 
million, and $473 million respectively for the EHE Initiative. 
Resources are focused on 57 jurisdictions with the greatest share of 
HIV incidence, enabling these jurisdictions to craft and implement 
community-specific plans to reduce the spread of HIV. HRSA's EHE 
funding for Community Health Centers has already shown promising 
results, with over 389,000 new PrEP prescriptions for people at risk 
for HIV. Through this funding the Ryan White Program engaged over 
19,000 people in HIV care during 2020. With greater funding and 
continued commitment from the Biden Administration to grow the EHE 
Initiative, The AIDS Institute believes this nation can make 
significant progress toward the goal of ending the HIV epidemic.
    We urge you to fund year four of the EHE Initiative at the 
following levels: $310 million for the CDC Division of HIV/AIDS 
Prevention to conduct targeted testing, connection to treatment, and 
robust surveillance; $290 million for the Ryan White HIV/AIDS Program 
to increase access to high-quality HIV care and treatment; $172 million 
for HRSA's Community Health Center program to provide prevention 
services emphasizing PrEP; $26 million for NIH's Centers for AIDS 
Research to provide best practices to guide the plan; and $52 million 
for the Indian Health Service to provide HIV prevention, treatment, 
education, and hepatitis C (HCV) elimination in Native American 
communities.
                           cdc hiv prevention
    CDC's Division of HIV Prevention focuses resources on those 
populations and communities most affected by investing in high-impact 
prevention. Through partnerships with State and local public health 
departments and community-based organizations, the CDC has expanded 
targeted prevention programs that work to address racial and geographic 
health disparities. There is no single way to prevent HIV, but 
jurisdictions use a combination of effective evidence-based approaches 
including testing, linkage to care, education, condoms, syringe service 
programs, and PrEP. We urge the subcommittee to fund CDC's HIV 
Prevention program at $1.233 billion, including $100 million for 
school-based HIV prevention efforts and $310 million for the Ending the 
HIV Epidemic Plan.
                    the ryan white hiv/aids program
    The Ryan White HIV/AIDS Program provides medications, medical care, 
and essential coverage completion services to almost half of all people 
living with HIV in the United States, many of whom are uninsured or 
underinsured. The Ryan White Program successfully engages individuals 
in care and treatment, increases access to HIV medications, and helps 
nearly 90 percent of clients achieve viral suppression (which is 
critical for HIV prevention, because people who have achieved viral 
suppression cannot transmit HIV to others). The cost of medical care 
has consistently increased over the last decade, yet Ryan White 
programs have not received increased funding. Because of this, flat 
funding is essentially a cut to Ryan White programs.
    The AIDS Institute requests that the subcommittee fund the Ryan 
White HIV/AIDS Program at a total of $2.942 billion in FY 2023, 
distributed in the following manner: Part A at $751.1 million; Part B 
(Care) at $509.4 million; Part B (ADAP) at $968.3 million; Part C at 
$231 million; Part D at $85 million; Part F/AETC at $58 million; Part 
F/Dental at $15.4 million; and Part F/SPNS at $34 million; Ending the 
HIV Epidemic Plan at $290 million.
                        minority aids initiative
    As racial and ethnic minorities in the U.S. are disproportionately 
impacted by HIV/AIDS, it is critical that the subcommittee continue to 
fund the Minority HIV/AIDS Fund and Minority AIDS programs at SAMHSA. 
We urge the subcommittee to appropriate $105 million for the Minority 
HIV/AIDS Fund; and $160 million for SAMHSA's Minority AIDS Initiative 
Program.
                        pre-exposure prophylaxis
    This year will mark the ten-year anniversary of FDA approving the 
first medication for PrEP, potentially the greatest advent in the fight 
to prevent HIV. Despite the tremendous promise of PrEP, it is severely 
underutilized. Of the estimated 1.2 million people who could benefit 
from PrEP, only 23 percent have a prescription. Among racial and ethnic 
minorities, only 16 percent of Hispanic/Latino people and 9 percent of 
Black people who could benefit from PrEP have a prescription. This 
stark divide must be addressed if we are to end the HIV epidemic.
    President Biden's FY 2023 Budget Request included a proposal for a 
10-year, $9.8 billion mandatory program to provide PrEP at no cost for 
un-and-underinsured people and develop a comprehensive provider network 
to ensure that we fill the large gaps in PrEP coverage. A national PrEP 
program is desperately needed, and it must start right away by 
increasing funding for Community Health Centers, CDC-funded health 
departments, and HHS grantees to establish and expand PrEP programs in 
places where PrEP uptake is low. But to overcome barriers to PrEP 
uptake, we also urge the Committee to task and fund HHS with creating a 
national PrEP program based on the President's proposal, with input 
from the HIV community. This program should ensure that cost is not a 
barrier to PrEP; that people have access to the suite of PrEP services 
required to maintain a prescription; that providers and people at risk 
for HIV know about PrEP and how to get it; and it should combat the 
misinformation and stigma that impede demand for PrEP.
                       viral hepatitis in the u.s
    Viral hepatitis continues to have a dramatic impact on the health 
of some of the Nation's most vulnerable communities and show no signs 
of abating as lack of sterile equipment among people who use drugs 
creates perfect conditions for the viruses to thrive. There are highly 
effective vaccines to prevent hepatitis A (HAV) and B (HBV), yet cases 
of HAV have increased 1,300 percent since 2015 and the number of new 
cases of HBV have stubbornly plateaued for the past decade. CDC 
estimates there were 57,800 new HCV cases in 2019, with 70 percent of 
those cases a result of drug use. Since 2010, the country has 
experienced a nearly 500 percent increase in new HCV cases.
    Of the nearly 5 million people now living with HBV and/or HCV in 
the U.S., as many as 65 percent are not aware of their infection. Left 
untreated, viral hepatitis causes liver damage, liver disease, cancer, 
and death. It also contributes to or exacerbates other serious and 
chronic conditions, increasing health care costs. We also expect to see 
even greater increases in viral hepatitis cases when data become 
available for 2020, as we know that many state public health systems 
were unable to maintain outreach, testing, and treatment services for 
viral hepatitis while also battling COVID-19, and many harm reduction 
programs were also unable to operate at full capacity during the 
pandemic. With so many Americans impacted by viral hepatitis, it is 
imperative the evidence-based prevention, testing, surveillance, and 
treatment programs have the resources they need to protect the 
country's health.
             infectious disease impact of the opioid crisis
    The recent explosion of opioid use has created tremendous risk for 
viral hepatitis and HIV outbreaks and increasing infection rates among 
new groups and undoing progress toward curbing transmissions. The 
COVID-19 pandemic has caused another surge in injection drug use, with 
2020 having the highest overdose death total on record. The systems 
built to respond to HIV and viral hepatitis are well poised to conduct 
outreach, engagement, and early intervention services with individuals 
who use drugs. A comprehensive response to the opioid epidemic must 
include infectious disease prevention efforts to reduce the infectious 
disease consequences of the epidemic. Starting in FY19, Congress 
allocated new funding to surveil, prevent and treat infectious diseases 
commonly associated with injection drug use, including viral hepatitis 
and HIV. We urge the subcommittee to appropriate $150 million for the 
CDC's infectious diseases and opioid epidemic efforts.
                     cdc viral hepatitis prevention
    CDC's Viral Hepatitis program is the lead agency combating viral 
hepatitis at the National level by providing important technical 
assistance and funding to the States. The division is currently funded 
at only $41 million and has received only minor increases over the past 
decade. Current funding is nowhere near what is needed for a national 
viral hepatitis program focused on decreasing mortality and reducing 
the spread of the disease. We have the tools to prevent this growing 
epidemic, laid out in the Viral Hepatitis National Strategic Plan for 
the United States: A Roadmap to Elimination (2021--2025). However, only 
with a significant investment can there be an adequate level of 
testing, education, screening, treatment, surveillance, and on-the-
ground syringe service programs needed to reduce new infections and put 
the U.S. on the path to eliminate hepatitis as a public health threat. 
This year, we request that the subcommittee appropriate $140 million to 
the CDC to address the rise in viral hepatitis and combat the 
infectious diseases consequences of drug use.
                        syringe service programs
    Syringe service programs (SSPs) are a critical tool in the fight to 
end the drug use epidemic and eliminate viral hepatitis. These 
important public safety programs reduce the spread of infectious 
disease, prevent overdose deaths, and connect clients to infectious 
disease and substance use treatment. The presence of SSPs has been 
associated with a 50 percent decline in new HIV and viral hepatitis 
incidence, and when combined with medication-assisted treatment, there 
is a two-thirds reduction in HIV and HCV transmission. Extensive 
research shows that these programs save money and that they do not 
increase drug use. But there are not enough SSPs to meet the growing 
need, and appropriations language prohibiting them from using Federal 
funds to purchase sterile syringes makes it difficult for many programs 
to meet their biggest expense. We urge your subcommittee to increase 
funding for SSPs and to remove all restrictions on Federal funding for 
syringe service programs, including for the purchase of sterile 
syringes.
    Thank you for your consideration of this written testimony. If you 
have questions or would like to discuss these issues further, please do 
not hesitate to contact Nick Armstrong at [email protected] or 
Frank Hood at [email protected].

    [This statement was submitted by Rachel Klein, Deputy Executive 
Director, The AIDS Institute.]
                                 ______
                                 
                   Prepared Statement of AIDS United
    Dear Chairwoman Murray, and Ranking Member Blunt:
    As the subcommittee continues its important deliberations on the 
Fiscal Year (FY) 2023 Labor, Health and Human Services, Education, and 
Related Agencies (Labor-HHS) appropriation bill, we thank you for your 
commitment to ending the HIV/AIDS epidemic in the United States and 
request that you increase the Federal Government's financial commitment 
to meet the goals of the Federal ending the epidemic initiative and 
support safety net programs that protect the public health.
    Our scientific knowledge of HIV treatment, prevention and 
epidemiology has never been stronger, but progress, until recently, has 
stalled. Over the past 4 years, a concerted effort to target resources 
where they can be most effective has occurred through the Ending the 
HIV Epidemic Initiative (EHE Initiative), which has the goal of 
reducing new HIV infections by 90 percent by 2030. Additionally, an 
updated National HIV/AIDS Strategy was recently released that expands 
upon and continues the bipartisan commitment to a whole-of-society 
approach addressing the HIV epidemic in the United States. We urge 
Congress to capitalize on the expertise developed by communities as 
part of the EHE Initiative so that we can improve and grow the 
Initiative. Ending HIV by 2030 is possible, but resources are needed to 
achieve this goal.
    Over the past 2 years, the COVID-19 pandemic has shone a light on 
the impact of decades of underfunding our Nation's public health 
infrastructure, resulting in an inadequate response to an incredibly 
destructive pandemic. But, at the same time, it has shown what is 
possible when we come together to confront a significant public health 
crisis with the energy and resources that are required. Below are 
detailed domestic HIV funding requests that we join our coalition 
partners in the Federal AIDS Policy Partnership in urging the committee 
to include in the fiscal year 2023 appropriations bills. A chart 
detailing each request as well as previous fiscal year funding levels 
for each program is available here: http://federalaidspolicy.org/fy-
abac-chart/.
                   ending the hiv epidemic initiative
    Over the last 3 years, on a bipartisan basis, Congress has 
appropriated additional funding for the Ending the HIV Epidemic 
Initiative, which looks to reduce new HIV infections by 50 percent by 
2025, and 90 percent by 2030. We ask Congress to increase funding in FY 
2023 for the Ending the HIV Epidemic Initiative by at least the amounts 
listed below in the following divisions:
  --$310 million for CDC Division of HIV/AIDS Prevention for testing, 
        linkage to care, and prevention services, including pre-
        exposure prophylaxis (PrEP) (+$115 million);
  --$290 million for HRSA Ryan White HIV/AIDS Program to expand 
        comprehensive treatment for people living with HIV (+$165 
        million);
  --$172 million for HRSA Community Health Centers to increase clinical 
        access to prevention services, particularly PrEP (+$50 million)
                    the ryan white hiv/aids program
    The Ryan White Program provides comprehensive care to populations 
disproportionately impacted by the HIV epidemic. Over three quarters of 
Ryan White clients are racial and ethnic minorities, and nearly two 
thirds are under the Federal poverty level. With 88 percent of Ryan 
White clients achieving viral suppression, the program has a proven 
track record of success.
    The Ryan White Program provides services critical to managing HIV, 
often inadequately covered by insurance, including case management; 
mental health and substance use services; adult dental services; and 
transportation, legal, and nutritional support services. Many Ryan 
White Program clients live in States that have not expanded Medicaid 
and must rely on the Ryan White Program as their only source of HIV/
AIDS care and treatment. While increasingly clients have access to 
insurance, patients still experience cost barriers, such as high 
premiums, deductibles, and other patient cost sharing. The Ryan White 
Program, particularly the AIDS Drug Assistance Program (ADAP), assists 
with these costs.
    Currently ADAPs are experiencing increased demand, particularly as 
people have lost health coverage and incomes due to the economic impact 
of COVID-19 and State and local budgets have been increasingly 
stressed. We urge Congress to fund the Ryan White HIV/AIDS Program at a 
total of $2.942 billion in FY 2023, an increase of $447.5 million over 
FY 2022, distributed in the following manner: Part A: $751.1 million, 
Part B (Care): $509.4 million, Part B (ADAP): $968.3 million, Part C: 
$231 million, Part D: $85 million, Part F/AETC: $58 million, Part F/
Dental: $15.4 million, Part F/SPNS: $34 million, EHE Initiative: $290 
million;
                        cdc prevention programs
CDC HIV Prevention and Surveillance
    Increasing funding for high-impact, community focused HIV 
prevention services has proven to result in a strong return on 
investment. Not only are these prevention tools effective at halting 
new HIV infections, but in the long term they result in decreased 
lifetime medical costs that are associated with HIV treatment. HIV 
prevention tools that meet the special prevention needs of these 
populations must be expanded.
    The CDC's Division of HIV Prevention is the Federal leader in 
creating innovative strategies for HIV prevention. Through partnerships 
with State and local public health departments and community-based 
organizations, the CDC has expanded targeted, high-impact prevention 
programs that address racial and geographic health disparities. We urge 
you to fund the CDC Division of HIV Prevention at $822.7 million in FY 
2023, an increase of $67.1 million over FY 2022. This is in addition to 
the $310 million for EHE Initiative work within the Division.
CDC Infectious Diseases and Opioid Epidemic Funding
    The United States is in the midst of an unprecedented and horrific 
overdose crisis. Last year, over 100,000 Americans lost their lives to 
overdose. At the same time, HIV transmissions among people who use 
drugs have risen over the past 5 years and viral hepatitis transmission 
among people who inject drugs continues to skyrocket. Combatting the 
overdose crisis requires significant and sustained support for 
evidence-based harm reduction interventions, particularly for Syringe 
Services Providers (SSPs), who are the first responders to the overdose 
and infectious disease crisis and effectively help prevent drug 
overdoses and new HIV and hepatitis infections. Harm reduction workers 
have the knowledge, contacts, and ability to reach people who use 
drugs; they provide naloxone and other overdose prevention resources; 
and they connect people to medical care and support. And the CDC's 
Opioid Related Infectious Diseases program is best situated to support 
harm reduction programs and spearhead funding our syndemic approach to 
ending the overdose, HIV and viral hepatitis crises.
    We urge you to fund the CDC's Infectious Diseases and Opioid 
Epidemic program in FY 2023 at the $150 million, an increase of $132 
million over fiscal year 2022.
Syringe Services Programs
    The Department of Health and Human Services, relying on the results 
of multiple studies, States that syringe service programs (SSPs) are a 
proven, evidence-based, and effective tool in HIV and hepatitis 
prevention. Beyond providing access to sterile syringes, SSPs prevent 
overdose, connect people to substance use treatment, HIV and hepatitis 
testing, and other supportive services. SSPs have also been providing 
COVID-19 related services to vulnerable populations during the 
pandemic. The FY 2022 omnibus continued a harmful policy rider that 
restricts the use of Federal funds for the purchase of sterile 
syringes, which negatively impacts the ability of State and local 
public health groups from expanding SSPs.
    We urge you to remove all restrictions on Federal funding for 
syringe service programs in those jurisdictions that are experiencing 
or at risk for a significant increase in HIV or hepatitis infections 
due to injection drug use.
Pre-Exposure Prophylaxis
    Pre-exposure prophylaxis, or PrEP, is a medication that effectively 
prevents HIV transmission when taken as prescribed. The first PrEP 
medication was approved by the FDA 10 years ago, and now there are 
multiple medications available, including generic medications and a new 
long-acting injectable version of PrEP. Increasing access to PrEP has 
been a key strategy in ending the HIV epidemic, yet more progress must 
be made.
    It is estimated that only 23.4 percent of people who could benefit 
from PrEP have received a prescription. PrEP coverage is highest among 
white people, at 63.3 percent, yet only 8.2 percent of black people and 
14 percent of Hispanic/Latino people who could benefit from PrEP in the 
United States are on a prescription. Additionally, PrEP coverage among 
women is only at 9.7 percent.
    We are thankful that there has been an increased focus on PrEP both 
in Congress and from President Biden. In his FY 2023 Budget Request, 
President Biden called for a new mandatory funding program to expand 
PrEP across the United States through providing medication to un and 
under insured individuals, as well as supporting and expanding PrEP 
programs across a variety of agencies. Additionally, there is a bill in 
Congress seeking to increase insurance coverage of PrEP and ancillary 
services (S. 3295) and a bill which seeks to provide grants to HHS 
entities to expand PrEP programs throughout the U.S. (H.R. 5605).
    As Congress moves through the regular appropriations cycle, we urge 
you to support funding for new and innovative programs to expand PrEP 
access, and ensure that those who want PrEP can easily access the 
medication without any costs or barriers.
Minority HIV/AIDS Initiative (MAI)
    Racial and ethnic minorities in the U.S. are disproportionately 
impacted by HIV/AIDS. African Americans, more than any other racial/
ethnic group, continue to bear the greatest burden of HIV in the U.S. 
Three out of four new HIV infections occur among people of color.
    The Minority HIV/AIDS Fund supports cross-agency demonstration 
initiatives to support HIV prevention, care and treatment, and outreach 
and education activities across the Federal Government. MAI programs at 
the Substance Abuse and Mental Health Administration target specific 
populations and provide prevention, treatment, and recovery support 
services, along with HIV testing and linkage service when appropriate, 
for people at risk of mental illness and/or substance abuse. We urge 
you fund the Minority HIV/AIDS Fund at $105 million, and SAMHSA's MAI 
program at $160 million in FY 2022, an increase of $48.1 million and 
$44 million over FY 2021 levels, respectively. We also urge you to fund 
Minority AIDS Initiative programs across HHS agencies at $610 million 
in FY 2023.
    We thank you for your continued leadership and support of these 
critical programs for so many people living with HIV, and the 
organizations and communities that serve them nationwide.
    Please do not hesitate to be in touch for more information 
regarding HIV appropriations with our Director of Advocacy Drew Gibson, 
at [email protected].
    Sincerely.

    [This statement was submitted by Carl Baloney, Jr., Vice President 
& Chief 
Advocacy Officer, AIDS United.]
                                 ______
                                 
   Prepared Statement of the Alliance to End Slavery and Trafficking
    The Alliance to End Slavery and Trafficking (ATEST) thanks you for 
your leadership in the fight to end child labor, forced labor and human 
trafficking. We appreciate your efforts to pass legislation and provide 
resources to Federal agencies engaged in combating these horrific 
crimes. Due to underlying vulnerabilities, those most at risk of, and 
victim to, trafficking and exploitation will experience 
disproportionate impacts as a result of COVID-19 in the short, medium, 
and long-term. With this in mind, we seek your assistance in funding 
essential programs in the fiscal year 2023 Labor, Health and Human 
Services, Education, and Related Agencies Appropriations bill. The 
number of trafficking victims significantly exceeds the availability of 
services at the Departments of Labor (DOL), Health and Human Services 
(HHS) and Education (ED). ATEST recommends robust funding and 
accountability for programs at these key departments to fulfill the 
highest priority mandates of the Trafficking Victims Protection Act of 
2000 and subsequent reauthorizations (TVPA) and related legislation.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


                          department of labor
    International Labor Affairs Bureau: $168,000,000.--We request 
$168,000,000 for the Bureau of International Labor Affairs (ILAB) in 
the Department of Labor (DOL). Specifically, we request $27,000,000 for 
the administration of ILAB, $70,000,000 for the Child Labor and Forced 
Labor program, $48,000,000 for Workers' Rights Programs, and 
$23,000,000 for program evaluation.
    ILAB is an essential part of the U.S. government's international 
response to forced labor, human trafficking, and child labor. It is 
responsible for implementing Section 105(b)(2) of the TVPRA of 2005 
(Public Law109-164) and Section 110 of the TVPRA of 2008 (Public 
Law110-457). In the past, these requirements have not been funded. 
Funding provided would allow ILAB to fulfill its Congressional mandates 
including: producing annual findings on worst forms of child labor in 
certain U.S. trade beneficiary countries; the development and 
maintenance of a list of goods produced by child or forced labor, 
including inputs to goods made with child or forced labor; and 
increased responsibilities in enforcing the U.S. Mexico Canada 
Agreement (USMCA). Adequate funding will ensure that staff is able to 
travel to the countries with which ILAB has partnered or where 
important research is needed to accurately maintain the list of goods 
made with forced labor or child labor. In addition, a robust and 
expertly staffed entity within the U.S. government's foreign policy 
establishment--that sits outside of the diplomatic constraints of the 
State Department and focuses particularly on worker rights--is 
tremendously important to the government's ability to tackle human 
trafficking and address the underlying factors that place individuals 
at risk of trafficking.
    We request $48,000,000 for Workers' Rights Programs because they 
are essential to maintaining coherence with the U.S. trade agenda. ILAB 
provides technical assistance to countries on a variety of worker 
rights issues, many of which correspond directly to labor rights 
commitments under trade agreements. Project goals include adopting or 
reforming labor laws or standards, improving labor inspectorates' 
enforcement capacity, increasing awareness of fundamental labor rights, 
and improving occupational safety and health conditions. ILAB also 
provides technical advice and other support to labor ministries through 
workshops and exchange programs and hones in on areas of particular 
concern including the cocoa and fishing sectors as well as other supply 
chains with heightened risks of child labor or forced labor.
    Employment and Training Administration: $5,000,000.--The Department 
of Labor Employment and Training Administration (ETA) should conduct a 
review of all employment readiness, training, and other discretionary 
programs, and revise program guidance as needed to explicitly include 
eligibility for trafficking victims where possible, per Sec. 107(b) of 
the Trafficking Victims Protection Act (Public Law 106-386). The 
requested funds should be used to develop and implement a pilot grant 
program to deliver trauma-informed employment and training services 
that address particular barriers to service, and challenges to finding 
employment, faced by survivors of human trafficking. The U.S Advisory 
Council on Human Trafficking highlighted the need to provide access to 
employment and training programs to all survivors of human trafficking. 
In their inaugural report, released in 2016, the council noted that 
``...after leaving their trafficking situations, survivors [...] can 
find it difficult to live financially independent. Career development 
programs help survivors become self-sufficient and provide for their 
families. When survivors are employed, it positively affects their 
lives and prevents dependence on public benefits.'' We also recommend 
that the DOL integrate training to identify potential signs of 
trafficking and referral options as a regular activity for State 
Farmworker Monitor Advocates, and during the provision of relevant 
services to particular at-risk populations, including through the Youth 
Build, Job Corps and Reentry Employment Opportunity programs.
    Employment and Training Administration: Report Language.--Labor 
trafficking affects both U.S. citizens and foreign nationals working 
across many industries, most commonly domestic work, agriculture, 
manufacturing, janitorial services, hotel services, construction, 
health and elder care, hair and nail salons, and strip club dancing. 
DOL needs resources to protect and support victims, particularly with 
much needed skills training and job placement services, as well as 
providing referrals to shelter, medical care, mental health services, 
legal services, and case management. ATEST members have also worked 
with human trafficking survivors who were forced to engage in criminal 
acts of labor, including forced activities related to gangs, weapons 
and narcotics. Victims impacted by this form of labor trafficking also 
require additional legal services in the realms of criminal law and 
immigration.
    Proposed Report Language: The Committee encourages the Employment 
and Training Administration to increase access and eligibility to 
employment and training services for survivors of all forms of human 
trafficking as required by Sec. 107(b) of the Trafficking Victims 
Protection Act (Public Law 106-386). The Committee also encourages the 
development and integration of training to identify potential signs of 
trafficking and referral options as a regular activity for State 
Farmworker Monitor Advocates, and during the provision of relevant 
services to particular at-risk populations, including through the Youth 
Build, Job Corps and Reentry Employment Opportunity programs. The 
Committee also encourages the Department to continue and expand its 
pilot initiative to develop and support networks of service providers 
in collaboration with HHS and DOJ.
                department of health and human services
    Administration for Children and Families, Victim Services (ACF): 
$50,000,000.--ACF fulfills mandates of the Trafficking Victims 
Protection Act to (1) Identify and serve victims who are foreign 
nationals; and (2) Create specialized case management programs to 
assist U.S. citizen victims. The number of trafficking victims 
certified as needing comprehensive, trauma-informed, gender-specific 
services has risen dramatically but funding for services has not kept 
pace. Additionally, funding increases for victim services programs 
under HHS have never matched the increases provided to programs under 
DOJ. Both programs are essential to effectively assist victims and 
survivors and we encourage parity in funding for both programs. While 
HHS departments have worked efficiently with limited resources to 
support service providers, further funding would allow HHS to fulfill 
legislated and related needs of victims more fully. We encourage ACF to 
use a portion of increased funding for legal services for victims. We 
request that increased funds be utilized equally for services for both 
foreign national victims and U.S. citizen and legal permanent resident 
victims, consistent with demonstrated need.
    Service providers across the country have noted a significant 
increase in the services required by victims and survivors during the 
COVID-19 crisis. Data from one ATEST member organization providing 
services showed a 556 percent increase in emergency response cases to 
escaping survivors since 2019 at the start of the pandemic. 
Furthermore, this service provider has experienced a 455 percent 
increase in costs for basic necessities. A survey conducted by the OSCE 
Office for Democratic Institutions and Human Rights and the United 
Nations Entity for Gender Equality and the Empowerment of Women (the 
``OSCE ODIHR Survey'') confirms the increased needs of service 
providers to effectively assist victims during the pandemic. The crisis 
has heightened vulnerabilities to exploitation and required providers 
to work with limited resources to provide expanded services. We have 
seen unprecedented unemployment rates and significantly heightened 
client financial needs in all areas. Both trafficking victims currently 
receiving services and those newly seeking services have shown an 
increased need for direct assistance to pay for basic necessities like 
food and shelter. With the pandemic impacting employment opportunities 
in all industries where human trafficking survivors have formerly 
sought employment and stability, we expect a significant increase in 
the coming years in the need for sustained comprehensive services for 
all survivors for longer periods of time. Specifically, data from the 
National Human Trafficking Hotline showed that in April 2020, the 
number of crisis trafficking situations increased by more than 40 
percent and the number of situations in which people needed immediate 
emergency shelter nearly doubled. We therefore request an increase in 
funds in fiscal year 2023 to $50,000,000, which will help keep up with 
the expected needs of trafficking victims and their family members. 
Relatedly, we also request that any portion of these funds that 
currently operate under a match requirement are exempted from the 25 
percent non-federal funding match requirement for fiscal year 2023.
    Administration for Children and Families, the National Human 
Trafficking Hotline: $6,000,000.--The National Human Trafficking 
Hotline (``Trafficking Hotline'') is a toll-free 24/7 center available 
to answer calls, text messages, online tips and email queries. The 
Trafficking Hotline connects victims with anti-trafficking services in 
their area (such as shelter, case management, and legal services), 
collects tips on human trafficking cases, and, where appropriate, 
reports actionable tips to law enforcement. The Trafficking Hotline 
serves both domestic and foreign victims inside the U.S. In fiscal year 
2021, the National Human Trafficking Hotline received 13,450 signals 
from victims and survivors themselves, a 26 percent increase from 
fiscal year 2019. The significant increase in signals from victims and 
survivors underscores what an important and trusted resource the 
hotline has become for people experiencing trafficking.
    As efforts to increase awareness, training, and education of the 
public and key industries on human trafficking generally and the 
National Human Trafficking Hotline specifically have succeeded, call 
volume on the hotline has increased thirty-fold since its inception in 
2007. From fiscal year 2019 to fiscal year 2021 the hotline has 
experienced a whopping 60 percent increase in total signal volume. 
Given the disruptive impact of the COVID-19 pandemic on social, 
economic, and health outcomes, call volume will continue to steadily 
increase throughout fiscal year 2023 and beyond. We request $6,000,000 
in fiscal year 2023 to support the National Human Trafficking Hotline 
to continue to meet the needs of victims and survivors of human 
trafficking.
    Administration for Children and Families, Runaway and Homeless 
Youth Act: $300,000,000.--We request a total of $300,000,000 for ACF to 
implement the Runaway and Homeless Youth Act (RHYA) programs, Title III 
of the Juvenile Justice & Delinquency Prevention Act. This is the 
amount to be included in the most recently introduced bill to fully 
reauthorize RHYA, the Runaway and Homeless Youth and Trafficking 
Prevention Act of 2021. RHYA programs have been chronically underfunded 
since its inception, despite these programs costing less than other 
systems that many youth experiencing homelessness and survivors of 
trafficking encounter. Everyone should have the opportunity to succeed 
regardless of their start in life, but young people who are trafficked 
and youth experiencing homelessness are not plugged into the networks, 
resources, and supports they need for healthy development.
    RHYA programs prevent trafficking, identify survivors, and provide 
housing and services to runaway, homeless, and disconnected youth. RHYA 
has been a necessary bridge for our youth, but more recently, it has 
supported us to meet the unprecedented need for safe and stable housing 
and supportive services for homeless youth. The COVID-19 pandemic 
significantly increased children and youth homelessness due to high 
unemployment, unstable living conditions, and job insecurity. Some of 
our sites, such as Covenant House Missouri, saw their waiting lists 
double.
    In a typical year, 4.2 million young people (ages 13-25) experience 
homelessness annually, including 700,000 unaccompanied youth ages 13 to 
17. Recent data from the National Human Trafficking Hotline also show 
that being a runaway homeless youth and living in unstable housing are 
two of the top risk factors for human trafficking. Numerous studies 
have found trafficking rates among youth experiencing homelessness 
ranging from 19 percent to 40 percent. Using the lower end estimate 
means that about 800,000 of the youth and young adults who experience 
homelessness in a year are also victims of sex trafficking or forced 
labor in cities, suburbs, rural communities, and American Indian 
Reservations across the country.
    The cost of not investing in the lives of youth experiencing 
homelessness is an economic burden that affects the young person, 
taxpayers, and society. Researchers have found that taxpayers face an 
estimated lump sum 2011 fiscal cost per youth of $248,182 and social 
cost of $613,182.\1\ Taking the modest taxpayer \2\ cost of $248,182 
per youth and applying it to only half of the 4.2 million youth who 
experience homelessness every year in America, the taxpayer cost is 
over $521 billion (2.1 million x $248,182). Through increased 
investments, all youth in need of safe and stable housing and 
supportive services will be able to connect to the networks of support 
and resources needed to stabilize, heal, and thrive. These connected 
youth in turn become part of the solution to trafficking and 
homelessness and contribute to the community's well-being.
---------------------------------------------------------------------------
    \1\ Foldes, Steven S. and Lubov, Andrea. (2015) The Economic Burden 
of Youth Experiencing Homelessness and the Financial Case for Investing 
in Interventions to Change Peoples' Lives: An Estimate of the Short-and 
Long-Term Costs to Taxpayers and Society in Hennepin County, Minnesota. 
https://www.youthlinkmn.org/wp-content/uploads/2016/04/the-economic-
burden-of-homeless-youth-in-hennepin-county.pdf. Social cost is defined 
as the total costs to society including lost earnings, lost tax 
payments, public crime expenditures, victim costs, welfare support 
programs, education, excess tax burden and public housing support.
    \2\ Belfield, et. al., The Economic Value of Opportunity Youth. 
January 2012.
---------------------------------------------------------------------------
    RHYA has provided base funding to communities across the country to 
develop community-based responses to youth and young adult homelessness 
and trafficking. These local systems of care are based on the unique 
needs of each region, their available resources, and local priorities. 
When we support young people experiencing homelessness, we prevent 
trafficking. RHYA programs are also trained in identifying and serving 
survivors of trafficking. Specifically, RHYA funds: emergency shelters, 
family reunification when safe, aftercare, street outreach, education, 
employment training, behavioral and mental health care, transitional 
housing, and independent housing options. This support achieves the 
following successful outcomes for youth: (1) safe exit from 
homelessness and hopelessness; (2) family reunification and/or 
establishment of permanent connections in their communities; (3) 
education, employment, and sustainable independence; and (4) prevention 
of human trafficking. Further, these programs are best positioned to 
prevent trafficking and commercial sexual exploitation and provide 
early identification of and services to youth victims of crimes.
    Proposed Report Language: The Committee strongly encourages 
programs to have the ability to serve youth involved in other systems 
(such as child welfare and juvenile justice) that are not currently 
housed by that system.
    Administration for Children and Families, Office of Trafficking in 
Persons: Report Language.--In establishing the Office of Trafficking in 
Persons (OTIP), HHS underscored the importance of coordinating 
trafficking efforts across the Administration for Children and Families 
(ACF). ACF works directly with all victims of human trafficking--men, 
women, children, LGBTQ, foreign nationals and domestic clients--and the 
diverse needs and vulnerabilities of these populations can only be met 
by an effective coordinating body networked agency-wide. Additionally, 
the ongoing migration flows and refugee crises that swelled in scope 
around 2015 and have continued further highlight the need to develop 
responsible and robust parameters to ensure that unaccompanied minors 
working with ACF and the Office of Refugee Resettlement are not 
released to families or guardians who further exploit these vulnerable 
youth. Unaccompanied minors released to guardians after being 
identified as a victim of or at risk of human trafficking continue to 
report to service providers that they are exploited or labor/sex 
trafficked by those to whom they were entrusted. We also expect that 
the United States may well accept unaccompanied minors from Ukraine 
within the next year, and we strongly encourage ACF and ORR to 
implement and enforce strong protections for these youth to prevent re-
trafficking or new forms of exploitation.
    Proposed Report Language: Within the funds provided, the Committee 
encourages ACF to hire sufficient full-time employees to support the 
Office of Trafficking in Persons and coordinate trafficking efforts 
across ACF. Furthermore, these funds should be used to develop robust 
and effective protective mechanisms to ensure that unaccompanied minors 
processed through the Office of Refugee Resettlement are not further 
exploited or trafficked by the guardians or families to whom they are 
entrusted after their release.
    Administration for Children and Families, Family Youth Services 
Bureau: Report Language.--The process of informing RHYA grantees has 
restricted the ways in which service providers are able to continue to 
provide services to vulnerable youth. For the past several years, RHYA 
grantees have been notified whether they will receive a grant or not 
within one day before a grant period is to begin. This lack of 
sufficient notice is extremely problematic for agencies and community-
based organizations working to serve runaway and homeless youth who 
face higher risks of trafficking and violence. We recommend that the 
current bureaucratic process be streamlined, so that RHYA grant 
applicants are notified regarding whether they will receive a grant or 
not within at least 3 months in advance of the start date of a grant.
    Proposed Report Language: When awarding funds under the Runaway and 
Homeless Youth Act program, the Secretary shall notify all applicants 
if they were successful or not at least 30 days before the grant is to 
begin as well as 30 days before an existing grant is set to end.
                        department of education
    Department of Education Grants to Local Education Agencies, Title 
I: $2,000,000.--The Department of Education interfaces with 
approximately 50 million elementary and secondary school children each 
year, placing it in a unique position to identify victims of sex 
trafficking and forced labor and to prevent the victimization and 
exploitation of children who might be susceptible. While ED has been 
able to create some resources for educators without any dedicated 
Federal resources, dedicated funding for the prevention of child 
trafficking is essential. The funds should be used to develop materials 
regarding all forms of human trafficking, including sex trafficking and 
forced labor, to ensure that educators and students are aware of how to 
identify and address all types of trafficking. Further, we request that 
ED publish a white paper examining the appropriate role of educators 
and students, as well as the role of the education system, in 
preventing, identifying, and supporting child trafficking victims. The 
outcome of the white paper should inform the development of a model 
curriculum on the prevention of both sex trafficking and forced labor.
    McKinney-Vento Act Education for Homeless Children and Youth 
Program (EHCY): $300,000,000.--The EHCY removes barriers to the 
enrollment, attendance, and opportunity for success for homeless 
children and youth; all of whom are at high risk of human trafficking. 
The EHCY is effective in addressing youth homelessness. With the 
support of EHCY grants, local education agencies have provided 
identification, enrollment and transportation assistance, as well as 
academic support and referrals for basic services. Unfortunately, the 
resources directed to child and youth homelessness programs have not 
been sufficient in recent years. ED reported that during the 2017-2018 
school year, public schools identified 1.5 million homeless children 
and youth, a 15 percent increase over the 3 previous school years. 
However, only 22 percent of school districts receive support through 
the EHCY in any given year. As a result, homeless children and youth 
are under-identified and continue to face significant barriers to 
school enrollment and continuity.
    Under the McKinney-Vento Act's EHCY, all school districts are 
required to designate a homeless liaison, who proactively identifies 
homeless children and youth and connects them with vital resources, 
including food, housing, and clothing. Because all school districts-
even those in communities without youth shelters-must designate a 
liaison for homeless students, schools are uniquely positioned to 
identify youth who are being trafficked, or are at risk of being 
trafficked, and provide connections to services. Yet many liaisons are 
designated in name only and lack the time and the training to carry out 
their duties. This lack of capacity is particularly severe in light of 
the increase in student homelessness due to the COVID-19 crisis. 
Increasing funding for the EHCY will support a dedicated infrastructure 
within the Nation's public schools to identify and serve children and 
youth who are at very high risk of human trafficking, both during the 
current public health and economic crisis and as the economy is 
rebuilt.
    As a champion for the victims of child labor, forced labor and sex 
trafficking, you understand the complexities of these issues and the 
resources needed to respond. We have carefully vetted our requests to 
focus on the most important and effective programs. We thank you for 
your consideration of these requests and your continued leadership. If 
you have any questions, please contact ATEST Director Terry FitzPatrick 
([email protected]).

    Sincerely,

    Coalition to Abolish Slavery and Trafficking (CAST)
    Coalition of Immokalee Workers (CIW)
    Covenant House
    Free the Slaves
    HEAL Trafficking
    Human Trafficking Institute
    Human Trafficking Legal Center
    Humanity United Action
    McCain Institute for International Leadership
    National Network for Youth (NN4Y)
    Polaris
    Safe Horizon
    Solidarity Center
    T'ruah: The Rabbinic Call for Human Rights
    United Way Worldwide
    Verite
    Vital Voices Global Partnership
                                 ______
                                 
              Prepared Statement of the Alpha-1 Foundation
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Provide the National Institutes of Health (NIH) with at least $49. 
        Billion, a $3.5 billion increase over Fiscal Year (FY) 2022.
    --Please provide proportional increases for individual NIH 
            Institutes and Centers especially the National Heart Lung 
            and Blood Institute (NHLBI) & the National Institute for 
            Diabetes, Digestive and Kidney Diseases (NIDDK).
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least $11 billion, a $2.55 billion increase over FY 2022.
    --Please provide CDC's National Center for Chronic Disease 
            Prevention and Health Promotion (NCCDPHP) with systematic 
            and meaningful annual increases to bring total funding up 
            to $3.75 billion over the next 3 years.
_______________________________________________________________________

    Thank you for the opportunity to submit testimony on behalf of the 
Alpha-1 Foundation. Chairwoman Murray, Ranking Member Blunt, and 
distinguished members of the subcommittee, the Alpha-1 community 
extends our thanks for the significant investments in HHS through the 
FY 2022 omnibus package, particularly the annual increases for the 
National Institutes of Health (NIH) and the Centers for Disease Control 
and Prevention (CDC). As you work with your colleagues on 
appropriations for FY 2023, please continue to invest in medical 
research programs that serve the rare disease community. Thank you 
again for your leadership on health funding issues and for the 
opportunity to present the views of the rare chronic disease community.
                  about alpha-1 antitrypsin deficiency
    Alpha-1 Antitrypsin Deficiency (Alpha-1) is a rare, genetic 
condition, passed from parents to their children through their genes. 
Alpha-1 may result in serious lung disease in adults and liver disease 
at any age. Alpha-1 occurs when there is a severe lack of a protein in 
the blood called Alpha-1 antitrypsin (AAT) which is mainly produced by 
the liver. The main function of AAT is to protect the lungs from 
inflammation caused by infection and inhaled irritants such as tobacco 
smoke. The low level of AAT in the blood occurs because the AAT is 
abnormal and cannot be released from the liver at a normal rate. This 
leads to a buildup of abnormal AAT in the liver that can cause liver 
disease.
    Alpha-1 lung disease has been called ``Genetic COPD''. Normal white 
blood cells in the lungs produce an enzyme called neutrophil elastase 
that destroys invading germs and digests damaged or aging cells. In 
most people, the alpha-1 protein neutralizes the enzyme after a short 
time. In Alpha-1 patients, there is not enough alpha-1 protein in the 
lungs; the enzyme then keeps working, attacking and destroying normal 
lung tissue. As the damage continues over years, lung diseases such as 
COPD can develop.
    There is no cure yet for Alpha-1 Antitrypsin Deficiency. However, 
there are treatments available for Alpha-1 lung disease. Augmentation 
therapy consists of intravenous infusions, usually weekly, of alpha-1 
antitrypsin protein purified from healthy plasma donors. The goal is to 
increase the level of alpha-1 protein in the blood and lungs to slow or 
stop the progression of Alpha-1 lung disease.
    Alpha-1 Antitrypsin Deficiency can cause liver problems in infants, 
children, and adults. Large amounts of abnormal alpha-1 antitrypsin 
protein (AAT) are manufactured in the liver; nearly 85 percent of this 
protein gets stuck in the liver. If the liver cannot break down the 
abnormal protein, the liver gradually gets damaged and scarred. 
Currently, there is no way to prevent the abnormal AAT from getting 
stuck in the liver. This highlights the need for additional research at 
the National Institutes of Health.
    The Alpha-1 Foundation supports the $3.5 billion increase for the 
National Institutes of Health being advocated by the Ad Hoc Group for 
Medical Research. This additional funding would make possible research 
priorities for the Alpha-1 Foundation such as working with NIDDK to 
help develop treatments for Alpha-1 Liver Disease since there is no 
treatment currently.
                   home-infusion for alpha-1 patients
    This year the Alpha-1 Foundation advocated to Congress regarding 
home infusion for the Alpha-1 patient community utilizing Medicare. 
Alpha patients with commercial health insurance coverage are allowed to 
receive their infusions of augmentation therapy at the home. Whereas 
Medicare beneficiaries are mandated to receive their infusions at 
infusion clinics, hospitals, and physician offices. With the onset of 
the COVID-19 pandemic, it is no longer safe for Alpha-1 Antitrypsin 
Deficiency patients to receive their infusions in the clinical setting.
    Early in the COVID-19 pandemic, the Alpha-1 Foundation petitioned 
the Centers for Medicare and Medicaid Services (CMS) to grant a 
temporary home infusion benefit for Alpha-1 patients utilizing coverage 
through Medicare. CMS issued a temporary benefit however the specialty 
pharmacies would not implement it so the community had to choose 
between skipping treatments or potentially exposing themselves to a 
fatal respiratory virus.
    The Alpha-1 Community is working to create a permeant home infusion 
benefit in Medicare Part B by supporting HR 7346, The John Walsh Alpha-
1 Home Infusion Act. The legislation named for the legendary founder of 
The Alpha-1 Foundation would establish a permeant benefit in Medicare 
Part B. The pandemic has shown that precautions need to be taken to 
protect vulnerable populations such as the Alpha-1 Community from 
exposure to viruses such as COVID-19 and Influenza.
    The Alpha-1 patient community serves as an inspiration to the 
leadership of the organization. This year we lost a wonderful Alpha-1 
community member, Mr. Rich Lee. Rich Lee was a patient advocate, a 
social worker, and a congressional staffer but most importantly he was 
a husband and father. Rich passed away on February 13, 2022. Rich spent 
his career in service to our community, our state, and our country and 
all the lives he touched are better for that service.
    Rich served on the staff of our former colleague, Representative 
John LaFalce; helping families here in New York through the casework 
Rich spearheaded in the district office. The work he did with the 
families of the Love Canal environmental disaster was one of his most 
important contributions. During his tenure, Rich developed a respect 
and love for the House of Representatives as an institution that he 
carried and discussed for the rest of his life.
    Rich Lee would eventually be diagnosed with Alpha-1 Antitrypsin 
Deficiency. Rich Lee was an advocate for increased medical research for 
improved treatments and increased access to care for those like himself 
who battle this disorder. True to form Rich was working to advocate for 
the Alpha-1 community to the end by helping the foundation with the 
home infusion legislation. I am honored to acknowledge this life well 
lived in service to others.

    [This statement was submitted by Scott Santarella, President & CEO, 
Alpha-1 Foundation.]
                                 ______
                                 
   Prepared Statement of the Alzheimer's Association and Alzheimer's 
                            Impact Movement
    The Alzheimer's Association and Alzheimer's Impact Movement (AIM) 
appreciate the opportunity to submit outside witness testimony on the 
Fiscal Year (FY) 2023 appropriations for Alzheimer's and other dementia 
research and public health activities at the U.S. Department of Health 
and Human Services. Specifically, we respectfully request a $226 
million increase for Alzheimer's research at the National Institutes of 
Health (NIH) and $30 million for implementation of the Building Our 
Largest Dementia (BOLD) Infrastructure for Alzheimer's Act (Public Law 
115-406) at the Centers for Disease Control and Prevention (CDC).
    The Alzheimer's Association is the world's leading voluntary health 
organization in Alzheimer's care, support, and research. It is the 
nonprofit with the highest impact in Alzheimer's research worldwide and 
is committed to accelerating research toward methods of treatment, 
prevention, and, ultimately, a cure. The Alzheimer's Impact Movement is 
the advocacy affiliate of the Alzheimer's Association, working in 
strategic partnership to make Alzheimer's a national priority. 
Together, the Alzheimer's Association and AIM advocate for policies to 
fight Alzheimer's disease, including increased investment in research, 
improved care and support, and development of approaches to reduce the 
risk of developing dementia.
        alzheimer's impact on american families and the economy
    Alzheimer's is a progressive brain disorder which damages and 
eventually destroys brain cells, leading to a loss of memory, thinking, 
and other brain functions. Ultimately, Alzheimer's is fatal. We have 
yet to celebrate the first survivor of this devastating disease.
    In addition to the suffering caused by the disease, Alzheimer's is 
also creating an enormous strain on the health care system, families, 
and Federal and State budgets. The annual cost for all individuals with 
Alzheimer's or other dementia will total $321 billion for health care, 
long-term care, and hospice care in 2022. The U.S. taxpayer-funded 
Federal health care programs Medicare and Medicaid are expected to 
cover $206 billion, or 64 percent, of the total health care and long-
term care payments for people with Alzheimer's or other dementias this 
year. An estimated 6.5 million Americans aged 65 and older are living 
with Alzheimer's in 2022. By 2050, the number of people 65 and older 
with Alzheimer's may grow to a projected 12.7 million people. Unless a 
treatment to slow, stop, or prevent the disease is developed, in 2050, 
Alzheimer's is projected to cost nearly $1 trillion dollars. 
Alzheimer's and other dementia threaten to bankrupt families, 
businesses, and our health care system.
                  investing in alzheimer's treatments
    Last year, the Food and Drug Administration (FDA) approved the 
first treatment for Alzheimer's disease since 2003, and the first to 
address the underlying biology of Alzheimer's disease. The FDA 
determined there is substantial evidence that aducanumab (marketed as 
Aduhelm) reduces amyloid plaques in the brain and that the reduction in 
these plaques is reasonably likely to predict important benefits to 
patients.
    This approval represents an important step forward in Alzheimer's 
research. This new treatment, while not a cure, is a pivotal moment in 
addressing the disease. This is the first of a number of new treatments 
to come. We do recognize the drug may work differently for everyone who 
takes it, and may not work for some individuals. Importantly, 
aducanumab was studied in and is appropriate for people living with 
early Alzheimer's dementia and mild cognitive impairment due to 
Alzheimer's who showed evidence of a buildup of amyloid plaques in the 
brain. The therapy has not yet been tested on people with more advanced 
cases of dementia or Alzheimer's disease.
    Years of increased investment provided by Congress to NIH have been 
integral to this and other promising therapeutic approaches to treating 
Alzheimer's disease. For example, NIH supported basic science 
investigations behind the discovery of immunotherapies like aducanumab, 
as well as translational research for next-generation immunotherapies. 
Additionally, the selection of participants for aducanumab clinical 
trials hinged on amyloid PET imaging, a technology that would not exist 
today without the publicly-funded research supported by NIH. The 
Federal commitment, combined with unprecedented philanthropic support, 
provides the foundation for an optimistic view of the future, which is 
needed because there is much work to be done.
    This is just the beginning of meaningful treatment advances. 
History has shown us that approvals of the first drug in a new category 
invigorates the field, increases investments in new treatments, and 
encourages greater innovation. We are hopeful that this drug is just 
the beginning for better treatments to come. Looking at the big picture 
of science, there is a crucial need for effective treatment options for 
diverse populations living in all stages of Alzheimer's. Alzheimer's 
must be addressed through multiple pathways--more than just amyloid--
with an eye toward effective combination therapies, pharmacological and 
nonpharmacological, that work at different stages of the disease.
    While recent NIH funding increases have laid the foundation for 
breakthroughs in diagnosis, treatment, and prevention, and enabled 
significant advances in understanding the complexities of Alzheimer's, 
there is still much left to be done. We cannot leave any stone 
unturned. Investment in Alzheimer's research is only a fraction of 
what's been applied over time, with great success, to address other 
major diseases. Between 2000 and 2017, the number of people dying from 
Alzheimer's increased by 145 percent while deaths from other major 
diseases have decreased significantly or remained approximately the 
same. It is vitally important that NIH continues to build upon 
promising research advances. An increase of $226 million in Alzheimer's 
research at NIH in FY 2023 would enable scientists to conduct more 
inclusive, efficient, and practical clinical trials; increase knowledge 
of risk and protective factors in individuals and across diverse 
populations; discover better biomarkers to detect disease and monitor 
treatment response; pursue a precision medicine approach to detect the 
disease earlier and tailor treatment plans to an individual's unique 
symptoms and risk profile; and leverage emerging digital technologies 
and big data to speed discoveries. We need to continue to increase 
investment in Alzheimer's and dementia research to maximize every 
opportunity for success.
            addressing alzheimer's as a public health crisis
    As scientists continue to search for ways to cure, treat, or slow 
the progression of Alzheimer's through medical research, public health 
plays a critical role in promoting cognitive function and reducing the 
risk of cognitive decline. Now more than ever it is apparent how 
crucial it is to have an established infrastructure in place to respond 
to public health threats.
    In 2018, Congress acted decisively to address Alzheimer's as an 
urgent and growing public health threat through the passage of the 
bipartisan BOLD Act. This law authorizes $100 million over 5 years for 
CDC to build a robust Alzheimer's public health infrastructure across 
the country focused on public health actions that can allow individuals 
with Alzheimer's to live in their homes longer and delay costly long-
term nursing home care. Congress appropriated $10 million for the first 
year of BOLD's implementation in FY 2020, which allowed CDC to award 
funding to three Public Health Centers of Excellence (PHCOE), focused 
on risk reduction, caregiving, and early detection, and 16 public 
health departments across the country. These State, local, and Tribal 
public health department recipients are creating statewide dementia 
coalitions, hiring dementia coordinators, and developing or updating 
Alzheimer's and other dementia strategic plans. The $15 million 
Congress appropriated for the second year of BOLD's implementation in 
FY 2021 helped fund additional public health departments and expand the 
impact of this crucial work into more communities across the country. 
In FY 2022, Congress appropriated $25 million dollars for continuing 
its support for BOLD implementation, and will further enable the public 
health agencies to expand their activities.
    The Alzheimer's Association is grateful to be leading the Dementia 
Risk Reduction PHCOE, focusing on community-level actions to reduce the 
risk of developing Alzheimer's and other dementia. Researchers are 
increasingly studying the impact that lifestyle behaviors may have on 
the risk of developing Alzheimer's and other dementia. The future of 
reducing Alzheimer's could be in treating the whole person with a 
combination of drugs and modifiable risk factor interventions, as we do 
now with heart disease. The Center works with public health agencies on 
addressing social determinants of health with respect to dementia risk; 
capacity building to enable smaller public health agencies to engage in 
dementia risk reduction activities; and partnering with health systems 
in their communities to advance risk reduction.
    Over 65 percent of American adults have at least one risk factor 
for dementia. Although risk factors like age, genetics, and family 
history cannot be changed, other risk factors can be modified to reduce 
the risk of cognitive decline and dementia. Examples of modifiable risk 
factors are physical activity, smoking, education, staying socially and 
mentally active, blood pressure, and diet. In fact, the 2020 
recommendations of The Lancet Commission on dementia prevention, 
intervention, and care suggest that addressing modifiable risk factors 
might prevent or delay up to 40 percent of dementia cases.
    The Alzheimer's Association is currently leading a 5-year clinical 
trial to evaluate a 2-year intervention to see whether lifestyle 
interventions that simultaneously target multiple risk factors can 
protect cognitive function in older adults at increased risk for 
cognitive decline. The U.S. Study to Protect Brain Health Through 
Lifestyle Intervention to Reduce Risk (U.S. POINTER) will evaluate the 
effects of lifestyle interventions, like physical exercise, a healthier 
diet, cognitive and social stimulation, and self-management of heart 
and vascular health, on changes in cognitive function. It is crucial 
that forthcoming findings from studies like U.S. POINTER are translated 
into public health interventions across the country. Investing now in a 
robust public health infrastructure ensures cutting edge research can 
be effectively and efficiently disseminated into local communities.
    While these BOLD implementation efforts are important steps 
forward, and we are grateful to this subcommittee and Congress for the 
initial funding, CDC must receive the $30 million authorized in the law 
for FY 2023 to ensure the meaningful impact that Congress intended. The 
Alzheimer's Association and AIM urge Congress to include the full $30 
million for the third year of BOLD's implementation at CDC in FY 2023. 
Activities supported by the requested $30 million in FY 2023 would 
enable CDC to expand the number of State, local, and Tribal public 
health departments across the country that receive funding for 
Alzheimer's public health activities. Finally, as Alzheimer's is one of 
the most prevalent chronic diseases facing our Nation, we look forward 
to the day that the subcommittee and CDC elevate Alzheimer's and other 
dementia to the Division level as with other major chronic diseases.
                               conclusion
    The Alzheimer's Association and AIM appreciate the steadfast 
support of the subcommittee and its priority setting activities. We 
urge the subcommittee and Congress to provide an additional $226 
million for Alzheimer's research activities at NIH and $30 million for 
full implementation of the BOLD Infrastructure for Alzheimer's Act at 
CDC in FY 2023.
                                 ______
                                 
        Prepared Statement of the American Academy of Pediatrics
    The American Academy of Pediatrics (AAP), a non-profit professional 
organization of 67,000 primary care pediatricians, pediatric medical 
subspecialists, and pediatric surgical specialists dedicated to the 
health, safety, and well-being of infants, children, adolescents, and 
young adults, appreciates the opportunity to submit this statement for 
the record in support of strong Federal investments in children's 
health in Fiscal Year 2023 and beyond. AAP urges all Members of 
Congress to put children first when considering short and long-term 
Federal spending decisions, and supports funding levels for the 
following programs: $30 million for Pediatric Subspecialty Loan 
Repayment (HRSA), $60 million for Firearm Injury and Mortality 
Prevention Research (CDC/NIH), $14 million for Pediatric Mental Health 
Care Access Grants (HRSA), $28.134 million for Emergency Medical 
Services for Children (HRSA), $205 million for the National Center for 
Birth Defects and Developmental Disabilities (CDC), $356 million for 
Global Immunizations (CDC), $12 million for implementation of 
Scarlett's Sunshine Act (CDC/HRSA), $26.2 million for the 
administrative component of the National Vaccine Injury Compensation 
Program (HRSA), and $15 million for provisions in the Vaccine Awareness 
Campaign to Champion Immunization Nationally and Enhance Safety 
(VACCINES) Act (CDC).
Pediatric Subspecialty Loan Repayment Program (HRSA):
    FY 23 Request: $30 million; FY 22 Level: $5 million.--The AAP 
appreciates first-time funding of $5 million in FY22 for the Pediatric 
Subspecialty Loan Repayment Program, a Title VII health professions 
program designed to improve access to care for children with special 
health care needs by offering loan repayment to pediatric 
subspecialists and child mental health providers who agree to serve in 
an underserved area. To expand the number of beneficiaries of this 
program, the Academy respectfully requests $30 million in FY23. The 
United States' current supply of pediatric subspecialists is inadequate 
to meet children's health needs. Many children must wait more than 3 
months for an appointment with a pediatric subspecialist, and 
approximately 1 in 3 children must travel 40 miles or more to receive 
care from a pediatrician certified in certain subspecialties such as 
developmental behavioral pediatrics. Spotlighting the needs of children 
with autism spectrum disorder (ASD), as an example, there are 
approximately 1.5 million children with ASD but there are only about 
700 practicing board-certified developmental-behavioral pediatricians. 
The national wait time for a pediatric developmental evaluation is 5.4 
months. In terms of equity, ASD prevalence among Hispanic children is 
about 16 percent lower than among white and black children, which 
suggests that more Hispanic children with autism are not being 
identified. In addition, black children with ASD are significantly less 
likely than white children to have a first evaluation by the age of 
three.
Firearm Injury and Mortality Prevention Research (CDC/NIH):
    FY 23 Request: $60 million total; FY 22 Level: $25 million total.--
The AAP is tremendously appreciative of and applauds Congress for 
continuing to provide $25 million total, split evenly between CDC and 
NIH, for firearm injury and mortality prevention research in fiscal 
Year22. Gun violence remains a public health problem, but the dearth of 
research on how best to prevent firearm-related morbidity and mortality 
makes it difficult to address it. Federally funded public health 
research has a proven track record of reducing public health-related 
deaths, whether from motor vehicle crashes or smoking. This same 
approach should be applied to increasing gun safety and reducing 
firearm-related injuries and deaths, including suicides, and continuing 
and expanding CDC and NIH research will be critical to that effort. As 
such, for FY23, the Academy urges Congress to allocate $60 million for 
firearm injury and mortality prevention research, with $35 million 
dedicated to CDC and $25 million to NIH.
Pediatric Mental Health Care Access Grants (HRSA):
    FY 23 Request: $14 million; FY 22 Level: $11 million.--The AAP 
appreciates the support Congress has shown for Pediatric Mental Health 
Care Access Grants, with $11 million in funding for the program in 
FY22, as well as robust funding in the American Rescue Plan in 
recognition of the impact of COVID-19 on child and adolescent mental 
health. The 45 States, Tribal organizations, and territories who are 
receiving grants through this program are providing tele-consultation, 
training, technical assistance, and care coordination for pediatric 
primary care providers to diagnose, treat and refer children with 
behavioral health conditions. Research shows pervasive shortages of 
child and adolescent mental/behavioral health specialists throughout 
the United States. Integrating mental health and primary care has been 
shown to substantially expand access to mental health care, improve 
health and functional outcomes, increase satisfaction with care, and 
achieve costs savings. In fact, a recent RAND study found that 12.3 
percent of children in States with programs such as the ones funded 
under this HRSA program had received behavioral health services while 
only 9.5 percent of children in States without such programs received 
these services. In FY23, the AAP urges Congress to provide $14 million 
in funding for Pediatric Mental Health Care Access Grants so that his 
proven program can be extended to every State, Tribal organization, and 
territory.
Emergency Medical Services for Children (HRSA):
    FY 2023 Request: $28.134 million; FY 22 Level: $22.334 million.--
The AAP urges the committee to increase funding for the Emergency 
Medical Services for Children (EMSC) Program to $28.134 million in 
fiscal Year23. EMSC is the only Federal program that focuses 
specifically on improving the pediatric components of the emergency 
medical services (EMS) system. EMSC aims to ensure state of the art 
emergency medical care is available for the ill and injured child or 
adolescent, pediatric services are well integrated into an EMS system 
backed by optimal resources, and that the entire spectrum of emergency 
services is provided to all children and adolescents no matter where 
they live. An additional $5.8 million in funding in FY23 will allow the 
program to provide increased funding to States to address gaps in 
children's access to high quality emergency and trauma care as well to 
support States building mental health capacity for children in 
emergency departments.
National Center for Birth Defects and Developmental Disabilities (CDC):
    FY 23 Request: $205 million; FY 22 Level: $177.06 million.--The AAP 
requests $205 million for fiscal Year23 for the National Center for 
Birth Defects and Developmental Disabilities (NCBDDD). According to the 
CDC, birth defects affect 1 in 33 babies and are a leading cause of 
infant death in the United States. NCBDDD conducts important research 
on fetal alcohol syndrome, infant health, autism, attention deficit and 
hyperactivity disorders, congenital heart defects, and other conditions 
like Tourette Syndrome, Fragile X, Spina Bifida and Hemophilia. NCBDDD 
supports extramural research in every State and has played a crucial 
role in the country's response to the Zika virus, as well as COVID-19. 
Increased FY23 funding would be used to build upon and expand work 
within the Center's priorities such as uniform data collection for 
neonatal abstinence syndrome; supporting the act Early: Children's 
Mental Health program, data collection around sickle cell disease, and 
expansion of the Surveillance for Emerging Threats to Mothers and 
Babies (SET-NET) program to allow more States to participate and gather 
needed information to protect pregnant individuals and infants from 
emerging public health threats.
Global Immunization--Polio and Measles/Other (CDC):
    FY 23 Request: $356 million ($276 million for Polio and $80 million 
for Measles/Other); FY 22 Level: $228 million ($178 million for Polio 
and $50 million for Measles/Other).--The CDC's global immunization 
program is one of the most cost-effective and successful public health 
solutions available and U.S. investments have driven remarkable 
results. The CDC was a founding member of the Measles and Rubella 
Initiative, which has vaccinated over 2 billion children and prevented 
23.2 million deaths from measles since 2001. Since 1988, the CDC's 
global polio immunization work has reduced the number of polio cases 
globally by 99.9 percent, saving more than 10 million children from 
paralysis and bringing the disease close to eradication. Thanks to 
sustained funding by the U.S. government through the CDC and USAID and 
the coordinated efforts of the Global Polio Eradication Initiative 
(GPEI), the opportunity for a polio-free world is within reach. 
Unfortunately, the gains from global immunization are in jeopardy. 
Throughout the ongoing COVID-19 pandemic, many countries diverted 
resources set aside for polio and routine immunizations to fight the 
pandemic. While this was vital to many countries' ability to quickly 
respond to COVID-19, it has come at a terrible cost to polio 
eradication and routine child vaccination. In the first 2 months of 
2022, measles cases were up 79 percent compared with the year prior. 
The World Health Organization and UNICEF warned of a ``perfect storm'' 
of conditions for measles outbreaks. Additionally, polio cases have 
increased, with Malawi experiencing its first wild polio case in three 
decades. To recover from pandemic-related disruptions, the Academy 
urges Congress to appropriate at least $276 million for polio and $80 
million for measles vaccination programs.
Activities Authorized under Scarlett's Sunshine Act (CDC/HRSA):
    FY 23 Request: $12 million ($8.5 million at CDC for the Safe 
Motherhood and Infant Health account and $3.5 million at MCHB within 
the Special Projects of Regional and National Significance account); FY 
22: Level: $1 million at HRSA and $2 million at CDC.--In passing the 
Scarlett's Sunshine Act in late 2020, Congress recognized the need for 
Federal investments in research and prevention of sudden unexpected 
infant death (SUID) and sudden unexplained death in childhood (SUDC). 
The law authorized $12 million for HHS to award grants and improve data 
and monitoring. Full funding for this initiative will strengthen 
efforts to better understand SUID and SUDC, facilitate data collection 
and analysis to improve prevention efforts, and support children and 
families. Requested CDC funding would improve communities' responses to 
infant and child death cases, inform prevention and clinical care, and 
help standardize data collection and reporting, as well as procedures 
and protocols for death scene investigations and autopsies. The grants 
can also fund safe sleep outreach efforts, which can reduce the risk of 
SUID. The funds at MCHB would support the expansion and use of the Case 
Reporting System to provide data summaries and dashboards on all SUIDs 
and making datasets available to researchers. These MCHB funds can also 
support bereavement services for affected families, which MCHB cannot 
currently provide.
National Vaccine Injury Compensation Program Administration (HRSA):
    FY 23 Request: $26.2 million; FY 22 Level: $13.2 million.--The 
Academy supports increased funding for the administrative component of 
the National Vaccine Injury Compensation Program (NVICP), which was 
established in 1988 to ensure an adequate supply of vaccines, stabilize 
vaccine costs, and establish and maintain an accessible and efficient 
forum for individuals found to be injured by certain vaccines. NVICP is 
an alternative to the traditional tort system for resolving vaccine 
injury claims and provides compensation to individuals found to be 
injured by certain vaccines. NVICP claims have increased more than 
fivefold from 402 claims filed in FY 2012 to 2,057 claims filed in FY 
2021 while the administrative funding barely doubled from $6.5 million 
to $11.2 million during the same period. The steep increase in claims 
filed is due in large part to the flu vaccine being administered to 
adults. In fact, most of all petitions filed are now adult claims for 
alleged injuries from the flu vaccine. Though the number of petitions 
has risen, the number of staff to administer the claims has not risen 
at the same level. By hiring more staff and thereby expediting the 
processing of claims filed in the NVICP, the children and families who 
have been injured by a vaccine will be able to receive their due 
compensation in a timely manner. It will also help prepare HRSA to 
administer the NVICP program if the COVID-19 vaccine is eventually 
transferred from the Countermeasures Injury Compensation Program and 
included in NVICP program.
Activities Authorized under the VACCINES Act (CDC):
    FY 23 Request: $15 million; FY 22 Level: N/A.--The AAP is very 
appreciative that Congress specifically included the Vaccine Awareness 
Campaign to Champion Immunization Nationally and Enhance Safety 
(VACCINES) Act as part of Section 2302 of the American Rescue Plan that 
provided $1 billion to improve vaccine confidence for both COVID-19 and 
routine immunizations. Much of this funding was distributed to State 
and local public health departments to help promote the uptake of 
COVID-19 vaccines and to provide Americans with accurate information 
about these vaccines. As we pass 2 years of living through the 
pandemic, it is more important than ever to bolster American's 
confidence in vaccines and debunk misinformation and disinformation 
about vaccines. The VACCINES Act authorizes the development of a 
national vaccination rate surveillance system at CDC and allows data 
collected to be used to identify communities with low vaccination 
utilization or where vaccine misinformation may be targeted. It also 
authorizes research grants to better understand vaccine hesitancy, 
attitudes towards vaccines, and develop strategies to address 
nonadherence to the recommended use of vaccines. Additionally, the 
VACCINES Act authorizes an evidence-based public awareness campaign on 
the importance of vaccinations to increase vaccination rates, including 
targeting communities that have particularly low vaccination levels. 
The AAP urges Congress to allocate the authorized $15 million for CDC 
to ensure these activities take place to boost vaccine confidence in 
routine and COVID-19 immunizations and boost vaccination rates across 
the lifespan.
    There are many ways Congress can help meet children's needs and 
protect their health and well-being. Adequate funding for children's 
health programs is one of them. The American Academy of Pediatrics 
looks forward to working with Members of Congress to prioritize the 
health of our Nation's children in FY 2023 and beyond. If we may be of 
further assistance, please contact the AAP Department of Federal 
Affairs at 202-347-8600 or [email protected]. Thank you for your 
consideration.

    [This statement was submitted by Moira A. Szilagyi, MD, FAAP, 
President, 
American Academy of Pediatrics.]
                                 ______
                                 
            Prepared Statement of the American Association 
                    for the Study of Liver Diseases
    The American Association for the Study of Liver Diseases (AASLD) 
thanks this subcommittee for the opportunity to submit outside witness 
testimony on opportunities to support and improve the health of 
Americans living with various forms of liver disease, ranging from non-
alcoholic fatty liver disease to liver cancer, in the Fiscal Year 
(FY)2023 Labor, Health and Human Services, Education and Related 
Agencies bill and report.
    The liver, the largest solid organ in the body, is a master 
regulator of a diverse array of life sustaining chemical processes. In 
liver disease, these processes are disrupted. The result is ongoing 
organ injury, progressive scarring, and the development of cirrhosis 
and liver cancer. Over 40,000 Americans die each year from these 
complications. In 2019, liver disease was the fourth leading cause of 
death for those 45 to 64 years of age, and that figure continues to 
grow. AASLD is calling on this subcommittee to support biomedical 
research and public health programs to reverse the growing public 
health burden of liver disease. We respectfully request that you 
provide at least $49.048 billion for the National Institutes of Health 
(NIH) and $140 million for the Centers for Disease Control and 
Prevention (CDC) Division of Viral Hepatitis (DVH).
                            funding for nih
    Robust, sustained, and predictable funding is important to advance 
the entire biomedical research enterprise, not just work related to the 
full spectrum of liver diseases. AASLD is deeply appreciative of the 
investment Congress has made to provide NIH with the resources for 
meaningful growth above inflation, and our request of $49.048 billion 
will ensure this trajectory can be maintained and meritorious research 
in liver disease will be supported.
    To meaningfully advance our understanding of liver diseases, all 
NIH Institutes and Centers (I/Cs) must receive a proportional increase 
in funding in FY 2023. Many I/Cs support the research our members 
perform, reinforcing the importance of providing a proportional 
increase across the NIH: the National Cancer Institute supports 
research in liver cancer, one of the most lethal cancers; the National 
Institute of Allergy and Infectious Diseases-funded projects are 
advancing our understanding of viral hepatitis and helping us move 
closer to its elimination; and the National Institute of Alcohol Abuse 
and Alcoholism (NIAAA) is funding projects to address the growing 
burden of alcohol-associated liver disease. AASLD would like to stress 
the importance of the National Institute of Diabetes and Digestive and 
Kidney Diseases (NIDDK), the home for liver disease research, receiving 
at least a proportional increase to NIH. Unlike many other I/Cs, NIDDK 
did not receive any emergency COVID-19 funding, yet it supports many 
chronic conditions such as liver disease that increase a person's risk 
for severe COVID-19 and long COVID. The institute is already being 
forced to make difficult choices about funding COVID-19 related 
research and other research areas, which will only be exacerbated by 
receiving an increase that is not proportional to the broader NIH. 
Additionally, we are requesting this robust appropriation for NIH to 
provide for meaningful support of a diverse physician-scientist 
workforce. AASLD is concerned that the physician-scientist workforce is 
shrinking at a time when their expertise is needed to meet the needs of 
Americans living with liver diseases, especially as COVID-19 continues 
to pose an increased risk for these patients.
    AASLD would also like to take this opportunity to address the 
Advanced Research Projects Agency for Health (ARPA-H). The $49.048 
billion we are requesting for NIH should be separate from any 
appropriation made to ARPA-H in FY 2023; any funds appropriated to 
ARPA-H should supplement, not supplant, those for NIH. AASLD strongly 
supports and believes in the potential for ARPA-H to meaningfully 
improve the health of Americans living with liver disease by developing 
new tools to treat and potentially prevent these conditions. However, 
this work cannot be done at the expense of the basic science and 
investigator-initiated research in which NIH invests; AASLD strongly 
believes the best way to support both lines of inquiry is for Congress 
to authorize ARPA-H so that is housed outside of NIH.
          appropriate $140 million for cdc dvh to support the 
                     elimination of viral hepatitis
    AASLD is committed to meeting the goal of eliminating viral 
hepatitis. We have vaccines to prevent Hepatitis A and Hepatitis B, and 
while we may not have a Hepatitis C vaccine, we now have the 
therapeutics to cure those infected. However, vaccines and effective 
therapeutics alone cannot move the country towards elimination; 
therefore, we urge Congress to provide the investment necessary to 
support this goal. The overall CDC budget has decreased in real dollars 
several times in the last decade. Despite recent pandemic-related 
investments across the agency, funding for DVH has remained relatively 
flat, leaving the Division unable to support the policies and programs 
necessary to bolster efforts towards the elimination of viral 
hepatitis. We therefore urge you to appropriate $140 million for DVH as 
a down payment on progress towards elimination.
    We recognize that this request represents a $99 million increase in 
DVH's funding, yet it does not come close to providing the funding that 
the CDC estimated would be required to put the United States on the 
path to eliminating viral hepatitis. In its 2016 Professional Judgement 
Budget, the CDC estimated it would take at least $316 million to do 
this. There is a critical need to enhance the capacity to detect and 
respond to outbreaks. Increased funding for DVH is also critically 
important to support adult vaccination programs for Hepatitis A and 
Hepatitis B and address the ongoing opioid epidemic, which has been 
exacerbated by the COVID-19 pandemic.
       support the formation of a national liver disease strategy
    The burden of liver disease is growing rapidly, imposing 
significant costs to the country's public health and health care 
systems. For example, liver cancer has emerged as one of the fastest 
rising causes of cancer deaths in the country, and with a forecasted 
40,000 new liver cancer diagnoses and 30,000 liver cancer deaths in 
2022, survival rates remain poor. Additionally, at least 5.3 million 
Americans are infected with viral hepatitis and the majority are 
undiagnosed while the disease destroys their liver.
    Despite the growing toll the full spectrum of liver diseases is 
imposing, there is no strategy to address the breadth of the health and 
economic effects of this disease in the United States. For these 
reasons, AASLD calls on Congress to direct the Department of Health and 
Human Services (HHS) to develop a department-wide strategic plan to 
combat liver disease, including viral hepatitis, fatty liver disease, 
alcohol-associated liver disease, cirrhosis, and liver cancer. HHS 
should seek input from across the government, including from the CDC, 
the NIH, the Food and Drug Administration, and the Health Resources and 
Services Administration (HRSA), as well as researchers, providers, and 
patients to formulate this strategy.
    Accordingly, the AASLD requests the inclusion of the following 
language in the report accompanying the FY 2023 LHHS Appropriations 
bill with regards to the HHS Office of the Secretary:
    National Liver Disease Strategy.--The Committee recognizes the 
growing burden of liver disease, including viral hepatitis, non-
alcoholic fatty liver disease, cirrhosis, and liver cancer, and its 
significant costs to the country's health care system. In 2019, liver 
disease was the fourth leading cause of death for those 45 to 64 years 
of age. Despite the growing toll the full spectrum of liver diseases is 
imposing, there is no strategy to address the breadth of the health and 
economic effects of this disease in the United States. For these 
reasons, the Committee directs the Secretary of HHS to develop a 
department-wide strategic plan to combat liver disease. This strategy 
should include a framework to guide the development of policies and 
initiatives to prevent, diagnose, and treat liver disease across 
Federal agencies. Specifically, the strategy should coordinate efforts 
to prevent future cases of liver disease through improved disease 
surveillance and improve liver disease outcomes for current patients by 
addressing health disparities and inequities. The Committee provides $2 
million to support this effort and requests an update on the 
department's plans to begin this work within 180-days of enactment.
               support universal hepatitis b vaccination
    Hepatitis B is a highly infectious disease with an estimated 20,700 
acute infections each year, and almost two million people are living 
with chronic hepatitis B in the US today. Today, some parts of the 
country, particularly those States most affected by the opioid 
epidemic, are experiencing sharp increases in infections. The hepatitis 
B virus can lead to serious complications, such as liver failure, 
cirrhosis, and liver cancer.
    For these reasons, the AASLD was pleased to see the CDC Advisory 
Committee on Immunization Practices (ACIP) recommendation for universal 
hepatitis B vaccination for adults aged 19 to 59. CDC will be formally 
supporting this recommendation in a forthcoming edition of the 
Morbidity and Mortality Weekly Report. This is a key step towards 
eliminating this vaccine-preventable and treatable disease. As such, we 
respectfully request the inclusion of the following report language in 
the report that accompanies the FY 2023 LHHS appropriations bill under 
the HHS Office of the Secretary:
    Universal Hepatitis B Vaccination.--The Committee believes the 
Centers for Disease Control and Prevention's Advisory Committee on 
Immunization Practices (ACIP) recommendation for universal hepatitis B 
vaccination for adults aged 19 to 59 is a crucial step towards the 
elimination of this vaccine-preventable virus. It comes as parts of the 
country, particularly those States most affected by the opioid 
epidemic, are experiencing sharp increases in hepatitis B infections. 
The Committee requests a report back on the specific steps being taken 
to implement this recommendation across the agency and departments, 
including but not limited to the CDC Division of Viral Hepatitis, the 
CDC Immunization Services Divisions, and the HRSA Health Center 
Program, and any barriers that have been encountered and assistance 
needed to overcome them within 120 days of enactment.
          advance research on alcohol-associated liver disease
    Alcohol-associated liver disease (ALD) represents a wide-range of 
liver injury resulting from alcohol use, including inflammation of the 
liver, cirrhosis, or permanent scarring of the liver, and other life-
threatening complications. ALD is a major cause of liver disease and 
research advancements in this area are urgently needed, particularly 
due to the increased rates of alcohol consumption during the COVID-19 
pandemic. Preliminary data indicate a significant increase in alcohol 
consumption during the pandemic, and increased alcohol use has the 
potential to increase morbidity and mortality from ALD. Moreover, early 
data suggest that patients with ALD may experience worse COVID-19 
outcomes and complications. For these reasons, AASLD believes this area 
of research could benefit from a more comprehensive approach to 
research on ALD and alcohol use disorders at the NIH. Therefore, the 
AASLD respectfully requests that you include the following report 
language in the report that accompanies the FY 2023 LHHS appropriations 
bill under the NIH NIAAA:
    Alcohol-Associated Liver Disease.--The Committee is aware that 
alcohol use disorder and alcohol-associated liver disease are distinct 
diseases. However, it is rare for patients to have the latter without 
first having the former. Combining the research in this area in a 
holistic approach could lead to advancements for both, which are needed 
urgently given the increased rates of alcohol consumption during the 
pandemic. The Committee requests a report in next year's budget 
justification on the viability of this approach, including NIAAA's 
capacity to award related grants and the field's capacity to develop 
scientifically valid research projects.
                               conclusion
    Thank you again for the opportunity to submit testimony to the 
Committee as you begin your work on the FY 2023 appropriations bills. 
We look forward to working with you to improve the health and well-
being of all Americas living with liver disease.
                                 ______
                                 
   Prepared Statement of the American Association for Cancer Research
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee, thank you for the opportunity to submit testimony. I am 
Dr. Lisa Coussens, Associate Director for Basic Research at the Knight 
Cancer Institute, an NCI Comprehensive Cancer Center, and Chair of the 
Department of Cell, Developmental & Cancer Biology at Oregon Health & 
Science University. I am submitting testimony as President of the 
American Association for Cancer Research (AACR), the world's first and 
largest professional organization dedicated to advancing cancer 
research and its mission to prevent and cure all cancers. On behalf of 
the AACR's more than 50,000 members, who are scientists, physicians, 
other healthcare workers, and patient advocates, I ask for your support 
for at least $49 billion in Fiscal Year (FY) 2023 funding for the 
National Institutes of Health (NIH) and $7.766 billion for the National 
Cancer Institute (NCI).
    The AACR is grateful for your commitment to cancer research and the 
increase of $353 million Congress provided NCI in FY 2022. Today, as 
you begin work on FY 2023 appropriations, I humbly ask that you build 
on that support and address the urgent financial pressures at NCI.
    History shows what can be achieved when Congress prioritizes 
medical research. After years of underinvestment, former President 
Clinton embarked on a path of doubling NIH funding, a goal which 
Congress far exceeded. In 1999, success rates, i.e., the percent of 
research grant applications that receive funding, reached 32 percent 
across NIH and 28 percent at NCI. The NCI Director at the time, Dr. 
Richard D. Klausner, referred to this era as ``a golden age of 
discovery, one unique in human history.'' This funding fueled 
discoveries at an unprecedented rate.
    Thanks to these investments, truly remarkable progress has been 
made. For example, treating late-stage lung cancer and melanoma has 
been revolutionized with the development of a new class of 
immunotherapies that activate a patient's own immune system to fight 
cancer. In the 1990s and early 2000s, fewer than 1 in 6 patients 
diagnosed with metastatic melanoma lived 5 years after diagnosis. But 
now more than half of patients with metastatic melanoma who receive 
immunotherapy combinations live longer than 5 years, many without any 
signs of disease. These remarkable new therapies emerged out of Federal 
investments in basic science.
    And as a result, we see similar results playing out for the 
millions of Americans who otherwise might have lost their lives to 
cancer, as there are now nearly 17 million cancer survivors living in 
the United States. In the 50 years since the enactment of the National 
Cancer Act, cancer mortality rates have dropped by 27 percent. These 
drastic reductions are due to prevention efforts such as reduced 
smoking rates, more effective screening tools which detect cancer at an 
earlier, more treatable stage, and the success of better, more targeted 
drugs that allow patients with cancer to live longer after a diagnosis. 
These developments and therapies would not have been possible without 
decades of basic research funded by NCI and NIH to understand the 
causes and development of cancer, the immune system, and how cancer 
cells evade detection.
    Researchers are building on these discoveries to find additional 
anti-cancer drug targets within the immune system and to understand why 
some tumors do not respond as well to treatment. We are so close to 
unlocking new discoveries that could fundamentally change cancer care 
and survivorship, but to do so, we need Federal investments to keep up 
with the growing demands on basic research for cancer.
    The cancer research community's ability to understand, detect, and 
treat cancers is exploding with potential. Between 2013 and 2018, NCI 
witnessed a nearly 46 percent increase in grant applications, dwarfing 
the increase of other institutes at NIH which only increased by 4.9 
percent. And yet, NCI funding has not kept up with application growth 
or inflation. Even with the significant funding provided by Congress, 
NCI's success rate in FY 2021 was only 13 percent, less than half the 
rate that spurred historic success two decades ago. NCI's success rate 
is also among the lowest of all institutes at NIH. Currently, less than 
one-in-seven grant applications are approved, leaving well-reviewed 
science unfunded and jeopardizing our ability to spur further 
innovative approaches to cancer science. This extremely low funding 
rate is not only limiting scientific discovery, but it is also having 
an adverse impact on the financial and career security of cancer 
scientists, in particular, early-stage researchers who may be forced to 
choose other, more secure career paths.
    By meeting the NCI professional judgment budget level of $7.766 
billion in FY 2023, NCI can invest in more early-stage researchers, 
increase the availability of research grants, and accelerate the path 
to discoveries that will save lives. While financial constraints at NCI 
pre-date the emergence of COVID-19, the pandemic has exacerbated 
challenges within the cancer research community by closing 
laboratories, disrupting the implementation of clinical trials, and 
contributing to hiring freezes, forced staff turnovers, and delays and 
shortages of supplies. Many of these activities are yet to fully 
recover.
    In addition, we do not yet know the full scope of what COVID-19 
will mean for patients who delayed their cancer screenings, many of 
whom will be diagnosed with later stage disease that will be harder and 
costlier to treat. Former NCI Director, Dr. Norman ``Ned'' Sharpless, 
estimated that COVID-19 could result in 5,000 to 10,000 excess cancer 
deaths from breast cancer and colorectal cancer alone in the next 
decade due to delayed cancer screenings and medical appointments. The 
NCI's work will be crucial in rebuilding cancer science and ensuring 
that we emerge from this crisis with better tools to assist patients 
navigating a cancer diagnosis.
    Throughout my career, some truths about cancer have become 
abundantly clear. Cancer does not care where you live, or whether you 
are rich or poor. It forces a tremendous economic and social impact 
regardless of whom it touches. But with investments in medical 
research, it is my goal that one day, even advanced cancers will be 
treated as a chronic condition that a person can control and live with, 
but one that will not ultimately take their life. We have the power to 
achieve this goal within our grasp. Now is the time to put our foot on 
the gas and accelerate discoveries. We do not have a moment to spare.
    Thank you for the opportunity to submit testimony on behalf of the 
AACR and for your commitment to bringing us closer to our mutual goal 
of conquering cancer.

    [This statement was submitted by Lisa M Coussens, MD (hc), PhD, 
FAACR, President, American Association for Cancer Research.]
                                 ______
                                 
 Prepared Statement of the American Association for Dental, Oral, and 
                         Craniofacial Research
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee, thank you for the opportunity to submit this testimony on 
behalf of the American Association for Dental, Oral, and Craniofacial 
Research (AADOCR). I am pleased to submit this statement describing 
AADOCR's funding requests for FY 2023. I currently serve as President 
of the Association. I am also a professor and former dean at the 
University of North Carolina-Chapel Hill Adams School of Dentistry and 
an adjunct professor at UNC's Gillings School of Global Public Health.
    For FY 2023, AADOCR--along with our colleagues in the oral health 
community--is seeking at least $540 million for the National Institute 
of Dental and Craniofacial Research (NIDCR) and a total of $49 billion 
for all of the Institutes and Centers at the National Institutes of 
Health (NIH). Funding at these levels is necessary for the entities' 
base budgets to keep pace with the biomedical research and development 
price index (BRDPI).
    The NIH, through the biomedical research it conducts and supports, 
plays a critical role in improving Americans' health and well-being. 
When the COVID-19 pandemic hit our Nation and the world, the NIH helped 
safeguard the public health through its significant contributions to 
the development of testing, vaccines and treatments. The NIH continues 
to develop and maintain the resources, both human and scientific, that 
provide our Nation with the tools it needs to address other diseases 
and disabilities.
    The NIDCR, established by President Harry S. Truman in 1948, is the 
largest institution in the world exclusively dedicated to researching 
ways to improve dental, oral, and craniofacial health for all. 
Investments in NIDCR-funded research during the past half-century have 
led to improvements in oral health for millions of Americans and 
continue to show promise in areas encompassing the prevention of dental 
caries (cavities) and periodontal disease (gum disease), new diagnostic 
methods of oral and dental conditions, pain biology and management, 
regenerative medicine, oral cancer, and in assessing the efficacy of a 
human papillomavirus (HPV) vaccine for oral and pharyngeal cancers.
    Oral health--too often considered in isolation--is integral to 
overall health. The research being conducted at, and supported by, 
NIDCR impacts the lives of millions of Americans. Poor oral health can 
affect activities that may be taken for granted--the ability to eat, 
drink, swallow, smile, speak, and maintain proper nutrition--and create 
economic burden that disproportionately harms older adults, low income, 
and underserved communities.
    The oral cavity also serves as a window into many health issues, 
including but not limited to systemic diseases, such as diabetes, HIV/
AIDS, and Sjogren's, an autoimmune disease that causes one's immune 
system to attack parts of its own body. Additionally, researchers are 
exploring the debilitating loss of salivary gland functioning and 
saliva production stemming from radiation treatment for head and neck 
cancers and even from common medications and aging itself.
    The NIDCR played a critical role in responding to the COVID-19 
public health crisis funding approximately $3.9 million in high-impact 
coronavirus research. The Institute's research into minimizing 
infection risk in dental offices, the use of biosensors to detect SARS-
CoV-2 in saliva, the role of periodontal disease in COVID-19 
complications, and exploring mechanisms of viral entry into the tissues 
of the oral cavity played a critical role in combatting COVID-19. 
Continued investment in NIDCR will allow the Institute to pursue these 
research efforts and expand into new areas of research, such as the 
interplay between the oral microbiome and immune system, to improve 
Americans' oral and overall health.
    In December 2021, NIDCR released ``Oral Health in America: Advances 
and Challenges'', a data-driven report with input from over 400 
contributors documenting 20 years of progress in oral health since the 
2020 Surgeon General's Report on Oral Health. The report provides 
insight into issues currently affecting oral health and serves as a 
call to action for a coordinated effort among oral health 
practitioners; researchers; and other stakeholders to improve oral 
health for all Americans.
    AADOCR deeply appreciates Congress' longstanding and bipartisan 
support for the public health research enterprise. The funding 
increases NIDCR has received since 2015 have allowed the Institute to 
build its data repository and registry in several disease and research 
areas to meet the increasing need for open-source data sharing. These 
include clinical registries and repositories related to head and neck 
cancers, orofacial birth defects and craniofacial anomalies, and 
craniofacial microsomia cohorts to identify genetic risk factors. The 
Institute also participates in trans-NIH and NIH Common Fund 
initiatives for data analysis and sharing.
    Despite NIDCR's impressive research agenda and scientific 
accomplishments, the Federal Government's annual investment in the 
Institute has not kept pace with the overall funding increases provided 
to NIH over the past several years. Funding of at least $540 million in 
FY 2023 would help bring NIDCR funding into alignment with the overall 
NIH appropriation and allow NIDCR to build on its myriad successes in 
its mission to improve dental, oral and craniofacial health.
    Recognizing that Federal research and public health efforts work in 
concert with one another and that success in one area can benefit 
another, we encourage Congress to support the full breadth of Federal 
agencies supporting oral health. Complementing our NIDCR and NIH 
requests, we urge you to provide $35 million for the CDC's Division of 
Oral Health, $46 million for the Title VII Health Resources and 
Services Administration (HRSA) programs that train the dental health 
workforce, $500 million for the Agency for Healthcare Research and 
Quality (AHRQ), and $210 million for the National Center for Health 
Statistics (NCHS) in FY 2023.
    Finally, AADOCR strongly supports the establishment of the Advanced 
Research Projects Agency for Health (ARPA-H), which will help fill gaps 
in the biomedical research ecosystem by utilizing a bold new approach 
focused on the development of evidence-based, real-world-driven cures 
for a range of diseases. We urge you to support the Administration's 
request of $5 billion for ARPA-H in FY 2023, but not at the expense of 
funding for the NIH's base budget. It's critical that funding for this 
new agency complement--not supplant--the foundational investment in 
traditional NIH Institutes and Centers.
    We appreciate the opportunity to submit this testimony and thank 
the subcommittee for its support of biomedical research, including 
dental, oral and craniofacial research, in FY 2023 so our Nation's 
citizens can continue to enjoy the benefits of state-of-the-art and 
world-leading health care. We stand ready to assist the members of this 
subcommittee in any way we can and are happy to answer any questions 
you may have.
    Sincerely.

    [This statement was submitted by Jane Weintraub, DDS, MPH, 
President (2022-2023), American Association for Dental, Oral, and 
Craniofacial Research.]
                                 ______
                                 
 Prepared Statement of the American Association for the Study of Liver 
                                Diseases
    The American Association for the Study of Liver Diseases (AASLD) 
thanks this subcommittee for the opportunity to submit outside witness 
testimony on opportunities to support and improve the health of 
Americans living with various forms of liver disease, ranging from non-
alcoholic fatty liver disease to liver cancer, in the Fiscal Year (FY) 
2023 Labor, Health and Human Services, Education and Related Agencies 
bill and report.
    The liver, the largest solid organ in the body, is a master 
regulator of a diverse array of life sustaining chemical processes. In 
liver disease, these processes are disrupted. The result is ongoing 
organ injury, progressive scarring, and the development of cirrhosis 
and liver cancer. Over 40,000 Americans die each year from these 
complications. In 2019, liver disease was the fourth leading cause of 
death for those 45 to 64 years of age, and that figure continues to 
grow. AASLD is calling on this subcommittee to support biomedical 
research and public health programs to reverse the growing public 
health burden of liver disease. We respectfully request that you 
provide at least $49.048 billion for the National Institutes of Health 
(NIH) and $140 million for the Centers for Disease Control and 
Prevention (CDC) Division of Viral Hepatitis (DVH).
                            funding for nih
    Robust, sustained, and predictable funding is important to advance 
the entire biomedical research enterprise, not just work related to the 
full spectrum of liver diseases. AASLD is deeply appreciative of the 
investment Congress has made to provide NIH with the resources for 
meaningful growth above inflation, and our request of $49.048 billion 
will ensure this trajectory can be maintained and meritorious research 
in liver disease will be supported.
    To meaningfully advance our understanding of liver diseases, all 
NIH Institutes and Centers (I/Cs) must receive a proportional increase 
in funding in FY 2023. Many I/Cs support the research our members 
perform, reinforcing the importance of providing a proportional 
increase across the NIH: the National Cancer Institute supports 
research in liver cancer, one of the most lethal cancers; the National 
Institute of Allergy and Infectious Diseases-funded projects are 
advancing our understanding of viral hepatitis and helping us move 
closer to its elimination; and the National Institute of Alcohol Abuse 
and Alcoholism (NIAAA) is funding projects to address the growing 
burden of alcohol-associated liver disease. AASLD would like to stress 
the importance of the National Institute of Diabetes and Digestive and 
Kidney Diseases (NIDDK), the home for liver disease research, receiving 
at least a proportional increase to NIH. Unlike many other I/Cs, NIDDK 
did not receive any emergency COVID-19 funding, yet it supports many 
chronic conditions such as liver disease that increase a person's risk 
for severe COVID-19 and long COVID. The institute is already being 
forced to make difficult choices about funding COVID-19 related 
research and other research areas, which will only be exacerbated by 
receiving an increase that is not proportional to the broader NIH. 
Additionally, we are requesting this robust appropriation for NIH to 
provide for meaningful support of a diverse physician-scientist 
workforce. AASLD is concerned that the physician-scientist workforce is 
shrinking at a time when their expertise is needed to meet the needs of 
Americans living with liver diseases, especially as COVID-19 continues 
to pose an increased risk for these patients.
    AASLD would also like to take this opportunity to address the 
Advanced Research Projects Agency for Health (ARPA-H). The $49.048 
billion we are requesting for NIH should be separate from any 
appropriation made to ARPA-H in FY 2023; any funds appropriated to 
ARPA-H should supplement, not supplant, those for NIH. AASLD strongly 
supports and believes in the potential for ARPA-H to meaningfully 
improve the health of Americans living with liver disease by developing 
new tools to treat and potentially prevent these conditions. However, 
this work cannot be done at the expense of the basic science and 
investigator-initiated research in which NIH invests; AASLD strongly 
believes the best way to support both lines of inquiry is for Congress 
to authorize ARPA-H so that is housed outside of NIH.
  appropriate $140 million for cdc dvh to support the elimination of 
                            viral hepatitis
    AASLD is committed to meeting the goal of eliminating viral 
hepatitis. We have vaccines to prevent Hepatitis A and Hepatitis B, and 
while we may not have a Hepatitis C vaccine, we now have the 
therapeutics to cure those infected. However, vaccines and effective 
therapeutics alone cannot move the country towards elimination; 
therefore, we urge Congress to provide the investment necessary to 
support this goal. The overall CDC budget has decreased in real dollars 
several times in the last decade. Despite recent pandemic-related 
investments across the agency, funding for DVH has remained relatively 
flat, leaving the Division unable to support the policies and programs 
necessary to bolster efforts towards the elimination of viral 
hepatitis. We therefore urge you to appropriate $140 million for DVH as 
a down payment on progress towards elimination.
    We recognize that this request represents a $99 million increase in 
DVH's funding, yet it does not come close to providing the funding that 
the CDC estimated would be required to put the United States on the 
path to eliminating viral hepatitis. In its 2016 Professional Judgement 
Budget, the CDC estimated it would take at least $316 million to do 
this. There is a critical need to enhance the capacity to detect and 
respond to outbreaks. Increased funding for DVH is also critically 
important to support adult vaccination programs for Hepatitis A and 
Hepatitis B and address the ongoing opioid epidemic, which has been 
exacerbated by the COVID-19 pandemic.
       support the formation of a national liver disease strategy
    The burden of liver disease is growing rapidly, imposing 
significant costs to the country's public health and health care 
systems. For example, liver cancer has emerged as one of the fastest 
rising causes of cancer deaths in the country, and with a forecasted 
40,000 new liver cancer diagnoses and 30,000 liver cancer deaths in 
2022, survival rates remain poor. Additionally, at least 5.3 million 
Americans are infected with viral hepatitis and the majority are 
undiagnosed while the disease destroys their liver.
    Despite the growing toll the full spectrum of liver diseases is 
imposing, there is no strategy to address the breadth of the health and 
economic effects of this disease in the United States. For these 
reasons, AASLD calls on Congress to direct the Department of Health and 
Human Services (HHS) to develop a department-wide strategic plan to 
combat liver disease, including viral hepatitis, fatty liver disease, 
alcohol-associated liver disease, cirrhosis, and liver cancer. HHS 
should seek input from across the government, including from the CDC, 
the NIH, the Food and Drug Administration, and the Health Resources and 
Services Administration (HRSA), as well as researchers, providers, and 
patients to formulate this strategy.
    Accordingly, the AASLD requests the inclusion of the following 
language in the report accompanying the FY 2023 LHHS Appropriations 
bill with regards to the HHS Office of the Secretary:

      National Liver Disease Strategy.--The Committee recognizes the 
        growing burden of liver disease, including viral hepatitis, 
        non-alcoholic fatty liver disease, cirrhosis, and liver cancer, 
        and its significant costs to the country's health care system. 
        In 2019, liver disease was the fourth leading cause of death 
        for those 45 to 64 years of age. Despite the growing toll the 
        full spectrum of liver diseases is imposing, there is no 
        strategy to address the breadth of the health and economic 
        effects of this disease in the United States. For these 
        reasons, the Committee directs the Secretary of HHS to develop 
        a department-wide strategic plan to combat liver disease. This 
        strategy should include a framework to guide the development of 
        policies and initiatives to prevent, diagnose, and treat liver 
        disease across Federal agencies. Specifically, the strategy 
        should coordinate efforts to prevent future cases of liver 
        disease through improved disease surveillance and improve liver 
        disease outcomes for current patients by addressing health 
        disparities and inequities. The Committee provides $2 million 
        to support this effort and requests an update on the 
        department's plans to begin this work within 180-days of 
        enactment.
               support universal hepatitis b vaccination
    Hepatitis B is a highly infectious disease with an estimated 20,700 
acute infections each year, and almost two million people are living 
with chronic hepatitis B in the US today. Today, some parts of the 
country, particularly those States most affected by the opioid 
epidemic, are experiencing sharp increases in infections. The hepatitis 
B virus can lead to serious complications, such as liver failure, 
cirrhosis, and liver cancer.
    For these reasons, the AASLD was pleased to see the CDC Advisory 
Committee on Immunization Practices (ACIP) recommendation for universal 
hepatitis B vaccination for adults aged 19 to 59. CDC will be formally 
supporting this recommendation in a forthcoming edition of the 
Morbidity and Mortality Weekly Report. This is a key step towards 
eliminating this vaccine-preventable and treatable disease. As such, we 
respectfully request the inclusion of the following report language in 
the report that accompanies the FY 2023 LHHS appropriations bill under 
the HHS Office of the Secretary:
      Universal Hepatitis B Vaccination.--The Committee believes the 
        Centers for Disease Control and Prevention's Advisory Committee 
        on Immunization Practices (ACIP) recommendation for universal 
        hepatitis B vaccination for adults aged 19 to 59 is a crucial 
        step towards the elimination of this vaccine-preventable virus. 
        It comes as parts of the country, particularly those States 
        most affected by the opioid epidemic, are experiencing sharp 
        increases in hepatitis B infections. The Committee requests a 
        report back on the specific steps being taken to implement this 
        recommendation across the agency and departments, including but 
        not limited to the CDC Division of Viral Hepatitis, the CDC 
        Immunization Services Divisions, and the HRSA Health Center 
        Program, and any barriers that have been encountered and 
        assistance needed to overcome them within 120 days of 
        enactment.
          advance research on alcohol-associated liver disease
    Alcohol-associated liver disease (ALD) represents a wide-range of 
liver injury resulting from alcohol use, including inflammation of the 
liver, cirrhosis, or permanent scarring of the liver, and other life-
threatening complications. ALD is a major cause of liver disease and 
research advancements in this area are urgently needed, particularly 
due to the increased rates of alcohol consumption during the COVID-19 
pandemic. Preliminary data indicate a significant increase in alcohol 
consumption during the pandemic, and increased alcohol use has the 
potential to increase morbidity and mortality from ALD. Moreover, early 
data suggest that patients with ALD may experience worse COVID-19 
outcomes and complications. For these reasons, AASLD believes this area 
of research could benefit from a more comprehensive approach to 
research on ALD and alcohol use disorders at the NIH. Therefore, the 
AASLD respectfully requests that you include the following report 
language in the report that accompanies the FY 2023 LHHS appropriations 
bill under the NIH NIAAA:

      Alcohol-Associated Liver Disease.--The Committee is aware that 
        alcohol use disorder and alcohol-associated liver disease are 
        distinct diseases. However, it is rare for patients to have the 
        latter without first having the former. Combining the research 
        in this area in a holistic approach could lead to advancements 
        for both, which are needed urgently given the increased rates 
        of alcohol consumption during the pandemic. The Committee 
        requests a report in next year's budget justification on the 
        viability of this approach, including NIAAA's capacity to award 
        related grants and the field's capacity to develop 
        scientifically valid research projects.
                               conclusion
    Thank you again for the opportunity to submit testimony to the 
Committee as you begin your work on the FY 2023 appropriations bills. 
We look forward to working with you to improve the health and well-
being of all Americas living with liver disease.
                                 ______
                                 
 Prepared Statement of the American Association of Colleges of Nursing
         strengthening the current and future nursing workforce
    On behalf of the American Association of Colleges of Nursing 
(AACN), we would like to thank the subcommittee for its leadership and 
continued support of nursing education, the nursing profession, and 
nursing research, especially during this unprecedented time. As the 
National voice for academic nursing, AACN represents more than 850 
schools of nursing at private and public universities, who educate more 
than 565,000 students and employ more than 52,000 faculty.\1\ 
Collectively, these institutions graduate our Nation's registered 
nurses (RN), advanced practice registered nurses (APRN), educators, 
researchers, and frontline providers.
---------------------------------------------------------------------------
    \1\ American Association of Colleges of Nursing. (2022) Who We Are. 
Retrieved from: https://www.aacnnursing.org/About-AACN/Who-We-Are.
---------------------------------------------------------------------------
    As we work to combat current public health challenges, such as 
COVID-19, and prepare for the future, ensuring a robust nursing pathway 
requires a strong and sustained Federal investment. For Fiscal Year 
(FY) 2023, AACN respectfully requests that you provide support of at 
least $530 million for the Nursing Workforce Development Programs 
(Title VIII of the Public Health Service Act [42 U.S.C. 296 et seq.] 
administered by HRSA and at least $210 million for the National 
Institute of Nursing Research (NINR).
Landscape Overview: The Growing Nursing Workforce Demand
    Nurses comprise the largest sector of the healthcare workforce, 
with more than four million RNs and APRNs, which include Nurse 
Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), 
Certified Nurse-Midwives (CNMs), and Clinical Nurse Specialists 
(CNSs).\2\ Nurse educators, students, and practitioners are leaders 
within their institutions and communities; many of whom are also 
serving on the frontlines of this public health emergency.
---------------------------------------------------------------------------
    \2\ National Council of State Boards of Nursing. (2021). Active RN 
Licenses: A profile of nursing licensure in the U.S. as of April 23, 
2021. Retrieved from: https://www.ncsbn.org/6161.htm.
---------------------------------------------------------------------------
    From the classroom to the frontline, we have witnessed how critical 
a well-educated nursing workforce is to the provision of high-quality 
health care. This need is only expected to grow, as the Bureau of Labor 
Statistics projects a 9 percent increase in RN workforce demand through 
2030, representing the need for an additional 276,800 jobs.\3\ Demand 
for certain APRNs (NPs, CRNAs, and CNMs) is expected to grow even more, 
by 45 percent.\4\
---------------------------------------------------------------------------
    \3\ U.S. Bureau of Labor Statistics. (2022). Occupational Outlook 
Handbook- Registered Nurses. Retrieved from: https://www.bls.gov/ooh/
healthcare/registered-nurses.htm.
    \4\ U.S. Bureau of Labor Statistics. (2022). Occupational Outlook 
Handbook- Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. 
Retrieved from: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-
nurse-midwives-and-nurse-practitioners.htm.
---------------------------------------------------------------------------
    While AACN saw student enrollment in entry-level baccalaureate 
nursing programs increase by 3.3 percent in 2021, the increase was 2.3 
percent lower than 2020.\5\ Further, nursing schools saw enrollment 
decline in baccalaureate degree-completion programs and some graduate 
programs at the master's and PhD levels.\6\ For the first time since 
2001, enrollment in master's programs decreased by 3.8 percent, which 
translates to 5,766 fewer students enrolled in 2021 than in the 
previous year.\7\ This is concerning because graduate programs prepare 
individuals for a variety of advanced roles in administration, 
teaching, research, informatics, and direct patient care.
---------------------------------------------------------------------------
    \5\ American Association of Colleges of Nursing. (2022) Nursing 
Schools See Enrollment Increases in Entry-Level Programs, Signaling 
Strong Interest in Nursing Careers. Retrieved from: https://
www.aacnnursing.org/News-Information/PressReleases/View/ArticleId/
25183/Nursing-Schools-See-Enrollment-Increases-in-Entry-Level-Programs.
    \6\ Ibid.
    \7\ Ibid.
---------------------------------------------------------------------------
    There were bright spots in 2021, with enrollments in Doctor of 
Nursing Practice (DNP) programs up 4.0 percent.\8\ However, the fact 
remains that a total of 91,938 qualified applications (not applicants) 
were not accepted at schools of nursing nationwide in 2021 alone.\9\ As 
our annual survey found, ``the primary barriers to accepting all 
qualified students at nursing schools continues to be insufficient 
clinical placement sites, faculty, preceptors, and classroom space, as 
well as budget cuts.'' \10\
---------------------------------------------------------------------------
    \8\ Ibid.
    \9\ Ibid.
    \10\ Ibid.
---------------------------------------------------------------------------
    Educational pathways are just one piece of the puzzle. Strong and 
historic investments in the current nursing workforce are imperative, 
especially as we contend with an aging nursing workforce and the 
lasting impact COVID-19 has had on the profession. In fact, registered 
nurses age 65 and older already make up 19 percent of the workforce, 
and ``more than one-fifth of all nurses reported they plan to retire 
from nursing over the next 5 years.'' \11\ Not to mention a recent 
study which found 52 percent of nurses considered leaving their 
position during the pandemic, up from 40 percent a year earlier.\12\ We 
must minimize the loss of experienced nurses who may prematurely leave 
the profession, and at the same time support nursing education to meet 
the current and future demand for nurses.
---------------------------------------------------------------------------
    \11\ National Council of State Boards of Nursing and the National 
Forum of State Nursing Workforce Centers (2021) The 2020 National 
Nursing Workforce Survey. Retrieved from: https://
www.journalofnursingregulation.com/article/S21558256(21)00027-2/
fulltext.
    \12\ American Nurses Foundation. (2022). Pulse on the Nation's 
Nurses Survey Series: COVID-19 Two-Year Impact Assessment Survey. 
Retrieved from: https://www.nursingworld.org/492857/contentassets/
872ebb13c63f44f6b11a1bd0c74907c9/covid-19-2-year-impact-assessment-
written-report-final.pdf.
---------------------------------------------------------------------------
    With increasing demands, an aging population, nursing retirements, 
and an increase in workplace stress,\13\ bold investments in Title VIII 
Nursing Workforce Development Programs and NINR are imperative, not 
only as we confront existing health challenges, but as we provide 
tomorrow's equitable and innovative healthcare solutions.
---------------------------------------------------------------------------
    \13\ American Association of Colleges of Nursing. (2020) Fact 
Sheet: Nursing Shortage. Retrieved from: https://www.aacnnursing.org/
Portals/42/News/Factsheets/Nursing-Shortage-Factsheet.pdf.
---------------------------------------------------------------------------
Investments in Nursing Education Lead to a Strong Nursing Workforce
    For over fifty years, Title VIII Nursing Workforce Development 
Programs have been a catalyst for strengthening nursing education at 
all levels, from entry-level preparation through graduate study. 
Through grants, scholarships, and loan repayment programs, Title VIII 
Federal investments positively impact the profession's ability to serve 
America's patients in all areas, bolster diversity within the 
workforce, and increase the number of nurses, including those at the 
forefront of public health emergencies and caring for our aging 
population.
    Each Title VIII Nursing Workforce Development Program provides a 
unique and crucial mission to support nursing education and the 
profession. For example, the Advanced Nursing Education (ANE) programs 
help increase the number of APRNs in the primary care workforce and 
supported more than 8,800 students in Academic Year 2020-2021 
alone.\14\ In addition, the Nurse Faculty Loan Program (NFLP) supported 
2,763 graduate nursing students who intend to serve as nurse 
faculty.\15\ ``By the end of the Academic Year, the programs graduated 
779 trainees, 92 percent of whom intended to teach nursing.'' \16\
---------------------------------------------------------------------------
    \14\ Health Resources and Services Administration. Fiscal Year 2023 
Budget Justification. Pages 164-170. Retrieved from: https://
www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-
justification-fy2023.pdf.
    \15\ Health Resources and Services Administration. Fiscal Year 2023 
Budget Justification. Page 181. Retrieved from: https://www.hrsa.gov/
sites/default/files/hrsa/about/budget/budget-justification-fy2023.pdf.
    \16\ Ibid.
---------------------------------------------------------------------------
    As we address social determinants of health and work to build an 
equitable healthcare system for all patients, it is imperative that we 
recruit individuals from diverse backgrounds into the nursing 
profession. Increasing diversity in the profession will not only create 
lifelong career pathways, but will also improve care quality and access 
to population-centered care. A recent HHS Assistant Secretary for 
Planning and Evaluation (ASPE) report makes the recommendation to 
``optimize existing workforce development programs to support diversity 
in the health professional workforce and further support the 
development of a diverse workforce though pipeline programs.'' \17\ The 
Nursing Workforce Diversity (NWD) program serves as a glowing example 
of a successful Title VIII initiative that accomplishes this goal. In 
fact, in Academic Year 2020-2021, the NWD program awarded grants 
supporting 10,155 nursing students from disadvantaged backgrounds.\18\ 
To ensure the stability of our nursing workforce now and in the future, 
we request at least $530 million for Title VIII Nursing Workforce 
Programs in FY 2023.
---------------------------------------------------------------------------
    \17\ Assistant Secretary for Planning and Evaluation, Office of 
Health Policy. Impact of the COVID-19 Pandemic on the Hospital and 
Outpatient Clinician Workforce Challenges and policy responses. (2022) 
Retrieved from: https://aspe.hhs.gov/sites/default/files/documents/
9cc72124abd9ea25d58a22c7692dccb6/aspe-covid-workforce-report.pdf.
    \18\ Health Resources and Services Administration. Fiscal Year 2023 
Budget Justification. Pages 171-174. Retrieved from: https://
www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-
justification-fy2023.pdf.
---------------------------------------------------------------------------
From Research to Reality: Nursing Science Protects Americans' Health
    AACN recognizes that scientific research and discovery are the 
foundation on which nursing practice is built and is essential to 
advancing evidence-based interventions, informing policy, and 
sustaining the health of the Nation. In fact, a recent ASPE's report 
recommends to ``support research that investigates long-term workforce 
trends arising from the pandemic and how they can be addressed 
including entry and departure issues, impact on facility staffing, and 
factors associated with health worker morale.'' \19\
---------------------------------------------------------------------------
    \19\ Assistant Secretary for Planning and Evaluation, Office of 
Health Policy. Impact of the COVID-19 Pandemic on the Hospital and 
Outpatient Clinician Workforce Challenges and policy responses. (2022) 
Retrieved from: https://aspe.hhs.gov/sites/default/files/documents/
9cc72124abd9ea25d58a22c7692dccb6/aspe-covid-workforce-report.pdf.
---------------------------------------------------------------------------
    As one of the 27 Institutes and Centers at NIH, NINR plays a 
fundamental role in improving care and is on the cutting edge of new 
innovations impacting how nurses are educated and how they practice. In 
fact, 80 percent of research-focused educational training grants at 
nursing schools are funded by NINR.\20\ Through these grants and 
others, nurse scientists, often working collaboratively with other 
health professionals, are generating groundbreaking findings and 
leading translation research that works to address strategic 
imperatives, to include health equity, social determinants of health, 
population health, health promotion, and models of care. To further 
this vital work, we are requesting a total of at least $210 million for 
the National Institute of Nursing Research.
---------------------------------------------------------------------------
    \20\ Journal of Professional Nursing (2019) National Institute of 
Health (NIH) funding patterns in Schools of Nursing: Who is funding 
nursing science research and who is conducting research at Schools of 
Nursing? Retrieved from https://www.sciencedirect.com/science/article/
abs/pii/S8755722319301164?via=ihub.
---------------------------------------------------------------------------
                               conclusion
    Strong investments in Title VIII Nursing Workforce Development 
Programs and NINR have a direct impact on sustaining pathways into 
nursing and patient access to high-quality, evidence-based care in all 
communities across the Nation. During these unprecedented times, AACN 
respectfully requests support in FY 2023 of at least $530 million for 
the Title VIII Nursing Workforce Development Programs and at least $210 
million for the National Institute of Nursing Research. Together, we 
can ensure that such investments promote innovation and improve health 
care in America.

    [This statement was submitted by Cynthia McCurren, PhD, RN, Board 
Chair, American Association of Colleges of Nursing.]
                                 ______
                                 
     Prepared Statement of the American Association of Colleges of 
                          Osteopathic Medicine
    The American Association of Colleges of Osteopathic Medicine 
(AACOM) appreciates the opportunity to highlight priorities for the 
osteopathic medical education (OME) community in the LHHSE fiscal year 
(FY) 2023 budget.
    AACOM advocates for the full continuum of OME to improve the health 
of the public. Founded in 1898 to support and assist the Nation's 
osteopathic medical schools, AACOM represents all 38 accredited 
colleges of osteopathic medicine (COMs)--educating nearly 34,000 future 
physicians, 25 percent of all U.S. medical students--at 60 teaching 
locations in 34 U.S. States, as well as osteopathic graduate medical 
education professionals and trainees at U.S. medical centers, 
hospitals, clinics and health systems.
    AACOM supports FY23 funding for the following priority programs:
  --$49 billion for the National Institutes of Health (NIH)
  --$11 billion for the Centers for Disease Control and Prevention
  --$9.8 billion for discretionary Health Resources and Services 
        Administration
  --$1.51 billion for the PHSA Title VII and Title VIII health 
        professions workforce programs
  --$500 million for Teaching Health Center Graduate Medical Education
  --$500 million for the Agency for Healthcare Research and Quality
  --$375 million for Children's Hospital Graduate Medical Education
  --$210 million for discretionary National Health Service Corps 
        Scholarship and Loan Repayment programs
  --$75 million for the Medical Student Education Program
  --$67 million for the Area Health Education Center Program
  --$59 million for the Primary Care Training and Enhancement Program
  --Permanent funding for the Rural Residency Planning and Development 
        Program
    Osteopathic medicine plays an essential role in our Nation's 
healthcare delivery system and is the fastest growing medical field in 
the country according to the U.S. Bureau of Health Professions. 
Osteopathic physicians are trained to see the body as a unit of 
interdependent systems which promotes healing through a dynamic 
interaction of body, mind, and spirit. DOs have expertise in the 
musculoskeletal system, receiving extensive training in osteopathic 
manipulative treatment, a hands-on technique and non-pharmacological 
solution to pain management.
    AACOM is concerned that scientists at osteopathic medical schools 
are underutilized in NIH research and underrepresented on NIH Advisory 
Councils and study sections. The Joint Explanatory Statement 
accompanying the Consolidated Appropriations Act, 2022 (Public Law 117-
103) highlighted this concern and requires NIH to report on the status 
of NIH funding to colleges of osteopathic medicine and the 
representation of DOs on NIH National Advisory Councils and study 
sections. We thank you for acknowledging this disparity and urge the 
subcommittee to ensure swift implementation.
    If this disparity in funding and representation continues, NIH will 
miss a key opportunity to bolster its capacity to address some of the 
Nation's most pressing health threats. COMs have a commitment to 
serving rural and underserved communities: 58 percent are located in 
Health Professional Shortage Areas and almost all schools have a 
mission to address these populations. Moreover, nearly 40 percent of 
physicians practicing in medically-underserved areas are DOs. They 
serve as the backbone of the primary care system with more than half of 
DOs practicing in primary care specialties. Finally, COMs routinely 
train osteopathic medical students in community-based settings, which 
aligns with the U.S. Department of Health and Human Services Initiative 
to Strengthen Primary Health Care. Maintaining a focus on this issue 
will benefit the public by ensuring increased NIH research on these 
disadvantaged populations.
    AACOM appreciates the opportunity to share our LHHSE FY23 funding 
priorities and looks forward to continuing to work with the 
subcommittee on these important matters.

    [This statement was submitted by Robert A. Cain, DO, FACOI, FAODME, 

President and Chief Executive Officer, American Association of Colleges 
of 
Osteopathic Medicine.]
                                 ______
                                 
      Prepared Statement of American Association of Immunologists
    The American Association of Immunologists (AAI), the Nation's 
largest professional association of research scientists and physicians 
who are dedicated to understanding the immune system through basic, 
translational, and clinical research, respectfully submits this 
testimony regarding fiscal year (FY) 2023 appropriations for the 
National Institutes of Health (NIH). AAI recommends an appropriation of 
at least $49 billion for NIH's base budget for FY 2023. In addition, 
AAI recommends providing substantial funding for the Advanced Research 
Projects Agency for Health (ARPA-H), though it is crucial that this 
funding supplements, and does not supplant, NIH's base budget. Robust 
investment in NIH will support needed research to prevent and treat 
dangerous infectious and debilitating chronic diseases, fund 
meritorious research proposals and scientists at all career stages, and 
ensure the continuity of our Nation's robust, preeminent biomedical 
research enterprise. Because the COVID-19 pandemic continues, AAI also 
strongly supports an infusion of supplemental funds to address ongoing 
COVID-19 needs, help scientists whose work was adversely impacted by 
pandemic-related interruptions, and prepare for future pandemics.
   how investment in immunological research transformed the covid-19 
                                response
    Immunological research, including understanding how vaccine-induced 
immunity and memory are formed, has been vital to the development and 
use of safe and effective vaccines to protect against coronavirus 
disease 2019 (COVID-19). While the current vaccines against severe 
acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that 
causes COVID-19, continue to provide strong protection against severe 
disease, hospitalization, and death, the emergence of variants like 
delta have resulted in surges of infections, leading to significant 
morbidity and mortality and placing great strain on our health care 
system. Although the latest variants (omicron and its subvariants) 
spread much more easily, they have generally caused less serious 
disease. Nevertheless, we must be vigilant and prepared for new 
variants and continue to invest significantly in research aimed at 
understanding the immune response to the virus and whether--and when--
these new variants are able to evade vaccine-induced immunity.
    As a result of three substantial coronavirus outbreaks across the 
globe [SARS, Middle East respiratory syndrome (MERS), and COVID-19] in 
the last two decades, scientists are working to discover new approaches 
for vaccinating against coronaviruses. One such approach currently 
being explored by NIH is the development of universal coronavirus 
(``pan-coronavirus'') vaccines that could protect against these and 
other types of coronaviruses and viral variants.\1\ Another approach 
that shows great promise is an intranasal vaccine, currently being 
tested against COVID-19. Delivering the vaccine intranasally could 
generate robust mucosal immunity at the site of infection, potentially 
resulting in long-term protection from infection. There are over a 
dozen intranasal vaccine candidates in various stages of clinical 
trials; preliminary data from one recent preclinical study showed the 
potential utility of using an intranasal vaccine as a booster dose to 
our current COVID-19 vaccines to induce long lasting, protective immune 
responses.\2\
---------------------------------------------------------------------------
    \1\ https://www.nih.gov/news-events/news-releases/niaid-issues-new-
awards-fund-pan-coronavirus-vaccines.
    \2\ https://www.nytimes.com/2022/02/02/health/covid-vaccine-
nasal.html.
---------------------------------------------------------------------------
    Advances have also been made in the development of effective 
treatments for active COVID-19. Various therapeutics are now available 
to those who test positive for COVID-19, often preventing the 
development of serious disease. In other areas, treatment is lacking. 
There are few therapeutics available for those who experience post-
acute sequelae of SARS-CoV-2 (PASC, or ``long COVID''), a chronic 
condition that can affect almost every part of the body and 
incapacitate individuals who have recovered from initial infection. 
While research is ongoing, particularly through the NIH Researching 
COVID to Enhance Recovery (RECOVER) Initiative,\3\ there is currently 
limited understanding of what causes long COVID and why only some 
patients develop the condition. Some individuals, even those who had 
mild infections, experience lingering health problems that can severely 
limit their activity for months. More research is needed to investigate 
the cause and pathology of long COVID and discover treatments for this 
enigmatic and often debilitating condition.
---------------------------------------------------------------------------
    \3\ https://recovercovid.org/.
---------------------------------------------------------------------------
                    other important vaccine advances
    Malaria: Every year, malaria infects millions and kills hundreds of 
thousands of vulnerable people around the world, in particular young 
children living in poor countries with inadequate health systems. The 
development of the first World Health Organization (WHO)-recommended 
vaccine for malaria represents a major scientific advance with the 
potential to significantly improve health outcomes and was the result 
of decades of basic research funded in part by NIH.\4\ In addition, an 
NIH-funded phase 1 clinical trial found that a novel monoclonal 
antibody conferred unprecedentedly high levels of durable protection 
against malaria.\5\
---------------------------------------------------------------------------
    \4\ https://www.nih.gov/news-events/news-releases/investigational-
malaria-vaccine-gives-strong-lasting-protection; https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC7227679/.
    \5\ https://www.nih.gov/news-events/nih-research-matters/
monoclonal-antibody-prevents-malaria-early-trial.
---------------------------------------------------------------------------
    Influenza: The Centers for Disease Control and Prevention (CDC) 
estimates that influenza has caused between 9 and 41 million 
infections, 140,000 and 710,000 hospitalizations, and 12,000 and 52,000 
deaths each year in the United States over the last decade.\6\ Annual 
vaccination is currently the most effective way to prevent illness due 
to flu; however, these vaccines must be updated annually and their 
ability to protect against infection varies widely from year to year 
due to seasonal shifts in the type of influenza viruses that circulate. 
NIH is currently supporting research to develop new types of vaccines, 
including universal flu vaccines (currently in phase 1 clinical 
studies), that would protect more broadly and effectively against 
multiple strains of flu, including newly emerging strains that pose a 
pandemic risk.\7\
---------------------------------------------------------------------------
    \6\ https://www.cdc.gov/flu/about/burden/index.html.
    \7\ https://www.niaid.nih.gov/news-events/nih-launches-clinical-
trial-universal-influenza-vaccine-candidate.
---------------------------------------------------------------------------
    Tuberculosis (TB): In 2020, 10 million people were infected with, 
and 1.5 million people died from, TB.\8\ Although TB is the second 
leading infectious cause of death in the world, the only available 
vaccine against TB is the BCG (Bacillus Calmette-Guerin) vaccine, which 
has variable efficacy against pulmonary disease. NIH-supported research 
is seeking to understand how the TB bacterium interacts with its human 
host. Recently, NIH-funded researchers identified a method to 
dramatically improve the efficacy of the BCG vaccine in non-human 
primates by changing the route of administration.\9\
---------------------------------------------------------------------------
    \8\ https://www.who.int/news-room/fact-sheets/detail/tuberculosis.
    \9\ https://www.nih.gov/news-events/news-releases/changed-route-
immunization-dramatically-improves-efficacy-tb-vaccine.
---------------------------------------------------------------------------
    Opioid Use Disorder: The opioid epidemic has devastated families 
and communities across America, with 1.6 million people diagnosed with 
opioid use disorder and more than 70,000 people dying from opioid-
related overdoses in the past year alone.\10\ NIH is currently funding 
cutting-edge research seeking to prevent addiction by generating 
antibodies to block opioid molecules from entering the brain and by 
developing a vaccine that could combat opioid use disorder.\11\
---------------------------------------------------------------------------
    \10\ https://www.hhs.gov/opioids/about-the-epidemic/index.html.
    \11\ https://heal.nih.gov/news/stories/OUD-vaccine; https://
www.gao.gov/assets/gao-19-706sp.pdf.
---------------------------------------------------------------------------
    Alzheimer's Disease: Alzheimer's disease, which afflicts more than 
six million Americans, is a devastating illness that deprives its 
victims of their lifelong memories and ultimately destroys their brain 
function.\12\ NIH-funded basic research has revealed how the immune 
system can contribute to the formation of amyloid plaques in the brains 
of Alzheimer's patients, causing irreversible neuronal damage. 
Currently, there are multiple novel vaccine candidates, all currently 
in different stages of clinical studies, that aim to prevent 
Alzheimer's disease from ever developing.\13\
---------------------------------------------------------------------------
    \12\ https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet.
    \13\ https://www.beingpatient.com/there-are-9-alzheimers-vaccines-
in-trials-right-now/.
---------------------------------------------------------------------------
            immunology and other diseases, including cancer
    While immunology has been in the news because of its extraordinary 
role in understanding and combatting COVID-19, critically important 
immunological research continues--and is advancing--in many other 
areas. Research on the immune system is improving our understanding of 
how to treat chronic conditions such as multiple sclerosis and 
cardiovascular disease; how to ensure successful organ or tissue 
transplantation; and how to protect against natural or man-made agents 
of bioterrorism.
    Cancer research is also advancing, as immunologists have been able 
to effectively leverage the immune system's ability to recognize and 
eliminate tumor cells into treatments called immunotherapies. 
Scientists continue to unravel the complicated interaction between 
immune cells and cancer, with the hope that this will lead to the 
discovery of effective new cancer treatments. Recently, the Food and 
Drug Administration (FDA) approved the first KRAS inhibitor (sotorasib) 
to treat advanced KRAS G12C-mutant non-small cell lung cancer (NSCLC), 
which accounts for 82 percent of all lung cancer cases.\14\ With lung 
cancer one of the three most common cancers diagnosed in U.S. adults, 
and with mutations to the KRAS gene one of the most common genetic 
alterations observed in NSCLC, this approval marks a major breakthrough 
in oncology.\15\
---------------------------------------------------------------------------
    \14\ https://www.cancer.net/cancer-types/lung-cancer-non-small-
cell/statistics.
    \15\ https://www.cancer.gov/news-events/cancer-currents-blog/2021/
fda-sotorasib-lung-cancer-kras.
---------------------------------------------------------------------------
the role of a robust nih in the nation's biomedical research enterprise
    The nation's major funding agency for biomedical research, NIH is 
also a key source of economic activity in every U.S. state and in 
countries around the world. More than 80 percent of its $45 billion 
budget is distributed, following a competitive peer review process, to 
more than 300,000 researchers at more than 2,500 universities, medical 
schools, and other research institutions across the Nation,\16\ while 
approximately 10 percent of its budget supports 6,000 researchers and 
clinicians who work at NIH facilities around the country.\17\ This 
funding supports both scientific research and local economies; in 2021, 
NIH funding supported more than 552,000 jobs and accounted for $94 
billion in economic activity across the U.S.\18\ The basic research 
that NIH funds is also critical to the biomedical research pipeline; it 
contributed to the discovery of all 210 new drugs that were approved by 
the FDA from 2010-2016.\19\
---------------------------------------------------------------------------
    \16\ https://www.nih.gov/about-nih/what-we-do/budget.
    \17\ https://irp.nih.gov/about-us/research-campus-locations.
    \18\ https://www.unitedformedicalresearch.org/wp-content/uploads/
2022/03/UMR_NIHs-Role-in-Sustaining-the-U.S.-Economy-FY21.pdf.
    \19\ https://directorsblog.nih.gov/2018/02/27/basic-research-
building-a-firm-foundation-for-biomedicine/.
---------------------------------------------------------------------------
    NIH is the indisputable leader of biomedical research in the world, 
and its scientists play an indispensable role in responding to both 
emerging and ongoing health threats. Together with scientists from the 
CDC and other Federal health and science agencies, NIH scientists have 
been essential to guiding the Nation through the coronavirus pandemic, 
in part by providing timely and candid scientific advice to the 
President, Congress, and the American public.
    For many years, strong bipartisan support for biomedical research 
has led to substantial increases in the NIH budget. Although these 
increases have largely restored the purchasing power that NIH had lost 
to inflation and inadequate budgets since 2003, meaningful budget 
growth is needed to enable NIH to invest not just in important research 
priorities across its Institutes and Centers, but also in its most 
valuable resource: the research workforce. While NIH should continue to 
support meritorious senior scientists, it is essential that it have the 
ability to support a sufficient cadre of trainees and early to mid-
career scientists who are able to both address increasingly complex 
scientific challenges and eventually lead the research enterprise. 
Congress must, therefore, provide NIH with the resources needed for the 
training, development, and support of our next generation of 
researchers, doctors, professors, and inventors--and give them the 
dynamic research environment they need to pursue these careers.
                               conclusion
    AAI greatly appreciates the subcommittee's strong, continuous, and 
bipartisan support for NIH and urges an NIH base budget of at least $49 
billion for FY 2023 to help the agency invest in vital immunologic 
research, support meritorious biomedical scientists at all career 
stages, and help researchers and doctors discover new ways to prevent, 
treat, and cure disease. In addition, AAI recommends the appropriation 
of substantial funding for ARPA-H, which has the potential to greatly 
advance human immunology in an era of unprecedented scientific 
opportunity.

    [This statement was submitted by Peter E. Jensen, M.D., Chair of 
the Committee on Public Affairs, American Association of 
Immunologists.]
                                 ______
                                 
    Prepared Statement of the American College of Obstetricians and 
                             Gynecologists
    The American College of Obstetricians and Gynecologists (ACOG), 
representing more than 60,000 physicians and partners dedicated to 
advancing women's health, is pleased to offer this statement to the 
House Committee on Appropriations, subcommittee on Labor, Health and 
Human Services, Education, and Related Agencies. We thank Chairman 
Murray, Ranking Member Blunt, and the entire subcommittee for this 
opportunity to provide comments on some of the most important programs 
to support and advance women's health.
    ACOG commends Congress for making great strides in advancing 
research and data collection to advance the health of women and 
families. Looking ahead, we urge you to make funding of the following 
programs and agencies a priority in FY23:
Title V Maternal and Child Health Block Grant at the Health Resources 
        and Services Administration (HRSA):
    The Title V Maternal and Child Health (MCH) Block Grant at HRSA is 
the only Federal program that exclusively focuses on improving the 
health of mothers and children. The Block Grant is a cost-effective, 
accountable, and flexible funding source used to address critical, 
pressing, and unique needs of maternal and child health populations in 
each State, territory and jurisdiction. Notably, through the Special 
Projects of Regional and National Significance (SPRANS) discretionary 
grant, the Block Grant supports the Alliance for Innovation on Maternal 
Health (AIM)--a program that works with States and hospital systems to 
implement evidence-based toolkits to improve maternal outcomes and 
reduce rates of maternal mortality and severe morbidity. For FY23, ACOG 
requests $15.3 million for SPRANS to support continued implementation 
of AIM.
    HRSA has also invested in the Women's Preventive Services 
Initiative (WPSI), supporting the WPSI multidisciplinary committee's 
development of guidelines for preventive services that are specific to 
women and improve women's health across the lifespan. More than 150 
million people with private insurance--including 58 million women and 
37 million children--currently can receive preventive services without 
cost-sharing. Additionally, 20 million Medicaid adult expansion 
enrollees and 61 million Medicare beneficiaries receive preventive 
services. ACOG recommends an investment of $3,000,000 in FY23 to 
support the ongoing and expanding work of WPSI, to include data 
collection to gauge performance and progress in implementing preventive 
services guidelines and assessing utilization across clinical sites.
Safe Motherhood and Infant Health Program; Maternal Mortality Review 
        Committees and Perinatal Quality Collaboratives at Centers for 
        Disease Control and Prevention (CDC):
    The United States has the highest rate of maternal mortality and 
severe morbidity of any developed country. The Safe Motherhood 
Initiative at CDC works with State health departments to collect 
information on pregnancy-related deaths, supports maternal mortality 
review committees, tracks preterm births, and improves maternal 
outcomes through perinatal quality collaboratives. Important strides 
have been made as nearly every State either currently has, is in the 
process of implementing, or is making plans to develop a State maternal 
mortality review committee. We must continue to build on this progress 
and improve maternal health outcomes. ACOG requests that you fund the 
Safe Motherhood Initiative at $164 million to help States expand or 
establish maternal mortality review committees and State-based 
perinatal quality collaboratives.
Women's Health Research at the National Institutes of Health (NIH):
    Women represent half of the US population. As such, conditions and 
diseases that are specific to women's health, or those that present 
differently in women than men, must be a priority for federally-funded 
research. Women's health research is a central part of the research 
mission and portfolio of the Eunice Kennedy Shriver National Institute 
of Child Health and Human Development (NICHD), and the Institute has 
achieved great success in advancing research on women's health 
throughout the life cycle; maternal, child, and family health; fetal 
development; reproductive biology; population health; and medical 
rehabilitation. With sufficient resources, NICHD can build upon its 
existing initiatives to produce new insights and solutions to benefit 
women and families. ACOG supports an appropriation of $49 billion for 
the NIH in FY23, including $1.816 billion for NICHD.
Advancing Maternal Therapeutics at the NIH:
    Each year, more than 4 million women give birth in the United 
States and more than 3 million breastfeed. However, little is known 
about the effects of most drugs on the woman and her child. In 2015 as 
part of the 21st Century Cures Act (Sec. 2041 of Public Law 114-255), 
Congress created the Task Force on Research Specific to Pregnant Women 
and Lactating Women (PRGLAC) to advise the Secretary of HHS on gaps in 
knowledge and research on safe and effective therapies for pregnant and 
breastfeeding women. In 2018, PRGLAC produced a report to the Secretary 
outlining 15 recommendations to facilitate the inclusion of this 
population in clinical research, and in 2020 an implementation plan was 
published. ACOG supports the implementation of these recommendations 
under the oversight of NICHD, working with other relevant NIH 
Institutes, the CDC, and the Food and Drug Administration, and urges 
Congress to express its continued support.
Title X Family Planning Program within the Office of Population Affairs 
        (OPA):
    Title X is the only Federal program dedicated to providing family 
planning services for people with low incomes. For many individuals, 
particularly those who are low-income, uninsured, or adolescents, Title 
X is essential to their ability to affordably and confidentially obtain 
birth control, cancer screenings, STI tests and other basic care. Title 
X has been cut or flat-funded every year for the past decade. A 
significant investment is needed to support robust restoration of the 
program and ensure demand for services is met, particularly as we 
prepare for the likely event of the U.S. Supreme Court overturning the 
protections afforded by Roe v. Wade. ACOG requests $512 million for 
Title X in FY23 to ensure individuals in need have access to evidence-
based care. ACOG urges Congress to show its strong support for 
transparent, respectful, evidence-based, and comprehensive reproductive 
health care by funding this critical program.
    Thank you again for the opportunity to submit our recommendations 
to the subcommittee, and for your commitment to improving women's 
health.

    [This statement was submitted by Rebecca Lauer, Federal Affairs 
Manager.]
                                 ______
                                 
    Prepared Statement of the American College of Obstetricians and 
                             Gynecologists
    The American College of Obstetricians and Gynecologists (ACOG), 
representing more than 60,000 physicians and partners dedicated to 
advancing women's health, is pleased to offer this statement to the 
House Committee on Appropriations, subcommittee on Labor, Health and 
Human Services, Education, and Related Agencies. We thank Chairman 
Murray, Ranking Member Blunt, and the entire subcommittee for this 
opportunity to provide comments on some of the most important programs 
to support and advance women's health.
    ACOG commends Congress for making great strides in advancing 
research and data collection to advance the health of women and 
families. Looking ahead, we urge you to make funding of the following 
programs and agencies a priority in FY23:
Title V Maternal and Child Health Block Grant at the Health Resources 
        and Services Administration (HRSA):
    The Title V Maternal and Child Health (MCH) Block Grant at HRSA is 
the only Federal program that exclusively focuses on improving the 
health of mothers and children. The Block Grant is a cost-effective, 
accountable, and flexible funding source used to address critical, 
pressing, and unique needs of maternal and child health populations in 
each State, territory and jurisdiction. Notably, through the Special 
Projects of Regional and National Significance (SPRANS) discretionary 
grant, the Block Grant supports the Alliance for Innovation on Maternal 
Health (AIM)--a program that works with States and hospital systems to 
implement evidence-based toolkits to improve maternal outcomes and 
reduce rates of maternal mortality and severe morbidity. For FY23, ACOG 
requests $15.3 million for SPRANS to support continued implementation 
of AIM.
    HRSA has also invested in the Women's Preventive Services 
Initiative (WPSI), supporting the WPSI multidisciplinary committee's 
development of guidelines for preventive services that are specific to 
women and improve women's health across the lifespan. More than 150 
million people with private insurance--including 58 million women and 
37 million children--currently can receive preventive services without 
cost-sharing. Additionally, 20 million Medicaid adult expansion 
enrollees and 61 million Medicare beneficiaries receive preventive 
services. ACOG recommends an investment of $3,000,000 in FY23 to 
support the ongoing and expanding work of WPSI, to include data 
collection to gauge performance and progress in implementing preventive 
services guidelines and assessing utilization across clinical sites.
Safe Motherhood and Infant Health Program; Maternal Mortality Review 
        Committees and Perinatal Quality Collaboratives at Centers for 
        Disease Control and Prevention (CDC):
    The United States has the highest rate of maternal mortality and 
severe morbidity of any developed country. The Safe Motherhood 
Initiative at CDC works with State health departments to collect 
information on pregnancy-related deaths, supports maternal mortality 
review committees, tracks preterm births, and improves maternal 
outcomes through perinatal quality collaboratives. Important strides 
have been made as nearly every State either currently has, is in the 
process of implementing, or is making plans to develop a State maternal 
mortality review committee. We must continue to build on this progress 
and improve maternal health outcomes. ACOG requests that you fund the 
Safe Motherhood Initiative at $164 million to help States expand or 
establish maternal mortality review committees and State-based 
perinatal quality collaboratives.
Women's Health Research at the National Institutes of Health (NIH):
    Women represent half of the US population. As such, conditions and 
diseases that are specific to women's health, or those that present 
differently in women than men, must be a priority for federally-funded 
research. Women's health research is a central part of the research 
mission and portfolio of the Eunice Kennedy Shriver National Institute 
of Child Health and Human Development (NICHD), and the Institute has 
achieved great success in advancing research on women's health 
throughout the life cycle; maternal, child, and family health; fetal 
development; reproductive biology; population health; and medical 
rehabilitation. With sufficient resources, NICHD can build upon its 
existing initiatives to produce new insights and solutions to benefit 
women and families. ACOG supports an appropriation of $49 billion for 
the NIH in FY23, including $1.816 billion for NICHD.
Advancing Maternal Therapeutics at the NIH:
    Each year, more than 4 million women give birth in the United 
States and more than 3 million breastfeed. However, little is known 
about the effects of most drugs on the woman and her child. In 2015 as 
part of the 21st Century Cures Act (Sec. 2041 of Public Law 114-255), 
Congress created the Task Force on Research Specific to Pregnant Women 
and Lactating Women (PRGLAC) to advise the Secretary of HHS on gaps in 
knowledge and research on safe and effective therapies for pregnant and 
breastfeeding women. In 2018, PRGLAC produced a report to the Secretary 
outlining 15 recommendations to facilitate the inclusion of this 
population in clinical research, and in 2020 an implementation plan was 
published. ACOG supports the implementation of these recommendations 
under the oversight of NICHD, working with other relevant NIH 
Institutes, the CDC, and the Food and Drug Administration, and urges 
Congress to express its continued support.
Title X Family Planning Program within the Office of Population Affairs 
        (OPA):
    Title X is the only Federal program dedicated to providing family 
planning services for people with low incomes. For many individuals, 
particularly those who are low-income, uninsured, or adolescents, Title 
X is essential to their ability to affordably and confidentially obtain 
birth control, cancer screenings, STI tests and other basic care. Title 
X has been cut or flat-funded every year for the past decade. A 
significant investment is needed to support robust restoration of the 
program and ensure demand for services is met, particularly as we 
prepare for the likely event of the U.S. Supreme Court overturning the 
protections afforded by Roe v. Wade. ACOG requests $512 million for 
Title X in FY23 to ensure individuals in need have access to evidence-
based care. ACOG urges Congress to show its strong support for 
transparent, respectful, evidence-based, and comprehensive reproductive 
health care by funding this critical program.
    Thank you again for the opportunity to submit our recommendations 
to the subcommittee, and for your commitment to improving women's 
health.

    [This statement was submitted by Rebecca Lauer, Federal Affairs 
Manager.]
                                 ______
                                 
        Prepared Statement of the American College of Physicians
    The American College of Physicians (ACP) is pleased to submit the 
following statement for the record on its priorities, as funded under 
the U.S. Department of Health & Human Services, for Fiscal Year (FY) 
2023. ACP is the largest medical specialty organization and the second-
largest physician group in the United States. ACP members include 
161,000 internal medicine physicians, related subspecialists, and 
medical students. Internal medicine physicians are specialists who 
apply scientific knowledge and clinical expertise to the diagnosis, 
treatment, and compassionate care of adults across the spectrum from 
health to complex illness. As the subcommittee begins deliberations on 
appropriations for FY2023, ACP is urging funding for the following 
proven programs to receive appropriations from the subcommittee:
  --Health Resources Services Administration (HRSA), $9.8 billion; 
        Health Workforce, National Health Service Corps (NHSC), $860 
        million in total program funding; Primary Care Training and 
        Enhancement (PCTE), $71 million; Maternal and Child Health, 
        Maternal and Child Health Block Grant, $1 billion; Title X 
        Family Planning Program, $400 million;
  --Agency for Healthcare Research and Quality (AHRQ), $500 million;
  --Centers for Medicare and Medicaid Services (CMS), Program 
        Operations, Private Health Insurance, $145.3 million;
  --Centers for Disease Control and Prevention (CDC), $11 billion; 
        Injury Prevention and Control, Firearm Injury and Mortality 
        Prevention Research, $35 million; Chronic Disease
    Prevention and Health Promotion, Social Determinants of Health, 
$153 million;
  --National Institutes of Health (NIH), $49 billion; Office of the 
        Director, Firearms Research, $25 million;
  --Public Health and Social Services Emergency Fund (PHSSEF), $3.8 
        billion.
    The United States is facing a shortage of physicians in key 
specialties, notably in general internal medicine and family medicine--
the specialties that provide primary care to most adult and adolescent 
patients. Current projections indicate there will be a shortage of 
17,800 to 48,000 primary care physicians by 2034. Without critical 
funding for vital workforce programs, this physician shortage will only 
grow worse. Therefore, we urge the subcommittee to provide $9.8 billion 
for HRSA programs for FY2023 to improve the care of medically 
underserved Americans by strengthening the health workforce. The 
College urges at least $860 million in total program funding for the 
NHSC in FY2023. The NHSC awards scholarships and loan repayment to 
health care professionals to help expand the country's primary care 
workforce and meet the health care needs of underserved communities 
across the country. In FY 2021, with a field strength of almost 20,000 
primary care clinicians, NHSC members are providing culturally 
competent care to a target of almost 20 million patients at over 18,000 
NHSC-approved health care sites in urban, rural, and frontier areas. 
The health professions' education programs, authorized under Title VII 
of the Public Health Service Act and administered through HRSA, support 
the training and education of health care clinicians to enhance the 
supply, diversity, and distribution of the health care workforce. 
Within the Title VII program, we urge the subcommittee to fund the 
Section 747 PCTE program at $71 million, to expand the pipeline for 
individuals training in primary care. ACP urges more funding because 
the Section 747 PCTE program is the only source of Federal training 
dollars available for general internal medicine, general pediatrics, 
and family medicine. For example, general internists, who have long 
been at the frontline of patient care, have benefitted from PCTE grants 
for primary care training in rural and underserved areas that have 
helped prepare physicians for a career in primary care.
    Also, within HRSA, ACP supports $1 billion for the Title V Maternal 
and Child Health (MCH) Services Block Grants within FY2023 Maternal and 
Child Health funding. ACP believes that policies--such as MCH Block 
Grants-must be implemented to address and eliminate disparities in 
maternal mortality rates among Black, Indigenous, and other women who 
are at greatest risk. MCH Block grants helped give access to health 
care and public health services for 60 million people in FY2020. ACP 
also supports the administration's request for $400 million for Title X 
Family Planning in FY2023. The College has extensive policy supporting 
programs that provide access to essential family planning services, 
such as Title X. ACP believes that it is essential for women to have 
access to affordable, comprehensive, nondiscriminatory public or 
private health care coverage that includes evidence-based care over the 
course of their lifespans. Accordingly, women should have sufficient 
access to evidence-based family planning and sexual health information 
and the full range of medically accepted forms of contraception which 
can be accessed through Title X Family Planning programs.
    AHRQ is the leading public health service agency focused on health 
care quality. AHRQ's research provides the evidence-based information 
needed by consumers, clinicians, health plans, purchasers, and 
policymakers to make informed health care decisions. The College is 
dedicated to ensuring AHRQ's vital role in improving the quality of our 
Nation's health and recommends a budget of $500 million, to help 
restore the agency to its FY2010 enacted level adjusted for inflation. 
This amount will allow AHRQ to help clinicians help patients by making 
evidence-informed decisions, to fund research that serves as the 
evidence engine for much of the private sector's work to keep patients 
safe, and to make the healthcare more efficient by providing quality 
measures to health professionals.
    ACP supports at least $145.3 million in discretionary funding 
within CMS' Program Operations for private health insurance protections 
and programs. This funding would allow CMS to continue overseeing 
State-based Marketplaces (SBMs) and operating the Federally-facilitated 
Marketplaces (FFMs) if a State has declined to establish an exchange 
that meets Federal requirements. CMS now manages and operates some or 
all marketplace activities in over 30 States. Specifically, ACP 
supports the administration's request for $11.2 million for market 
oversight and $134.1 million to operate and administer Federal 
marketplaces. Without these funds it will be much more difficult for 
the Federal Government to operate and manage a FFM, raising questions 
about where and how their residents would obtain and maintain coverage, 
especially with increased need for health coverage due to the COVID-19 
pandemic.
    The Center for Disease Control and Prevention's mission is to 
collaborate to create the expertise, information, and tools needed to 
protect their health-through health promotion, prevention of disease, 
injury, and disability, and preparedness for new health threats. ACP 
supports $11 billion overall for this mission, especially considering 
the ongoing COVID-19 public health emergency (PHE). The College also 
supports $35 million for the CDC's Injury and Prevention Control to 
fund research on firearm Injury and mortality prevention research and 
support 10 to 20 multi-year studies to continue to continue to rebuild 
lost research capacity in this area. ACP greatly appreciates funding 
for this research in FY2020, FY2021, and FY2022 after many years of no 
Federal resources for researching the prevention of firearms-related 
injuries and deaths. The College also supports the administration's 
budget request of $153 million for the Social Determinants of Health 
within Chronic Disease Prevention and Health Promotion programs. The 
PHE caused by the COVID-19 has highlighted the urgent need to collect 
racial, ethnic, and language preference demographic data on testing, 
infection, hospitalization, and mortality during a pandemic. These data 
should be shared with local, State, territorial, and Tribal 
governments.
    The College strongly supports $49 billion for the NIH in FY2023 so 
the Nation's medical research agency continues making important 
discoveries that treat and cure disease to improve health and save 
lives and that maintain the United States' standing as the world leader 
in medical and biomedical research. ACP also supports the 
administration's request for $25 million for research related to the 
prevention of firearms injury and mortality within the NIH Office of 
the Director.
    Lastly, as the Federal Government continues to respond to COVID-19, 
ACP supports the administration's request of $3.8 billion for the 
PHSSEF in FY2023 to fund programs such as the Strategic National 
Stockpile and the Biomedical Advanced Research and Development 
Authority. The PHSSEF must be funded adequately enough to maintain a 
robust pandemic response, especially when emergency supplemental funds 
are no longer available.
    The College greatly appreciates the support of the subcommittee on 
these issues and looks forward to working with Congress during the 
FY2023 appropriations process.

    [This statement was submitted by Jared Frost, Senior Associate, 
Legislative 
Affairs, American College of Physicians.]
                                 ______
                                 
         Prepared Statement of the American College of Surgeons
    Chairwoman Murray, Ranking Member Blunt, and Members of the 
subcommittee, on behalf of the more than 84,000 members of the American 
College of Surgeons (ACS), thank you for the opportunity to submit 
written testimony addressing fiscal year (FY) 2023 appropriations. The 
ACS is a scientific and educational organization of surgeons that was 
founded in 1913 to raise the standards of surgical practice and improve 
the quality of care for all surgical patients. ACS is dedicated to the 
ethical and competent practice of surgery. Its achievements have 
significantly influenced the course of scientific surgery in America 
and have established it as an important advocate for all surgical 
patients.
    The ACS respectfully requests your consideration of the following 
priorities as the subcommittee works through the annual appropriations 
process for FY 2023:
Fully Fund the Military and Civilian Partnership for the Trauma 
        Readiness Grant Program (MISSION ZERO)
    In 2016, the National Academies of Science, Engineering, and 
Medicine (NASEM) released a report titled, ``A National Trauma Care 
System: Integrating Military and Civilian Trauma Systems to Achieve 
Zero Preventable Deaths After Injury.'' This report suggests that one 
in four military trauma deaths and one in five civilian trauma deaths 
could be prevented if advances in trauma care reach all injured 
patients. The report concludes that military and civilian integration 
is critical to saving lives both on the battlefield and at home, 
maintaining the Nation's readiness and homeland security.
    The MISSION ZERO Act was signed into law on June 24th, 2019 as part 
of S. 1279, the Pandemic and All Hazards Preparedness and Advancing 
Innovation (PAHPAI) Act (Public Law No:116-22). The MISSION ZERO Act 
acts upon the recommendations of the NASEM report to create a grant 
program, within the U.S. Department of Health and Human Services (HHS), 
to cover the administrative costs of embedding military trauma 
professionals in civilian trauma centers. These military-civilian 
trauma care partnerships will allow military trauma care teams and 
providers to gain exposure to treating critically injured patients and 
increase readiness for when these units are deployed, further advancing 
trauma care and providing greater patient access.
    ACS thanks Congress for providing $2 million in funding for the 
program in FY 22. However, ACS strongly encourages Congress to fully 
fund the Military and Civilian Partnership for the Trauma Readiness 
Grant Program at the authorized amount of $11.5 million for FY 2023. 
Building on previous funding will allow for implementation of military-
civilian trauma partnerships, preserve lessons learned from the 
battlefield, translate those lessons to civilian care, and ensure that 
service members maintain their readiness to deploy in the future.
Cancer Prevention Research
    The ACS Cancer Programs, including the Commission on Cancer (CoC), 
is dedicated to improving survival and quality of life for cancer 
patients through advocacy on issues pertaining to prevention and 
research. To continue the progress that has led to medical 
breakthroughs for treatment therapies for millions of cancer patients, 
the ACS supports the following funding increases for FY 2023.
    To ensure a robust, long-term commitment to cancer research and 
prevention, Congress should increase the overall budget of the National 
Institutes of Health (NIH) to at least $49.048 billion including $7.776 
billion for the National Cancer Institute (NCI). The ACS also urges the 
inclusion of $462.6 million for cancer programs at the Centers for 
Disease Control and Prevention (CDC), including $30 million for the 
National Comprehensive Cancer Control Program, and $61.4 million for 
the National Program of Cancer Registries (NPCR).
Firearm Morbidity and Mortality Prevention Research
    According to the Centers for Disease Control and Prevention (CDC), 
there were more than 45,000 firearm-related fatalities in 2020, a 
measured increase over previous years. ACS believes that the number of 
firearm-related fatalities can be reduced through federally funded 
public health research into firearm morbidity and mortality. As with 
other injury prevention related efforts, public health research can 
play a role in reducing the number of firearm-related injuries and 
deaths.
    Federally funded research from the perspective of public health has 
contributed to reductions in motor vehicle crashes, smoking, and Sudden 
Infant Death Syndrome (SIDS). ACS believes that a similar approach can 
provide necessary data to inform efforts to reduce firearm-related 
injuries and deaths. ACS supports a total of $60 million-35 million for 
the U.S. Centers for Disease Control and Prevention (CDC) and $25 
million for the National Institutes of Health (NIH) to conduct public 
health research into firearm morbidity and mortality prevention.
Removal of Language in Section 510
    Serious patient safety concerns arise if a patient's health record 
is mismatched or includes inaccurate or incomplete information, 
potentially resulting in missed allergies, medication interactions, or 
duplicate tests ordered. Unfortunately, there is no accurate or 
consistent way for surgeons to link patients to their health 
information across the continuum of care, due to long-standing Federal 
statutory language. The language, located in Section 510 of the LHHS 
Appropriations bill, has prohibited HHS from spending any Federal 
dollars to promulgate or adopt a Unique Patient Identifier, thereby 
hampering public-private sector collaborative efforts to advance a 
nationwide patient identification strategy that is cost-effective, 
scalable, secure, and prioritizes patient privacy.
    Removing the language in Section 510 will provide HHS with the 
ability to evaluate a range of patient identification solutions and 
enable the agency to work with the private sector to explore potential 
challenges. ACS supports removal of Section 510 from the Labor-HHS 
appropriations bill that prohibits HHS from spending any Federal 
dollars to promulgate or adopt patient identification strategies.
    Thank you for your consideration of our requests. Please contact 
Amelia Suermann, ACS Senior Congressional Lobbyist, at 
[email protected], if you have any questions or would like additional 
information.
    Sincerely.

    [This statement was submitted by Patricia L. Turner, MD, MBA, FACS, 
Executive Director, American College of Surgeons.]
                                 ______
                                 
    Prepared Statement of the American Dental Education Association
    The American Dental Education Association (ADEA) represents all 68 
U.S. dental schools; more than 800 dental hygiene, dental therapy and 
other allied dental programs, as well as advanced dental education 
programs; over 50 corporate partners; and more than 18,000 individuals. 
ADEA submits this testimony on the Department of Health and Human 
Services and the Department of Education budgets for the record and for 
your consideration as you begin prioritizing fiscal year 2023 (FY23) 
appropriation requests.
    ADEA's 68 U.S. member dental institutions' clinics and extramural 
dental school facilities provide dental care to more than 2.7 million 
patients annually. America's dental schools are one of the nation's 
largest dental care safety nets, providing more than $74 million in 
uncompensated health care annually to the uninsured and underinsured.
    According to the Health Resources and Services Administration 
(HRSA), 67 million Americans live in one of the 6,946 dental care 
Health Professional Shortage Areas (HPSAs). To close this gap, HRSA 
estimates that over 11,567 new practitioners are needed. When you 
consider there are slightly more than 201,000 practicing dentists in 
the United States and more than 72,500 of them are over age 50, and 
that U.S. dental schools graduate about 6,300 students per year, it is 
clear that additional work needs to be done to ensure all citizens have 
access to culturally competent, comprehensive and quality oral health 
care.
    For dental students, the patient care experience begins in dental 
clinics, which are in all dental schools. These clinics must include 
most of the major service areas of a hospital and adhere to the 
rigorous guidelines that protect the health and safety of the public, 
much like hospitals do. Dental schools operate full clinical facilities 
with all the necessary treatment rooms and surgical suites, including 
areas for sterilization, diagnostic services such as radiology and 
pathology, and business operations. In contrast, medical schools 
conduct the majority of their clinical teaching and training in 
separate hospitals or affiliated academic medical centers and are not 
required to adhere to the stringent protective guidelines in their 
education buildings that are in place at dental school clinics.
    Many dental schools are part of the same campuses as the medical 
schools, which are often in underserved communities. Dental schools 
also exist within minority-serving institutions. Dental schools are 
part of their local communities' health care safety net and have been a 
previously untapped health care resource, as demonstrated during the 
COVID-19 pandemic, and will be again in future pandemics. Dental school 
clinics serve the same geographic patient populations as their medical 
colleagues, providing care at reduced rates. A large number of the 
individuals who receive dental care in dental school clinics are 
members of underserved populations and do not have private insurance or 
the ability to pay private practice fees.
    As you deliberate funding for FY23, ADEA respectfully urges your 
support for the following funding requests.
$46 million: Oral Health Training Programs
    The dental programs in Title VII provide critical education for 
predoctoral dental, dental hygiene and dental therapy students and 
training for post-doctoral advanced dental education residents in 
general, pediatric and public health dentistry. Support for these 
programs will help ensure an adequately prepared and culturally 
competent dental workforce. The program also expands access to care for 
underserved areas in community-based settings located in HPSAs.
    HRSA programs address the dental school faculty shortage with 
Dental Faculty Development and Dental Faculty Loan Repayment Program 
grants to those who teach pediatric, general or public health dentistry 
and dental hygiene. Currently, more than 200 open, budgeted faculty 
positions exist in dental schools. The Primary Care Dental Faculty 
Development Program assists schools with recruiting and retaining both 
full-time and part-time faculty and community-based faculty to develop/
enhance training focused on improving care for vulnerable and 
underserved populations.
    Increased support is needed for the Oral Health Training Programs 
so the Federal Government can continue to assist in educating and 
training oral health professionals in areas where access to quality 
care is difficult. The positive impact of these programs is clear. In 
academic year 2020-21, 9,562 dental and dental hygiene students were 
educated in predoctoral degree programs, 736 dental residents and 
fellows in primary care dental residency and fellowship programs 
received post-doctoral training in advanced care, and 847 dental 
faculty members participated in faculty development activities and 
programs. Of the dental residents and fellows, 89 percent received 
training on COVID-19 and 79 percent received training on health equity 
or the social determinants of health. Awardees were offered experience 
and training opportunities at 483 sites. Over 60 percent of these sites 
were in medically underserved communities and over 60 percent were in 
primary care settings. Almost 40 percent of the sites offered COVID-19-
related services, demonstrating oral health professionals' ability to 
provide such care.
    In addition to the Oral Health Training Programs, other Title VII 
programs play a key role in furthering the ability of the health 
professions workforce to respond to the changing makeup of those who 
need care. The Diversity and Student Aid programs play a critical role 
in ensuring the future health professions workforce reflects the 
Nation's changing demographics. These programs must receive adequate 
funding to sustain the progress necessary to meet the challenges of an 
increasingly diverse U.S. population.
    The Health Careers Opportunity Program (HCOP) provides a vital 
source of support for dental professionals serving underserved and 
disadvantaged patients by providing a career pathway for individuals 
from these populations. This unique workforce program encourages young 
people from diverse and disadvantaged backgrounds to explore careers in 
health care generally, and dentistry specifically. One criticism often 
heard is that budget analysts do not know if the program is impactful. 
That is simply because the participants are not tracked to see what 
their future career path becomes. The success of the following career 
pathway program demonstrates that these programs can be effective.
    ADEA and the Association of American Medical Colleges, through 
funding from the Robert Wood Johnson Foundation, operate a 
complimentary program, the Summer Health Professions Education Program 
(SHPEP). SHPEP is a six-week academic enrichment program for rising 
college sophomores and juniors from historically underrepresented 
racial and ethnic (HURE) populations who are interested in the health 
professions. A study of participants from 2006 to 2015 found that 65 
percent of those who participated in the program's dental portion 
applied to dental school and, as of 2015, 589 graduated from dental 
school. These pathway programs are effective in attracting HURE 
individuals. ADEA requests that funding for HCOP be continued and we 
encourage the greatest possible support for the HCOP program.
    The Area Health Education Centers (AHEC) program enhances high-
quality, culturally competent care in community-based interprofessional 
clinical training settings. The infrastructure development grants, and 
point-of-service maintenance and expansion grants, ensure that patients 
from underserved populations receive quality care and health 
professionals receive experience working with diverse populations. ADEA 
strongly encourages the Committee to continue funding the vitally 
important AHEC program.
$540 million: National Institute of Dental and Craniofacial Research
    Dental research serves as the foundation of the dental professions. 
Discoveries stemming from dental research have reduced the burden of 
oral diseases, led to better dental health for millions of Americans, 
and uncovered important links between oral and systemic health. ADEA 
and dental school researchers are grateful for the increase NIDCR 
received in FY22; however, we note that NIDCR continues to have the 
smallest budget of all the Institutes, while evidence of the link 
between oral health and overall systemic health continues to grow.
    The requested increase for FY23 will not bring us to parity, but it 
will bring us closer and provide the stable and consistent growth in 
research sought by former NIH Director Dr. Francis Collins, and shared 
by the NIH Acting Director, Dr. Lawrence Tabak, who is a dentist, 
dental educator and researcher, and former NIDCR Director. Through 
NIDCR grants, dental researchers in academic dental institutions have 
enhanced the quality of the Nation's dental and overall health. Dental 
researchers are poised to make dramatic breakthroughs, such as 
restoring natural form and function to the mouth and face as a result 
of disease, accident, or injury; and diagnosing systemic disease (such 
as HIV and certain types of cancer) from saliva instead of blood and 
urine samples. These breakthroughs, and countless others that bolster 
America's role as a global scientific leader, require adequate funding.
$35 million: Centers for Disease Control and Prevention (CDC) Division 
        of Oral Health
    The CDC Division of Oral Health expands the coverage of effective 
prevention programs. The division increases the basic capacity of state 
oral health programs to accurately assess the needs of the state, 
organize and evaluate prevention programs, develop coalitions, address 
oral health in State health plans, and effectively allocate resources 
to the programs. This strong public health response is needed to meet 
the challenges of dental disease affecting children and vulnerable 
populations. The current path of decreased funding will have a 
significant negative effect on the overall health and preparedness of 
the Nation's States and communities.
$18 million: Ryan White HIV/AIDS Treatment and Modernization Act, Part 
        F: Dental Reimbursement Program (DRP) and Community-Based 
        Dental Partnerships Program
    Patients with compromised immune systems are more prone to oral 
infections, such as periodontal (gum) disease and caries (tooth decay). 
The DRP is a federal/institutional partnership that provides partial 
reimbursement to academic dental institutions for costs incurred from 
providing dental care to people living with HIV/AIDS. Simultaneously, 
the program provides educational and training opportunities to dental 
students, residents and allied dental students. However, DRP 
reimbursement only averages 26 percent of the dental schools' 
unreimbursed costs. The current reimbursement rate is unsustainable 
long term. Adequate funding of the Ryan White Part F programs will help 
ensure that people living with HIV/AIDS receive necessary dental care.
    ADEA thanks you for your consideration of these funding requests 
and looks forward to working with you to ensure the continuation of 
these critical programs and improve the oral and systemic health and 
well-being of the Nation. Please consider ADEA a resource on any matter 
under your purview pertaining to academic dentistry and education of 
the dental workforce.
                                 ______
                                 
  Prepared Statement of the American Educational Research Association
    Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee, thank you for the opportunity to submit written testimony 
on behalf of the American Educational Research Association (AERA). AERA 
recommends that the Institute of Education Sciences (IES) within the 
Department of Education receive at least $815 million for fiscal year 
2023, aligned with the request from the Friends of IES coalition, for 
which we are a leading member. In addition, AERA recommends $49 billion 
in base funding for the National Institutes of Health (NIH) in fiscal 
year 2023. Within NIH, we recommend proportional increases for 
important research supported by the Eunice Kennedy Shriver National 
Institute of Child Health and Human Development (NICHD) and the Office 
of Behavioral and Social Science Research (OBSSR).
    AERA is the major national scientific association of 25,000 
faculty, researchers, graduate students, and other distinguished 
professionals dedicated to advancing knowledge about education, 
encouraging scholarly inquiry related to education, and promoting the 
use of research to improve education and serve the public good.
                    institute of education sciences
    IES is the independent and nonpartisan statistics, research, and 
evaluation arm of the U.S. Department of Education charged with 
supporting and disseminating rigorous scientific evidence on which to 
ground education policy and practice. Located within the Department of 
Education to provide essential education data, statistics, and science 
to the Department, the Federal Government, and the Nation, the mission 
of IES is analogous to other prominent Federal research agencies such 
as the National Science Foundation and the National Institutes of 
Health.
    Our members, as well as State and Federal policymakers and 
practitioners, rely on IES to provide reliable education statistics, 
support research to improve academic and non-academic outcomes, and 
develop evidence-based practices to inform instruction and support 
student learning at all educational levels into the workforce. We 
appreciate the increases to IES appropriations over the past few fiscal 
years, which has helped support unanticipated costs for the National 
Assessment of Educational Progress (NAEP) in the delay in administering 
the 4th and 8th grade reading and math assessments due to the COVID-19 
pandemic. We are also thankful for the inclusion of a specific line 
item within IES for program administration in the fiscal year 2022 
omnibus appropriations legislation. This allocation is an important 
step in providing additional flexibility and resources for IES to hire 
staff. Program officers and statistical staff are critical to carrying 
out IES's mission, and particularly for the National Center for 
Education Statistics (NCES), which has seen the attrition of 23 staff 
positions since fiscal year 2015.
    Since IES was created in 2002, it has made scientifically-based 
contributions to the progress of education that are used in classrooms 
across the country. For example, research findings supported by the 
National Center for Special Education Research (NCSER) have informed 
supports for implementing positive behavior interventions and supports, 
including Team-Initiated Problem Solving, used in over 1,000 schools. 
Recent work supported by the National Center for Education Research 
(NCER) has led to the development of measurements of reading used in 
schools across the Nation, including the Lexia(r) RAPID(tm) Assessment 
program, Capti Assess with ETS(r) ReadBasix(tm), and the Phonological 
Awareness Literacy Screening in Spanish (PALS espanol). Innovations in 
NAEP have led to the examination of process data to better understand 
how students arrive at responding to assessment questions, with 
implications for future test item development.
    Throughout the pandemic, IES has served as an important resource in 
providing information about distance learning; pursuing interventions 
to address socioemotional needs; and collecting data from schools on 
learning modes, school staffing, and COVID-19 mitigation strategies 
through the School Pulse Panel. The increased demand for evidence-based 
programs since the onset of COVID-19 and the need to address persistent 
and exacerbated learning gaps only further speak to the priority 
importance of supporting education research and statistics at IES to 
inform policy and practice.
    We were pleased to see IES enlist the National Academies of 
Science, Engineering, and Medicine (NASEM) to conduct three studies to 
inform future directions for IES assessment, research, and statistical 
activities. The Future of Education Research at IES report included 
several recommendations to build on the current strengths of the 
research and training programs within NCER and NCSER. These 
recommendations called on IES to advance heterogeneity and knowledge 
mobilization as project types, fund additional mixed-methods and 
qualitative research, support research focusing on teacher- and system-
level outcomes alongside student outcomes, and collect data on and 
measure impact of NCER and NCSER training programs.
    As one overarching recommendation, the NASEM committee called upon 
Congress to reexamine the IES budget in light of comparative funding 
for other Federal research agencies with purposes no more salient than 
that of IES. We encourage the subcommittee to provide additional 
resources in the Research, Development, and Dissemination and Research 
in Special Education line items for IES to expand support for these 
emerging priorities and foundational research areas.
    The Statistics line item supports NCES administrative data 
collections and longitudinal surveys, as well as participation by our 
Nation's students in important international assessments such as the 
Programme for International Student Assessment. Data from NCES, 
including from the Integrated Postsecondary Education Data System and 
the National Teacher and Principal Survey, are frequently cited and 
used to describe the condition of education in the United States. NCES 
also has an essential leadership role in implementing the Foundations 
of Evidence-based Policymaking Act, which directs Federal agencies to 
leverage data and evaluations to inform policy decisions.
    Despite NCES' significant roles in producing, disseminating, and 
using these important education indicators, funding for NCES 
statistical activities remains below fiscal Year2016 levels. In A 
Vision and Roadmap for Education Statistics, the NASEM committee that 
examined NCES statistical work referenced the limited capacity that 
NCES has in both funding and staff. Additional resources are essential 
to carry out several of the report's key recommendations, including 
developing a strategic plan, broadening outreach to data users to 
gather feedback on their needs, and establishing a joint statistical 
research program in partnership with IES. We strongly recommend 
providing sufficient funding for the Statistics line that would address 
the 15 percent loss of purchasing power for this account over the past 
decade and increase the capacity of NCES to conduct these activities.
    Alongside the important survey work NCES supports, States are 
increasingly seeking ways to determine the long-term impact of state 
policies, including in education, and they turn to information in their 
Statewide Longitudinal Data Systems (SLDS). Initially developed to help 
States measure accountability, data has transformed from a hammer to a 
flashlight, increasing understanding about student performance and 
teacher effectiveness. The most recent SLDS grants are also providing 
States the opportunity to partner in the development of meaningful 
measures-in this case, to pilot an NCES-developed indicator to measure 
poverty using school geocoded addresses as an alternative to using 
free-and-reduced lunch eligibility. States participating in this pilot 
have provided feedback on this NCES initiative and have also noted 
strengthened data capacity and integrity within their data systems as a 
result.
    To date, NCES has been unable to meet the State demand for SLDS 
grants. For the fiscal year 2019 competition, 28 of 44 States that 
submitted applications received grants, although the average amount of 
grants was reduced by half compared with those awarded in fiscal year 
2015. Growing interest in using data from these systems, including an 
IES research competition encouraging the research use of these data for 
examining longitudinal impacts of State policies, show the importance 
of continuing investment in these data systems. Inadequacies in funding 
reduce the vitality of this Federal-State partnership to support 
evidence-based policy work within and across States.
    In A Vision and Roadmap for Education Statistics, the NASEM 
committee recommended that NCES strengthen State capacity to link data, 
adopt shared data standards, and provide actionable information to 
State and local education agencies to help improve student learning 
outcomes. Additional funding for SLDS would help enhance NCES technical 
assistance and ongoing efforts to promote best practices for State data 
governance structures and data interoperability, including through the 
voluntary Common Education Data Standards.
    In sum, sustained, robust investment in the education research and 
statistical infrastructure at IES is necessary to support the success 
of our Nation's students, teachers, and education leaders.
                     national institutes of health
    AERA recommends $49 billion for the National Institutes of Health 
(NIH) in fiscal year 2023 with proportional increases for the Eunice 
Kennedy Shriver National Institute of Child Health and Human 
Development (NICHD) and the Office of Behavioral and Social Science 
Research (OBSSR).
    NICHD supports research at the intersection of health and 
education, including ways to foster health literacy, potential 
influencers of family environments on child well-being and cognitive 
development, and interventions for students with learning disabilities 
who struggle with reading. Providing $1.816 billion for NICHD in fiscal 
year 2023 will allow the institute to expand research to increase 
understanding of how best to support executive functioning, support 
additional research on early language and motor development, and to 
bolster the professional development of early career researchers.
    OBSSR plays an important role in coordinating and co-funding 
behavioral and social science research across NIH that contribute to 
the understanding of influences on health and interventions to improve 
health outcomes. OBSSR has long recognized the interdependence of 
education and health in terms of prevention, intervention, and the 
health-risk consequences of a lack of or limited educational exposure. 
We recommend no less than the fiscal year 2022 funding level for OBSSR, 
including a proportionate increase in its fiscal Year2023 budget as 
provided to the NIH.
    Thank you for the opportunity to submit written testimony in 
support of at least $815 million for IES and $49 billion in base level 
funding for NIH in fiscal year 2023. AERA welcomes working with you and 
your subcommittee on strengthening investments in essential research, 
data, and statistics related to education and learning.

    [This statement was submitted by Felice J. Levine, PhD, Executive 
Director, American Educational Research Association.]
                                 ______
                                 
         Prepared Statement of the American Geriatrics Society
    The American Geriatrics Society (AGS) greatly appreciates the 
opportunity to submit this testimony. The AGS is a national non-profit 
organization of nearly 6,000 geriatrics healthcare professionals and 
basic and clinical researchers dedicated to improving the health, 
independence, and quality of life of all older Americans. The AGS 
believes in a just society--one where we all are supported by and able 
to contribute to communities and where ageism, ableism, classism, 
homophobia, racism, sexism, xenophobia, and other forms of bias and 
discrimination no longer impact healthcare access, quality, and 
outcomes for older adults and their caregivers. As the subcommittee 
works on its fiscal year (FY) 2023 Labor, Health and Human Services, 
and Related Agencies Appropriations Bill, we ask that you prioritize 
funding for the geriatrics education and training programs under Title 
VII of the Public Health Service (PHS) Act, and for aging research 
within the National Institutes of Health (NIH) and National Institute 
on Aging (NIA).
    We are appreciative of your ongoing support of the Title VII 
Geriatrics Health Professions Programs at the Health Resources and 
Services Agency (HRSA), which includes the Geriatrics Workforce 
Enhancement Program (GWEP) and Geriatrics Academic Career Award (GACA) 
program. However, the AGS believes it is urgent that we increase the 
educational and training opportunities in geriatrics and gerontology 
and ensure that HRSA receives the funding expansion necessary for these 
critically important programs for the care and health of older adults.
    We ask that the subcommittee consider the following funding levels 
for these programs in FY 2023:
  --At least $82 million to support the GWEP and GACA program (PHS Act 
        Title VII, Sections 750 and 753(a))
  --At least $49 billion, an increase of no less than $4.1 billion over 
        the enacted FY 2022 level, in the FY 2023 budget for total 
        spending at NIH for current institutes and operations; a 
        minimum increase of $60 million for the Brain Research Through 
        Advancing Innovative Neurotechnologies (BRAIN) Initiative; and 
        a minimum increase of $226 million for research on Alzheimer's 
        disease and related dementias over the enacted FY 2022 level in 
        the FY 2023 budget
    Sustained and enhanced Federal investment in these initiatives is 
essential to delivering high-quality, better coordinated, efficient, 
and cost-effective care to our older Americans whose numbers are 
projected to increase dramatically in the coming years. According to 
the U.S. Census Bureau, the number of people age 65 and older is 
projected to nearly double from 52.4 million today \1\ to more than 94 
million by 2060, while those 85 and older is projected to almost triple 
from 6.6 million today to 19 million by 2060.\2\ As our aging 
population increases, so too will the prevalence of diseases 
disproportionately affecting older people--most notably Alzheimer's 
disease and related dementias (including vascular, Lewy body, and 
frontotemporal dementia)--and the economic burden associated with these 
diseases.
---------------------------------------------------------------------------
    \1\ U.S. Census Bureau. 2020 American Community Survey 5-Year 
Estimates Subject Tables. Published 2020. Accessed April 25, 2022. 
https://data.census.gov/cedsci/table?t=Populations
%20and%20People&tid=ACSST5Y2020.S0101.
    \2\ U.S. Census Bureau. An Aging Nation: Projected Number of 
Children and Older Adults. Updated October 8, 2019. Accessed April 25, 
2022. https://www.census.gov/library/visualizations/2018/comm/historic-
first.html.
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    To ensure that our Nation is prepared to meet the unique healthcare 
needs of this rapidly growing population, we request that Congress 
provide additional investments necessary to expand and enhance the 
geriatrics workforce, which is an integral component of the primary 
care workforce, and to foster groundbreaking medical research.
         programs to train geriatrics healthcare professionals
Geriatrics Workforce Enhancement Program and Geriatrics Academic Career 
        Award Program (at least $82 million)
    Our healthcare workforce receives little, if any, training in 
geriatric principles,\3\ which leaves us ill-prepared to care for older 
Americans as health needs evolve. With our Nation continuing to face a 
severe shortage of geriatrics healthcare providers and academics with 
the expertise to train these providers, the AGS believes it is urgent 
that we increase the number of educational and training opportunities 
in geriatrics and gerontology. The requested increase in funding over 
FY 2022 levels would help ensure that HRSA receives the funding 
necessary to expand these critically important programs commensurate 
with the increasing need.
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    \3\ Only 3 percent of medical students take even one class in 
geriatric medicine and fewer than 1 percent of RNs, pharmacists, 
physician assistances and physical therapists are certified in 
geriatrics or gerontology. Yet estimates are that by 2030, 3.5 million 
additional health care professionals and direct-care workers will be 
needed to care for older adults. 2018 Issue Brief, Eldercare Workforce 
Alliance, Available at https://eldercareworkforce.org/wp-content/
uploads/2018/03/GWEP_OnePager_v2.pdf.
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    The GWEP is currently the only Federal program designed to increase 
the number of providers, in a variety of disciplines, with the skills 
and training to care for older adults. The GWEP awardees educate and 
engage the broader frontline workforce, including the caregiving 
workforce and family caregivers, and focus on opportunities to improve 
the quality of care delivered to older adults, particularly in 
underserved and rural areas. Due to GWEPs' partnerships with primary 
care and community-based organizations, GWEPs are uniquely positioned 
to rapidly address the needs of older adults and their caregivers. The 
GWEP was launched in 2015 by HRSA with 44 3-year grants provided to 
awardees in 29 States. In 2019, HRSA funded a second cohort of 48 GWEPs 
across 35 States and two territories (Guam and Puerto Rico) and 
provided extension grants to 15 former GWEP awardees. Additional 
funding would allow 80 GWEPs at $950,000 per program, enabling every 
State to have a GWEP and ensure that more rural and underserved areas 
of the country can have access to geriatrics training and expertise.
    The GACA program is an essential complement to the GWEP. GACAs 
ensure we can equip early-career clinician educators to become leaders 
in geriatrics education and research. It is the only Federal program 
designed to increase the number of faculty with geriatrics expertise in 
a variety of disciplines. The program was eliminated in 2015 through a 
consolidation of several training programs. However, the program was 
reestablished in November 2018 when HRSA released a funding opportunity 
indicating their intention to fund 26 GACAs for 4 years starting 
September 1, 2019. Since 1998, original GACA recipients have trained as 
many as 65,000 colleagues in geriatrics expertise and have contributed 
to geriatrics education, research, and leadership across the U.S. 
Additional funding would allow 60 GACAs at $100,000 per award, ensuring 
we have a larger and more geographically diverse pipeline of geriatrics 
research and training expertise with the incentives and resources 
needed to grow the field.
    GWEPs and GACAs have been successfully leading and preparing the 
healthcare workforce, caregivers, and their communities, and most 
recently on the frontline throughout the COVID-19 pandemic, including 
working with health systems to participate in the outreach to 
vulnerable and hard-to-reach populations, preventing widening the 
health disparity gap exacerbated by the pandemic. These programs are 
critical in providing assistance for proactive public health planning 
with their geriatrics expertise and knowledge of long-term care and can 
help ensure States and local governments have improved plans for older 
adults in disaster preparedness for future pandemics and natural 
disasters. Furthermore, as the U.S. population rapidly ages, access to 
a well-trained workforce and appropriate care for medically complex 
older adults is imperative to maintaining the health and quality of 
life for this growing segment of the Nation's population.
    To address this issue, we ask the subcommittee to provide a FY 2023 
appropriation of at least $82 million for the GWEP and GACA program. 
This increase in funding over FY 2022 levels would help ensure that 
HRSA receives the funding necessary to carry these critically important 
programs forward. Additional funding will also allow HRSA to expand the 
number of GWEPs and GACAs and move towards closing the current 
geographic and demographic gaps in geriatrics workforce training. Given 
the increasing diversity among older people \4\ and rapid growth of the 
older population,\5\ the need for a diverse workforce as well as 
training in geriatrics and gerontology will continue to increase. The 
infrastructure of care in the U.S. needs substantial investments so 
that access to long-term services and supports is expanded while the 
healthcare workforce is adequately supported and prepared to care for 
us all as we age.
---------------------------------------------------------------------------
    \4\ Matthews KA, Xu W, Gaglioti AH, et al. Racial and Ethnic 
Estimates of Alzheimer's Disease and Related Dementias in the United 
States (2015-2060) in Adults Aged >=65 Years. Alzheimers Dement. 
2019;15(1):17-24. doi:10.1016/j.jalz.2018.06.3063.
    \5\ U.S. Census Bureau. An Aging Nation: Projected Number of 
Children and Older Adults. Updated October 8, 2019. Accessed April 25, 
2022. https://www.census.gov/library/visualizations/2018/comm/historic-
first.html.
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                      research funding initiatives
National Institutes of Health/National Institute on Aging (additional 
        $60 million for the Brain Research Through Advancing Innovative 
        Neurotechnologies Initiative and a minimum increase of $226 
        million for Alzheimer's disease and related dementias research)
    The institutes that make up the NIH, and specifically the NIA, lead 
the National scientific effort to understand the nature of aging and to 
extend the healthy, active years of life. As a member of the Friends of 
the NIA (FoNIA)--a broad-based coalition of aging, disease, research, 
and patient groups committed to the advancement of medical research 
that affects millions of older Americans--the AGS urges you to include 
an increase of at least $60 million in the FY 2023 budget for the BRAIN 
Initiative and a minimum increase of $226 million for research on 
Alzheimer's disease and related dementias over the enacted FY 2022 
level.
    The Federal Government spends a significant and increasing amount 
of funds on healthcare costs associated with age-related diseases. By 
2050, for example, the number of people age 65 and older affected by 
dementia is estimated to reach 12.7 million cases--nearly double the 
number in 2021--and is projected to cost $355 billion which does not 
include the $256.7 billion in unpaid caregiving by family and 
friends.\6\ Further, chronic diseases related to aging, such as 
diabetes, heart disease, and cancer continue to afflict 80 percent of 
people age 65 and older.\7\ Forty percent of Medicare beneficiaries 
have four or more chronic conditions and account for 78 percent of 
Medicare expenditures.\8\ Continued and increased Federal investments 
in scientific research will ensure that the NIH and NIA have the 
resources to conduct groundbreaking research related to the aging 
process, foster the development of research and clinical scientists in 
aging, provide research resources, and communicate information about 
aging and advances in research on aging.
---------------------------------------------------------------------------
    \6\ Alzheimer's Association. 2021 Alzheimer's Disease Facts and 
Figures. Alzheimers Dement. 2021;17(3):327-406. doi:10.1002/alz.12328.
    \7\ National Prevention Council. Healthy Aging in Action: Advancing 
the National Prevention Strategy. Published November 2016. Accessed 
April 25, 2022. https://www.cdc.gov/aging/pdf/healthy-aging-in-
action508.pdf.
    \8\ Centers for Medicare and Medicaid Services. Chronic Conditions 
Charts: 2018. Published 2018. Accessed April 26, 2022. https://
www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/Chronic-Conditions/Chartbook_Charts.
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    Additionally, the AGS supports at least $49 billion, no less than a 
$4.1 billion increase over the enacted FY 2022 level, in the FY 2023 
budget for total spending at NIH for current institutes and operations. 
We also urge you to ensure that any funding for the Advanced Research 
Projects Agency for Health (ARPA-H) supplement, not supplant, the total 
$49 billion base budget recommendation. We believe that a meaningful 
increase in NIH-wide funding, in combination with aging and increase in 
prevalence of diseases, will be essential to sustain the research 
needed to make progress in addressing chronic disease, Alzheimer's 
disease, and related dementias that disproportionately affect older 
people.
    Strong support such as yours will help ensure that every older 
American is able to receive high-quality care. We greatly appreciate 
the subcommittee for the opportunity to submit this testimony.
                                 ______
                                 
          Prepared Statement of the American Heart Association
    Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee, as President of the American Heart Association, I would 
like to submit my written testimony on behalf of our 40 million 
volunteers and supporters. My name is Dr. Donald Lloyd-Jones, and as 
the President of the American Heart Association, I serve as the chief 
volunteer scientific and medical officer, responsible for the oversight 
of all medical, scientific, and public health matters, and those 
related to public policy. I am also the Chair of the Department of 
Preventive Medicine, the Eileen M. Foell Professor of Heart Research, 
and Professor of Preventive Medicine, Medicine, and Pediatrics at 
Northwestern University's Feinberg School of Medicine in Chicago.
    As an epidemiologist and board-certified practicing cardiologist 
for more than 23 years, I understand firsthand the burden of 
cardiovascular disease. I have a broad and deep understanding of what 
individuals and families need to promote health, prevent disease, cure 
illness, and manage chronic health conditions. As a volunteer with the 
American Heart Association for more than 24 years, I have been proud to 
advance the organization's mission to be a relentless force for a world 
of longer, healthier lives for all. I am also proud to represent the 
American Heart Association as a major advocate for population health at 
the Federal, State, and local levels, as a supporter of healthy 
communities, and as a champion for health equity.
    The American Heart Association is the largest nonprofit funding 
source for cardiovascular and cerebrovascular disease research, next to 
the Federal Government. We have funded 14 Nobel Prize winners and 
several important medical breakthroughs, including techniques and 
standards for cardiopulmonary resuscitation (CPR), the first artificial 
heart valve, implantable pacemakers, cholesterol inhibitors, 
microsurgery, and drug-coated stents. Of note, the American Heart 
Association is also the largest and most experienced provider of CPR 
training-training millions of individuals, first-responders, and health 
care workers worldwide each year through a vast network of more than 
3,500 Authorized Training Centers and more than 400,000 instructors.
    As Congress works to draft the Labor, Health and Human Services, 
Education and Related Agencies (Labor-HHS-ED) appropriations 
legislation for fiscal year (FY) 2023, the American Heart Association 
respectfully requests that the subcommittee provide $25 million over no 
more than the next five fiscal years to the Centers for Disease Control 
and Prevention (CDC) Division for Heart Disease and Stroke Prevention 
to expand an existing, national sudden cardiac registry to capture data 
from all States, nationwide. Annually, more than 350,000 people fall 
victim to sudden cardiac arrest outside of a hospital environment. It 
is the single leading mechanism of death in the US, and yet it is not 
well recognized as a major public health challenge. When a person 
experiences a sudden cardiac arrest, seconds count in the response of 
bystanders and the emergency system to restore a normal heart rhythm 
and blood pressure. Indeed, these seconds determine the difference 
between life and death, and the chance for a meaningful neurological 
recovery. Unfortunately, only about 1 in 10 victims survive a sudden 
cardiac arrest, and many survivors are left with permanent heart and 
brain damage.
    During an emergency response to an out-of-hospital cardiac arrest, 
the victim's chances depend entirely on a team of volunteers and 
professionals that span laypersons, emergency dispatch, law 
enforcement, medical first responders, EMS providers, and later 
hospital-based nurses and physicians. The team must work together to 
resuscitate the cardiac arrest patient by quickly recognizing the 
cardiac arrest event, providing early CPR and early defibrillation, 
delivering expert advanced care, and downstream post-resuscitation 
critical care and rehabilitation.
    Traditionally, these efforts have been well-intentioned but have 
not leveraged quality improvement strategies that measure care and 
outcome. Consequently, there is marked disparity across emergency 
systems with survival varying as much as 10-fold across different 
communities.\1\ The disparity is unacceptable and can be addressed with 
key programmatic implementation designed to impact local performance. 
The effective strategy for improvement was detailed in the National 
Academies of Science publication: Cardiac Arrest Resuscitation: A Time 
to Act.\2\ Since its publication, there has been substantial effort to 
provide high-traction, accessible resources that can impact 
resuscitation quality improvement, and in turn, advance public health.
---------------------------------------------------------------------------
    \1\ Cardiac Arrest Registry to Enhance Survival (CARES), 2020 
Annual Report, Page 38, https://mycares.net/sitepages/uploads/2021/
2020_flipbook/index.html?page=1.
    \2\ Institute of Medicine. 2015. Strategies to Improve Cardiac 
Arrest Survival: A Time to Act. Washington, DC: The National Academies 
Press. https://doi.org/10.17226/21723.
---------------------------------------------------------------------------
    The cornerstone of quality improvement--as highlighted in the 
National Academies document--is the need for consistent, broadly-
accessible, scientifically-informed registry data to measure the care 
and outcome of cardiac arrest and identify opportunities for 
programmatic improvement. The Cardiac Arrest Registry to Enhance 
Survival (CARES) was first established by the CDC in 2004 in 
collaboration with the Department of Emergency Medicine at the Emory 
University School of Medicine to meet this need and provide 
informative, high-fidelity surveillance that can direct quality 
improvement. CARES is the only national out-of-hospital cardiac arrest 
(OHCA) registry in the United States and currently includes 31 State-
based registries covering 51 percent of the U.S. population and 
representing more than 2,500 EMS agencies and 2,000 hospitals. To date, 
CARES has published more than 100 articles in peer-reviewed journals 
and has supported countless quality improvement efforts in 
participating communities, resulting in an increase in cardiac arrest 
survival and a more thorough understanding of OHCA treatment and 
survival in the field of emergency medicine. CDC's funding for the 
CARES registry was eliminated in 2012 because of sequestration and 
other budget cuts. The CARES registry operations have continued in the 
absence of Federal funding for 10 years through an infusion of private 
funding each year. This is an unsustainable model for this critically 
important work. In addition, expansion of the registry to all remaining 
States and to cover the remaining half of the US population will 
require Federal support.
    The CARES registry allows communities and public health 
organizations to monitor their quality of care, compare patient 
populations, measure interventions and outcomes, and ascertain whether 
resuscitation is provided according to evidence-based guidelines. 
Without uniform and reliable data collection in every State, 
communities cannot ascertain the effectiveness of their sudden cardiac 
arrest response systems, nor can they assess the impact of 
interventions designed to improve survival rates. In other words, one 
cannot improve what one does not measure, and every State across the 
Nation should be collecting these data in a unified, harmonized, and 
standardized central registry to best serve their communities.
    Multiple systems--large and small--now use CARES as they move 
forward with program improvements. The emergence of CARES corresponds 
to dynamic programmatic opportunities to improve care for 
resuscitation. Implementation of these innovative programs to improve 
early CPR, defibrillation, and advanced treatment can accelerate with 
the use of CARES to evaluate how local implementation impacts 
prognosis. Early evaluation of this ``measure and improve'' quality 
approach has highlighted some remarkable success, ranging from outcome 
improvement in rural communities in North Carolina and Washington State 
to lives saved in urban centers such as Chicago and Detroit.
    Now is the time to scale the registry to be an inclusive and truly 
national initiative that will leverage CARES measurement to achieve 
wide-ranging ``best-practices'' implementation that can improve care 
across emergency systems and in turn benefit community health and save 
many more lives from sudden cardiac arrest. We thank you for the 
consideration of our request to include $25 million for the CDC 
Division for Heart Disease and Stroke Prevention to enable national 
access to CARES and its consequent strategy to measure and improve 
resuscitation, address substantial system disparities, and in turn 
improve the Nation's health.

    [This statement was submitted by Donald M. Lloyd-Jones, MD, ScM, 
FACC, FAHA, President, American Heart Association.]
                                 ______
                                 
 Prepared Statement of the American Indian Higher Education Consortium
    On behalf of the Nation's 35 accredited Tribal Colleges and 
Universities (TCUs), which collectively are the American Indian Higher 
Education Consortium (AIHEC), we thank you for the opportunity to share 
our fiscal Year2023 funding requests. The following is a list of 
recommendations including Department, program, and funding requests.
Department of Education--Office of Postsecondary Education
  --Strengthening Tribal Colleges and Universities (HEA Title III-Part 
        A (Sec. 316): $70,000,000 (discretionary)
  --Perkins Career and Technical Education Programs (Sec. 117): 
        $16,000,000
Department of Education--Office of Indian Education
  --Indian Education Professional Development Program: $20,000,000
Department of Health and Human Services-Administration for Children and 
        Families-Office of Head Start
  --TCU-Head Start Partnership Program: $10,000,000

Tribal Colleges and Universities: Serving Students Across Indian 
        Country and Rural America
    Currently, 35 accredited TCUs operate more than 75 campuses and 
sites in 15 States. TCU geographic boundaries encompass 80 percent of 
American Indian reservations and Federal Indian trust lands. American 
Indian and Alaska Native (AI/AN) TCU students represent more than 230 
federally recognized Tribes and hail from more than 30 States. Nearly 
80 percent of these students receive Federal financial aid, and nearly 
half are first generation students. In total, TCUs serve over 160,000 
American Indians, Alaska Natives, and other rural residents each year 
through a wide variety of academic and community-based programs. 
Funding cuts of any amount to even one TCU program would force TCUs to 
scale back vital programs and services that students rely on to 
complete degree and certificate programs needed to succeed in their 
chosen career paths. Any reduction in funding will threaten TCU 
accreditation status and will further stretch overtaxed faculty and 
staff or result in cuts to faculty and staff. The following are 
justifications for TCU fiscal Year2023 funding requests.
                      u.s. department of education
Strengthening Tribal Colleges (HEA Title III--Part A--Section 316): 
        TCUs urge the subcommittee to provide $70,000,0000 for the 
        Strengthening Tribal Colleges and Universities program (HEA 
        Title III-Part A).
    The Strengthening Institutions HEA Title III program for TCUs 
(Section 316) is specifically designed to address the critical, unmet 
needs of AI/AN students and their communities. Through this program, 
TCUs are able to provide student support services, Native language 
preservation, basic upkeep of campus buildings and infrastructure, 
critical campus expansion, enterprise management systems, faculty for 
core courses, and other necessary elements for a quality educational 
experience. The Strengthening Institutions program provides formula-
based aid to 35 accredited TCUs through two funding sources Part A 
discretionary funding: FY 23 request $70 million (FY 2022, $43.895 
million) and Part F mandatory funding (FY 2022, $28.29 million).
    In 2019, TCUs feared losing nearly half of Title III funding when 
Part F funding temporarily expired. Fortunately, the ``Fostering 
Undergraduate Talent by Unlocking Resources to Education Act (Public 
Law 116-91) was signed into law on December 20, 2019, permanently 
authorizing Part F mandatory funding at $30 million for TCUs. With 
increased Part A funding, TCUs will be able to expand critical student 
support programs, meet accreditation requirements, and address ongoing 
infrastructure needs, which are all essential in supporting 
institutional development.
Carl D. Perkins Career and Technical Education Programs
            Tribally Controlled Postsecondary Career and Technical 
                    Institutions: AIHEC requests $16,000,000 to fund 
                    grants under Sec. 117 of the Perkins Act.
    Carl D. Perkins Career and Technical Education Act provides a 
competitively awarded grant opportunity for Tribally chartered career 
and technical institutions (Sec.117), which provide critical workforce 
development and job creation, education, and training programs to AI/
ANs from Tribes and communities with some of the highest unemployment 
rates in the Nation.
    Native American Career and Technical Education Program (NACTEP): 
NACTEP (Sec. 116) reserves 1.25 percent of appropriated funding to 
support AI/AN career and technical programs. The TCUs strongly urge the 
subcommittee to continue to support NACTEP, which is vital to the 
continuation of career and technical education programs offered at TCUs 
that provide job training and certifications to remote reservation 
communities.
Office of Indian Education
            Indian Education Professional Development Program: AIHEC 
                    requests $20,000,000 for grants to TCUs and other 
                    institutions of higher education.
    The Indian Education Professional Development Program, administered 
by the Office of Indian Education at the U.S. Department of Education, 
provides grants to institutions of higher education to prepare and 
train AI/ANs to serve as teachers and school administrators at 
elementary and secondary schools. There is a growing teacher shortage 
across the country, especially in urban and rural communities with high 
AI/AN populations, where teacher recruitment and retention pose unique 
challenges. In communities with teacher shortages, existing obstacles 
to student success such as inadequate facilities and limited broadband 
are further compounded by overcrowded classrooms. Targeted resources 
like the Indian Education Professional Development Program help address 
this shortage and ensure that AI/AN students receive high-quality 
elementary and secondary education.
    Report Language Needed: Funding for two distinct activities is 
provided under the ``Special Programs for Indian Children'' account: 
the Indian Education Professional Develop Program and Native Youth 
Community Projects. Despite increased funding in 2016 to the overall 
account, increases were only provided to Native Youth Community 
Projects; the Indian Education Professional Development Program did not 
receive increased funding. In fiscal Year2020, the Special Programs for 
Indian Children account received $67,993,000, of which $13,668,000 was 
allocated for the Indian Education Professional Development Program. 
AIHEC requests specific report language in order to increase funding 
for the Indian Education Professional Development Program, at a minimum 
of $20,000,000 in fiscal year 2023.
              u.s. department of health and human services
    Administration for Children and Families--Office of Head Start: 
Tribal Colleges and Universities Head Start Partnership Program: AIHEC 
requests $10,000,000 for the TCU-Head Start Partnership program. The 
TCU-Head Start Partnership program was re-established in fiscal 
Year2020 with $4,000,000, continued in fiscal Year2021 with $4,000,000, 
and increased in fiscal year 2022 with $6,000,000. TCUs have had 
demonstrated success in training early childhood educators and Head 
Start teachers who are urgently needed across Indian Country. In 2021, 
71.7 percent of Head Start teachers nationwide held a bachelor's degree 
or higher as required by Federal law; but only 42 percent of Head Start 
teachers met the requirement in Indian Country (Head Start Region 11); 
only 39 percent of assistant teachers in Region 11 met the associate-
level requirements, compared to 76 percent nationally. TCUs are the 
most cost-effective way for filling this gap. From 2000 to 2007, the 
U.S. Department of Health and Human Services provided modest funding 
for the TCU-Head Start Partnership Program (42 U.S.C. 9843g), which 
helped TCUs build capacity in Early Childhood Education (ECE) by 
providing scholarships and stipends for Head Start teachers and 
assistant teachers to enroll in TCU ECE programs. Before the program 
ended in 2007 (ironically, the same year that Congress specifically 
authorized the program in the reauthorization of the Head Start Act), 
TCUs had trained more than 400 Head Start teachers and assistant 
teachers. However, recent reports revealed high turnover rates for Head 
Start workers. Many ECE teachers cited leaving their Head Start 
positions for higher paying jobs or retirement, due to pandemic-related 
stress, and other reasons.
    In the 18 months since the program was re-established, six TCUs 
have accomplished incredible success in supporting the early childhood 
teacher pipeline. Recently, Stone Child College (Box Elder, MT) 
expanded its Early Childhood Education program to offer a bachelor's 
degree, in addition to an associate degree, in response to student 
requests for in-person classes. Cankdeska Cikana Community College 
(Fort Totten, ND) offers an ECE associate degree and has an 
articulation agreement allowing students to transfer into the ECE 
bachelor's degree program at Mayville State University (Mayville, ND). 
Many of the current ECE students are full-time Head Start teachers 
while balancing part-time course work in addition to meeting family 
responsibilities. Through this program, TCUs are able to provide 
students with mental and emotional health resources to support and 
retain these resilient ECE students. Likewise, Navajo Technical 
University (Crownpoint, NM), Salish Kootenai College (Pablo, MT), Fond 
Du Lac Tribal and Community College (Cloquet, MN), and White Earth 
Tribal and Community College (Mahnomen, MN) have developed ECE student 
support programs to meet similar student needs. However, due to limited 
funding, only six of the 25 TCUs with ECE programs are funded to 
provide these transformative opportunities to advance early childhood 
education careers. With increased funding, TCUs can leverage resources 
to aid in building an early childhood education workforce to better 
serve the education needs of AI/AN children.
                               conclusion
    Tribal Colleges and Universities provide thousands of AI/AN 
students with access to high-quality, culturally appropriate, 
postsecondary education opportunities, including critical early 
childhood education programs. The modest Federal investment in TCUs has 
paid great dividends in terms of employment, education, and economic 
development. We ask you to renew your commitment to help move our 
students and communities toward self-sufficiency and request your full 
consideration of our FY 2023 appropriations requests. Thank you.
                                 ______
                                 
         Prepared Statement of the American Library Association
    The American Library Association (ALA) urges the subcommittee to 
include in its Fiscal Year (FY) 2023 appropriations bill at least $50 
million for Innovative Approaches to Literacy (IAL) under the 
Department of Education (DOE).
    As the Nation struggles with the lingering effects of COVID-19, we 
are beginning to see the troubling consequences on early literacy 
development. Librarians work heroically to continue needed services for 
all students and assist classroom teachers and administrators in new 
and innovative ways. During the pandemic, school librarians continued 
to support access to education and tutoring sites for homework help. 
School libraries lent books, eReaders, computers and hotspots to 
students, many of whom did not have access to these basic services at 
home. Some libraries are even streaming story times and author visits 
to encourage young children and their families to keep up reading in 
their homes.
    School library services are in great demand yet face tightening 
budgets and reduced staff at many schools, which limits their ability 
to provide literacy training and support.
    Innovative Approaches to Literacy is the only Federal program 
providing dedicated support to school libraries. Authorized in the 
Every Students Succeeds Act (ESSA), IAL provides competitive awards to 
school libraries as well as national not-for-profit organizations, 
including partnerships that reach families outside of local educational 
agencies (LEAs), to support children and families in high-need, 
underserved communities. By providing age-appropriate books, supporting 
parental engagement programs, and reinforcing professional development, 
the IAL program helps to support literacy skills to ensure that 
children enter school ready to learn and best positioned for success.
    Since its inception in FY 2012, more than 200 IAL grants have been 
awarded to national non-profit organizations and school districts 
across every region of the U.S., delivering critical literacy resources 
in these communities. In light of interrupted learning this past year 
due to the pandemic, it is even more urgent to support children's 
literacy at home and in school. This is particularly acute for minority 
and low-income students. The IAL program is designed to provide the 
kind of support children and families need. Some examples of IAL grant 
activities include:
  --In 2021, an IAL grant was awarded to Tuscaloosa (AL) City Schools, 
        a midsize urban city school district serving 10,500 K-12 
        students in 20 locations. This collaborative grant with school 
        libraries will provide a learning environment that is racially, 
        ethnically, culturally, disability status and linguistically 
        responsive. The grant will allow the district to implement the 
        Alabama Literacy Act to improve reading proficiency of public-
        school kindergarten through grade 3 students. The district will 
        be able to provide early literacy services and distribute high-
        quality books on a regular basis to children from low-income 
        communities. Tuscaloosa schools have set goals that include a 
        minimum of 85 percent of librarians will receive literacy 
        training; 100 percent of participating schools will develop, 
        improve, or expand their K-12 literacy plan; a 4 percent 
        increase over baseline; and 100 percent of students will 
        receive personal books and/or access to online books.
  --The Yakama Nation Tribal School in Washington state joined 
        community partners to receive an IAL grant in 2021. Their 
        Reading Through Mirrors & Windows IAL grant targets 14 schools 
        with a large percentage of Native American and Hispanic 
        students and will support literacy programs for educators, 
        students, and parents designed to improve literacy skills. The 
        grant will promote book distribution, mobile libraries, out-of-
        school time literacy activities, reader/writer theaters, and 
        read-a-loud events. The 3-year grant has established laudable 
        goals for the schools to achieve each year.
    A strong learning environment begins with literacy skills in early 
childhood. However, only 35 percent of fourth grade students, 34 
percent of eighth grade students, and 37 percent of twelfth grade 
students performed at or above the proficient level on the 2019 NAEP 
reading assessment (National Center for Education Statistics, 2019). 
This was exacerbated during the pandemic by school building closings 
and remote learning, which challenged students and educators alike. A 
study by McKinsey & Company found that students taking formative 
assessments in spring 2021 lost the equivalent of 4 months of learning 
in reading on average, but the unfinished learning was especially for 
students of color and those from low-income households. Without 
immediate and sustained interventions, researchers estimate that 
pandemic-related unfinished learning could reduce lifetime earnings for 
K-12 students by an average of $49,000 to $61,000.
    The American Academy of Pediatrics reports that children introduced 
to early reading and literacy support tend to read earlier and excel in 
school compared to children who lack the same access to books and 
literacy activities. Early literacy mastery is a strong indicator of 
future success in school and in life. Unfortunately, more than one in 
three American children start kindergarten without foundational skills 
to learn to read.
    Recent studies and articles demonstrate the challenges facing out 
youngest students. One article notes that early reading skills in 
Virginia are at a 20-year low while 60 percent of high-poverty students 
in Boston are high-risk for reading problems. Goldstein, Dana (2022, 
March 8) New York Times. Another article reports that more than one in 
three children who started school during the pandemic need 
``intensive'' reading help. Sparks, Sarah (2022, February 16) Education 
Week.
    Providing books and childhood literacy for such children is crucial 
to their learning to read, which is crucial to their--and our 
Nation's--economic futures. IAL is an important literacy support 
program that is urgently needed to address reading decline. IAL grants 
have been awarded during the life of the program to almost every State 
in the Nation. Schools across the country have received grants, 
including Dillingham (AK) City School District; Savannah (GA) Chatham 
City Public School System, Ypsilanti (MI) Community Schools, Cottonwood 
(OK) School, and as well as many others.
    For families living in poverty, access to reading materials is 
severely limited. Children in such households have fewer books in their 
homes than their peers, which hinders their ability to prepare for 
school and to stay on track. IAL helps bridge that gap. Accordingly, we 
urge the subcommittee to foster this work by continuing to invest at 
least $50 million in IAL.
    ALA asks for a modest, but critical, Federal investment of $50 
million in the FY 2022 Innovative Approaches to Literacy (IAL) program, 
authorized under the Every Student Succeeds Act. IAL provides 
competitive awards to high-need school libraries and national not-for-
profit organizations (including partnerships that reach families 
outside of local educational agencies) to put books into the hands of 
children and their families.
    ALA understands the tight fiscal constraints on the subcommittee, 
and we appreciate its continued dedicated support of IAL. Thank you for 
your commitment to sustaining and strengthening our communities and our 
Nation by supporting America's school libraries.
                                 ______
                                 
          Prepared Statement of the American Liver Foundation
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Provide the National Institutes of Health (NIH) with at least $49. 
        billion and provide individual NIH Institutes and Centers, such 
        as NIDDK, NIMHD, and NCI with proportional discretionary 
        increases.
    --Please provide additional, distinct funding for the emerging 
            Advanced Research Projects Agency for Health (ARPA-H) at 
            NIH, which would facilitate implementation of this 
            important program without supplanting ongoing NIH research 
            activities.
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least $11 billion to facilitate timely public health efforts 
        along with proportional increases for CDC Centers and 
        Divisions, such as NCCDPHP and NCHHSTP.
    --Please provide $54.5 million for the Division of Viral Hepatitis 
            at CDC.
    --Please provide $150 million for the Opioid and Infectious 
            Diseases Program at CDC.
    --Please provide $6 million for the Chronic Disease Education and 
            Awareness Program at CDC.
  --Provide the Health Resources and Services Administration (HRSA) 
        with a funding level of at least $9.8 billion and ensure that 
        the agency has sufficient resources to enhance organ donation 
        through awareness activities and partnerships.
  --Please support the communities Think Liver, Think Life awareness 
        campaign and include timely committee recommendations 
        prioritizing liver health efforts.
_______________________________________________________________________

    Thank you for the opportunity to submit testimony on behalf of the 
American Liver Foundation (ALF) and the liver disease community. 
Chairwoman Murray, Ranking Member Blunt, and distinguished members of 
the subcommittee, we extend our thanks for the significant investments 
in HHS, particularly CDC and the emerging Chronic Disease Education and 
Awareness program, provided over recent years. Please maintain this 
commitment and further enhance support for public health programs as 
you work with your colleagues on appropriations for FY 2023. Thank you 
again.
                          about the foundation
    The American Liver Foundation is the Nation's largest non-profit 
organization focused solely on promoting liver health and disease 
prevention. The American Liver Foundation achieves its mission in the 
fight against liver disease by funding scientific research, education 
for medical professionals, advocacy, information and support programs 
for patients and their families as well as public awareness campaigns 
about liver wellness and disease prevention. The mission of the 
American Liver Foundation is to promote education, advocacy, support 
services and research for the prevention, treatment and cure of liver 
disease. Additional information and support can be found at 
www.liverfoundation.org or by calling 1 800 GO LIVER (800-465-4837)
                              liver facts
    The liver is one of the body's largest organs, performing hundreds 
of functions daily including, removal of harmful substances from the 
blood, digestion of fat, and storing of energy. Non-alcoholic fatty 
liver disease (NAFLD), hepatitis C, and heavy alcohol consumption are 
the most common causes of chronic liver disease or cirrhosis (severe 
liver damage) in the U.S. Nearly 100 million people in the U.S. are 
affected by liver disease. Approximately 30 percent of adults and 3-10 
percent of children have excessive fat in the liver or NAFLD which can 
lead to a severe liver disease called non-alcoholic steatohepatitis 
(NASH). Approximately 4.4 million Americans are living with Hepatitis B 
or C but most do not know they are infected. More than 2 million 
Americans are living with alcohol related liver disease. Approximately 
5.5 million Americans are living with chronic liver disease or 
cirrhosis. Vaccinations for hepatitis A and B and treatments for 
hepatitis C are helping to change the course of this chronic life 
altering disease for the patient community.
           cdc chronic disease education & awareness program
    Thank you for establishing the CDC Chronic Disease Education & 
Awareness Program in FY 2021 and providing $1.5 million in initial 
support and then doubling that support for $3 million for FY 2022.The 
first round of funding is now supporting four cooperative agreements in 
key areas, but many patient organizations seek valuable collaborations 
with CDC that can directly impact patients and improve public health. A 
few contemporary examples include raising awareness of NASH/NAFLD, and 
sharing public health information that can slow or stop the progression 
of various liver conditions into liver cancer. This new program 
provides a competitive mechanism that allows CDC to award meritorious 
cooperative agreements on an annual basis and it is only growing more 
popular. Since there is tremendous demand in this area, and no shortage 
of quality opportunities for CDC, we ask that funding be systematically 
increased again with $6 million provided for FY 2023.
                             organ donation
    Consistently, the number of organs available for transplantation on 
an annual basis amounts to only a fraction of the number of patients on 
the transplant list. Compounding this situation is the fact that fatty 
liver disease affects a large and growing number of individuals and 
makes livers unavailable for transplantation. Another complicating 
factor is the fact that the rationing of cures for hepatitis ensures 
that many patients who could otherwise be healthy end up on the 
transplant list too and arbitrarily deny available organs to other 
patients facing a variety of life-threatening illnesses. Please promote 
organ donation and otherwise work to ensure Medicaid and other patients 
impacted by hepatitis receive curative therapy when medically 
appropriate.
                          the opioid epidemic
    CDC has dubbed opioids and the infectious diseases that arrive in 
the wake of the opioid crisis a ``dual epidemic''. This epidemic has 
been further fueled by the well-documents rise in opioid abuse during 
the COVID-19 pandemic. Due to the ongoing increase in rates of 
injection drug use, CDC recently identified a 400 percent increase in 
rates of hepatitis C among 20--29 year olds an 300 percent increase 
among 30--39 year olds. The elimination initiative has been well-
supported since its establishment, but much more can be done. We ask 
that this allocation be systematically increased along with the annual 
funding for the Division of Viral Hepatitis (which saw is first modest 
funding increase in many years for FY 2022) to ensure CDC has adequate 
resources to make progress.
                      covid-19 and liver diseases
    There is a growing body of work focused on COVID-19's impact on the 
liver and persistent impacts for COVID ``long haulers''. We appreciate 
that a well-resourced NIH and public health response can continue to 
advance research in this critical area. Moreover, in regards to 
vaccination, please note that the American Association for the Study of 
Liver Diseases (AASLD) recommends that providers advocate for 
prioritizing patients with compensated or decompensated cirrhosis or 
liver cancer, patients receiving immunosuppression such as SOT 
recipients, and living liver donors for COVID-19 vaccination based upon 
local health policies, protocols, and vaccine availability.
                          nash bill of rights
    Nonalcoholic steatohepatitis or NASH is liver inflammation and 
damage caused by a buildup of fat in the liver. The prevalence of NASH 
has been rising and innovative treatment options have been coming to 
market along with improved healthcare. To better serve patients, ALF 
crafted a NASH Patient Bill of Rights that provides critical 
information on non-invasive testing options and coordinating 
multidisciplinary healthcare. The Foundation looks forward to working 
with the U.S. Public Health Services to disseminate critical 
information about NASH to patients and providers.
                          patient perspectives
    Alison.--Alison is now a healthy 25-year-old from Trumbull, 
Connecticut, only 5 years ago she was near death. Alison had been 
suffering for most of her life with primary sclerosing cholangitis 
(PSC), a condition that left her in need of a live-saving liver 
transplant. On October 19th, 2009, Alison began her new life when her 
transplant was successfully performed at Yale-New Haven Hospital. 
Further complications ensued. Alison needed three additional surgeries 
to ensure her health and that of her new liver. Today, she is healthy.
    Kevin.--In May 2007, a medical team at New York Columbia 
Presbyterian Hospital conducted its first living donor liver transplant 
surgery on a bile duct cancer patient. The patient was Kevin, my 
younger brother. I was the living donor. The transplant worked, but 
Kevin had to endure multiple follow-up surgeries to address a bile 
leakage that would not stop. But now, over 10 years later, he has long 
since healed and doing great. We were lucky. And we know it. Despite 
advances in medical and surgical science, the demand for organs 
continues to vastly exceed the number of donors. Here, in New York, 
only 27 percent of people age 18 and over have enrolled in the New York 
State Donate Life Registry. But every 10 minutes another person is 
added to the National transplant waiting list. We need to encourage 
more people to sign up to donate organs.
    David.--In October 2014 my mother Geraldine passed away after a 
very brief and completely unexpected battle with late-stage NASH. They 
call NASH the ``silent killer'' and in Mom's case it was certainly 
true; she was never diagnosed with any form of liver disease at all 
before NASH. We had noticed some yellowing of her eyes and convinced 
her to go to the doctor about a month earlier, but it took time to get 
an appointment with a specialist, who checked her into a hospital upon 
the visit. I founded NASHAWARE.com to help raise awareness and educate 
others. If I can help even a few people it will all be worth it. But I 
still want to do much more.

    [This statement was submitted by Lorraine Stiehl, Chief Executive 
Officer, 
American Liver Foundation.]
                                 ______
                                 
          Prepared Statement of the American Lung Association
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

$11 billion for the Centers for Disease Control and Prevention (CDC)
  --National Center for Chronic Disease Prevention & Health Promotion 
        (NCCDPHP)
    Provide $3.75 billion for NCCDPHP
      -- Provide $310 million for CDC's Office of Smoking and Health 
            (OSH)
      -- Provide $6 million for CDC's Chronic Disease Education and 
            Awareness Program
  --National Immunization Program at CDC's National Center for 
        Immunization and Respiratory Diseases (NCIRD)
    Provide $1.13 billion for NCIRD
  --National Center for Environmental Health (NCEH)
    Provide $322 million for NCEH
    --Provide $110 million for CDC's Climate and Health Program
    --Provide $40 million for CDC's National Asthma Control Program 
            (NACP)

$49 billion for the National Institutes of Health (NIH)
  --Provide $4.015 billion for the National Heart, Lung, and Blood 
        Institute (NHLBI)
  --Provide $932 million for the National Institute of Environmental 
        Health Sciences (NIEHS)
_______________________________________________________________________

    The American Lung Association is the leading public health 
organization working to save lives by improving lung health and 
preventing lung disease through education, advocacy and research. 
Chairwoman Murray, Ranking Member Blunt, and distinguished members of 
the subcommittee, we extend our thanks for the significant investments 
in the Department of Health and Human Service (HHS), including the 
robust response to the COVID-19 pandemic. Please maintain this 
commitment and further enhance support for public health programs as 
you work on appropriations for FY 2023. The American Lung Association 
also asks for your leadership in opposing all policy riders that would 
weaken key lung health protections.
    The ongoing COVID-19 pandemic continues to underscore the need for 
significant and sustained investments in our Nation's public health 
infrastructure, especially at CDC. For years, the Lung Association has 
requested for robust CDC funding. Unfortunately, the consequences of 
the failure to adequately invest in both cross-cutting and individual 
programs at CDC has become evident. The pandemic has taken the lives of 
more than one million people in the U.S. and lung disease deaths this 
past year have increased 80 percent due to COVID-19. We ask that CDC 
funding be increased to at least $11 billion for FY 2023. This funding 
must be in addition to, not in lieu of, emergency funds to respond to 
the current pandemic.
    The COVID-19 pandemic has also highlighted the importance of 
preventing and managing chronic lung conditions. Individuals living 
with certain lung diseases and people who smoke are among the most at 
risk for severe illness from COVID-19. Research also suggests possible 
links between long-term exposure to air pollution and worse COVID-19 
outcomes. The Lung Association recognizes the tremendous challenges 
Congress has faced in responding to the pandemic and appreciates all 
that it has done thus far. Continued investment in CDC programs that 
help smokers quit; promote asthma control; support prevention and 
treatment of lung and other chronic diseases, including chronic 
obstructive pulmonary disorder (COPD) and lung cancer; and prepare for 
the health impacts created by a warming climate is vital.
    The American Lung Association strongly supports substantial Federal 
investments in key public health and biomedical research activities, 
especially at CDC and NIH, respectively. For FY23, the Lung Association 
encourages Congress to take a balanced approach in its increases for 
these vital agencies and urges Congress to make significant investments 
in public health and biomedical research.
    Provide $11 billion for the Centers for Disease Control and 
Prevention (CDC): CDC is faced with unprecedented challenges and 
responsibilities, especially in the respiratory space. Consequently, 
the American Lung Association strongly supports the CDC Coalition's 
request of $11 billion for CDC for FY23 and sustained, robust and 
predictable funding moving forward annually for both cross-cutting 
initiatives such as workforce and data modernization, as well as 
individual lines as outlined below.
    Provide $3.75 billion for National Center for Chronic Disease 
Prevention and Health Promotion (NCCDPHP): Chronic diseases can be 
prevented and/or managed through supportive public health interventions 
including tobacco prevention and cessation; however, they continue to 
be a major problem in the United States. Over 90 percent of the 
Nation's $3.8 trillion in annual health care costs result from chronic 
diseases. The American Lung Association strongly supports tripling the 
NCCDPHP budget over 3 years (FY23-FY25) to $3.75 billion. Such funding 
will allow NCCDPHP to fulfill its mission by expanding the current 
patchwork of existing programs to all jurisdictions nationwide and by 
implementing new efforts to address health challenges currently without 
programs, including the chronic disease cohort of those experiencing 
the long-term effects of COVID-19, or ``long COVID.'' It will also 
enable a significant investment in CDC's Social Determinants of Health 
(SDOH) program, which seeks to work with communities to identify and 
remedy SDOH.
    Provide $310 million for CDC's Office of Smoking and Health (OSH): 
One in four high school students continues to use at least one tobacco 
product. OSH is the lead Federal agency for tobacco prevention and 
control. The American Lung Association is appreciative of the $4 
million increase in funding for OSH in FY22 and asks for an additional 
$68.5 million for FY23. OSH works with State and local governments to 
prevent youth tobacco use and to promote evidence-based methods to help 
smokers quit; for example, OSH's ``Tips from Former Smokers'' campaign 
has successfully prompted one million Americans to quit smoking. The 
additional funding will be used to continue to address the e-cigarette 
pandemic, to enhance the ``Tips from Former Smokers'' campaign so that 
it can be run year-round, to invest in youth prevention efforts and to 
work to eliminate health inequities among racial, ethnic, sexual, rural 
and socio-economic groups.
    Provide $6 million for CDC's Chronic Disease Education and 
Awareness Program: Far too many individuals in the United States have 
or are at risk of potentially devastating chronic diseases without 
knowing. COPD is one of the leading causes of death and disability in 
the United States. Approximately 16 million people in the United States 
have COPD, and millions more remain undiagnosed and unaware of the 
warning signs that would prompt earlier treatment. Given this 
significant gap in knowledge, the Lung Association greatly appreciates 
the creation and funding of the Chronic Disease Education and Awareness 
competitive grant program at CDC in fiscal year 2021 and the increase 
in FY22. In FY23, the Lung Association asks for this program to be 
increased to $6 million to continue the momentum and allow CDC to 
expand its work with stakeholders to respond to chronic diseases, such 
as COPD, that do not have stand-alone programs.
    Provide $110 million for CDC's Climate and Health Program: CDC's 
Climate and Health Program is the only HHS program devoted to 
identifying the risks and developing effective responses to the health 
impacts of climate change (which include worsening air pollution; 
diseases that emerge in new areas; stronger and longer heat waves; and 
more frequent and severe droughts and wildfires) and providing guidance 
to States in adaptation. The Climate and Health Program includes the 
Climate Ready States and Cities Initiative (CRSCI) that utilizes a 
five-step Building Resilience Against Climate Effects (BRACE) program 
to protect communities. The CRSCI program is a valuable tool for 
States, localities, Tribes and territories, but it has received 
insufficient funding. Just recently, funding for a number of States was 
actually cut. The President's budget requests $110 million, which would 
allow CDC to implement a climate and health program across all States 
and territories.
    Provide $40 million for CDC's National Asthma Control Program 
(NACP): It is estimated that 24.8 million Americans currently have 
asthma, of whom 5.5 million are children. The NACP tracks asthma 
prevalence, promotes asthma control and prevention and builds capacity 
in States. This program has been highly effective: asthma mortality 
rates have decreased despite the rate of asthma increasing. We thank 
Congress for the increase in funding of $500,000 in FY22. Additional 
funding would allow increased surveillance in States, including where 
pediatric asthma surveillance is not available. At present, 24 States, 
Puerto Rico, and Houston, TX, receive funding, and additional entities 
are funded to collect detailed surveillance data so that public health 
interventions are more focused and effective. Additional funding of $40 
million in FY23 would also allow for the NACP to continue its efforts 
to develop public health interventions aimed at protecting people with 
asthma from wildfire smoke.
    Provide $1.13 billion for the National Immunization Program at 
CDC's National Center for Immunization and Respiratory Diseases 
(NCIRD): The success of the Nation's vaccination programs has enabled 
many individuals to forget about the impact of many vaccine-preventable 
diseases, such as polio, that once wreaked havoc. The COVID-19 
pandemic, however, has provided a stark reminder of the need and 
significance of vaccines and a robust national vaccination program. As 
the Nation waits to know if COVID-19 vaccines will be made available 
for children under 5, and if research shows that booster shots for non-
immunocompromised adults are a viable way to reduce the effects of 
COVID-19, it is crucial that national vaccine programs remain prepared 
and well-funded as we enter the third year of the COVID-19 pandemic. 
The National Immunization Program must receive strong and sustained 
funding. The Lung Association asks for $1.13 billion for NCIRD to 
enhance COVID-19 vaccinations, bolster the Nation's immunization 
infrastructure and address any gaps in routine immunizations that may 
have emerged as a result of the pandemic.
    Provide $49 billion for the National Institutes of Health (NIH): 
The Lung Association supports increased funding for NIH research on the 
prevention, diagnosis, treatment and cures for tobacco use and all lung 
diseases including lung cancer, asthma, COPD, pulmonary fibrosis, 
influenza and tuberculosis. The Lung Association also supports robust 
funding increases for the individual institutes within NIH, recognizing 
the need for research funding increases to ensure the pace of research 
is maintained across NIH. Lastly, the Lung Association urges increased 
funding for lung cancer research in addition to the Cancer Moonshot and 
the All of Us Program. Although lung cancer remains the leading cause 
of cancer deaths in the United States, the lung cancer survival rate 
has increased 33 percent in the past 10 years due to improvements in 
treatment. It is important that funding for lung cancer research 
increase concurrently in order to continue to make life-saving 
advancements in research.
    Provide $4.015 billion for the National Heart, Lung, and Blood 
Institute (NHLBI): The Lung Association supports increased funding for 
the National Heart, Lung, and Blood Institute in FY23. NHLBI is a 
global leader in lung, heart and blood disease research, and invests in 
prevention programs and new treatments for chronic lung conditions. 
NHLBI currently conducts research on improving early identification and 
treatment of COPD, and on new asthma treatments for the half of all 
severe asthma patients who do not respond to conventional medication. 
As the COVID-19 pandemic continues, NHLBI research also addresses the 
uncertainty regarding the long-term impacts of COVID-19 on patients on 
the heart, lungs and blood. Additional funding of $4 billion would 
allow NHLBI to bolster these crucial projects.
    Provide $932 million for the National Institute of Environmental 
Health Sciences (NIEHS): The Lung Association requests funding of $932 
million for NIEHS. Research at NIEHS studies and identifies links 
between chronic diseases and patients' environmental surroundings, 
which is fundamental to treating lung diseases such as asthma and COPD. 
Patients with asthma can be triggered by extreme weather events such as 
wildfires, underscoring the importance of research that prepares 
patients and providers for the health impacts of a changing climate. 
The Lung Associations supports $100 million for climate change and 
human health research within NIEHS.
    Thank you for your consideration of our recommendations.

    [This statement was submitted by Harold P. Wimmer, President and 
CEO, 
American Lung Association.]
                                 ______
                                 
     Prepared Statement of the American Massage Therapy Association
    The American Massage Therapy Association (AMTA) appreciates the 
opportunity to submit a Statement to the Senate subcommittee on Labor, 
Health and Human Services, and Education, and Related Agencies in 
support of continued robust funding in the FY 2023 budget for the 
National Center for Complementary and Integrative Health (NCCIH) within 
the National Institutes of Health (NIH). We also encourage additional 
support for the Centers for Medicare and Medicaid Services (CMS) to 
implement and disseminate the recommendations of the 2019 HHS ``Pain 
Management Task Force (PMTF)'', which include utilization of massage 
therapy for pain management.
    Established in 1943 and numbering over 95,000 members, AMTA works 
to advance the massage therapy profession through the promotion of fair 
and consistent licensing of massage therapists in all States, public 
education on the benefits of massage therapy, and support of research 
to advance knowledge about massage therapy. Massage therapists are 
currently licensed in 46 States and the District of Columbia.
    The impact of COVID restrictions on patient access to health care 
for a variety of pain conditions is being felt now throughout the 
health care system. Opioid and substance abuse rates have increased. 
While there is no single solution to the opioid crisis, massage therapy 
demonstrably reduces reliance on opioids to address pain.
    CMS includes massage therapy provided by a State licensed massage 
therapist as a supplemental benefit for pain management in Medicare 
Advantage plans, and massage is also a covered benefit for our Nation's 
veterans and active-duty military personnel.
    As well, massage therapy is specifically supported in the May 2019 
final report of the PMTF, and is part of the ``Pain Management 
Toolbox'' as an example of a treatment modality that should be 
considered as part of an overall integrative and collaborative care 
model to ensure optimal patient outcomes. https://www.hhs.gov/sites/
default/files/pmtf-final-report-2019-05-23.pdf.
    NCCIH notes the value of massage therapy for a wide variety of 
health conditions involving both acute and chronic pain, including low 
back pain, neck and shoulder pain, symptoms and side effects associated 
with certain cancers, fibromyalgia, HIV/AIDS, among others. In addition 
to NIH, massage therapy is supported by the American College of 
Physicians and The Joint Commission. Massage is currently utilized in 
many nationally renowned hospitals and other institutions, such as the 
Mayo Clinic, M.D. Anderson Cancer Center, Duke Integrative Medicine, 
the Cleveland Clinic, and Memorial Sloan Kettering Cancer Center.
    We would like to highlight that massage has been specifically noted 
in guidelines for non pharmacologic opioid alternatives issued by the 
Attorney General of West Virginia; and, it is among a list of four non-
pharmacologic approaches to pain in a September 18, 2017 letter to 
American's Health Insurance Plans, signed by 37 Attorneys General, 
which urges health insurance companies to encourage health care 
providers to prioritize non-opioid pain management options for chronic 
pain, as follows:

      ``When patients seek treatment for any of the myriad conditions 
        that cause chronic pain, doctors should be encouraged to 
        explore and prescribe effective non-opioid alternatives, 
        ranging from non-opioid medications (such as NSAIDs) to 
        physical therapy, acupuncture, massage, and chiropractic 
        care.''

    Despite the demonstrated value and efficacy of massage therapy 
through research, we know that more needs to be done. Research will 
continue to identify the optimal benefits of massage for particular 
demographic groups, including patients as young as infants up to 
Medicare beneficiaries. And, we need to better understand the 
underlying mechanisms of pain, and how and why pain manifests 
differently for different patients.
    Maintaining a robust Federal research program at NCCIH dedicated to 
advancing massage therapy is vital, and health care providers need to 
be aware of the value of massage therapy in order for research findings 
to be put in action. For this reason, we believe it is critical that 
NCCIH continue to drive forward the most promising science surrounding 
massage and other integrative therapies to address both acute and 
chronic pain conditions. It is equally important that public and 
provider awareness of the known benefits of massage therapy be 
optimized, and we encourage additional support by this Committee for 
CMS to implement and disseminate the PMTF's report and recommendations.
    Thank you again for the opportunity to provide this statement.
                                 ______
                                 
        Prepared Statement of the American Physiological Society
    The American Physiological Society (APS) thanks the subcommittee 
for its ongoing support of the National Institutes of Health (NIH). The 
sustained budget increases over the past several years have allowed the 
agency to support biomedical discoveries and innovations that drive the 
development of the next generation of therapies. The existing 
Institutes and Centers at the NIH rely on consistent and steady funding 
growth to keep pace with the inflation of research costs and it is 
absolutely essential that the NIH continues to provide robust support 
for such investigator-driven research. Therefore, the APS urges you to 
sustain this vital effort by providing the NIH with a base budget of at 
least $50 billion in fiscal year (FY) 2023.
    While APS supports the goals of the new Advanced Research Project 
Agency for Health (ARPA-H) (ARPA-H), it is critical that any funding 
provided for this new program does not come at the expense of the NIH's 
fundamental research efforts. The ARPA-H budget should therefore be in 
addition to the $50 billion base budget.
    The NIH is the Nation's largest funder of biomedical research. More 
than 80 percent of the agency's funding supports extramural research, 
largely awarded through competitive grants. These grants fuel economic 
activity and job creation in every State. NIH funding in 2021 supported 
over 550,000 jobs and generated an estimated $94 billion in economic 
activity.\1\ The discoveries that emerge from NIH-supported basic and 
translational research provide the foundation for new drugs and 
therapies and prepare our Nation to confront challenging public health 
threats such as obesity and diseases associated with an aging 
population.
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    \1\ https://www.unitedformedicalresearch.org/wp-content/uploads/
2022/03/UMR_NIHs-Role-in-Sustaining-the-U.S.-Economy-FY21.pdf.
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    The historically robust support of the NIH and other Federal 
research agencies by Congress is a primary reason the US is the global 
leader in biomedical research. However, the rate of growth of Federal 
funding for research lags behind that of some other countries, 
including China.\2\ Unless the US prioritizes investments in science, 
the Nation risks losing its edge in highly competitive technology 
driven industries.
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    \2\ https://ncses.nsf.gov/pubs/nsb20221/executive-summary.
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    While the private sector brings the majority of new treatments to 
the market, it relies on the breakthroughs from federally funded 
research to identify new targets and strategies to treat diseases. This 
partnership between industry and academic research has been key for 
decades of success of the American biomedical industry. A study 
published in the Proceedings of the National Academy of Sciences found 
that every single one of the 210 new pharmaceuticals approved by the 
FDA between 2010 and 2016 depended on research funded by the NIH.\3\
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    \3\ https://www.pnas.org/doi/10.1073/pnas.1715368115.
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    The NIH has proven its value as an institution over the past 
several decades. The rapid development of effective and safe COVID-19 
vaccines was possible only because of many previous years of 
fundamental research supported by NIH. Other achievements include 
improvements in diagnostics, new cancer treatment options, and a better 
understanding of antibiotic resistance. The NIH also plays an important 
role in training the next generation of scientists by supporting 
trainees with individual fellowships and institutional grants as they 
complete their graduate degrees and seek the post-doctoral training 
necessary to pursue successful independent research careers.
    Our public health system continues to face significant challenges. 
COVID-19 cases have decreased, but hospitals continue to see new 
infections. Millions of Americans potentially face long-term health 
effects due to COVID-19. In addition, our aging population will face 
increasing rates of conditions such as heart disease, diabetes, 
arthritis, kidney failure, and cancer. If we are to continue to advance 
new and innovative ways to address these and other challenges on the 
horizon-including developing the workforce necessary to do so--the NIH 
will need stable and predictable funding increases in future years.
    The APS joins the Federation of American Societies for Experimental 
Biology (FASEB) in urging that NIH be provided with no less than $50 
billion in FY 2023, with additional funds for ARPA-H provided in 
addition to that amount.
    Physiology is a broad area of scientific inquiry that focuses on 
how molecules, cells, tissues and organs function in health and 
disease. The American Physiological Society connects a global, 
multidisciplinary community of more than 10,000 biomedical scientists 
and educators as part of its mission to advance scientific discovery, 
understand life and improve health. The Society drives collaboration 
and spotlights scientific discoveries through its 16 scholarly journals 
and programming that support researchers and educators in their work.
                                 ______
                                 
 Prepared Statement of the American Psychological Association Services
    The American Psychological Association (APA) is the largest 
scientific and professional organization representing psychology in the 
United States, with more than 133,000 researchers, educators, 
clinicians, consultants, and students as its members. Our mission is to 
promote the advancement, communication, and application of 
psychological science and knowledge to benefit society and improve 
lives.
    Many programs in the Labor-HHS-Education Appropriations bill are 
critical to strengthening the mental health workforce, supporting 
psychology-based research and education, and improving access to needed 
mental and behavioral health services, particularly for underserved 
communities. As the COVID-19 pandemic continues to present broad 
challenges for our Nation in both the short and long term, Federal 
investments are needed to bolster research, expand equitable access to 
primary and mental health services, and support data-informed 
approaches to education and public welfare at all levels. To boost 
critical research funding, support the psychology workforce, improve 
access to mental and behavioral health services across the lifespan, 
and address social determinants of health, APA requests the following 
funding levels for fiscal year 2023 within the U.S. Department of 
Health and Human Services, U.S. Department of Education, and U.S. 
Department of Labor.
Boosting Critical Research Funding:
    APA requests at least $40.048 billion for NIH in fiscal year 2023, 
an increase of $4.1 billion ($3.5 billion or 7.9 percent in NIH 
appropriation plus funding from the 21st Century Cures Act for specific 
initiatives) above the fiscal year 2022 funding level. This is a 
critical year for NIH to expand its support of youth mental health 
research, including work on the potential harms and benefits of social 
media. APA encourages the Committee to resist calls to limit the 
availability or use of non-human animal models in research, and to 
ensure this research continues to be conducted appropriately and 
ethically. As an association with a longstanding history of devoting 
attention to and advancing diversity, equity, inclusion, and 
accessibility related issues, APA strongly believes these factors are 
critical to advancing biomedical, behavioral, and psychological 
research supported by the NIH.
    APA recommends at least $815 million for the Institute of Education 
Sciences (IES), which supports and disseminates scientific evidence on 
which to base education policy and practice and funds innovative 
research into many aspects of teaching and learning. This sum is 
necessary to fully support the education research and statistical 
infrastructure essential to education policy and practice.
    Finally, APA urges the Committee to provide $60 million for gun 
violence research in fiscal year 2023, $35 million to the CDC and $25 
million to the NIH to conduct public health research into firearm 
morbidity and mortality prevention. This research is fundamental to 
helping our Nation better understand and address our gun violence 
public health crisis.
Supporting the Psychology Workforce:
    The nation's mental and behavioral health workforce must be 
expanded to adequately respond to the long-term mental health and 
substance use disorder ramifications of the COVID-19 pandemic, 
particularly the needs of long-underserved populations like communities 
of color and older adults. This includes foundational investments in 
higher education, as well as workforce training programs that support 
the integration of behavioral healthcare. To address this, APA supports 
increased funding for the following programs within the Department of 
Education, and HHS' Health Resources and Services Administration (HRSA) 
and Substance Abuse and Mental Health Services Administration (SAMHSA).
    Given the heavy burden of student loan debt, APA supports added 
investments in grant programs for graduate study within the Department 
of Education, including $35 million for the Graduate Assistance in 
Areas of National Need (GAANN) Program. Recent funding cycles marked 
the first time in nearly a decade where psychology was among the 
designated areas of national need under this program. As the mental 
health impact of the pandemic continues to unfold, APA requests that 
the Committee again direct the Secretary to include academic areas that 
fall under the Classification of Instructional Programs (CIP) 51.15 
Mental Health Services in the next grant competition.
    Within HRSA, APA joins the Mental Health Liaison Group (MHLG) in 
urging the Committee to provide $30 million for the Graduate Psychology 
Education Program; $225.8 million for the Behavioral Health Workforce 
Education and Training (BHWET) Programs; and $38 million for the Mental 
and Substance Use Disorder Workforce Training Demonstration, including 
the Integrated Substance Use Disorder Program (ISTP). These essential 
programs increase work to increase our Nation's supply of health 
service psychologists trained to provide integrated services to high-
need, underserved populations in rural and urban communities. To expand 
access to non-pharmacological pain management to improve pain care and 
reduce the incidence of opioid use disorders, APA recommends $10 
million for a program for education and training in pain care, as 
authorized by the SUPPORT Act under Section 759 of the Public Health 
Service Act (42 U.S.C. 294i).
    Within SAMHSA, APA requests $25 million for the Minority Fellowship 
Program (MFP). This increase will support the program's dual mission to 
both increase the diversity of the mental and behavioral health 
workforce while improving access to mental health and substance use 
disorder services in underserved communities.
Improving Access to Mental and Behavioral Health Care Across the 
        Lifespan:
    Given the rise in COVID-related mental health concerns, APA joins 
MHLG in requesting $1.7 billion for SAMHSA's Community Mental Health 
Block Grant (MHBG) and $3 billion for the Substance Abuse Prevention 
and Treatment (SAPT) Block Grant in fiscal year 2023. APA is also 
asking the Committee to include a new 10 percent set aside for 
prevention and early intervention in the MHBG, similar to the SAPT set-
aside. This would include growing school-based and community 
initiatives to address mental health before a person is deemed SED/SMI, 
which is the current statutory language for using block grant funding.
    To address rising suicide rates and ensure proper implementation of 
988 as the Nationwide number for the National Suicide Prevention 
Lifeline network, we urge the Committee to provide $140 million for the 
National Suicide Prevention Lifeline, $560 million for the 988/Lifeline 
Crisis Call Centers, $10 million for the Behavioral Health Crisis and 
988 Coordinating Office, $200 million for the 988 Public Awareness 
Campaign, and $100 million for the Mental Health Crisis Response 
Partnership Program. Additionally, we ask the Committee to include $37 
million for the State/Tribal Youth Suicide Prevention Program, $12 
million for the Campus Mental and Behavioral Health Program, and $9.3 
million for the Suicide Prevention Resource Center.
    To ensure that our K-12 students receive a well-rounded education, 
and access to school-based mental health services and programs that 
foster safe and healthy schools, APA requests $2 billion for Title IV-
A, the Student Support and Academic Enrichment (SSAE) block grant and 
$244 million for Project AWARE. Additionally, to increase the number of 
mental health providers working in school settings, APA requests $1 
billion for the Safe Schools National Activities Program in order to 
support new competitions for the School Based Mental Health Services 
Professional Demonstration Grant and the School-Based Mental Health 
Services Grant Program. APA also urges the Committee to include $16.2 
billion for Part B (Grants to States) of the Individuals with 
Disabilities Education Act (IDEA) to help provide an equitable 
education for students with disabilities.
    To prevent maternal deaths, eliminate inequities in maternal health 
outcomes, and improve maternal health, APA urges the committee to 
prioritize the highest possible funding level for essential public 
health programs, including the Maternal and Child Health Services Block 
Grant and Healthy Start at CDC; Safe Motherhood and Infant Health at 
CDC; and research into pregnancy at NIH. In addition, APA requests $100 
million for maternal mental health equity grant programs.
    Finally, APA urges the Committee to provide much-needed funding to 
support Mental Health Parity and Addiction Equity Act (MHPAEA) 
enforcement. Within the DOL's Employee Benefits Security 
Administration, APA requests $27.5 million for MHPAEA enforcement, with 
10 percent allocated to the Office of the Solicitor for parity 
litigation. To support MHPAEA enforcement within HHS, APA requests $125 
million for CMS' Center for Medicaid and CHIP Services (CMCS).
Addressing Social Determinants of Health & Social Safety Net:
    Within HHS' Administration for Children and Families, APA supports 
$1.7 billion for the Social Services Block Grant, which provides vital 
social services, such as protective services agencies and special 
services to people with disabilities. In addition, APA urges the 
Committee to provide $12.2 billion for the Head Start Program, $7.6 
billion for the Child Care and Development Block Grant, $450 million 
for Preschool Development Grants, and $500 million for CAPTA Title I to 
support State child abuse prevention and treatment.
    To expand the reach of Federal school-based health education, APA 
requests $100 million for the CDC Division of Adolescent and School 
Health (DASH), to increase access to health services, implement 
evidence-based sexual health education, and foster supportive 
environments for young people to learn.
    APA also supports $160 million for the SAMHSA Minority AIDS 
Initiative to expand efforts at preventing domestic HIV transmission 
and to increase treatment options for those living with co-morbid 
conditions.
               fiscal year 2023 requested report language
Health Resources and Services Administration
            Graduate Psychology Education [GPE] Program
    U.S. Department of Health & Human Services Health Resources and 
Services Administration (HRSA) Interdisciplinary Community-Based 
Linkages
Mental and Behavioral Health
    The Committee recommendation includes $30 million for the 
interprofessional Graduate Psychology Education (GPE) Program to 
increase the number of health service psychologists trained to provide 
integrated services to high-need, underserved populations in rural and 
urban communities. The Committee recognizes the severe impact of COVID-
19 on Americans' mental and behavioral health and urges HRSA to 
strengthen investments in the training of health service psychologists 
to help meet these demands.
National Institutes of Health
            NIMH: Research on Youth Mental Health and Disparities
    The Committee is encouraged by the work of NIMH to support research 
on issues related to youth mental health, including among youth of 
color and underserved LGBTQ+ and those with disabilities, and 
appreciates NIMH's work on a 10-year strategic plan to eliminate racial 
mental health disparities. From within the increase of $---- that the 
Committee has provided NIMH, the Institute is directed to use $50 
million to lead a multi-institute research collaboration including 
NICHD and NIMHD to guide preventive measures, targeting of 
interventions, improved treatments, and long-term recovery. This 
collaboration should sponsor fundamental and applied research including 
social, behavioral, cognitive and developmental research, to build 
resilience, increase our communities' capacity to identify and care for 
young people at risk and those in crisis, and improve the targeting and 
delivery of clinical and community-based mental health interventions.
Centers for Disease Control and Prevention
    The Committee is encouraged by the Administration's National COVID-
19 Preparedness Plan strong emphasis on COVID-19 health equity and data 
collection. According to the plan, the Administration will continue to 
prioritize providing equitable access to COVID-19 health care and 
public health resources. Central to achieving this goal is continued 
progress in modernizing national disease surveillance and building the 
capacity at Centers for Disease Control and Prevention (CDC) and State 
and local health jurisdictions. The committee asks the Department of 
Health and Human Services (HHS) to provide a report detailing the CDC's 
progress toward disaggregating COVID-19 surveillance data by race, 
ethnicity, geography, disability status, sexual orientation, gender 
identity and other factors, including mental health conditions and 
substance use.

    [This statement was submitted by Katherine B. McGuire, Chief 
Advocacy Officer, American Psychological Association Services, Inc.]
                                 ______
                                 
      Prepared Statement of the American Psychological Association
    The American Psychological Association (APA) is the largest 
scientific and professional organization representing psychology in the 
United States, with more than 133,000 researchers, educators, 
clinicians, consultants, and students as its members. Our mission is to 
promote the advancement, communication, and application of 
psychological science and knowledge to benefit society and improve 
lives.
    Many programs in the Labor-HHS-Education Appropriations bill are 
critical to strengthening the mental health workforce, supporting 
psychology-based research and education, and improving access to needed 
mental and behavioral health services, particularly for underserved 
communities. As the COVID-19 pandemic continues to present broad 
challenges for our Nation in both the short and long term, Federal 
investments are needed to bolster research, expand equitable access to 
primary and mental health services, and support data-informed 
approaches to education and public welfare at all levels. To boost 
critical research funding, support the psychology workforce, improve 
access to mental and behavioral health services across the lifespan, 
and address social determinants of health, APA requests the following 
funding levels for fiscal Year23 within the U.S. Department of Health 
and Human Services, U.S. Department of Education, and U.S. Department 
of Labor.
Boosting Critical Research Funding:
    APA requests at least $40.048 billion for NIH in FY 23, an increase 
of $4.1 billion ($3.5 billion or 7.9 percent in NIH appropriation plus 
funding from the 21st Century Cures Act for specific initiatives) above 
the FY 22 funding level. This is a critical year for NIH to expand its 
support of youth mental health research, including work on the 
potential harms and benefits of social media. APA encourages the 
Committee to resist calls to limit the availability or use of non-human 
animal models in research, and to ensure this research continues to be 
conducted appropriately and ethically. As an association with a 
longstanding history of devoting attention to and advancing diversity, 
equity, inclusion, and accessibility related issues, APA strongly 
believes these factors are critical to advancing biomedical, 
behavioral, and psychological research supported by the NIH.
    APA recommends at least $815 million for the Institute of Education 
Sciences (IES), which supports and disseminates scientific evidence on 
which to base education policy and practice and funds innovative 
research into many aspects of teaching and learning. This sum is 
necessary to fully support the education research and statistical 
infrastructure essential to education policy and practice.
    Finally, APA urges the Committee to provide $60 million for gun 
violence research in FY 23, $35 million to the CDC and $25 million to 
the NIH to conduct public health research into firearm morbidity and 
mortality prevention. This research is fundamental to helping our 
Nation better understand and address our gun violence public health 
crisis.
Supporting the Psychology Workforce:
    The nation's mental and behavioral health workforce must be 
expanded to adequately respond to the long-term mental health and 
substance use disorder ramifications of the COVID-19 pandemic, 
particularly the needs of long-underserved populations like communities 
of color and older adults. This includes foundational investments in 
higher education, as well as workforce training programs that support 
the integration of behavioral healthcare. To address this, APA supports 
increased funding for the following programs within the Department of 
Education, and HHS' Health Resources and Services Administration (HRSA) 
and Substance Abuse and Mental Health Services Administration (SAMHSA).
    Given the heavy burden of student loan debt, APA supports added 
investments in grant programs for graduate study within the Department 
of Education, including $35 million for the Graduate Assistance in 
Areas of National Need (GAANN) Program. Recent funding cycles marked 
the first time in nearly a decade where psychology was among the 
designated areas of national need under this program. As the mental 
health impact of the pandemic continues to unfold, APA requests that 
the Committee again direct the Secretary to include academic areas that 
fall under the Classification of Instructional Programs (CIP) 51.15 
Mental Health Services in the next grant competition.
    Within HRSA, APA joins the Mental Health Liaison Group (MHLG) in 
urging the Committee to provide $30 million for the Graduate Psychology 
Education Program; $225.8 million for the Behavioral Health Workforce 
Education and Training (BHWET) Programs; and $38 million for the Mental 
and Substance Use Disorder Workforce Training Demonstration, including 
the Integrated Substance Use Disorder Program (ISTP). These essential 
programs increase work to increase our Nation's supply of health 
service psychologists trained to provide integrated services to high-
need, underserved populations in rural and urban communities. To expand 
access to non-pharmacological pain management to improve pain care and 
reduce the incidence of opioid use disorders, APA recommends $10 
million for a program for education and training in pain care, as 
authorized by the SUPPORT Act under Section 759 of the Public Health 
Service Act (42 U.S.C. 294i).
    Within SAMHSA, APA requests $25 million for the Minority Fellowship 
Program (MFP). This increase will support the program's dual mission to 
both increase the diversity of the mental and behavioral health 
workforce while improving access to mental health and substance use 
disorder services in underserved communities.
Improving Access to Mental and Behavioral Health Care Across the 
        Lifespan:
    Given the rise in COVID-related mental health concerns, APA joins 
MHLG in requesting $1.7 billion for SAMHSA's Community Mental Health 
Block Grant (MHBG) and $3 billion for the Substance Abuse Prevention 
and Treatment (SAPT) Block Grant in fiscal Year23. APA is also asking 
the Committee to include a new 10 percent set aside for prevention and 
early intervention in the MHBG, similar to the SAPT set-aside. This 
would include growing school-based and community initiatives to address 
mental health before a person is deemed SED/SMI, which is the current 
statutory language for using block grant funding.
    To address rising suicide rates and ensure proper implementation of 
988 as the Nationwide number for the National Suicide Prevention 
Lifeline network, we urge the Committee to provide $140 million for the 
National Suicide Prevention Lifeline, $560 million for the 988/Lifeline 
Crisis Call Centers, $10 million for the Behavioral Health Crisis and 
988 Coordinating Office, $200 million for the 988 Public Awareness 
Campaign, and $100 million for the Mental Health Crisis Response 
Partnership Program. Additionally, we ask the Committee to include $37 
million for the State/Tribal Youth Suicide Prevention Program, $12 
million for the Campus Mental and Behavioral Health Program, and $9.3 
million for the Suicide Prevention Resource Center.
    To ensure that our K-12 students receive a well-rounded education, 
and access to school-based mental health services and programs that 
foster safe and healthy schools, APA requests $2 billion for Title IV-
A, the Student Support and Academic Enrichment (SSAE) block grant and 
$244 million for Project AWARE. Additionally, to increase the number of 
mental health providers working in school settings, APA requests $1 
billion for the Safe Schools National Activities Program in order to 
support new competitions for the School Based Mental Health Services 
Professional Demonstration Grant and the School-Based Mental Health 
Services Grant Program. APA also urges the Committee to include $16.2 
billion for Part B (Grants to States) of the Individuals with 
Disabilities Education Act (IDEA) to help provide an equitable 
education for students with disabilities.
    To prevent maternal deaths, eliminate inequities in maternal health 
outcomes, and improve maternal health, APA urges the committee to 
prioritize the highest possible funding level for essential public 
health programs, including the Maternal and Child Health Services Block 
Grant and Healthy Start at CDC; Safe Motherhood and Infant Health at 
CDC; and research into pregnancy at NIH. In addition, APA requests $100 
million for maternal mental health equity grant programs.
    Finally, APA urges the Committee to provide much-needed funding to 
support Mental Health Parity and Addiction Equity Act (MHPAEA) 
enforcement. Within the DOL's Employee Benefits Security 
Administration, APA requests $27.5 million for MHPAEA enforcement, with 
10 percent allocated to the Office of the Solicitor for parity 
litigation. To support MHPAEA enforcement within HHS, APA requests $125 
million for CMS' Center for Medicaid and CHIP Services (CMCS).
Addressing Social Determinants of Health & Social Safety Net:
    Within HHS' Administration for Children and Families, APA supports 
$1.7 billion for the Social Services Block Grant, which provides vital 
social services, such as protective services agencies and special 
services to people with disabilities. In addition, APA urges the 
Committee to provide $12.2 billion for the Head Start Program, $7.6 
billion for the Child Care and Development Block Grant, $450 million 
for Preschool Development Grants, and $500 million for CAPTA Title I to 
support State child abuse prevention and treatment.
    To expand the reach of Federal school-based health education, APA 
requests $100 million for the CDC Division of Adolescent and School 
Health (DASH), to increase access to health services, implement 
evidence-based sexual health education, and foster supportive 
environments for young people to learn.
    APA also supports $160 million for the SAMHSA Minority AIDS 
Initiative to expand efforts at preventing domestic HIV transmission 
and to increase treatment options for those living with co-morbid 
conditions.
               fiscal year 2023 requested report language
Health Resources and Services Administration
      Graduate Psychology Education [GPE] Program
      U.S. Department of Health & Human Services Health Resources and 
        Services Administration (HRSA) Interdisciplinary Community-
        Based Linkages
Mental and Behavioral Health
    The Committee recommendation includes $30 million for the 
interprofessional Graduate Psychology Education (GPE) Program to 
increase the number of health service psychologists trained to provide 
integrated services to high-need, underserved populations in rural and 
urban communities. The Committee recognizes the severe impact of COVID-
19 on Americans' mental and behavioral health and urges HRSA to 
strengthen investments in the training of health service psychologists 
to help meet these demands.
National Institutes of Health
            NIMH: Research on Youth Mental Health and Disparities
    The Committee is encouraged by the work of NIMH to support research 
on issues related to youth mental health, including among youth of 
color and underserved LGBTQ+ and those with disabilities, and 
appreciates NIMH's work on a 10-year strategic plan to eliminate racial 
mental health disparities. From within the increase of $---------- that 
the Committee has provided NIMH, the Institute is directed to use $50 
million to lead a multi-institute research collaboration including 
NICHD and NIMHD to guide preventive measures, targeting of 
interventions, improved treatments, and long-term recovery. This 
collaboration should sponsor fundamental and applied research including 
social, behavioral, cognitive and developmental research, to build 
resilience, increase our communities' capacity to identify and care for 
young people at risk and those in crisis, and improve the targeting and 
delivery of clinical and community-based mental health interventions.
Centers for Disease Control and Prevention
    The Committee is encouraged by the Administration's National COVID-
19 Preparedness Plan strong emphasis on COVID-19 health equity and data 
collection. According to the plan, the Administration will continue to 
prioritize providing equitable access to COVID-19 health care and 
public health resources. Central to achieving this goal is continued 
progress in modernizing national disease surveillance and building the 
capacity at Centers for Disease Control and Prevention (CDC) and State 
and local health jurisdictions. The committee asks the Department of 
Health and Human Services (HHS) to provide a report detailing the CDC's 
progress toward disaggregating COVID-19 surveillance data by race, 
ethnicity, geography, disability status, sexual orientation, gender 
identity and other factors, including mental health conditions and 
substance use.

    [This statement was submitted by Katherine B. McGuire, Chief 
Advocacy Officer, American Psychological Association Services, Inc.]
                                 ______
                                 
      Prepared Statement of the American Public Health Association
    APHA is a diverse community of public health professionals that 
champions the health of all people and communities. We are pleased to 
submit our request of at least $11 billion for the Centers for Disease 
Control and Prevention and at least $9.8 billion for the Health 
Resources and Services Administration in FY 2023. Robust funding for 
CDC and HRSA programs that promote public health and prevention, 
support surveillance of infectious disease and bolster America's public 
health workforce will be critical in addressing both the short-term and 
long-term health impacts of COVID-19 and the many other health 
challenges we face as a nation. We are thankful for the emergency 
supplemental funding provided to CDC and HRSA to support the Nation's 
response to COVID-19 and we urge the committee to ensure that all CDC 
and HRSA programs are adequately funded in FY 2023.
               centers for disease control and prevention
    CDC provides the foundation for our State and local public health 
departments, supporting a trained workforce, laboratory capacity and 
public health education communications systems. It is notable that more 
than 70 percent of CDC's budget supports public health and prevention 
activities by State and local health organizations and agencies, 
national public health partners and academic institutions. We urge a 
funding level of at least $11 billion in FY 2023. We are grateful for 
the important increases provided for CDC programs in FY 2022 and for 
the critical emergency funding provided to the agency to address COVID-
19. We urge Congress to build upon these investments to strengthen all 
of CDC's programs, many of which remain woefully underfunded. We also 
urge your continued support for the Prevention and Public Health Fund 
which currently makes up nearly 11 percent of CDC's budget.
    CDC serves as the command center for the Nation's public health 
defense system against emerging and reemerging infectious diseases as 
well as man-made and natural disasters. From playing a leading role in 
aiding in the surveillance, detection and mitigation of the COVID-19 
pandemic in the U.S. and globally, to monitoring and investigating 
other disease outbreaks, to pandemic flu preparedness, CDC is the 
Nation's--and a global--expert resource and response center, 
coordinating communications and action and serving as the laboratory 
reference center. States, communities and international partners rely 
on CDC for accurate information, direction and resources to ensure they 
can prepare, respond and recover from a crisis or disease outbreak.
    We strongly support the president's budget request for an 
additional $400 million, for a total of $600 million, in funding to 
bolster core public health infrastructure and capacity at the federal, 
state, territorial and local levels. This flexible funding is critical 
to addressing the gaps in core public health infrastructure and 
capacity at all levels as well as ensuring our Nation's health 
departments are able to attract and retain experienced leaders and 
respond to future public health emergencies and disease outbreaks. 
Sustained, flexible funding is critical to rebuilding and strengthening 
the Nation's public health system.
    CDC serves as the lead agency for bioterrorism and other public 
health emergency preparedness and response programs. We urge you to 
provide adequate funding for the Public Health Emergency Preparedness 
grants which provide resources to our State and local health 
departments to help them protect communities during public health 
emergencies. We also urge you to provide adequate funding for CDC's 
infectious disease, laboratory and disease detection capabilities to 
ensure we are prepared to tackle both ongoing COVID-19 pandemic and 
other public health challenges and emergencies that will likely arise 
during the coming fiscal year. Your continued support for CDC's public 
health Data Modernization Initiative is critical to ensuring we have 
both the world-class data workforce and data systems that are ready for 
the next public health emergency.
    We thank Congress for providing CDC with dedicated funding for 
firearm morbidity and mortality prevention research in FY 2020 and FY 
2021 and we strongly urge you to increase this funding in FY 2023 to 
$35 million for CDC and $25 million for NIH, as requested in President 
Biden's FY 2023 budget proposal. This will allow CDC to continue to 
support research into important issues including the best ways to 
prevent unintended firearm injuries and fatalities among women and 
children; the most effective methods to prevent firearm-related 
suicides; and the measures that can best prevent the next shooting at a 
school or public place.
    CDC's National Center for Environmental Health works to control 
asthma, protect against threats associated with natural disasters and 
climate change, reduce and monitor exposure to lead and other 
environmental health hazards and ensure access to safe and clean water. 
We urge you to provide at least $401.85 million for NCEH in FY 2023, 
including $110 million for CDC's Climate and Health program, as 
requested in President Biden's FY 2023 budget request. Climate change 
is threating our health in many ways through the increased spread of 
vector-borne diseases, degraded air quality from ozone pollution and 
wildfire smoke, hotter temperatures and more extreme weather events. 
Increased funding will allow CDC to provide funding to all 50 States 
and to support additional, cities, counties and Tribes to help them 
prepare for and respond to the health impacts of climate change in 
their communities.
    Programs under the National Center for Chronic Disease Prevention 
and Health Promotion address heart disease, stroke, cancer, diabetes 
and tobacco use that are the leading causes of death and disability in 
the U.S. and are also among the costliest to our health system. CDC 
provides funding for State programs to prevent disease, conduct 
surveillance to collect data on disease prevalence, monitor 
intervention efforts and translate scientific findings into public 
health practice in our communities. We strongly urge increased 
investments in these critical programs that are essential to reducing 
death, disability and health care costs. In particular, we urge your 
support for the president's request of $153 million for CDC's Social 
Determinants of Health Program. This increased funding would allow CDC 
to provide public health departments, academic institutions and 
nonprofit organizations funding and tools to support cross sector 
efforts to address the impact that social determinants of health such 
as unsafe and unstable housing, income insecurity, lack of 
transportation, and underlying health inequities have on the health of 
their communities.
              health resources and services administration
    HRSA is the primary Federal agency dedicated to improving health 
outcomes and achieving health equity. HRSA's 90-plus programs and more 
than 3,000 grantees support tens of millions of geographically 
isolated, economically or medically vulnerable people, in every U.S. 
state and territory, to achieve improved health outcomes by increasing 
access to quality health care and services; fostering a health care 
workforce able to address current and emerging needs; enhance 
population health and address health disparities through community 
partnerships; and promote transparency and accountability within the 
health care system.
    We are grateful for the increases provided for HRSA programs in FY 
2022 and for the emergency supplemental funding to battle the COVID-19 
pandemic, but HRSA's discretionary budget authority is far too low to 
effectively address the Nation's current public health and health care 
needs. We recommend Congress build upon the important increases they 
provided HRSA in FY 2022 and provide at least $9.8 billion for the 
Health Resources and Services Administration in FY 2023.
    HRSA programs and grantees are providing innovative and successful 
solutions to some of the Nation's greatest health care challenges 
including the rise in maternal mortality, the severe shortage of health 
professionals, the high cost of health care and behavioral health 
issues related to substance use disorders- including opioid misuse. 
Additional funding will allow HRSA to build upon these successes and 
pave the way for new achievements by supporting critical HRSA programs, 
including:
  --Primary Health Care that supports more than 13,500 health center 
        sites which provide high quality primary care services to 
        nearly 29 million people and reduce barriers such as cost, lack 
        of insurance, distance and language for their patients.
  --Health Workforce supports the health workforce across the training 
        continuum by strengthening the workforce and connecting skilled 
        professionals to communities in need. Programs such as the 
        Public Health Training Centers assess and respond to critical 
        workforce needs through training, technical assistance and 
        student support.
  --Maternal and Child Health programs support patient-centered, 
        evidence-based programs that optimize health, minimize 
        disparities and improve health promotion and health care access 
        for medically and economically vulnerable women, infants and 
        children.
  --Ryan White HIV/AIDS programs provides medical care and treatment 
        services to over half a million people living with HIV. Ryan 
        White programs effectively engage clients in comprehensive care 
        and treatment, including increasing access to HIV medication, 
        which has resulted in 89.4 percent of clients achieving viral 
        suppression, compared to just 65.5 percent of all people living 
        with HIV nationwide.
  --Title X Family Planning program reduces unintended pregnancy rates, 
        limits transmission of sexually transmitted infections and 
        increases early detection of breast and cervical cancer by 
        ensuring access to family planning and related preventive 
        health services to millions of women, men and adolescents.
  --Rural Health supports community solutions to improve efficiencies 
        in delivering rural health services and expand access, 
        including supporting activities that aim to increase access to 
        opioid treatment in rural areas and promote the use of health 
        information technology and telehealth.
    HRSA has also been active in the COVID-19 pandemic response, 
awarding billions of dollars to health centers to administer COVID-19 
tests and reimbursing over $18 billion for testing and treatment 
provided to uninsured individuals.
    In closing, we emphasize that the public health system requires 
stronger financial investments at every stage. It is critical that 
Congress increase its investments in CDC and HRSA programs to enable 
the Nation to meet the mounting health challenges we currently face and 
to become a healthier nation.

    [This statement was submitted by Georges C. Benjamin, MD, Executive 
Director, American Public Health Association.]
                                 ______
                                 
  Prepared Statement of the American Red Cross and the United Nations 
                               Foundation
    Chair Patty Murray, Ranking Member Roy Blunt, and Members of the 
subcommittee, the American Red Cross and the United Nations Foundation 
appreciate the opportunity to submit testimony. We are grateful for the 
leadership that Congress has shown in funding CDC global health 
activities in prior years, and we urge Congress to protect and 
strengthen funding for the agency's global measles elimination 
activities for FY 2023 at $80 million, which is part of CDC's overall 
Global Immunization Division line.
              covid-19 pandemic and global health security
    COVID-19 has had an unprecedented impact on global immunization 
programs. From 2019 to 2020 the number of children receiving a first 
dose of measles containing vaccine (MCV1) decreased in five out of the 
six world regions, resulting in an overall drop in the global 
vaccination coverage rate from 86 percent to 84 percent over the 
period. It is estimated that more than 22 million children did not 
receive MCV1 through routine immunization, the highest increase in 
missed children since 2000. In addition, at least 93 million 
individuals did not receive MCV1 because of COVID-19-related 
postponements of 24 preventative measles vaccination campaigns 
scheduled during the year.
    The pandemic also significantly disrupted measles surveillance and 
disease reporting. The number of lab specimens for suspected measles 
cases submitted for testing was the lowest in over a decade. Many 
countries did not provide reports to WHO and UNICEF on measles 
incidence, and of those that did report, only 32 percent achieved the 
measles surveillance sensitivity indicators needed to consistently 
detect cases and outbreaks. Thus, while available data indicates the 
number of reported measles cases did not increase over the past 2 
years, this is likely due to underreporting that has led to significant 
surveillance gaps.
    These factors paint an alarming picture of a growing immunity gap 
setting the stage for an increase in measles outbreaks and accompanying 
loss of life from an easily preventable disease. Because the measles 
virus is one of the most transmissible human viruses--with each 
infectious person capable of infecting as many as 18 unvaccinated 
individuals--a drastic increase in measles outbreaks around the world 
is anticipated. Failing to close these immunity gaps will leave 
millions of children at risk and will compromise U.S. global health 
security by disrupting economies, trade, and country stability, as well 
as increasing the likelihood of the virus infecting U.S. communities. 
Global measles investments through the CDC Global Immunization Division 
will quickly close these global immunity gaps and strengthen 
surveillance systems. These investments will also help protect progress 
over the last decade in reducing maternal and child mortality and 
morbidity, as well as preserve and enhance the broader global 
immunization infrastructure. With this context in mind, we respectfully 
provide the following justification for continued robust investment in 
CDC's global measles and rubella elimination efforts.
                        why measles and rubella?
    U.S. leadership has played a pivotal role in saving the lives of 
31.7 million children between 2000 and 2020, partnering with the 
Measles & Rubella Initiative to drive measles deaths down by 94 
percent. Measles is a highly contagious disease that can cause 
blindness, swelling of the brain, and death. Nine out of 10 people who 
are not immune to measles will contract the disease if they come in 
contact with a contagious person, and the measles virus can cause long-
term damage to the immune system. Every day, roughly 166 children still 
die of measles-related complications.
    The rubella virus is a leading infectious cause of birth defects in 
the world despite availability of an affordable, effective vaccine 
since 1969. When rubella occurs early in a pregnancy, it can cause 
miscarriages, stillbirths, or a constellation of severe birth defects 
as part of congenital rubella syndrome (CRS) that can impact vision, 
hearing, heart health, overall development. Each year roughly 100,000 
babies are born with CRS despite the vaccine preventable nature of the 
disease.
    Since 2000, measles vaccines have been the single greatest 
contribution in reducing preventable child deaths globally. We have had 
safe and effective vaccines against both rubella and measles for over 
50 years, but unfortunately vaccination rates globally have stagnated 
for over a decade due to inadequate resources.
                         domestic implications
    In the U.S., measles control measures have been strengthened, and 
endemic transmission of measles cases has been eliminated since 2000 
and rubella in 2002. However, importations of measles cases into this 
country continue to occur each year. In 2019, for example, the U.S. 
reported 1,282 cases of measles in 32 States, the largest number of 
cases since 1992. Major outbreaks in New York and Washington state were 
linked to importation of the disease by unvaccinated U.S. residents 
returning from trips abroad from countries with active outbreaks. 
Controlling measles and rubella around the world reduces the likelihood 
of similar disease importations in the future.
    Responding to measles outbreaks is resource intensive for health 
systems. In the U.S. outbreaks are costly for State and local health 
departments to detect and respond to and have economic productivity 
costs. In 2019, in response to the measles outbreak in New York City, 
the NYC Department of Health spent over $6 million and dedicated more 
than 500 staff members to halt the spread of the disease which began 
with a single imported cases from outside the country.
                    the measles & rubella initiative
    The Measles & Rubella Initiative (M&RI)--which includes the 
American Red Cross, CDC, UNICEF, the United Nations Foundation, and 
WHO, all working in collaboration with Gavi, the Vaccine Alliance as 
well as the Bill & Melinda Gates Foundation--supports countries to 
prevent, identify, and respond to measles outbreaks through key 
interventions like surveillance, supplementary vaccination campaigns, 
and emergency response.
    M&RI has achieved outstanding results by helping to vaccinate over 
3 billion individuals in 88 countries since 2001, saving the lives of 
more than 31.7 million children. In part due to M&RI, global measles 
mortality has dropped 94 percent, from an estimated 1,072,800 deaths in 
2000 to an approximately 60,700 in 2020 (the latest year for which data 
is available), mostly children under the age of five. During this same 
period, measles deaths in Africa fell by 95 percent.
    Thanks to M&RI leadership, the majority of measles vaccination 
campaigns have been able to reach more than 90 percent of their target 
populations with health equity at the forefront to ensure that the most 
vulnerable children are reached in communities that are underserve and 
difficult to access. Countries recognize the opportunity that measles 
vaccination campaigns provide in reaching mothers and young children 
and integrating the campaigns with other life-saving health 
interventions. These include administering vitamin A, which is crucial 
for preventing blindness in under nourished children; de-worming 
medicine to reduce malnutrition; doses of oral polio vaccines; 
distributing insecticide treated bed nets to help prevent malaria; and 
screening for malnutrition. The provision of multiple child health 
interventions during a single, integrated campaign is far less 
expensive than delivering the interventions separately and has a far 
greater impact on a child's health.
    In addition to the lifesaving benefits of the measles-rubella 
vaccine, immunization makes sound economic sense, as in a low-income 
country it costs roughly $2 to administer the combined measles and 
rubella vaccine to a child. A 2016 Johns Hopkins University study 
compared the costs for vaccinating against 10 disease antigens in 94 
low- and middle-income countries between 2011-2020 versus the costs for 
estimated treatments of unimmunized individuals during the same period. 
Their findings show, on average, every $1 invested in these 10 
immunizations produces $44 in savings in healthcare costs, lost wages, 
and economic productivity. The return on investment for measles 
immunization was found to be the greatest with $58 saved for every $1 
invested.
    Securing sufficient funding for measles and rubella-elimination 
activities both globally and nationally is critical. The decrease in 
donor funds available at a global level to support measles and rubella 
elimination activities makes increased political commitment and country 
ownership of the activities critical for achieving and sustaining the 
goal of increasing measles vaccination coverage to 95 percent, the 
required level to establish herd immunity. Implementation of timely 
measles and rubella vaccination campaigns is increasingly dependent 
upon countries funding these activities locally, which can be 
challenging under such downward financial pressure.
    If such challenges are not addressed, the remarkable gains made 
since 2000 will be lost and a major resurgence in measles death and 
disability will occur. The combined factors of a highly contagious 
disease, growing immunity gaps exacerbated by COVID-19 disruptions, and 
our highly interconnected world means measles is poised to spread 
quickly, with devastating results that could even threaten countries 
that have already eliminated the disease. The threat of importation of 
measles was one of the reasons that the Global Health Security Agenda 
has selected measles as an important indicator of whether a country's 
routine immunization system is able to effectively reach and vaccinate 
all its children.
         the role of cdc in global measles mortality reduction
    The CDC plays an essential role by providing support for 
vaccination programs and surveillance to detect outbreaks early and 
stop them at their source. An increase in resources for these and other 
critical activities provided by the CDC is urgently needed to prevent 
needless childhood deaths around the globe.
    In 2020, thanks in part to U.S. funding through CDC, M&RI supported 
the vaccination of approximately 129 million children 32 countries. 
Funding for CDC permitted the provision of technical support to 
Ministries of Health that included: (1) planning, monitoring, and 
evaluating large-scale measles vaccination campaigns; (2) conducting 
epidemiological investigations and laboratory surveillance of measles 
outbreaks; (3) CDC's Global Measles Reference Laboratory serving as the 
leading worldwide reference laboratory for measles and rubella; and (4) 
conducting operations research to guide cost-effective and high-quality 
measles and rubella elimination programs.
    The CDC Global Immunization Division, through which the M&RI is 
funded, has been highly effective and we strongly support fully funding 
this work. All the programs funded through the Global Immunization 
Division budget line also help to build stronger health systems. As was 
seen during the response to COVID-19, resources like the Global Measles 
and Rubella Laboratory Network can be repurposed to quickly responded 
other critical health issues. By building the capacity for measles and 
rubella resources the U.S. is also building capacity for future 
response efforts.
                               conclusion
    Since fiscal Year2001, Congress has generously provided funding to 
protect children and their families from the threat of measles and 
rubella in developing countries, thereby also protecting the U.S. 
population from the threat of measles importations. U.S. government 
funding for global measles and rubella efforts, however, has remained 
level since FY 2010 at $50 million, which due to inflation has 
significantly lost purchasing power. Furthermore, the COVID-19 pandemic 
has gravely disrupted immunization systems around the world, leaving 
millions of children vulnerable to measles and other vaccine-
preventable diseases. We must quickly ``catch up'' vaccination coverage 
rates to reach unvaccinated populations and prevent devastating measles 
outbreaks.
    Because of these factors, for fiscal Year2023 the American Red 
Cross and United Nations Foundation respectfully request an increase of 
$30 million to raise funding to $80 million, as part of the overall 
funding for the entire Global Immunization Division account in FY 2023. 
This investment will allow the CDC to help countries to close the 
immunization gap created by COVID-19, strengthen global disease 
detection capacity, safeguard the progress made over the last decade to 
reduce maternal and child mortality, and protect Americans by 
preventing measles cases and deaths in the U.S. Thank you for the 
opportunity to submit testimony, and for your continued commitment to 
ending preventable death and disability from measles and rubella.

    [This statement was submitted by Koby J. Langley, Senior Vice 
President, International Services and Service to the Armed Forces the 
American National Red Cross and Peter Yeo, Senior Vice President United 
Nations Foundation.]
                                 ______
                                 
  Prepared Statement of the American Society for Engineering Education
                                summary
    This written testimony is submitted on behalf of the American 
Society for Engineering Education (ASEE) to the Senate subcommittee on 
Labor, Health and Human Services, Education, and Related Agencies for 
the official record. ASEE appreciates the Committee's support for the 
Department of Education (ED) in Fiscal Year (FY) 2022 and asks you to 
robustly fund student aid, teacher preparation, and STEM programs in FY 
2022. Additionally, ASEE requests continued Federal funding to support 
initiatives aimed at increasing the diversity of the STEM pipeline and 
support for Minority-Serving Institutions (MSIs). The strong support of 
the National Institutes of Health (NIH) in FY 2022 was greatly 
appreciated and ASEE requests continued support of NIH. In addition, 
ASEE is excited about the establishment of ARPA-H and its potential to 
support transformative, high-reward technologies to transform health 
and medicine.
                           written testimony
    The American Society for Engineering Education (ASEE) advances 
innovation, excellence, and access at all levels of education for the 
engineering profession and is the only society representing the 
country's schools and colleges of engineering and engineering 
technology. Membership includes over 12,000 individuals hailing from 
all disciplines of engineering and engineering technology including 
educators, researchers, and students as well as industry and government 
representatives. As the pre-eminent authority on the education of 
engineering professionals, ASEE seeks to advance the development of 
innovative approaches and solutions to engineering education and 
advocates for equal access to engineering educational opportunities for 
all.
Student Aid
    Student aid and support programs like Pell Grants, Federal Work-
Study (FWS), Graduate Assistance in Areas of National Need (GAANN), and 
others make higher education accessible and affordable for millions of 
students. We appreciate the commitment the Biden Administration has 
made to affordable education through its FY 2023 president's budget 
request, which proposed doubling the Pell Grant by 2029. ASEE joins the 
higher education community in requesting funding to support doubling 
the maximum Pell Grant award to $13,000. Pell Grants are essential to 
low-income students being able to afford higher education. These awards 
are vital in helping students access the significant life and career 
benefits that higher education provides. These benefits are especially 
prevalent for engineering education, which provides a proven pathway to 
the middle class, especially for students from low-income backgrounds. 
ASEE requests funding for Federal Work Study (FWS) at $1.52 billion and 
$1.09 billion for Supplemental Educational Opportunity Grant (SEOG). 
These programs are need-based, and often this aid provides the 
resources a student needs to complete their education. ASEE asks the 
Committee to consider ways to support work-based learning, such as co-
operative education and apprenticeships, within the FWS program. ASEE 
firmly believes in ensuring access to engineering and engineering 
technology education for all students, not just those who can afford 
it, which is why ensuring student aid programs for graduate students is 
also very important. ASEE also requests funding of $35 million for the 
Graduate Assistance in Areas of National Need (GAANN) program, which 
provides fellowships, through academic departments and programs of 
institutions of higher education, to assist graduate students with 
excellent records who demonstrate financial need to pursue graduate 
education in critical areas of need for the U.S. workforce such as 
engineering.
7Teacher Preparation
    The need for well-prepared and content-confident teachers in early 
childhood, elementary, and secondary education is high, particularly in 
STEM subjects. The lack of teacher training focused on STEM, and 
engineering in particular, is an important issue facing K-12 education. 
Problem-based learning that incorporates engineering design and 
analysis skills are often absent from teacher preparation and 
professional development programs. ASEE supports vigorous funding for 
Title II of the Elementary and Secondary Education Act (ESEA), which 
supports the preparation and professional development of school 
personnel, and Title II of the Higher Education Act, which supports 
teacher preparation programs at institutions of higher education. ASEE 
also supports President Biden's budget request proposal to invest $132 
million in the Teacher Quality Partnership grant program and $20 
million in the Augustus F. Hawkins Centers of Excellence grant program 
in fiscal Year2023. Having a well-prepared, diverse K-12 STEM educator 
workforce is absolutely essential to strengthening and growing the 
domestic STEM workforce. Furthermore, Congress should consider efforts 
to support teaching skills for STEM postsecondary faculty and include 
partnerships between STEM disciplines and Schools of Education to 
support STEM faculty and support for teaching and learning centers at 
postsecondary institutions. Support of postsecondary faculty and their 
promotion of STEM learning should utilize research-based methods. Our 
future is dependent on today's students finding solutions to tomorrow's 
problems. This can only be accomplished if those students have teachers 
who are prepared to guide them in developing the knowledge and skills 
needed to solve those problems.
STEM
    Support for science, technology, engineering, and mathematics 
(STEM) continues to grow and ASEE appreciates the support many STEM 
programs received in FY 2022. ASEE supports funding for Title IV of the 
Elementary and Secondary Education Act (ESEA) at its authorized amount 
of $1.6 billion, which will allow States and school districts 
additional resources to pursue STEM programs. ASEE supports robust 
funding for STEM programs for higher education students including the 
Hispanic-Serving Institutions (HSI) STEM and Minority Science and 
Engineering Improvement (MSEIP) programs. The STEM workforce is a 
driving force behind innovation and our economic development and needs 
to be grown and diversified in the United States. These and other 
programs targeted towards increasing the representation of historically 
underrepresented populations, including women, will ensure a healthy 
STEM workforce pipeline. Furthermore, ASEE supports the 
Administration's proposal from the fiscal Year2023 budget request to 
provide a $282 million increase above fiscal Year2021 enacted levels to 
enhance institutional capacity at Minority-Serving Institutions and to 
create a new $450 million grant program to expand the research capacity 
of institutions that are historically underrepresented in the research 
and development enterprise.
Career and Technical Education (CTE)
    ASEE knows that high-quality Career and Technical Education (CTE) 
prepares students for careers and further postsecondary education while 
fulfilling employer needs in high-demand sectors of the economy. ASEE 
supports CTE and wants to ensure best practices and high-quality 
programs are embedded in its programs, for example through faculty 
professional development and connections to the National Science 
Foundation -supported Advanced Technological Education (ATE) programs. 
ASEE also wants to strengthen pathways between CTE at the associate 
degree level to 4-year engineering and engineering technology degrees. 
ASEE believes that students should have lifelong options for continuing 
study and career advancement and that CTE programs can help students 
achieve their goals. In order for States and their CTE educators to 
provide high-quality CTE opportunities for students and strengthen 
pathways between two- and 4-year institutions of higher education, ASEE 
urges Congress to robustly fund the Perkins Basic State Grant funding 
program in fiscal Year2023 and encourage the program to build 
connections with NSF's ATE program.
National Institutes of Health
    The National Institutes of Health are a strong supporter of 
engineering research through many institutes, especially the National 
Institute of Biomedical Imaging and Bioengineering (NIBIB), the 
National Cancer Institute (NCI), the National Institute of General 
Medical Sciences (NIGMS), and the National Heart, Lung, and Blood 
Institute (NHLBI). ASEE is grateful to the committee for its strong 
bipartisan support of the NIH over many years and most recently in FY 
2022 appropriations. NIBIB is the major NIH Institute focused on 
engineering applications to human health and training the next 
generation of biomedical engineers. NIBIB funding is critical for the 
development of devices and tools that can improve the detection, 
treatment, and prevention of disease, and also plays a critical role in 
assessing the effectiveness of new drugs, diagnosis techniques, and 
treatment procedures. NIBIB also supports training programs to enhance 
and expand education and training for the next generation biomedical 
engineering workforce. Through grant programs like the Enhancing 
Science, Technology, and Math Education Diversity Research Education 
Experiences, and Team-Based Design in Biomedical Engineering Education, 
NIBIB is committed to supporting all stages of the biomedical 
engineering career pathway and increasing the participation of 
traditionally underrepresented groups in engineering. ASEE urges the 
Committee to provide NIH with $49.048 billion in base funding FY 2023 
so that NIBIB and other NIH institutes can continue to support critical 
biomedical engineering research and training.
              advanced research project agency for health
    ASEE is excited about the establishment of the Advanced Research 
Project Agency for Health (ARPA-H) and believe it will enable new 
models for disruptive health innovation and enable development of 
transformative health technologies. ASEE is encouraged by initial 
planning at the Department of Health and Human Services (HHS) to give 
ARPA-H independence, ensure it has a unique culture, and focus its 
efforts on disease-agnostic platform technologies that have high 
potential across many disease and health areas. Congress should 
continue to encourage the development of a true risk-taking culture at 
ARPA-H to enable high reward outcomes. ASEE urges the subcommittee to 
ensure that any funding provided for ARPA-H supplements, and does not 
supplant, the NIH's base budget funding. As noted above NIBIB and other 
NIH institutes continue to support critical research and need robust 
funding.
                               conclusion
    Engineering and engineering technology academic programs play 
critical roles in the STEM ecosystem. The requests made here support 
the development of a skilled technical workforce, broadening 
participation, and transdisciplinary study. Thank you for the 
opportunity to submit this testimony.

    [This statement was submitted by Adrienne R. Minerick Ph.D., 
President, and Norman Fortenberry, Sc.D., Executive Director, American 
Society for Engineering Education.]
                                 ______
                                 
      Prepared Statement of the American Society for Microbiology
    The American Society for Microbiology (ASM) is the one of the 
largest life science societies, composed of more than 30,000 scientists 
and health professionals. Our mission is to promote and advance the 
microbial sciences.
    ASM respectfully requests that Congress provide $49 billion for the 
National Institutes of Health (NIH) and $11 billion for the Centers for 
Disease Control and Prevention (CDC) in fiscal year (FY) 2023. Within 
the CDC budget, we request $175 million for the Advanced Molecular 
Detection (AMD) program in the National Center for Emerging and 
Zoonotic Infectious Diseases.
       continuing to lead through a strong investment in the nih
    We thank Congress for its longstanding, bipartisan support for the 
NIH and for its commitment to basic, translational, and clinical 
microbial research funded through multiple Institutes and Centers, 
particularly through the National Institute of Allergy and Infectious 
Diseases (NIAID). We especially thank Chair Murray, Ranking Member 
Blunt and members of the Senate Appropriations subcommittee on Labor, 
Health and Human Services, Education and Related Agencies for their 
unwavering support for the NIH and leadership over the past several 
years, during which they and their House counterparts have worked in a 
bipartisan manner to place the NIH budget back on the path of 
meaningful growth above inflation.
    Thanks to a renewed commitment to NIH, researchers were able to 
pivot when SARS-CoV-2 emerged and the race to develop tests, vaccines 
and therapeutics commenced. Researchers built on decades of federally 
funded basic science and technological advances to develop safe and 
effective vaccines at record speed. This remarkable achievement has 
reenergized existing and aspiring scientists worldwide, allowed our 
country to begin moving past the pandemic, and demonstrated the power 
of public-private partnerships. Continuing to provide robust, sustained 
and predictable funding for the NIH is the only way we will seize the 
unparalleled scientific opportunities in microbial research that lie 
before us, and the only way we will be equipped to address the demands 
that future infectious disease outbreaks will place on our society.
           nih funding has transformed the microbial sciences
    Even before the COVID-19 pandemic, investments in microbial 
research at NIH led to great strides in protecting and improving human 
health as illustrated by the following advances:
  --A young person diagnosed with Human Immunodeficiency Virus (HIV) 
        today who receives treatment will have a near normal life 
        expectancy. The AIDS death rate has dropped 80 percent from its 
        peak in 1995.
  --Routine childhood vaccinations prevent millions of cases of 
        illness. For children vaccinated in 2009, an estimated $82 
        billion in costs will be saved and 20 million cases, including 
        42,000 early deaths, will be prevented.
  --The first preventive vaccine and experimental treatments were 
        recently deployed in Africa against the Ebola virus, marking a 
        significant public health achievement. The Ebola virus, which 
        ravaged West Africa in 2013 and continues to cost lives in the 
        Democratic Republic of the Congo, has killed more than 10,000 
        people and severely strained regional socioeconomic stability.
  --Since 2007, the NIH has been on the forefront of supporting 
        microbiome research with the Common Fund's Human Microbiome 
        Project (HMP), which was formed to develop research resources 
        to study of microbial communities and how they impact human 
        health and disease. Microbiome research has increased over 40 
        times since the inception of the HMP, and the work engages over 
        20 NIH Institutes and Centers. This important research has had 
        implications for our understanding of microbiome interactions 
        in pregnancy and preterm birth, inflammatory bowel disease, and 
        diabetes, among other topics.
     continued progress requires sustained funding and support for 
                             investigators
    Even in the face of the promise and progress highlighted above, 
well known pathogens and antimicrobial resistance threaten our Nation's 
health with serious economic and social ramifications. Seasonal flu 
continues to cost the U.S. billions annually in direct medical costs 
and lost productivity due to illness and claims the lives of thousands 
of Americans each year. Through sustained funding to NIAID, scientists 
continue the quest for a universal flu vaccine. Antimicrobial 
resistance (AMR) is a daunting public health challenge and considered a 
global crisis by the World Health Organization, the G20 and the United 
Nations. Continued investment in research to better understand how 
microbes become resistant, and develop more precise clinical 
diagnostics, novel therapeutics and vaccines is greatly needed.
    The COVID-19 pandemic has exacted a toll on the broader research 
enterprise, especially early career investigators and those who were 
unable to pivot to work on SARS-CoV-2. Pandemic-related laboratory 
closures disrupted ongoing research, resulted in loss of animal 
colonies and cell lines, and loss of laboratory positions. Experiments 
had to be restarted, animal colonies repopulated, and fieldwork 
rescheduled. While our Nation's research capacity has demonstrated it 
can absorb shocks, the scale of this one was unprecedented in duration 
and impact. We must continue to nurture the research pipeline and 
workforce of tomorrow through sustained support for NIH and the 
training it provides to the next generation of scientists.
   cdc's indispensable role in preventing and controlling infectious 
                                disease
    The programs and activities supported by CDC are instrumental in 
protecting the health of the American people. ASM appreciates the 
extraordinary emergency funding provided to the agency in FY 2021 and 
FY 2022 to meet the needs presented by the pandemic. However, had 
Congress provided necessary support for CDC and public health 
infrastructure over time, our country would have been in a better 
position to address the public health crisis more effectively from the 
start. With this in mind, we urge Congress to build on emergency 
investments in FY 2023, including robust funding for the Data 
Modernization Initiative and the Prevention and Public Health Fund. CDC 
aids in surveillance, detection and prevention of global and domestic 
outbreaks from SARS-CoV-2, to foodborne illness, to Ebola, to the 
measles, to seasonal flu. CDC is the Nation's expert resource and 
response center, coordinating communications and action, and serving as 
the laboratory reference center. As we have seen over the course of the 
pandemic, States, communities, and international partners rely on CDC 
for accurate information, direction, and resources to ensure they 
continue to be prepared in a crisis or outbreak.
    Three areas that ASM would like to highlight under CDC are: (1) 
advanced molecular detection technology; (2) antimicrobial resistance; 
and (3) laboratory capacity.
  --The Advanced Molecular Detection (AMD) program brings cutting edge 
        genomic sequencing technology to the front lines of public 
        health by harnessing the power of next-generation sequencing 
        and high performance computing with bioinformatics and 
        epidemiology expertise to study pathogens. The program has 
        played an indispensable role by leading genomic surveillance 
        efforts and sequencing of SARS-CoV-2 samples, especially aimed 
        at getting in front of emerging variants. We thank Congress for 
        providing transformational funding for AMD in the American 
        Rescue Plan Act, and with increased base funding, the AMD 
        program can continue to promote innovation, expand workforce 
        development, and enter into productive partnerships with 
        academic research institutions, state/local public health 
        agencies and commercial entiti. ASM requests $175 million for 
        AMD in FY 2023.
  --Multiple programs support antimicrobial resistance, one of the most 
        daunting health challenges we face today. ASM requests funding 
        for the Antibiotic Resistance Solutions Initiative at $397 
        million, the National Healthcare Safety Network at $100 
        million, and the Division of Global Health Protection at $842.8 
        million, which will ensure that we have the resources across 
        multiple programs to address this urgent public health 
        challenge.
  --Support for laboratory capacity is paramount, and the Emerging and 
        Zoonotic Infectious Disease labs are the world's reference 
        labs. But maintaining labs costs more each year, from quality 
        and safety initiatives, to the cost of shipments and supplies, 
        to recruiting and retaining specialized and highly trained 
        staff. We urge you to consider additional funding for resources 
        to this area, particularly as we consider ways to bolster lab 
        capacity in times of public health emergency.
    ASM looks forward to working with you to ensure that researchers 
and public health professionals have the resources they need to apply 
fundamental microbial science research to meet 21st Century challenges 
in public health promotion, the prevention, detection and treatment of 
infectious diseases, and the prevention of outbreaks.

    [This statement was submitted by Allen Segal, Chief Advocacy 
Officer, American Society for Microbiology.]
                                 ______
                                 
        Prepared Statement of the American Society for Nutrition
    Dear Chairwoman Murray and Ranking Member Blunt:
    Thank you for the opportunity to provide testimony regarding Fiscal 
Year (FY) 2023 appropriations. The American Society for Nutrition (ASN) 
respectfully requests at least $49.048 billion dollars for the National 
Institutes of Health (NIH) and $210 million dollars for the Centers for 
Disease Control and Prevention/National Center for Health Statistics 
(CDC/NCHS) in FY 2023. ASN is dedicated to bringing together the 
world's top researchers to advance our knowledge and application of 
nutrition, and has more than 8,000 members working throughout academia, 
clinical practice, government, and industry.
                  national institutes of health (nih)
    The NIH is the Nation's premier sponsor of biomedical research and 
is the agency responsible for conducting and supporting the largest 
percentage of federally funded basic and clinical nutrition research 
with $3.2 billion in nutrition and obesity research in FY 2021. 
Although nutrition and obesity research make up only about five percent 
of the NIH budget, some of the most promising nutrition-related 
research discoveries have been made possible by NIH support. NIH 
nutrition-related discoveries have impacted the way clinicians prevent 
and treat heart disease, cancer, diabetes and other chronic diseases. 
Nevertheless, healthcare costs and risk factors for diet-related 
diseases remain high. In fact, from 2019 to 2020, age-adjusted death 
rates rose 4.1 percent for heart disease, 4.9 percent for stroke, 8.7 
percent for Alzheimer disease, and 14.8 percent for diabetes.\1\ With 
additional support for NIH, additional breakthroughs and discoveries to 
improve the health of all Americans and reduce the economic burden of 
diet-related diseases will be made possible.
---------------------------------------------------------------------------
    \1\ https://www.cdc.gov/nchs/products/databriefs/db427.htm.
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    Investment in biomedical research generates new knowledge, improved 
health, and leads to innovation and long-term economic growth. ASN 
recommends at least $49.048 billion dollars for the NIH base budget in 
FY 2023 to support NIH nutrition-related research that will lead to 
important disease prevention and cures. This represents an increase of 
$4.1 billion over the comparable FY 2022 funding level (an increase of 
$3.5 billion or 7.9 percent in the NIH appropriation plus funding from 
the 21st Century Cures Act for specific initiatives). ASN requests that 
any funding for the new Advanced Research Projects Agency for Health 
(ARPA-H) supplement our $49 billion recommendation for NIH's base 
budget, rather than supplant the essential foundational investment in 
the NIH.
    A budget of $49 billion will allow NIH to provide adequate support 
for the NIH Common Fund's Nutrition for Precision Health, powered by 
the All of Us Research Program, while still providing much needed 
increases to other parts of the portfolio. ASN strongly supports the 
President's budget proposal of $97 million for the NIH Office of 
Nutrition Research to advance nutrition science. This is an increase of 
$96 million above FY 2022 enacted to promote health and reduce the 
burden of diet-related diseases. By centrally coordinating 
implementation of the Strategic Plan for NIH Nutrition Research, the 
Office of Nutrition Research can support cross-cutting NIH nutrition 
research developed in collaboration with Institutes and Centers that 
already fund nutrition research. Increased support for nutrition 
research will provide solutions ensuring nutrition security and access 
to healthy food to prevent diet-related health disparities and promote 
health equity for a variety of diet-related diseases and conditions, 
such as cardiovascular disease, obesity, diabetes, and cancer. The 
complexity of human nutrition demands that cutting edge data science 
and system science methods be employed to move this field forward. 
Funds will support new training programs in Artificial Intelligence for 
Precision Nutrition that will focus on integration of related domains, 
including machine learning, systems biology, systems science, Big Data, 
and computational analytics to tackle complex biomedical challenges in 
nutrition science. NIH needs sustainable and predictable budget growth 
to fulfill the full potential of biomedical research, including 
nutrition research, that is aimed at improving the health and wellbeing 
of all Americans, as well as global populations.
 centers for disease control and prevention national center for health 
                         statistics (cdc nchs)
    The National Center for Health Statistics, housed within the 
Centers for Disease Control and Prevention, is the Nation's principal 
health statistics agency. ASN recommends a FY 2023 funding level of 
$210 million dollars for NCHS to help ensure uninterrupted collection 
of vital health and nutrition statistics and help cover the costs 
needed for technology and information security maintenance and upgrades 
that are necessary to replace aging survey infrastructure. The U.S. is 
a leader in this area but more than a decade of flat funding has taken 
a significant toll on NCHS's ability to keep pace. $210 million 
reflects an increase to NCHS's base budget of $30 million from its FY 
2022 appropriation, reversing a decade of sequestration and restoring 
the program to its FY 2010 funding level, adjusted for inflation.
    The NCHS provides critical data on all aspects of our health care 
system, and it is responsible for monitoring the Nation's health and 
nutrition status through surveys such as the National Health and 
Nutrition Examination Survey (NHANES), that serve as a gold standard 
for data collection around the world. Nutrition and health data, 
largely collected through NHANES, are essential for tracking the 
nutrition, health and well-being of the American population, and are 
especially important for observing nutritional and health trends in our 
Nation's children. This is an invaluable source of data that has been 
and can continue to be used to address major health issues as they 
arise. The U.S. Department of Agriculture uses this data to develop 
nutrition policies that guide multibillion dollar Federal food 
assistance programs, and nutrition researchers use this valuable data 
as well.
    Nutrition monitoring conducted by the Department of Health and 
Human Services in partnership with the U.S. Department of Agriculture/
Agricultural Research Service is a unique and critically important 
surveillance function in which dietary intake, nutritional status, and 
health status are evaluated in a rigorous and standardized manner. 
Nutrition monitoring is an inherently governmental function and 
findings are essential for multiple government agencies, as well as the 
public and private sector. Nutrition monitoring is essential to track 
what Americans are eating, inform nutrition and dietary guidance 
policy, evaluate the effectiveness and efficiency of nutrition 
assistance programs, and study nutrition-related disease outcomes. 
Funds are needed to ensure the continuation of this critical 
surveillance of the Nation's nutritional status and the many benefits 
it provides.
    Through learning both what Americans eat and how their diets 
directly affect their health, the NCHS is able to monitor the 
prevalence of obesity and other chronic diseases in the U.S. and track 
the performance of preventive interventions, as well as assess 
'nutrients of concern' such as calcium, iron, folate, iodine, vitamin 
D, and other micronutrients which are consumed in inadequate amounts by 
many subsets of our population. Data such as these are critical to 
guide policy development in health and nutrition, including food 
safety, food labeling, food assistance, military rations and dietary 
guidance. For example, NHANES data are used to determine funding levels 
for programs such as the Supplemental Nutrition Assistance Program 
(SNAP) and the Women, Infants, and Children (WIC) clinics, which 
provide nourishment to low-income women and children. Additional 
support would enable collection of more data on underrepresented 
groups, such as pregnant and lactating women, and assessment of 
nutritional status indicators for nutrients on which we have no, or 
inadequate, information.
    Thank you for the opportunity to submit testimony regarding FY 2023 
appropriations for the National Institutes of Health and the CDC/
National Center for Health Statistics. Please contact John E. Courtney, 
Ph.D., ASN Executive Officer, at 9211 Corporate Boulevard, Suite 300, 
Rockville, Maryland 20850, [email protected].
    Sincerely.

    [This statement was submitted by Paul M. Coates, Ph.D., 2021-2022 
President, American Society for Nutrition.]
                                 ______
                                 
        Prepared Statement of the American Society of Hematology
    The American Society of Hematology (ASH) represents more than 
18,000 clinicians and scientists committed to the study and treatment 
of blood and blood-related diseases, including malignant disorders such 
as leukemia, lymphoma, and myeloma, as well as non-malignant conditions 
such as sickle cell disease (SCD), thalassemia, bone marrow failure, 
venous thromboembolism, and hemophilia.
                  national institutes of health (nih)
    Hematology research, funded by many institutes at the NIH, 
including the National Heart, Lung and Blood Institute (NHLBI), the 
National Cancer Institute (NCI), the National Institute of Diabetes, 
Digestive and Kidney Diseases (NIDDK), the National Institute on Aging 
(NIA), and the National Institute of Allergy and Infectious Diseases 
(NIAID), has been an important component of this investment in the 
Nation's health. NIH-funded research has led to tremendous advances in 
treatments for children and adults with blood cancers and other 
hematologic diseases and disorders. Hematology advances also help 
patients with other types of cancers, heart disease, and stroke. Basic 
research on blood has aided physicians who treat patients with heart 
disease, strokes, end-stage renal disease, cancer, and AIDS.
    The field of hematology continues to make great strides in 
conquering blood diseases thanks to novel technologies, mechanistic 
insights, and cutting-edge therapeutic strategies. Groundbreaking 
scientific research highlighted at the December 2021 ASH Annual Meeting 
and Exposition, much of which was either funded by NIH or derived from 
NIH-funded research, presented information on advances in gene therapy, 
practice-changing discoveries in immunotherapies, and advances in 
patient care for a wide range of hematologic diseases and conditions. 
Moreover, the Society's regularly updated ASH Agenda for Hematology 
Research serves as a roadmap to prioritize research within the 
hematology field and includes recommendations for areas of additional 
Federal investment that will equip researchers to make truly practice-
changing discoveries in hematology and other fields of medicine for 
years to come.
    Additionally, extraordinary research that has occurred over the 
past 2 years to identify and develop COVID-19 vaccines, antivirals, and 
other medical countermeasures is all built on the scientific foundation 
enabled by the Federal investment in NIH. In response to the emergence 
of significant hematologic complications from COVID-19 infection, ASH 
developed the ASH COVID-19 Research Agenda in Hematology, which 
highlights fundamental questions that experts in hematology and blood 
research deem of critical importance to researchers, physicians, and 
patients. The questions outlined in the document identify significant 
questions about the biology, pathophysiology, and underlying clinical 
implications of COVID-19 as they relate to hematology science and 
clinical care and are meant to inspire research that leads to enhanced 
understanding of the disease process, decreased hematologic 
complications in COVID-19, and improved care of patients with 
hematologic disease. The original document outlined hematology-related 
basic science and clinical research questions that emerged in the first 
few months of the pandemic; the research agenda continues to be updated 
as our understanding of the natural history and treatment of COVID-19 
improves.
    ASH thanks Congress for the robust bipartisan support that has 
resulted in seven consecutive years of welcome and much needed funding 
increases for NIH. For fiscal year (FY) 2023, ASH joins nearly 400 
organizations and institutions across the NIH stakeholder community to 
strongly support the Ad Hoc Group for Medical Research recommendation 
that NIH receive a program level of at least $49.048 billion. This 
funding level would allow for meaningful growth above inflation in the 
base budget that would expand NIH's capacity to support promising 
science in all disciplines. ASH also joins the community in strongly 
urging lawmakers to ensure that any funding for the new Advanced 
Research Projects Agency for Health (ARPA-H) supplement the $49 billion 
recommendation for NIH's base budget, rather than supplant the 
essential foundational investment in the NIH. In addition, ASH supports 
the Administration's proposal to supplement NIH's budget with 
additional mandatory funding to speed the pace of pandemic response and 
readiness.
            centers for disease control and prevention (cdc)
    The Society also recognizes the important role of the CDC in 
preventing and controlling clotting, bleeding, and other hematologic 
disorders. This is especially important for improving the care and 
treatment of individuals with sickle cell disease (SCD).
    Sickle cell disease is an inherited, lifelong disorder affecting 
approximately 100,000 Americans. Individuals with the disease produce 
abnormal hemoglobin which results in their red blood cells becoming 
rigid and sickle-shaped, causing them to get stuck in blood vessels and 
block blood and oxygen flow to the body, which can cause severe pain, 
stroke, organ damage, and in some cases premature death. Though new 
approaches to managing SCD have led to improvements in diagnosis and 
supportive care, many people living with the disease are unable to 
access quality care and are limited by a lack of effective treatment 
options.
    The Sickle Cell Disease and Other Heritable Blood Disorders 
Research, Surveillance, Prevention, and Treatment Act of 2018 (Public 
Law 115-327) authorized CDC, through its Sickle Cell Data Collection 
program, to award grants to States, academic institutions, and non-
profit organizations to gather information on the prevalence of SCD and 
health outcomes, complications, and treatment that people with SCD 
experience. Currently 11 States participate in the data collection 
program, with data being collected from multiple sources (e.g., newborn 
screening programs and Medicaid) in order to create individual health 
care utilizations profiles. Funding through the CDC Foundation has 
allowed Georgia and California to collect data since 2015; additional 
CDC Foundation funding, along with discretionary funding from CDC and 
the Department of Health and Human Services (HHS) and $2 million in 
funding provided by Congress in fiscal Year2021 has allowed nine 
additional States (Alabama, Colorado, Indiana, Michigan, Minnesota, 
North Carolina, Tennessee, Virginia, and Wisconsin) to begin their data 
collection programs. These 11 States are estimated to include just over 
35 percent of the U.S. SCD population.
    ASH thanks Congress for the $3 million provided for the data 
collection program in fiscal Year2022. This funding will allow CDC to 
continue to support data collection efforts in all of the States 
currently participating in the program. ASH also appreciates the 
Administration's request for $4.5 million in funding for the program in 
fiscal Year2023. However, the Society strongly supports providing CDC 
with at least $10 million in FY 2023 for the Sickle Cell Data 
Collection program. This additional funding is necessary to allow the 
program to continue in the States currently participating in the 
programs and to also expand the programs to include additional States 
with the goal of covering the majority of the U.S. SCD population over 
the next 5 years.
    To further support CDC's sickle cell data collection efforts, ASH 
urges the inclusion of the following report language under CDC's 
National Center on Birth Defects and Developmental Disabilities 
(NCBDDD):
  --Public Health Approach to Blood Disorders/Sickle Cell Disease
    The Committee includes $10,000,000 for the Sickle Cell Data 
Collection program to allow for data collection and analysis in States 
currently participating in the program and to allow for expansion to 
additional States. The Committee encourages CDC to provide technical 
assistance to additional States with a higher prevalence of SCD, so 
that they can successfully participate in this grant program to better 
identify affected individuals in their States and better meet their 
needs.
    Additionally, ASH supports the public health community's request 
for at least $11 billion in overall funding for the CDC in FY 2023. 
Strong funding for CDC is critical to supporting all of CDC's 
activities and programs, which are essential to protect the health of 
our communities. In addition to ensuring a strong public health 
infrastructure and protecting our communities from public health 
threats and emergencies, CDC programs are crucial to reducing health 
care costs and improving health. However, due to years of underfunding, 
many CDC programs have not received the resources that are needed to 
address the many health challenges we face as a nation. A funding level 
of at least $11 billion would build upon the funding increase Congress 
provided CDC in FY 2022 and strengthen all of CDC's programs.
          health resources and services administration (hrsa)
    ASH supports funding for the SCD programs within HRSA's Maternal 
and Child Health Bureau, including $9.205 million for the SCD Treatment 
Demonstration Program (SCDTDP) and at least $6 million for the SCD 
Newborn Screening Program, which is part of HRSA's Special Projects of 
Regional and National Significance (SPRANS) program. The grantees 
funded by these programs work to improve access to quality care for 
individuals living with SCD and sickle cell trait. The SCDTDP funds 
five geographically distributed regional SCD grants that support SCD 
providers to increase access to high quality, coordinated, 
comprehensive care for people with SCD, while the SCD Newborn Screening 
Program provides grants to support the comprehensive care for newborns 
diagnosed with SCD. ASH also supports the inclusion of language in the 
report accompanying the FY 2023 appropriations bill recognizing the 
importance of the Sickle Cell Disease Treatment Demonstration Program 
in supporting the growth of comprehensive sickle cell disease centers:
  --Sickle Cell Disease Treatment Demonstration Program
    The Committee includes $9,205,000 for this program, a $2,000,000 
increase above the FY 2022 enacted level. The Committee recognizes the 
importance of the program in supporting the comprehensive sickle cell 
disease (SCD) centers in the provision of coordinated, comprehensive, 
culturally competent, and family-centered care to people with SCD. The 
Committee affirms the goals of the program to improve care delivery and 
access to high quality care for people with SCD, with a focus on 
increasing access to SCD specialists; increase the number of providers 
with SCD expertise and knowledge of SCD treatment methods; and enable 
access to the latest treatment options following evidence-based 
guidelines
    Finally, ASH joins many others in the physician community in 
supporting funding for HRSA's Preventing Burnout in the Health 
Workforce program. Health care professionals have long experienced high 
levels of stress and burnout, and our members have shared that COVID-19 
has only exacerbated the problem. Burnout has been shown to reduce job 
performance, increase turnover, and, in its most extreme instances, 
lead to mental health issues. This important program, established by 
the American Rescue Plan Act and modeled after provisions in the Dr. 
Lorna Breen Health Care Provider Protection Act, provides grants to 
health care organizations to support evidenced-based and evidence-
informed programs, practices, and trainings with the goal of reducing 
burnout and promoting mental health and wellness among the health care 
workforce. As the U.S. continues to deal with the COVID-19 crisis, ASH 
respectfully urges Congress to provide robust funding for the 
Preventing Burnout in the Health Workforce program in order to expand 
access to vital programs to address the growing mental health 
challenges facing our health care workforce.
    Thank you again for the opportunity to submit testimony. Please 
contact ASH Senior Manager, Legislative Advocacy, Tracy Roades at 
[email protected], if you have any questions or need further 
information concerning hematology research or ASH's FY 2023 requests.
                                 ______
                                 
     Prepared Statement of the American Society of Human Genetics,
    The American Society of Human Genetics (ASHG) thanks the 
subcommittee for its continued strong support and leadership in funding 
the National Institutes of Health (NIH). The $2.03 billion increase 
provided for Fiscal Year (FY) 2022 reinforces our Nation's commitment 
to the health and well-being of all Americans at a time when investing 
in biomedical research and scientific innovation is more important than 
ever.
    ASHG urges the subcommittee to appropriate $49 billion for NIH's 
base budget in FY 2023, with any additional funding for the newly 
established Advanced Research Projects Agency for Health (ARPA-H) to 
supplement, not supplant, the core investments in the NIH base budget.
      extraordinary progress in human genetics & genomics research
    Federal funding for human genetics and genomics research is 
enabling new insights into the structure of, and variation in, the 
human genome, and leading to new discoveries in preventing, diagnosing, 
and treating disease.\1\ Through the development of powerful DNA 
sequencing and computational tools, in the past year, an NIH-supported 
consortium generated the first complete assembly of a human genome, 
greatly expand our understanding of genomic variation and providing an 
essential tool for exploring the genetic underpinnings of disease.\2\ 
Researchers are also developing new 'polygenic score' tools to assess 
one's risk for many of the leading causes of death in the United 
States, including cardiovascular diseases, immune disorders, and 
cancers.\3\ Such tools hold promise for enabling a personalized 
approach to preempting and preventing disease.
---------------------------------------------------------------------------
    \1\ American Society of Human Genetics. (2021). Success Stories in 
Human Genetics and Genomics Research (Chronic Diseases) [Fact sheet]. 
https://www.ashg.org/wp-content/uploads/2022/01/The-Benifits-of-human-
genetics-Noncommunicable-Diseases-factsheets-v3.pdf.
    \2\ Nurk, S. et al. The Complete Sequence of a Human Genome. 
Science 376(6588): 44-53 (2022). https://doi.org/10.1126/
science.abj6987.
    \3\ https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
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    Genetic science is delivering major advances in the detection and 
treatment of chronic diseases, notably cancer. Through 'liquid biopsy' 
blood tests, clinicians can identify genetic changes in cancerous 
tumors in a non-invasive way to guide targeted treatments; this testing 
method is being further developed for the early screening and detection 
of multiple cancers. Because of federally funded research findings, we 
now have novel cancer treatment options such as CAR-T gene therapies. 
As of this year, the FDA currently lists 23 approved cellular and gene 
therapy products to treat cancers and other diseases.\4\
---------------------------------------------------------------------------
    \4\ https://www.fda.gov/vaccines-blood-biologics/cellular-gene-
therapy-products/approved-cellular-and-gene-therapy-products.
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    Human genetic and genomic research is also delivering hope for the 
millions of people in the United States living with rare diseases. For 
example, results from NIH-funded trials investigating gene therapies 
and gene editing technologies indicate that genetic approaches will 
allow patients afflicted with sickle cell disease to live pain-free and 
no longer in need of frequent blood transfusions. Effective gene 
therapy is now available for spinal muscular atrophy, a rare childhood 
disease characterized by progressive muscle weakness, and is being 
tested to treat other devastating diseases like Huntington's disease 
and familial amyotrophic lateral sclerosis (Lou Gehrig's disease).
 genetics & genomics: striving for equity and research cohort diversity
    Genetic science can advance health equity through the deliberate, 
meaningful inclusion and participation of individuals from diverse 
groups in human genetics and genomics research. The inclusion of 
populations representing diverse ancestries helps us gain a fuller 
understanding of the genetics of health and disease, knowledge which 
can be used to develop more accurate diagnostic tests and more 
effective treatments that benefit all Americans.\5\ Diverse 
participation in research is essential if we are to realize the full 
promise of human genetics and genomics research and the equitable 
application of genetic discoveries in healthcare and society.
---------------------------------------------------------------------------
    \5\ Collins, F., Doudna, J.A., Lander, E., and Rotimi, C.N. Human 
Molecular Genetics and Genomics--Important Advances and Exciting 
Possibilities. N.Engl.J.Med 384: 1-4 (2021).
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    Genetics research studies illustrate the importance of research 
cohorts reflecting humanity's diversity.\6\ For example, because most 
individuals participating in genetics research are of European 
ancestry, polygenic risk score tests are more effective for assessing 
disease risk in people of European ancestry than for individuals with 
Hispanic, South Asian, East Asian or African ancestries.\7\ The Society 
commends NIH's efforts to advance diverse participation in research, 
particularly the All of Us Research Program.\8\ Significantly, in 2022, 
this program released a database of health information and whole-genome 
sequences from almost 100,000 individuals,\9\ half of whom are from 
historically underrepresented racial or ethnic backgrounds.\10\
---------------------------------------------------------------------------
    \6\ Wojcik G., et al. Genetic Analysis of diverse populations 
improves discovery for complex traits. Nature 570(7762): 514-518 
(2019). https://doi: 10.1038/s41586-019-1310-4.
    \7\ Ibid.
    \8\ https://allofus.nih.gov/.
    \9\ https://www.researchallofus.org/.
    \10\ https://www.nih.gov/news-events/news-releases/nih-s-all-us-
research-program-releases-first-genomic-dataset-nearly-100000-whole-
genome-sequences.
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      return on investment: genetics research benefits the economy
    As the United States moves towards recovery from the COVID-19 
pandemic, economic activity across all sectors remains key for our 
return to normalcy. In addition to its importance for addressing health 
care needs in the United States, Federal investments in research and 
development have been shown to drive economic activity. A 2021 study 
commissioned by ASHG and conducted by TEConomy Partners highlights the 
growth of a dynamic ecosystem derived from human genetics and genomics 
research, and that the development and manufacturing of genomic 
technologies, diagnostics and therapeutics, and the associated 
healthcare services, ``generate substantial U.S. economic activity and 
support a large volume of jobs across the Nation.'' \11\ The report 
estimates that the human genetics and genomics sector supports 850,000 
jobs and generates $265 billion in total economic activity 
annually,\12\ demonstrating that this sector has grown around five-fold 
in the last decade.
---------------------------------------------------------------------------
    \11\ Tripp, S., and Grueber, M. 2021. The Economic Impact and 
Functional Applications of Human Genetics and Genomics.
    \12\ Ibid.
---------------------------------------------------------------------------
 broad data sharing: essential for human genetics and genomics research
    Broad sharing of human genome data from NIH-funded research is 
essential for advancing science and maximizing the public's return on 
investment in biomedical research. Since the human genome houses 
sensitive information, the genetics and genomics research community is 
a leader in developing best practices for sharing data while protecting 
individuals' privacy. We strongly support policies including the Common 
Rule, the Genetic Information Nondiscrimination Act (GINA), the 21st 
Century Cures Act, the NIH Genomic Data Sharing Policy, and HIPAA, 
which together act to protect individuals from the inappropriate 
disclosure of data for non-research purposes.\13\ As Congress 
encourages NIH to explore the National security risks associated with 
the sharing of individuals' health information, we urge the Committee 
to recognize the privacy protections already established by Congress 
and NIH for genetic research data, and to ensure that broad data-
sharing can continue to fuel scientific progress.
---------------------------------------------------------------------------
    \13\ American Society for Human Genetics. (2021). Perspectives: 
Research and Privacy [Fact sheet]. https://www.ashg.org/wp-content/
uploads/2021/08/Factsheet-DataPrivacy.pdf.
---------------------------------------------------------------------------
                                summary
    ASHG joins the Ad Hoc Group for Medical Research in recommending at 
least a $49 billion base budget for NIH for FY 2023. This funding level 
would allow NIH's base budget to keep pace with inflation, specifically 
the biomedical research and development price index, and support 
crucial research on human genetics and genomics across all of the NIH's 
27 Institutes and Centers. ASHG also recognizes the important and 
catalytic role of ARPA-H for advancing science and biomedicine, 
building on the foundation of basic research supported by NIH. Funding 
to establish ARPA-H should complement NIH's current investments in 
basic research.
    The American Society of Human Genetics (ASHG), founded in 1948, is 
the primary professional membership organization for human genetics 
specialists worldwide. The Society's nearly 8,000 members include 
researchers, clinicians, genetic counselors, nurses, and others who 
have a special interest in the field of human genetics.

    [This statement was submitted by Brendan Lee, MD, PhD, President-
Elect, 
American Society of Human Genetics.]
                                 ______
                                 
        Prepared Statement of the American Society of Nephrology
    On behalf of the more than 37 million Americans living with kidney 
diseases, the American Society of Nephrology respectfully requests that 
in the Office of the Secretary of Health and Human Services (IOS), 
General Department Management, $25 million be included for KidneyX, a 
public-private partnership to accelerate innovation in the prevention, 
diagnosis, and treatment of kidney diseases, in the Fiscal Year (FY) 
2023 Labor, Health and Human Services, Education and Related Agencies 
Appropriations bill.
    More than 37 million people in the United States are living with 
kidney diseases, and nearly 800,000 have kidney failure, for which 
there is no cure. This under-recognized epidemic disproportionately 
affects communities of color. For instance, Black Americans comprise 13 
percent of the U.S. population but represent 33 percent of Americans 
receiving dialysis, the most common therapy for kidney failure. 
Dialysis, while an important tool to manage kidney failure, has 
outcomes worse than most cancers: 50 percent of people starting 
dialysis today will die within 5 years.
    The COVID-19 pandemic is especially deadly for kidney patients. 
Americans with kidney diseases are the most at risk among Medicare 
beneficiaries for severe outcomes from COVID-19--including 
hospitalization and death--and COVID-19 damages the kidneys of 30 
percent of all hospitalized COVID-19 patients, even those without a 
prior history of kidney diseases.
    The status quo for treating and managing kidney diseases is far too 
costly to taxpayers to continue without intervention. Before the COVID-
19 pandemic, Medicare dedicated $125 billion, or 25 percent of all 
traditional Medicare fee-for-service spending, to the care of all 
kidney diseases, including $37 billion, or 7 percent of Medicare fee-
for-service spending, to manage kidney failure alone. Relative to other 
chronic diseases with comparable Federal spending and disease burden, 
people with kidney diseases have had a lack of innovation in the 
prevention, diagnosis, and treatment of kidney diseases, but hope is on 
the horizon: KidneyX is attracting a new generation of innovators and 
investors and transforming kidney care.
    KidneyX is incentivizing innovators to fill unmet patient needs 
through a series of prize competitions, de-risking the 
commercialization process by fostering coordination among Federal 
agencies and creating a sense of urgency on behalf of patients and 
families. To date, KidneyX has provided funding to 67 innovators across 
5 prize competitions for solutions ranging from patient-generated 
solutions that improve quality of life while living with kidney 
diseases to steps toward paradigm-shifting technologies such as a 
wearable or implantable artificial kidney and xenotransplantation. 
Further, KidneyX is delivering on its pledge to catalyze private 
markets to invest in the advancement of kidney care. For instance, 
investors contributed more than $300,000,000 to multiple winners of 
KidneyX's first prize competition, Redesign Dialysis.
    FY 23 funding will support Phase 2 of the Artificial Kidney Prize, 
which seeks to promote the integration and advancement of prototype 
bioartificial kidneys. With $25,000,000 in funding, KidneyX can support 
additional innovators in the Artificial Kidney Prize competitions and 
run prizes in other priority areas, such as refining the diagnosis of 
kidney diseases-currently more than 90 percent of people with kidney 
diseases are unaware they have the condition-and developing tools to 
prevent kidney diseases altogether. Recent advances in regenerative 
medicine and xenotransplantation have demonstrated the promise 
innovation can bring to kidney health.
    Winning innovations awarded KidneyX prizes have supported 
innovators in 22 States, including those highlighted below:
  --Applying advances in science and technology to improve current 
        kidney failure therapies, such as nanomaterials to reduce 
        infections in dialysis grafts and an innovative catheter which 
        might exponentially reduce infections in the provision of 
        dialysis, both seeded through the Redesign Dialysis Phase 1 and 
        Redesign Dialysis Phase 2 prize competitions
  --Patient generated solutions to better manage their care, such as 
        clothing which provides health care staff easy access to 
        dialysis ports without having to remove or scrunch up clothing, 
        seeded through the Patient Innovator Challenge
  --Novel methods for providing kidney health care during the pandemic 
        such as a ``Good Humoral Immunity Truck'' to deliver vaccines 
        to patients in hard-to-reach communities, and a new reusable N-
        95 respirator to aid in the high-touch care setting of a 
        dialysis unit, seeded through the COVID-19 Kidney Care 
        Challenge
  --Groundbreaking technologies that may lead to a fully implantable or 
        bioartificial kidney, such as an implantable silicon filter 
        cartridge paired with a bioreactor with kidney cells that 
        together provide continuous treatment without needing to be 
        tethered to a dialysis machine, or a method to genetically 
        engineer pig kidneys to make them perform life-sustaining 
        functions when transplanted in humans, both seeded through the 
        Artificial Kidney Prize competition
    A bipartisan achievement, KidneyX was first unveiled as a concept 
at the 2016 Obama White House Organ Summit and was a central pillar of 
Former President Donald J. Trump's July 2019 Executive Order on 
Advancing American Kidney Health. KidneyX is a true public-private 
partnership: the private sector has already committed $25 million to 
KidneyX and is committed to matching Federal funding to achieve a 
program total of $250 million. KidneyX has received $15 million since 
fiscal Year20 in enacted appropriations. Since its inception, KidneyX 
has demonstrated the success of its public-private prize funding model, 
delivering on its mission of accelerating innovation in kidney care, 
attracting new innovators and investors to the kidney space, and 
broadening the availability of novel ideas and capital to improve the 
lives of the 37 million Americans with kidney disease.
    In light of this strong track record, we respectfully request that 
the Labor-HHS subcommittee continue its commitment by appropriating $25 
million in FY 2023 for KidneyX, catalyzing private sector investment in 
kidney health including to develop the world's first artificial kidney. 
In addition, we also ask that you include the following language in the 
report accompanying your Committee's appropriations bill:
    The Committee is aware that more than 37 million people in the 
United States are living with kidney diseases, and for nearly 800,000 
of those individuals, the diseases progress to kidney failure, 
requiring access to dialysis or kidney transplantation to live. The 
Committee notes that kidney failure alone accounted for more than 7 
percent of Medicare spending (approximately $37 billion) in CY 2019, 
yet therapeutics for kidney failure remain limited and 50 percent of 
patients starting dialysis, the most common therapy for kidney failure, 
will die within 5 years.
    Given the high cost of kidney disease in terms of health 
consequences and Federal spending, the Committee recommends that a 
total of $25,000,000 be added to the funds for the Office of the 
Secretary in FY 2023 and that those funds be made available to support 
KidneyX. These funds will accelerate the development and adoption of 
the artificial kidney and other novel therapies and technologies that 
improve the diagnosis and treatment of people with kidney diseases.
    Thank you for your consideration of this important request. Should 
you have questions or need additional information, do not hesitate to 
contact Zach Kribs, Senior Government Affairs Specialist at the 
American Society of Nephrology, at [email protected].
                about the american society of nephrology
    Since 1966, ASN has been leading the fight to prevent, treat, and 
cure kidney diseases throughout the world by educating health 
professionals and scientists, advancing research and innovation, 
communicating new knowledge, and advocating for the highest quality 
care for patients. ASN has more than 20,000 members representing 132 
countries. For more information, visit www.asn-online.org and follow us 
on Facebook, Twitter, LinkedIn, and Instagram.

    [This statement was submitted by Zach Kribs, Senior Government 
Affairs 
Specialist, American Society of Nephrology.]
                                 ______
                                 
     Prepared Statement of the American Society of Plant Biologists
    On behalf of the American Society of Plant Biologists (ASPB), we 
would like to thank the subcommittee for its support for the National 
Institutes of Health (NIH). ASPB and its members strongly believe that 
sustained investments in scientific research are a critical component 
of economic growth, job creation, and innovation for our Nation. ASPB 
supports continued robust funding for NIH in fiscal year (FY) 2023 and 
asks that the subcommittee encourage increased support for plant-
related research with relevance to health within the agency, including 
within the newly established Advanced Research Projects Agency for 
Health (ARPA-H).
    ASPB, founded in 1924 as the American Society of Plant 
Physiologists, was established to promote the growth and development of 
plant biology, to encourage and publish research in plant biology, and 
to promote the interests and professional advancement of plant 
scientists in general. ASPB members educate, mentor, advise, and 
nurture future generations of plant biologists; they work to enhance 
understanding of plant biology and its impacts on public health and 
wellbeing, as well as science in general, in K-16 schools and among the 
general public; they advocate in support of plant biology research; 
work to convey the relevance and importance of plant biology; and they 
provide expertise in policy decisions world-wide. Overall, ASPB 
members, as representatives of the society, work to disseminate 
information and to excite future generations about plant sciences, 
especially through ASPB's advocacy, outreach activities, conferences, 
and publications.
              plant biology research and america's future
    Among many other functions, plants are the building blocks at the 
base of the food chain upon which all life depends. Importantly, plant 
research is also helping make many fundamental contributions to the 
study of human health, including that of a sustainable supply and 
discovery of plant-derived pharmaceuticals, nutraceuticals, and 
alternative medicines. One example is the antimalarial compound 
artemisinin, purified from sweet wormwood plants, whose biosynthetic 
pathway was defined and transplanted into yeast to create a low-cost 
source of this pharmaceutical for the developing world. Nearly 120 pure 
compounds extracted from plants are used globally in medicine, hinting 
at the significant possibilities for future discoveries applicable to 
human health, agriculture, and manufacturing.\1\ Plants can be 
harnessed as biofactories to produce vaccines against infectious 
diseases such as Ebola, hepatitis B, cholera, and coronavirus. Indeed, 
in February 2022, a plant-derived vaccine developed by GlaxoSmithKline 
and Medicago, trademarked as Covifenz, was approved by regulatory 
authorities in Canada for the prevention of COVID-19.\2\ Clinical 
trials showed that Covifenz was between 69-78 percent effective in 
preventing COVID-19 infection, demonstrating that this vaccine could be 
a valuable asset in ending the ongoing COVID-19 pandemic.\3\ Plant 
research also contributes to the continued, sustainable, development of 
better and more nutritious foods and the understanding of basic 
biological principles that underpin improvements in public health and 
human nutrition.
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    \1\ Page 19, Decadal Vision, https://
plantsummit.files.wordpress.com/2013/07/plantscience
decadalvision10-18-13.pdf.
    \2\ https://medicago.com/en/press-release/covifenz/.
    \3\ https://www.nejm.org/doi/full/10.1056/NEJMoa2201300.
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          plant biology and the national institutes of health
    Plant science and many of our ASPB member research activities have 
enormous positive impacts on the NIH mission to pursue ``fundamental 
knowledge about the nature and behavior of living systems and the 
application of that knowledge to extend healthy life and reduce the 
burdens of illness and disability.'' In general, plant research aims to 
improve the overall human condition-be it food, nutrition, medicine, 
clean air, or agriculture-and the benefits of plant science research 
readily extend across disciplines. In fact, plants are often the ideal 
model systems to advance our ``fundamental knowledge about the nature 
and behavior of living systems'' because they are, like humans, complex 
multi-cellular organisms yet afford ease of genetic manipulation, a 
lesser regulatory burden, and maintenance requirements that are less 
expensive and burdensome than those required for the use of animal 
systems.
    Fundamental Biological Research.--Many fundamental biological 
components and mechanisms are shared by plants and animals. Examples 
include but are not limited to genetic principles, cell division, host-
pathogen interactions, organism-environment interactions, polar growth, 
DNA methylation and repair, innate immune signaling, and circadian 
(biological) rhythms. Fundamental hereditary laws were derived from the 
study of garden peas. The phenomenon of RNA interference, which has 
application in gene therapies for human disease, was first discovered 
in plants. Contributions of plant genetics to advancing human health 
were exemplified when Barbara McClintock, an American scientist and 
cytogeneticist, was awarded the Nobel Prize in Physiology for the 
discovery of ``jumping genes'' or transposable elements in maize, which 
function as mobile DNA sequences within a genome. Similar elements 
constitute 40 percent or more of the human genome. More recently, 
plants are among organisms that have been used to develop revolutionary 
technologies such as gene editing (such as the CRISPR-Cas9 system), 
capable of precisely editing genomes to potentially correct mutations 
that lead to disease. These technologies are being deployed to produce 
more nutritious food and to sustainably increase production. 
Furthermore, many treatments and therapies are based on metabolites 
derived from plants, which exemplifies the application of plant biology 
research to improving human health. These important discoveries, among 
many others in science and technology, reflect the fact that some of 
the most important biological discoveries applicable to human 
physiology and medicine can find their origins in plant-related 
research endeavors.
    Use-Inspired Research.--In addition to their role in expanding our 
understanding of the basic mechanisms of biology, plants have been 
enormously beneficial in advancing use-inspired research aimed at 
developing breakthrough technologies, platforms, and solutions for 
health and medicine. The newly established Advanced Research Projects 
Agency for Health (ARPA-H) within NIH is a promising avenue for 
bringing new plant-based breakthroughs from idea to reality. The ARPA 
model for funding research has already proved to be an excellent fit 
for plant biology as shown by successful programs funded through the 
Defense Advanced Research Projects Agency (DARPA) and the Advanced 
Research Projects Agency--Energy (ARPA-E). As ARPA-H develops, ASPB 
supports the inclusion of plant-related research within the agency's 
portfolio.
    Health and Nutrition.--Plant biology research is also central to 
the application of basic knowledge to ``extend healthy life and reduce 
the burdens of illness and disability.'' Without good nutrition, there 
cannot be good health. Indeed, a World Health Organization study on 
childhood nutrition in developing countries concluded that over 50 
percent of child deaths under the age of five could be attributed to 
malnutrition's effects on weakening the immune system and exacerbating 
common illnesses such as respiratory infections and diarrhea; \4\ this 
is expected to worsen as global populations increase. One example of 
how advances in plant biology have been applied to tackling nutritional 
deficiencies is golden rice, designed to address vitamin A deficiency 
and reduce blindness risk in vulnerable children. Golden rice was 
engineered to include additional genes that switch on production of 
beta-carotene, and a bowl of this golden rice can provide 60 percent of 
a child's daily requirement of vitamin A to prevent blindness. 
Significant advances have also been made in the production of value-
added and resilient crops capable of withstanding drought, natural 
disasters, and extreme temperature shifts. DroughtGard Hybrid corn, 
engineered to maximize water storage, usage, and crop yield in 
unfavorable drought conditions, is just one example of the progress 
being made towards health, nutrient, and food security through 
innovations made in plant science.
---------------------------------------------------------------------------
    \4\ https://www.who.int/bulletin/archives/78(10)1207.pdf.
---------------------------------------------------------------------------
    Obesity, cardiac disease, and cancer also take striking tolls 
globally. Research to improve and optimize concentrations of plant 
compounds known to have, for example, anti-cancer properties, will help 
in reducing disease incidence rates. Ongoing development of crop 
varieties with value-added nutraceutical content is an important 
contribution that plant biologists are making toward realizing a common 
goal of personalized, preventative medicine.
    Drug Discovery.--Plants are fundamentally important as sources of 
both extant drugs and drug discovery leads. In fact, 60 percent of 
anti-cancer drugs in use within the last decade are of natural product 
origin-plants being a significant source. An excellent example is the 
anti-cancer drug Taxol, which was discovered as an anti-carcinogenic 
compound from the bark of the Pacific yew tree through collaborative 
work involving scientists at the NIH National Cancer Institute and 
plant natural product chemists. While the pharmaceutical industry has 
invested some efforts on natural products-based drug discovery, 
research support from NIH remains a crucial component of the drug 
development pipeline. Multidisciplinary teams of plant biologists, 
bioinformaticians, and synthetic biologists are being assembled to 
develop new tools and methods for natural products discovery and 
creation of new small-molecule pharmaceuticals. We appreciate NIH's 
current investment into understanding the biosynthesis of natural 
products through transcriptomics and metabolomics of medicinal plants 
and support more funding opportunities that, similar to the ``Genomes 
to Natural Products'' initiative, will enhance new plant-related 
medicinal research.
    Plant biology is also contributing to the advancement of new agents 
for cancer immunotherapy, a newer treatment strategy that uses the 
body's own immune system to fight disease. Research funded by NIH has 
shown that nanoparticles containing cowpea mosaic virus--which infects 
legumes but is harmless to humans--can be injected into tumors to bait 
the immune system into attacking and destroying cancerous cells. 
Ongoing support from NIH is enabling researchers to determine the 
mechanisms behind the efficacy of these nanoparticles in attacking 
tumors, research that will, in turn, pave the way for these and similar 
plant-derived treatments to enter clinical trials.\5\
---------------------------------------------------------------------------
    \5\ https://pubs.acs.org/doi/10.1021/acs.molpharmaceut.2c00058.
---------------------------------------------------------------------------
                               conclusion
    Plants play unique and pivotal roles in nutrition and health, 
agriculture, and the food supply, as well as basic science discoveries 
directly or indirectly relevant to public health. Plant biology 
research integrates seamlessly and synergistically with many different 
disciplines and core missions at NIH. As such, ASPB asks the 
subcommittee to provide continued robust funding for all components of 
the NIH and direct the agency to support additional plant research to 
continue to pioneer new discoveries and new methods with applicability 
and relevance in biomedical research. Thank you for your consideration 
of ASPB's testimony. For more information about ASPB, please see 
www.aspb.org.

    [This statement was submitted by Crispin Taylor, Ph.D., Chief 
Executive Officer, American Society of Plant Biologists.]
                                 ______
                                 
 Prepared Statement of the American Speech-Language-Hearing Association
    Chair Murray and Ranking Member Blunt: The American Speech-
Language-Hearing Association (ASHA) thanks you for the opportunity to 
submit testimony on the Fiscal Year (FY) 2023 Labor, Health and Human 
Services, Education and Related Agencies appropriations bill. My name 
is Judy Rich, EdD, CCC-SLP, BCS-CL, ASHA's President for 2022.
    As the subcommittee begins its work on this critical legislation, I 
offer ASHA's support for the following programmatic funding requests 
for the U.S. Department of Education (ED):
    1.  $16.76 billion for the Individuals with Disabilities Education 
        Act (IDEA) Part B State Grants, $503 million for IDEA Part B 
        Section 619 Preschool Grants, $932 million for IDEA Part C 
        Infants and Toddlers with Disabilities, and $250 million for 
        IDEA Part D section 662 personnel preparation grants within ED.
    2.  $1 billion for the Administration's proposed School-Based 
        Health Professionals program to support efforts to address 
        shortages of school-based health professionals. ASHA also urges 
        the subcommittee to ensure that speech-language pathologists 
        (SLPs) and audiologists are eligible for this program.
    In addition, ASHA encourages the subcommittee to include report 
language to establish issue-specific technical assistance (TA) centers 
within ED to improve the ability of school-based SLPs and educational 
audiologists to meet the needs of students with communication 
disorders. Specifically, ASHA urges the subcommittee to create TA 
centers focused on Communications/Speech Disorders; Medicaid Services 
and Reimbursement; Workload Mitigation; and Telepractice Services.
              individuals with disabilities education act
    ASHA thanks members of the subcommittee for increasing funding for 
the Individuals with Disabilities Education Act (IDEA) last year.
    Children and youth (ages 3-21) receive special education services 
and related services under IDEA Part B, and infants and toddlers 
(birth-2 years old) with disabilities and their families receive early 
intervention services under IDEA Part C. Congress must continue to make 
appropriate investments in IDEA to ensure children with disabilities 
receive the free appropriate public education (FAPE), which they are 
entitled to under law.
    A substantial increase in funding for IDEA is a step toward 
fulfilling the promise that Congress made to fund 40 percent of the 
average per-pupil expenditure in public elementary and secondary 
schools. This critical program serves more than 6.5 million children in 
our Nation's schools, including students with communication 
disorders.\1\ ASHA appreciates that the American Rescue Plan Act 
provided $2.58 billion for IDEA Part B State Grants, $200 million for 
IDEA Preschool Grants, and $250 million for Part C Infants and 
Toddlers, and that the Consolidated Appropriations Act, 2022 (Public 
Law 117-103) increased IDEA funding above FY 2021 levels for the 
remainder of the current fiscal year. However, additional funding is 
necessary to build on this progress.
---------------------------------------------------------------------------
    \1\ U.S. Department of Education. (n.d.). About IDEA. https://
sites.ed.gov/idea/about-idea/.
---------------------------------------------------------------------------
    These additional resources are essential to support States and 
local education agencies in providing FAPE to all students with 
disabilities. Schools and districts continue to grapple with costs 
associated with the Coronavirus Disease 2019 (COVID-19) pandemic and 
require additional resources to address challenges associated with 
ensuring continued education and delivering necessary services and 
supports for children with disabilities. ASHA supports the 
Administration's FY 2023 budget request for IDEA at the levels 
identified above to ensure students with disabilities can continue to 
access the services that they are legally entitled to.
                      technical assistance centers
    Speech-language pathology services are highly utilized by students 
served under IDEA. According to ED's 43rd Annual Report to Congress on 
the Implementation of IDEA, 2021, speech or language impairments 
represent the most prevalent disability category of services provided 
under IDEA Part B: 39.9 percent of children ages 3 through 5, and 16.3 
percent of students ages 6 through 21.\2\
---------------------------------------------------------------------------
    \2\ U.S. Department of Education, Office of Special Education and 
Rehabilitative Services, Office of Special Education Programs. (2021). 
43rd Annual Report to Congress on the Implementation of the Individuals 
with Disabilities Education Act, 2021. https://sites.ed.gov/idea/files/
43rd-arc-for-idea.pdf.
---------------------------------------------------------------------------
    ASHA's 2020 Schools Survey found that school-based SLPs' top two 
challenges identified were excessive paperwork (81.7 percent) and high 
workload/caseload (56.5 percent), while educational audiologists rated 
those as their second (53 percent) and fifth greatest challenges (41.7 
percent).\3,4\ Both SLPs and audiologists also identified challenges in 
Medicaid billing for eligible students.
---------------------------------------------------------------------------
    \3\ American Speech-Language-Hearing Association. (2020). 2020 
Schools survey. Survey summary report: Numbers and types of responses, 
SLPs. www.asha.org.
    \4\ American Speech-Language-Hearing Association. (2020). 2020 
Schools survey. Survey summary report: Numbers and types of responses, 
educational audiologists. www.asha.org.
---------------------------------------------------------------------------
    Establishing TA centers focused on key issues impacting school-
based SLPs and educational audiologists would provide them valuable 
support; thereby, helping to ensure a FAPE for students with challenges 
that SLPs and audiologists can help address. The TA centers would:
    1.  provide resources, guidance, and best practices pertaining to 
        the assessment and treatment to habilitate the communication 
        disorder(s);
    2.  identify and develop free or low-cost evidence-based tools, 
        model programs, and best practices to address clinical and 
        professional practice issues; and
    3.  offer support and guidance for utilizing Federal funding 
        sources to support capacity to address staffing shortages of 
        speech-language providers within the school, community, or home 
        setting to ensure the delivery of effective services for all 
        students and their families.
    The specific mission for each TA center would include:
    1.  Communications/Speech Disorders Center: Provide resources, 
        guidance, and best practices pertaining to the assessment and 
        treatment to habilitate the communication disorders for 
        clinicians and other members of the school community and 
        provide support and guidance regarding the utilization of 
        Federal funding sources to support capacity to ensure access to 
        such services for all students.
    2.  Medicaid Services and Reimbursement Center: Provide resources 
        to ensure that students who qualify for services under Medicaid 
        receive such services, and to streamline the reimbursement 
        process for providers, schools, and local and State education 
        agencies.
    3.  Workload Mitigation Center: Provide resources to mitigate the 
        workload burden for SLPs, audiologists, and other specialized 
        instructional support personnel to best serve students, and 
        support the State and local education agency's capacity 
        building of providers.
    4.  Telepractice Services Center: Provide resources to support 
        telepractice and the application of telecommunications 
        technology to the deliver audiology and speech-language 
        pathology professional services at a distance by linking 
        providers to students, and build capacity among State and local 
        education agencies to appropriately access services though a 
        range of venues.
    The establishment of one or more of these centers would support 
SLPs and audiologists in ensuring that all students have access to 
FAPE; and ensure that State and local education agencies, school 
administrators, and other educators have access to resources to support 
students and providers. ASHA strongly encourages the subcommittee to 
establish TA centers to support the ability of school-based SLPs and 
educational audiologists to support students with disabilities, 
particularly a Communications/Speech Disorders TA center to help 
address the needs of the significant population of students receiving 
speech-language services, and a Medicaid TA center to ensure that 
schools, districts, and States are able to receive reimbursement for 
services provided to Medicaid-eligible students.
                               conclusion
    Thank you for the opportunity to provide this testimony for the 
record. ASHA appreciates the subcommittee's past investments in IDEA 
and other critical education programs and urges continued support at 
the recommended funding levels. These investments are crucial to 
ensuring SLPs and audiologists can meet the hearing, balance, speech, 
language, swallowing, and cognition-related needs of students who are 
receiving special education services in schools.
    If you or your staff have any questions, please contact Eric 
Masten, ASHA's director of Federal affairs for education, at 
[email protected].
                                 ______
                                 
          Prepared Statement of the American Thoracic Society

                    SUMMARY: FUNDING RECOMMENDATIONS
                             (in millions $)
------------------------------------------------------------------------
 
------------------------------------------------------------------------
National Institutes of Health..............................     $49,048
    National Heart, Lung, and Blood Institute..............       $4,05
    National Institute of Allergy and Infectious Diseases..      $6,806
    National Cancer Institute..............................      $7,766
    National Institute of Environmental Health Sciences....        $909
    National Institute on Minority Health and Health               $660
     Disparities...........................................
    National Institute of Nursing Research.................        $199
Centers for Disease Control and Prevention.................     $11,000
    National Institute for Occupational Safety and Health..        $375
    Asthma Programs........................................         $40
    Division of Tuberculosis Elimination...................        $225
    Office on Smoking and Health...........................        $310
    Global Climate Change Program..........................        $110
    Chronic Disease Awareness Education Program............          $6
    National Center for Environmental Health...............     $401.85
------------------------------------------------------------------------

                       american thoracic society
    The American Thoracic Society (ATS) is the world's leading medical 
society dedicated to accelerating the advancement of global respiratory 
health through multidisciplinary collaboration, education, and 
advocacy. Core activities of the Society's more than 16,000 members are 
focused on leading scientific discoveries, advancing professional 
development, impacting global health, and transforming patient care.
National Institutes of Health
    The NIH is the world's leader in groundbreaking biomedical health 
research into the prevention, treatment, and cure of diseases such as 
lung cancer, chronic obstructive pulmonary disease (COPD), and asthma. 
The coronavirus pandemic has revealed the critical national public 
health security leadership role that the NIH holds in scientific 
expertise to guide the Nation and in critical biomedical research to 
develop new diagnostics, therapeutics, and prevention interventions, 
including vaccines.
    To continue to accelerate the development of life-saving cures and 
treatments and innovative prevention interventions, it is essential for 
Congress to continue to provide robust, predictable funding increases 
across the full spectrum of NIH-supported research. We ask the 
subcommittee to provide at least $49.048 billion in funding for the NIH 
in FY 2023.
    In addition, while the American Thoracic Society supports the 
Advanced Research Projects Agency for Health (ARPA-H), we feel strongly 
that funding for this new agency should complement--not supplant--NIH 
funding.
National Heart, Lung, and Blood Institute
    As the worldwide leader in research on heart, lung, blood, and 
blood vessel diseases as well as sleep disorders, the NHLBI effectively 
translates research results to the American public. To continue 
important advances in research, the NHLBI is investing in prevention 
programs and new treatments for cardiovascular disease including 
congenital heart disease, developing novel therapies for lung diseases 
such as COPD, asthma, cystic and pulmonary fibrosis, and driving 
precision medicine that is tailored to individual patient needs through 
data science.
National Institute of Allergy and Infectious Diseases
    ``Long COVID'' or Post-Acute Sequelae of SARS-CoV-2 Infection 
(PASC) refers to the prolonged symptoms or new or returning symptoms 
that people may develop after recovery from initial SARS-CoV-2 
infection. NIAID is conducting and supporting research, such as natural 
history studies, to understand what factors (e.g., age, sex, existing 
co-morbidities, and host genetic factors) may impact the development of 
post-acute symptoms, as well as the incidence and prevalence of long 
COVID. A better understanding of long COVID is essential to identifying 
and evaluating interventions to prevent and treat these long-term 
symptoms. The ATS supports the NIAID's evaluation of promising 
therapeutic and prevention strategies.
National Cancer Institute
    In 2022, lung and bronchus cancer were estimated to represent 12.3 
percent of all new cancer cases in the U.S. The ATS looks forward to 
continuing collaboration with the NCI, the Federal Government's lead 
agency for cancer research, on lung-cancer related research 
initiatives, including lung cancer screening, lung nodule management, 
lung cancer prevention, and the interaction between COPD and lung 
cancer.
National Institute of Environmental Health Sciences
    NIEHS-funded scientists are poised to make major fundamental 
discoveries that will help us appreciate the impact of a warming 
climate on public health. Furthermore, additional NIEHS-funded research 
is necessary to design and tailor interventions that will reduce the 
impact of climate change on the incidence and severity of disease, for 
disadvantaged communities that may not have resources to mitigate the 
effects of climate change.
National Institute on Minority Health and Health Disparities
    With the Administration's commitment to addressing health 
disparities, the ATS is committed to ongoing collaboration on the 
implementation of evidence-based interventions to address health 
disparities, including, for example, pulmonary rehabilitation, lung 
cancer screening, access to curative procedures for early-stage lung 
cancer and asthma home visiting programs.
National Institute of Nursing Research
    The American Thoracic Society's Assembly on Nursing represents a 
wide variety of clinical areas including treatment of pulmonary 
disease, critical illness, and sleep disorders. The ATS will continue 
its long history of collaboration with the NINR to support a research 
focus on studies to understand and develop communication strategies and 
technological advances to help vulnerable populations that experience 
disparities of care in COVID related health outcomes.
NIH Sleep Research Plan
    The NIH continues to lead global efforts to support research, 
innovation, education, and scientific advances related to sleep 
disorders and circadian biology through the National Center on Sleep 
Disorders Research (NCSDR). Last year, NCSDR released a five-goal Sleep 
Research Plan that aims to address sleep-related health disparities, 
facilitate clinical sleep and circadian research, and advance the 
scientific understanding and health impacts of sleep deficiency and 
circadian misalignment. The plan identifies nine Critical Opportunities 
(CO) related to the strategic goals, including working to develop tools 
for the early prediction, detection, and treatment of sleep deficiency, 
and identifying people-driven approaches to promote healthy sleep 
behaviors.
    As the NCSDR begins its work to implement the 2021 Sleep Research 
Plan, Congress must ensure that NIH is provided with adequate resources 
to achieve each of the five strategic goals and comprehensively explore 
each Critical Opportunity.
               centers for disease control and prevention
    Strong funding for CDC is critical to support essential public 
health programs that serve a wide range of U.S. communities. Due to 
years of underfunding, many CDC programs have not received the 
resources needed to address the myriad health challenges we face as a 
nation, resulting in many of CDC's most effective prevention programs 
not reaching all States.
National Institute for Occupational Safety and Health
    NIOSH is a Federal leader in research on occupational health. NIOSH 
also provides support of respiratory masks and other occupational 
protective technologies, occupational health research training, and 
provides technical assistance in cases of workplace exposure outbreaks.
Asthma Program
    Currently, twenty-three States, Houston, Texas, and Puerto Rico 
receive critical funding from the National Asthma Control Program to 
support State and local efforts to reduce the burden of asthma. Our 
request for $40 million in funding for the National Asthma Control 
Program would enable CDC to continue to fund these programs to combat 
the terrible human and economic burden caused by asthma. This increase 
in funding would also allow CDC to expand the Asthma Call-Back Survey 
to more States, thereby facilitating the collection of critical asthma 
surveillance data necessary for effective policy planning and 
implementation.
Division of Tuberculosis Elimination
    The COVID response has diverted staff and funds from TB control 
funding, resulting in missed opportunities to control TB in the U.S. 
Additional funding is needed to restore local TB control programs and 
to restore TB Trials Consortium (TBTC) trials sites that are conducting 
vital TB clinical drug trials critical to halting the TB pandemic.
Office on Smoking and Health
    Tobacco use is the leading cause of preventable disease, 
disability, and death in the United States. In 2020, 12.5 percent of 
U.S. adults (an estimated 30.8 million people) currently smoked 
cigarettes: 14.1 percent of men, 11 percent of women. Every day, about 
1,600 young people under age 18 smoke their first cigarette, and 235 
begin smoking cigarettes daily. Over 16 million people live with at 
least one disease caused by smoking, and fifty-eight million nonsmoking 
Americans are exposed to secondhand smoke. The CDC is at the forefront 
of the Nation's efforts to reduce deaths and prevent chronic diseases 
that result from tobacco use.
Global Climate Change Program
    Climate change continues to impact public health in a myriad of 
ways, including, smoke from wildland fires, droughts, intense heat, 
floods, and increased vector borne disease. Funding is needed to 
provide local communities the necessary funding to develop strategies 
for responding to health challenges posed by global climate change.
Chronic Disease Education Awareness Program
    CDC continues to be challenged to respond appropriately to the 
growth of chronic diseases in the U.S. CDC does not have an established 
program for major chronic diseases such as COPD as well as less 
prevalent chronic diseases. CDC has created a competitive grants 
program to fund public education efforts on important chronic disease 
that CDC has not yet addressed. Funding is needed to expand grant 
opportunities to conditions like COPD and other chronic respiratory 
diseases.
National Center for Environmental Health
    According to the CDC, over 25 million people, including over 5 
million children, live with asthma in the United States. Asthma 
disproportionately impacts women and minority communities who bear the 
brunt of the disease. Individuals living in poverty, as measured by the 
Federal poverty line, are also more likely to suffer from asthma. In 
addition, asthma imposes significant economic burdens, costing the 
United States over $80 billion in medical and indirect costs in the 
form of missed days of school and work. The ATS looks forward to 
further collaborations with the NCEH in highlighting asthma as a 
priority health condition with evidence-based interventions, which can 
prevent the need for costly emergency department visits.
                                 ______
                                 
       Prepared Statement of the American Urogynecologic Society
    The American Urogynecologic Society (AUGS) thanks the subcommittee 
for the opportunity to submit comments for the record regarding our 
Fiscal Year 2023 report language recommendations on two conditions that 
pose a significant personal burden for millions of women in this 
country and a significant financial burden on the U.S. healthcare 
system. AUGS is a national medical society whose mission is to promote 
the highest quality of care in female pelvic medicine and 
reconstructive surgery through excellence in education, research, and 
advocacy.
1. Overactive Bladder
    Overactive bladder is a sudden, intense urgency to urinate often 
followed by an involuntary loss of urine. It causes people to 
frequently go to the bathroom through the day and wake at night to 
urinate due to altered nerve signaling between the bladder and the 
brain. Overactive bladder occurs in the absence of a urinary tract 
infection or other pathology.
    Overactive bladder affects more than 38 million Americans, and 1 in 
every 3 older adults. It is more common with aging and in women. 
Overactive bladder has a significant impact on quality of life and on 
the healthcare system. Adults with overactive bladder are more likely 
to report anxiety and depression, falls, decreased quality of life, and 
have 20 percent higher health care utilization than matched 
counterparts without this condition. The Centers for Disease Control 
and Prevention estimated that the direct and indirect costs of 
overactive bladder in the U.S. was approximately $76 billion in 2015, 
with a projected increase to $82.6 billion by 2020.
    Anticholinergic medications are commonly prescribed to treat 
overactive bladder. These therapies are the most studied, most 
frequently used, and the most widely covered by insurance companies. 
However, there is increasing clinical evidence suggesting an 
association between long-term use of anticholinergic medications and 
the risk of developing cognitive impairment and Alzheimer's Disease and 
Related Dementia (ADRD). In fact, the evidence is compelling enough 
that the American Urogynecologic Society's ``Choosing Wisely'' campaign 
recommends the avoidance of anticholinergic medications to treat 
overactive bladder in women older than 70.
    It is well documented that the prevalence of overactive bladder 
increases with age. Therefore, as the American population continues to 
age over the next few decades, the personal and public health burden of 
overactive bladder will become more acute. Despite compelling data 
suggesting the negative impact of overactive bladder medications on 
cognitive function, more robust evidence is needed to guide evidence-
based treatment approaches. Thus, current overactive bladder 
medications must undergo additional study to definitively determine 
their impact on cognition and ADRD development and to determine if the 
risks substantially outweigh the benefits of these therapies. Such 
studies would have a vast public health impact, given the millions of 
people impacted by overactive bladder, the increasing number of people 
developing dementia, and the substantial social and economic impact 
that these conditions have on our country.
    For these reasons, the American Urogynecologic Society urges the 
subcommittee to adopt the following report language in the report 
accompanying the Fiscal Year 2023 Labor-HHS-Education appropriations 
bill that directs the National Institute of Diabetes, Digestive and 
Kidney Diseases (NIDDK) and the National Institute on Aging (NIA) to 
coordinate further study of anticholinergic medications and alternative 
treatments to determine the safety and efficacy of these medication for 
overactive bladder and their potential risks related to ADRD.
                     national institutes of health
National Institute on Diabetes, Digestive and Kidney Diseases/National 
        Institute on Aging
    Overactive Bladder.--The Committee remains concerned about the 
safety of medications used to treat overactive bladder, which may be 
increasing risk of Alzheimer's Disease and Related Dementia (ADRD). 
Overactive bladder affects 38 million Americans, and one in three older 
adults in this country. Overactive bladder has a significant impact on 
quality of life and the healthcare system. The anticholinergic 
medications typically used first-line to treat overactive bladder have 
been shown to increase the risk of developing dementia. Dementia 
continues to grow as a prevalent and serious public health issue. The 
Committee urges the National Institute on Diabetes, Digestive and 
Kidney Diseases (NIDDK) and the National Institute on Aging (NIA) to 
coordinate further study of anticholinergic medications and alternative 
treatments to determine the safety and effectiveness of medications for 
overactive bladder, and their potential risks related to ADRD. The 
Committee requests an update on the status of research activities 
focused on this issue in the fiscal year 2024 Congressional Budget 
Justification.
2. Pelvic Floor Disorders
    AUGS recommends report language to address pelvic floor disorders 
in minority populations. Pelvic floor disorders, which include pelvic 
organ prolapse and urinary and bowel incontinence, impact more than 25 
million women annually in the United States. Pelvic organ prolapse 
occurs when the pelvic floor muscles and connective tissue supporting 
the pelvic organs (the bladder, uterus and cervix, vagina, and rectum) 
weaken or tear and can no longer support these organs. The risk factors 
and causes of pelvic floor damage leading to pelvic organ prolapse 
include pregnancy and childbirth, aging and menopause, health 
conditions that involve repeated straining (such as obesity, chronic 
cough, and chronic constipation) and genetics.
    Pelvic organ prolapse is a common problem, with 1 out of 8 women 
undergoing surgery for prolapse at some point in their life. Studies 
have shown a prevalence difference in racial and ethnic populations. 
Pelvic organ prolapse can occur in reproductive age women but becomes 
more common as women age and after menopause. Treatment of pelvic organ 
prolapse requires significant healthcare resources. Non-surgical 
treatments require frequent health care visits and surgical treatments 
are imperfect with approximately 20 percent of women experiencing 
recurrences within 10 years. Surgical repair of prolapse is the most 
common inpatient procedure performed in women older than 70 years.
    Urinary incontinence and accidental bowel leakage are two 
additional pelvic floor disorders that impact over half of people aged 
65 and older living at home. In fact, these conditions are leading 
causes for admission to nursing homes as families are challenged for 
caring for their loved ones. Patients who suffer from pelvic floor 
disorders such as these experience a significant adverse impact on 
quality of life, resulting in restrictions in activities, social 
isolation, depression, and physical discomfort.
    Studies have shown that women from underrepresented backgrounds are 
much less likely to receive treatment for pelvic floor disorders. More 
research is needed to identify trends in clinical care and the efficacy 
associated with treatments for pelvic floor disorders. Furthermore, we 
need to better understand the role that medical literacy and barriers 
to care may play into the differences noted in outcomes amongst 
underrepresented populations who suffer from pelvic floor disorders. 
Families in this country with a loved one who suffers from a pelvic 
floor disorder will benefit from research that decreases barriers to 
effective identification and treatment of these impactful conditions.
    For these reasons, the American Urogynecologic Society urges the 
subcommittee to adopt the following report language in the report 
accompanying the Fiscal Year 2023 Labor-HHS-Education appropriations 
bill that directs the Eunice Kennedy Shriver National Institute on 
Child Health and Human Development to prioritize research activities 
that study pelvic floor disorders in minority populations.
Eunice Kennedy Shriver National Institute on Child Health and Human 
        Development
    Pelvic Floor Disorders.--Pelvic floor disorders including urinary 
incontinence, accidental bowel leakage and pelvic organ prolapse, 
negatively impact the quality of life of more than 25 million US women 
each year. There are socioeconomic disparities amongst women suffering 
from pelvic floor disorders, with differences in symptoms, knowledge, 
access to care, availability of treatments, and treatment outcomes 
noted in patients from different backgrounds. Recent studies have shown 
that minority women are much less likely to receive treatment for 
pelvic floor disorders. A better understanding of disparities among 
women with pelvic floor disorders can help guide the development of 
initiatives for education, outreach, and treatment of women with pelvic 
floor disorders. Therefore, the Committee urges the National Institute 
on Child Health and Human Development (NICHD) to prioritize research 
activities into underrepresented patient populations and pelvic floor 
disorders. Such activities should include the development of 
educational programs for general practitioners, the evaluation of 
effectiveness of screening protocols for pelvic floor disorders in the 
primary care setting, investigating medical literacy amongst minority 
women as it pertains to pelvic floor disorders, as well as assessing 
socio-economic and socio-cultural disease perspectives by designing 
qualitative studies using focus groups of women with varying socio-
economic, cultural and ethnic backgrounds, evaluating current 
educational resources, determining gaps in patient knowledge, and 
designing culture-specific educational materials and resources. The 
Committee requests an update on this issue and on research activities 
to advance pelvic floor disorders prevention and treatment in the FY 
2024 Congressional Budget Justification.
    Thank you in advance for your favorable consideration of these 
report language requests. Your support will positively impact 
knowledge, access to care and treatment for overactive bladder and for 
pelvic floor disorders and improve the lives of the millions of 
American women affected by these devastating conditions.
                                 ______
                                 
           Prepared Statement of the Animal Welfare Institute
Report Language Request
    The National Child Abuse and Neglect Data System (NCANDS) was 
established in response to the Child Abuse Prevention and Treatment Act 
of 1988. It is a voluntary data collection system that gathers 
information from all 50 States, the District of Columbia, and Puerto 
Rico about reports of child abuse and neglect. The data are used to 
examine trends in child abuse and neglect across the country, and its 
key findings are published in its Child Welfare Outcome Reports, which 
are submitted to Congress, and in its annual Child Maltreatment 
Reports. In light of the acknowledged close relationship between child 
maltreatment and animal abuse, and with exposure to animal abuse 
considered an Adverse Childhood Event (ACE), the Committee encourages 
the Department of Health and Human Services to expand its NCANDS 
reports to add a category of ``animal abuse'' to the child and 
caregiver characteristics and environmental factors that may place the 
child at risk for maltreatment. Moreover, the Committee asks DHHS to 
provide a report to the Committee within 90 days on any steps it may 
have taken to make this change.
Justification
    This language encourages DHHS to expand the data collected around 
child abuse cases to include animal abuse. To more accurately examine 
trends in child abuse and neglect, it is critical to pay attention to 
animal abuse as a risk factor in the family. Having such information 
will provide a better foundation for child abuse screening, prevention, 
and treatment programs and would benefit children, families, and pets.
    Animal abuse is a serious crime in and of itself, and well-
documented evidence has identified a strong link between it and many 
forms of interpersonal violence. For example, committing animal abuse 
is a better predictor of sexual assault conduct than previous 
convictions for homicide, arson, or weapons offenses. In a violent 
household, companion animals are often victims of the very same abuse 
that children, intimate partners, and vulnerable adults are suffering. 
A survey of families in New Jersey who had been referred for physical 
child abuse found that animal abuse was also present in 88 percent of 
those homes. As Dr. Lynn Loar wrote, ``The behavior that harms the 
animal is the same behavior that harms the human.'' Decades of research 
and practical experience have firmly established this link. In fact, 
the first person to suspect that a family may be in crisis could well 
be a law enforcement officer responding to an animal cruelty call.
    There is growing understanding that being alert to the presence of 
abused animals will help to protect not only the animals themselves but 
also other members of the family.
    Besides the direct abuse to which they may be subjected, children 
are particularly vulnerable to suffering long-term adverse effects from 
witnessing-or even being forced to participate in-the mistreatment of 
their pets.
    There is substantial evidence linking child and animal well-being:
  --Children form close bonds with their pets, often referring to them 
        as their ``best friends,'' or reporting that they turn to them 
        when troubled.
  --Threatening or actually harming a pet by a caretaker traumatizes 
        the child. Traumatized children are more likely to become 
        victims or perpetrators of violence.
  --The threat of animal abuse to silence child sex abuse victims has 
        been a factor in a number of criminal convictions.
  --Children who are cruel to animals are more likely to have been 
        maltreated than other children. Cruelty to animals as an 
        indicator of child maltreatment increases with the child's age, 
        persistence of behavior, and poorer social background.
  --Children are exposed to a variety of traumatic experiences, 
        referred to as ``poly- victimization'' or Adverse Childhood 
        Experiences (ACE). To successfully intervene and treat children 
        and families, all forms of polyvictimization need to be 
        recognized. Animal abuse is one of them.
  --Evidence of animal abuse has been introduced during child custody 
        hearings and in many of those cases, it has been one of the 
        factors leading to removal of children from one or both 
        parents. In one such case involving sexual abuse and neglect of 
        the children, the appellants motioned the court to sever the 
        animal cruelty charges from the sexual abuse charges; however, 
        the court declined, stating that the offenses were intertwined, 
        and evidence of ``animal cruelty was essential to establish the 
        physical abuse offenses.'' In reaching this conclusion, the 
        court considered that the animal abuse led to discovering the 
        child abuse, and that ``mistreatment of the animals greatly 
        reflected upon [the defendants'] state of mind when they 
        committed the physical and sexual abuse.'' Schambon v. 
        Commonwealth, 821 S.W.2d 804 (Ky. 1991)
    The National Council of Juvenile and Family Court Judges has gone 
all in in taking up this issue, working with the Animal Legal Defense 
Fund to bring a wide array of training opportunities to judges to 
expand their understanding of the relationship between animal cruelty 
and child abuse and how important this understanding is to the work 
they do with families. In a recent letter to her colleagues, Judge 
Katherine Tennyson (ret.) let them know that NCJFCJ ``has developed a 
resource, Toolkit for Starting a LINK Coalition in Your Community for 
Guidance (https://nationallinkcoalition.org/wp-content/uploads/2013/01/
TOOLKIT.pdf) for community leaders, including judges, to help with the 
skills and steps needed to form and sustain a coalition for addressing 
the pressing, but underacknowledged, issues relating to the link 
between animal abuse and interpersonal violence.''
    NCJFCJ notes on its website that ``[t]hrough their authority to 
issue protection and restraining orders, to remove children from 
abusive homes, and to order youthful offenders into treatment or secure 
placement, judges use the power of the courts to respond to cruelty and 
abuse, to protect victims and prevent future harm. Judges also have the 
opportunity to take measures to safeguard the wellbeing of an 
overlooked member of the household and the community--pets and animals. 
To do this effectively, they need to understand the links between 
behavior involving violence against animals and interpersonal 
violence.''
    Thus, there is an urgent need for more complete information about 
these patterns so that child welfare agencies and the courts can 
understand how to intervene safely and effectively.
                 current data collected on child abuse
    State child protection agencies voluntarily provide data to the 
Federal Government under the National Child Abuse and Neglect Data 
System (NCANDS), which tracks trends in child abuse and neglect across 
the country. Case reports on the nearly 700,000 children abused 
annually in the U.S. include a variety of details--such as the type of 
abuse a child suffered or whether the caregiver had a substance abuse 
disorder--that help researchers and service providers better understand 
the factors associated with child abuse. There can be no doubt that 
cruelty to animals, especially family pets, is such a factor. These 
data help to inform the need for screening and preventive services and 
to ``allow analysis of victim, caretaker, and perpetrator 
characteristics, as well as responses to abused/neglected children in 
need of services.''
    Information collected under NCANDS has been used to determine, for 
example, that children whose families face multiple stressors are at a 
higher risk of being repeatedly referred to Child Protective Services, 
and that some types of maltreatment are more likely to recur than 
others. Adding animal abuse to the range of stressors that are measured 
will give service providers and others a window into the lives of 
abused children that they currently do not have and may help identify 
children at risk who otherwise may have gone undetected.

    [This statement was submitted by Submitted by Nancy Blaney, 
Director, 
Government Affairs.]
                                 ______
                                 
             Prepared Statement of the Arthritis Foundation
    On behalf of the more than 58 million adults and 300,000 children 
living with doctor-diagnosed arthritis in the United States, the 
Arthritis Foundation thanks Chairwoman Murray and Ranking Member Blunt 
for the opportunity to provide written testimony to the Appropriations 
subcommittee on Labor, Health and Human Services (HHS), and Education 
and Related Agencies for Fiscal Year 2023. We respectfully request: $11 
billion in funding for the Centers for Disease Control and Prevention 
(CDC)--and within that $54 million for the CDC Arthritis Program--and 
$30 million for the Pediatric Subspecialty Loan Repayment Program to be 
administered by the Health Resources and Services Administration 
(HRSA).
                         cdc arthritis program
    Arthritis affects 1 in 4 Americans and is the leading cause of 
disability in the United States, according to the CDC. It limits the 
daily activities of over 23 million Americans and causes work 
limitations for 40 percent of the people with the disease. This 
translates to over $300 billion a year in direct and indirect costs. 
There is no cure for arthritis, and for some forms of arthritis like 
OA, there is no disease-modifying pharmaceutical therapy, making 
evidence-based self-management programs critical for managing the 
disease. The CDC is critical for the dissemination of evidence-based 
programs, data collection and disease surveillance, and public health 
research. The COVID-19 pandemic has exacerbated the challenges of 
disease management, making interventions like exercise programs more 
difficult to access and maintain. In FY 2023, Congress should increase 
CDC funding to $11 billion to support key public health programs, 
bolster critical infrastructure, improve disease surveillance and data 
collection, and strengthen pandemic preparedness. Within that $11 
billion, Congress should allocate $54 million for the Arthritis Program 
to expand the reach of its services and resources.
    The CDC Arthritis Program is the only Federal program dedicated 
solely to arthritis. Today, the program provides grants to 13 States to 
support evidence-based disease management programs. The program aims to 
connect all Americans with arthritis to resources to help them manage 
their disease. Evidence-based programs like EnhanceFitness help keep 
older adults active, and have shown a 35 percent improvement in 
physical function, resulting in fewer hospitalizations and lower health 
costs compared to non-participants. In addition, Walk With Ease is an 
evidence-based group walking program that encourages people with 
arthritis to start walking and stay motivated to keep active. The 
program allows participants to meet a few times per week to receive 
health education on an arthritis or exercise-related topic followed by 
stretching activities, and a group walk. A recent CDC-funded randomized 
controlled trial found that the program can help reduce arthritis 
symptoms, reduce disability, and improve strength and balance.
    Given the high prevalence and severity of this disease, the 
Arthritis Program is woefully under-funded compared to the investment 
in other chronic diseases. It is currently funded at $11 million, and 
due to either reduced funding or flat funding in recent years, the 
program has lost millions of dollars in purchasing power over the last 
decade.
    With full funding of $54 million, the program would be able to:
  --Provide funding to all 50 States to fully operationalize a National 
        Arthritis Program. Today, the CDC Arthritis Program funds only 
        13 State programs around the country (AR, KS, MA, MN, MO, NH, 
        NY, NC, OR, RI, UT, VA, and WA). These programs play a vital 
        role in the dissemination of proven strategies and programs, 
        and all States should receive funding to operate an arthritis 
        program;
  --Expand national partnerships that are critical to promoting 
        awareness, increasing primary provider referrals for non-
        pharmacologic management of chronic pain, and providing access 
        to arthritis self-management and physical activity programs; 
        and
  --Invest in robust data and intervention and prevention research to 
        better understand arthritis.
         pediatric subspecialty loan repayment program (pslrp)
    An estimated 300,000 children have arthritis, yet there are fewer 
than 450 board-certified practicing pediatric rheumatologists in the 
United States, mainly clustered in big cities and urban metro areas. 
Shockingly, seven States have no pediatric rheumatologists and five 
States have only one. Early diagnosis and treatment of arthritis is 
critical for disease management, and it can be difficult for providers 
untrained in pediatric rheumatology to diagnose arthritis.
    The pediatric rheumatology workforce is stretched now more than 
ever due to the pandemic. Serious shortages are causing decreased 
access to care for young people, resulting in myriad complex 
challenges, including entire days of missed work and school for the 
child, siblings, and parents because of the length of time traveling to 
the nearest specialist; families deciding to move to a different state 
to be closer to a specialist, and having to travel by airplane to reach 
the closest specialist.
    The Pediatric Subspecialty Loan Repayment Program (PSLRP) was 
funded for the first time in FY 2022 and will make loan repayment 
available for pediatric subspecialists like pediatric rheumatologists 
to practice in underserved areas. With initial funding of $5 million, 
the number of applications HRSA can fund will be severely limited, yet 
we anticipate demand will be high among pediatric subspecialists. We 
urge the inclusion of $30 million in the FY 2023 appropriations bill to 
build upon this important investment and address the ever-growing and 
critical pediatric workforce shortage.
    We thank the subcommittee for its commitment to the health and 
wellbeing of all Americans. As you write the FY 2023 Labor-HHS-
Education appropriations bill, we urge the inclusion of $11 billion for 
the CDC and $54 million within that for the CDC Arthritis Program, and 
$30 million for the Pediatric Subspecialty Loan Repayment Program in 
order to continue investments that improve the lives of people with 
chronic diseases like arthritis. Please contact Anna Hyde, Vice 
President of Advocacy and Access, at [email protected], with any 
questions.
                                 ______
                                 
                Prepared Statement of the Aspira Women's
    Thank you for the opportunity to comment on the National Institutes 
of Health (NIH) budget priorities for fiscal year (FY) 2023. We commend 
the efforts of the NIH to identify gaps and barriers in women's health 
and modernize priorities for research on the complete health of women. 
We provide this testimony in support of increased funding within the FY 
2023 Labor, Health and Human Services, and Education Appropriations 
bill for endometriosis and ovarian cancer, with an increased focus and 
attention on access and equity so all women can benefit from innovative 
and transformative healthcare advancement.
    As a women-led transformative women's health company, Aspira 
Women's Health is focused on bringing innovative and proprietary 
technologies to women where the healthcare system overall has failed to 
address their unmet healthcare needs. Specifically, Aspira Women's 
Health is currently the sole provider of OVA1, an innovative and the 
only FDA-cleared blood test for ovarian cancer risk assessment when a 
woman presents with a pelvic mass. We are also focused on a non-
invasive endometriosis blood-based detection test, as women suffering 
from this debilitating condition are also severely underserved. Current 
diagnostic and treatment options for endometriosis represent sub-
optimal care for women with this chronically painful condition that 
often is mis-diagnosed or diagnosed years after the onset severe 
symptoms.
    Women's health issues continue to be under-represented in terms of 
NIH resource allocation, with dire consequences. As it specifically 
relates to endometriosis, there are several specific important issues 
that need to be addressed. Foremost among them is that endometriosis is 
an irreversibly debilitating disease known to cause a wide spectrum of 
physical and psychological symptoms from chronic pain to infertility to 
increased risk of suicide, yet it is regularly mis-diagnosed or 
diagnosed up to 7-9 years after the onset of painful symptoms despite 
it impacting 10-20 percent of the overall female population and 5-50 
percent among women with infertility. These symptoms are extremely 
painful and uncomfortable and range from pain during intercourse and 
bowel movements to excessive bleeding. If this chronic pelvic pain is 
detected and treated early, laparoscopy surgery may be avoided, saving 
patients from invasive surgery and our healthcare system from 
preventable expenditures. The total expenditures per patient are 
similar to a Type 2 Diabetic patient, yet this condition is a silent, 
pervasive, irreversible, and chronically painful and debilitating 
disease impacting millions of women.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    A non-invasive biomarker-based blood test would be a significant 
improvement over surgery, and non-invasive methods for diagnosing 
endometriosis would reduce related costs. However, these advancements 
can't be realized unless funding for women's health issues is increased 
exponentially, particularly for debilitating and deadly conditions like 
endometriosis and ovarian cancer, respectively.
    In addition to endometriosis, ovarian cancer also deserves 
increased attention and investment. Ovarian cancer is pervasive, often 
fatal and is frequently missed or mis-diagnosed, especially among Black 
women. It is the only sex-specific cancer with greater than a 50 
percent mortality rate. Comparatively, breast cancer and prostate 
cancer have mortality rates lower than 10 percent. Today, Ovarian 
Cancer accounts for more deaths than any other cancer of the female 
reproductive system. In terms of public funding for research, there are 
major disparities. An example is prostate cancer, which has a 2 percent 
mortality rate, yet receives 50 percent more funding than ovarian 
cancer from the NIH. Ovarian cancer disproportionately affects women of 
color. For example, the all-cause mortality of Black women with ovarian 
cancer is 1.3 times higher than white women, even when access to care 
is equal. Furthermore, studies have shown that the risk of not 
receiving surgical intervention remains high among Black women and 
Hispanic women when compared to white women, and Black, Asian Pacific 
Islander, and Hispanic women were all at significantly greater risk of 
dying within the first 12 months of cancer diagnosis when compared to 
white women. A way to address these key disparities is an increase in 
funding for ovarian cancer research, especially among women of color, 
as it is critical to improving patient outcomes in the populations that 
suffer the most.
    A clear example as to why research dollars are key to expanding 
innovation is CA-125, the most widely used blood test for ovarian 
cancer detection, discovered in the early 1980s. This biomarker has low 
sensitivity for early-stage disease, approximately 50 percent, and may 
be even lower among women of color. Between CA125's poor sensitivity 
and the often asymptomatic nature of early-stage disease, as well as 
other factors, it is estimated that over three quarters of ovarian 
cancers are not discovered until they are in advanced stage. In 
addition to this, CA125 can be elevated in many benign conditions, 
resulting in false positives which can cause women to endure 
unnecessary exploratory, invasive, and costly surgery.
    Fortunately, there are innovations that improve outcomes, such as 
the only multivariate index assay for assessing the risk of ovarian 
cancer on the market, OVA1. OVA1 has an overall sensitivity of 92 
percent and an early-stage sensitivity of 91 percent. In Black women, a 
group for whom CA125 often provides inadequate risk assessment, OVA1 
detected 79 percent of malignancies, compared to 63 percent by CA125. 
When ovarian cancer is discovered and treated early, survival rates can 
be greater than 90 percent. In advanced stage disease, however, the 5-
year survival can be under 20 percent. Furthermore, evidence suggests 
that detecting ovarian cancer early costs nearly 84 percent less than 
treating late-stage disease, based on the increased costs of 
unnecessary care, making innovations in early detection of ovarian 
cancer a cost-effective solution. Increased NIH funding would enable 
additional advancements in ovarian cancer diagnoses and care, while a 
focus on minority women would ensure improved patient outcomes for 
those most likely to die of this disease.
    As you draft the Labor Health, and Human Services appropriations 
bill, I ask that you consider increased funding for endometriosis and 
ovarian cancer. With additional Federal research funding, innovators 
across the Nation can make significant improvements for women suffering 
from these dehabilitating and deadly diseases. We appreciate your 
consideration and your attention to endometriosis and ovarian cancer 
when making funding allocations and policy decisions, while providing 
increased focus and attention on access and equity so all women can 
benefit from innovative and transformative healthcare advancement.

References

American Cancer Society (2021) https://report.nih.gov/funding/
categorical-spending#/

    Oral E, Sozen I, Uludag S, et al. The prevalence of endometrioma 
and associated malignant transformation in women over 40 years of age. 
Journal of Gynecology Obstetrics and Human Reproduction. 
2020;49(5):101725. doi:10.1016/j.jogoh.2020.101725.
    Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA. 
Endometriosis and Risk of Coronary Heart Disease. Circ Cardiovasc Qual 
Outcomes. 2016;9(3):257-264. doi:10.1161/CIRCOUTCOMES.115.002224.
    Arion K, Orr NL, Noga H, et al. A Quantitative Analysis of Sleep 
Quality in Women with Endometriosis. Journal of Women's Health. 
2020;29(9):1209-1215. doi:10.1089/jwh.2019.8008.
    Warzecha D, Szymusik I, Wielgos M, Pietrzak B. The Impact of 
Endometriosis on the Quality of Life and the Incidence of Depression-A 
Cohort Study. International Journal of Environmental Research and 
Public Health. 2020;17(10):3641. doi:10.3390/ijerph17103641.
    Lorencatto C, Petta CA, Navarro MJ, Bahamondes L, Matos A. 
Depression in women with endometriosis with and without chronic pelvic 
pain. Acta Obstetricia et Gynecologica Scandinavica. 2006;85(1):88-92. 
doi:https://doi.org/10.1080/00016340500456118.
    Endometriosis: Thousands share devastating impact of condition. BBC 
News. https://www.bbc.com/news/health-49897873. Published October 6, 
2019. Accessed April 13, 2021.
    Fairbanks F, Abdo CH, Baracat EC, Podgaec S. Endometriosis doubles 
the risk of sexual dysfunction: a cross-sectional study in a large 
amount of patients. Gynecological Endocrinology. 2017;33(7):544-547. 
doi:10.1080/09513590.2017.1302421.
                                 ______
                                 
    Prepared Statement of the Association for Career and Technical 
                       Education and Advance CTE
    On behalf of the Association for Career and Technical Education 
(ACTE), the Nation's largest not-for-profit association committed to 
the advancement of education that prepares youth and adults for career 
success, and Advance CTE, the Nation's longest-standing not-for-profit 
that represents State Directors and leaders responsible for secondary, 
postsecondary and adult Career Technical Education (CTE) across all 50 
States and U.S. territories, we are writing to respectfully request 
that the subcommittee increase funding for the Carl D. Perkins Career 
and Technical Education Act's (Perkins V) Basic State Grant program, 
administered by U.S. Department of Education's Office of Career, 
Technical, and Adult Education, by $200 million- an overall amount of 
$1.58 billion in the forthcoming Fiscal Year 2023 (FY23) Labor, Health 
and Human Services, Education, and Related Agencies appropriations 
bill. It is vital that Congress continues to build upon the recent 
investments made in Perkins V in order to fully support the 
implementation of the law and the over 11 million secondary, 
postsecondary, and adult learners it serves across the Nation.
    As you are aware, the Biden Administration formulated its FY23 
Congressional budget request before Congress had yet finished work on 
FY22 appropriations legislation. As a consequence, the Administration 
used fiscal year 2021 funding levels as the starting point for 
developing its FY23 request for Perkins V. For this reason, the 
Administration proposed an ``artificial cut'' to Perkins V's basic 
State grant program of $25 million dollars. Officials from the U.S. 
Department of Education (ED) have since contended they support level-
funding for this program. Yet, as Congress continues to debate economic 
competitiveness legislation and oversees the implementation of last 
year's bipartisan infrastructure law, the need for highly skilled 
workers has never been greater. Flat-funding for Perkins V's State 
grant program would therefore be inadequate given the growing employer 
need for skilled talent and learner demand for CTE programs that 
provide on-ramps into these opportunities.
    In addition, the Administration has also proposed the creation of a 
new $200 million competitive grant program-roughly 15 percent of the 
total size of all Perkins V funding-which the Administration has dubbed 
the ``Career Connected High Schools'' initiative. This competitive 
funding proposal would serve limited students overall, and unfairly 
favor funding for eligible entities that already have the capacity to 
write grants while penalizing smaller and more rural districts and 
institutions. Distributing funding in this manner would likely further 
exacerbate many longstanding inequities in our Nation. Given that this 
proposal would fund activities that are largely duplicative of how 
Perkins V State grant funding is already used, this additional funding 
would be more efficiently and effectively deployed as part of the 
Perkins Basic State Grant allocation instead. Doing so would ensure far 
more learners are able to access high-quality CTE programs supported by 
Perkins V formula dollars- which go to every State and Congressional 
district-rather than this new competitive grant program which, by the 
Administration's own estimates, would only support 32 grantees.
    CTE at the secondary and postsecondary levels is an integral part 
of ensuring an equitable and efficient implementation of last year's 
bipartisan infrastructure legislation. According to the Brookings 
Institution, at least 15 million new workers will be needed for United 
States infrastructure in the next decade. In order to make good on 
Congress's promise to rebuild America's infrastructure, CTE will 
require robust funding to reskill the workforce in critical areas such 
as construction, transportation, housing, utilities, and 
telecommunications. CTE serves a critical role in preparing learners to 
enter into in-demand sectors of the economy which have immediate and 
longer-term hiring needs. CTE also is central to efforts to reskill and 
upskill learners who have been displaced by economic forces outside of 
their control or who have been sitting outside of the labor market for 
one reason or another. Examining data from the last recession, the vast 
majority of new and replacement jobs went to individuals with more than 
a high school diploma, including 3.1 million jobs that went to those 
with associate degree or postsecondary certificates.
    Just as all education programs have been hit hard by the pandemic, 
so have CTE programs. This has been exacerbated by the lack of 
dedicated CTE funding within any of the pandemic response bills. What 
sets CTE apart from other educational pathways is its focus on real-
world skills and applied learning. High-quality CTE programs provide 
opportunities for direct engagement between industry and learners and 
instructors, often include work-based learning experiences, and enable 
learners to earn credentials of value. Yet what sets CTE apart is also 
what has presented unique challenges during the pandemic era. CTE 
programs are facing many of the same dire needs as the entire education 
system, particularly those related to broadband and technology access, 
digital curriculum, and teacher professional development. However, many 
of the needs in CTE are exacerbated by the applied and lab-based nature 
of many courses, the need for learners to meet certification 
requirements, and the benefits of work-based learning and other 
experiential programs. Each of these activities are resource-intensive 
and even more challenging as a consequence of the pandemic.
    CTE programs stand ready to provide employers a talent pipeline, 
and prepare students for careers in high-skill, high-wage, or in-demand 
industry sectors and occupations. To achieve this, CTE programs need to 
be adequately resourced. Jobs that require more than a high school 
diploma but less than a baccalaureate degree were growing quickly 
before the pandemic and this trend is only expected to further 
accelerate. Further, the twin forces of automation and globalization 
require nimble, proactive, and responsive programs that provide 
specific technical skills as well as more transferable competencies. As 
jobseekers and employers have looked to recover from the economic 
impacts of the pandemic, additional funding will ensure that the CTE 
system is primed to support their needs.
    Despite these needs, no pandemic aid package passed by Congress in 
response to the public health emergency has included dedicated CTE 
funding. At a time of record-inflation, CTE programs are 
disproportionately impacted by pandemic-related financial challenges 
because of the need to purchase and maintain the industry-standard 
equipment required to adequately serve learners. Congress has an 
opportunity to provide much-needed resources to CTE programs as part of 
the FY23 appropriations process to begin to remedy some of these 
ongoing challenges.
    High-quality CTE programs are delivering real results. Across the 
country, CTE programs are preparing learners for promising career paths 
and giving employers and our economy a competitive edge. CTE programs 
provide unique opportunities for learners to engage with employers and 
participate in internships, apprenticeships and other meaningful on-
the-job experiences. In addition, these programs produce strong 
outcomes for the learners they serve. The average high school 
graduation rate for students concentrating in CTE is 95 percent, 
compared to a national adjusted cohort graduation rate of 85 percent. 
Additionally, students involved in CTE are far less likely to drop out 
of high school than other students, a difference estimated to save the 
economy $168 billion each year. Furthermore, those students are more 
likely to continue their education-91 percent of high school graduates 
who earned two to three CTE credits enrolled in college.
    The outcomes for adult learners are also significant: 84 percent of 
adults concentrating in CTE programs either continued their education 
or were employed within 6 months of completing their program. In fact, 
90 percent of Americans agree that apprenticeships and skills training 
programs prepare individuals for a good standard of living.
    Expanding funding for CTE programs will create a brighter future 
for communities--leading to more career options for learners, better 
results for employers, and increased growth for our economy. Investing 
in CTE programs provides substantial benefits for not just the students 
enrolled, but for States and communities across the country. Every 
dollar spent on secondary CTE students in Washington State leads to $26 
in lifetime earnings and employee benefits, while individuals who 
receive a certificate or degree from California Community Colleges 
almost double their earnings within 3 years. In Wisconsin, taxpayers 
receive $12.20 in return for every dollar invested in the technical 
college system. Oklahoma's economy reaps a net benefit of $3.5 billion 
annually from graduates of the CareerTech System. If we are serious 
about providing learners with the real-world skills, hands-on 
opportunities and real options for college and rewarding careers that 
come with CTE and making progress toward closing the skills gap, then 
there is no better time than now to invest $1.58 billion in the Perkins 
V CTE State Grant program.
    CTE programs are also preparing individuals with the skills that 
employers seek. A recent survey found that employers believe CTE is 
good for business, the economy, and public education, and the majority 
of those surveyed reported that those from a CTE program are better 
prepared with workplace, technical and real-world skills. Employers who 
recruit from CTE programs are also more likely to report industry 
growth. CTE programs have long provided unique opportunities for 
learners to engage with employers and participate in internships, 
apprenticeships, and other meaningful on-the-job experiences. Now more 
than ever, CTE serves a critical role in supporting learners in their 
reskilling or upskilling as they look to either re-enter the economy or 
grow into new opportunities as part of our shared economy.
    CTE programs prepare students for careers in in-demand fields and 
provide an affordable pathway to both a family-sustaining career and 
financial independence. Health care occupations, many of which require 
an associate degree or industry credential, are projected to grow 14 
percent by 2028-adding almost 2 million new jobs. Half of all STEM 
occupations, which offer students high-skilled, high-wage career 
opportunities, require less than a bachelor's degree. There are 
currently about 30 million ``good jobs"-jobs that pay a median income 
of $55,000 or more and require education below a bachelor's degree. 
Moreover, CTE programs can be leveraged as an important talent pipeline 
for occupational fields that are experiencing critical labor shortages 
due to the pandemic and other factors, such as nursing and teaching. 
CTE programs themselves can be harnessed to meet these needs directly, 
via ``Grow Your Own'' programs, that would help to alleviate labor 
shortages in these critical sectors of our economy.
    Additionally, the demand for workforce credentials is growing. The 
number of individuals earning certificates or associate degrees in CTE 
fields, such as manufacturing, health care, and STEM, rose 71 percent 
from 2002 to 2012. Students can pursue these valuable credentials at 
community and technical colleges for a fraction of the cost of tuition 
at other institutions: $3,730 on average for the 2019-2020 academic 
year. Highly-skilled workers deliver direct benefits to American 
employers through enhanced productivity and innovation. However, the 
increased demands on the workforce pipeline are a persistent barrier to 
economic growth. Meanwhile, 89 percent of executives agree there is a 
talent shortage in the U.S. manufacturing sector, 5 percent higher than 
2015 results. Other industries are also facing significant skilled 
labor shortages as they emerge from the pandemic.
    Funding Perkins V at adequate levels will ensure that educators can 
equip students with the skills and related credentials they will need 
for in-demand fields. This will become increasingly pressing as the 
country continues to recover from the current public health and related 
economic crisis. Already, healthcare jobs are projected to have the 
largest increase of any occupational sector. Filling these and other 
positions created as a result of the pandemic, as well as ensuring that 
each individual is able to access the training needed for employment, 
is critical.
    CTE programs can serve even more learners and employers--but only 
if they receive more resources. According to the most recent Job 
Openings and Labor Turnover (JOLTS) Survey from the Bureau of Labor 
Statistics, the ratio of unemployed workers to job openings is 0.6, 
meaning that there are nearly two open jobs for every unemployed 
person. This tight labor market underscores the immense demand for 
skilled workers, especially as we seek to implement last year's 
bipartisan infrastructure legislation. CTE remains a critical component 
of the workforce pipeline for key industries that are needed to sustain 
a long-term economic growth and recovery, such as health care, STEM, 
manufacturing, construction and transportation distribution and 
logistics.
    However, learner demand for CTE programs, especially programs in 
in-demand sectors is greater than supply. With current and anticipated 
demand growing, more resources are needed to build, expand and support 
high-quality CTE programs. It is vital that Congress continues to build 
upon the recent increases to Perkins V to ensure we have the talent 
pipeline needed to fully recover from the jobs crisis caused by the 
pandemic.
    And there's widespread support for CTE: 94 percent of parents 
approve of expanding access to CTE. However, a survey of school 
districts offering CTE found that the top barrier to offering CTE in 
high school was a lack of funding or the high cost of the programs. As 
our recent analysis demonstrates, funding for CTE State Grants remains 
$403 million below fiscal Year2004 enacted levels when using the Bureau 
of Economic Analysis' (BEA) Personal Consumption Expenditures (PCE) 
Price Index to adjust for inflation-the most conservative measure of 
inflation over time.
    Taking a longer view, before FY18, the investment in CTE State 
Grants had been relatively flat since 1991 without being tied to 
inflation, and the program's buying power had fallen by approximately 
$933 million in inflation-adjusted dollars--a 45 percent reduction over 
a quarter century. Congress recognized the need to begin to reverse 
this trend and from FY18 to FY22 provided an additional $262 million 
for CTE State Grants, bringing the total investment to $1.38 billion. 
While these budgets represented initial down payment to meet increased 
need, a significant, robust investment in CTE programs is still 
imperative to account for persistent underfunding, the lack of 
inflation-adjusted increases, and most importantly, the overwhelming 
growth in demand for these programs from both learners and the wider 
American economy. Congress should build on the momentum from recent 
years and continue to strengthen the investment in CTE State Grants in 
FY23. And, Americans agree: 93 percent of voters support increasing the 
investment in skills training.
    Now more than ever, individuals need access to upskilling and 
reskilling opportunities to be part of the evolving workforce, and CTE 
programs will be adapting, as always, to the needs of business and 
industry in the current economy. CTE is both a proactive and responsive 
strategy for attending to the economic downturn--CTE programs prepare 
learners for lifelong success while also offering targeted skilled 
training for others. We applaud the commitment to growing our 
investment in Perkins V, and we urge the subcommittee to make CTE a top 
priority in the forthcoming FY23 Labor, Health and Human Services, 
Education, and Related Agencies appropriations bill. Now is not the 
time to back away from our commitment to advancing high-quality CTE, 
but rather the time to redouble our collective commitment to these 
valuable programs and ensure CTE opportunities are available for every 
learner.
    Thank you for your thoughtful consideration of our request. For 
more information or if you wish to discuss our request, please contact 
ACTE's Government Relations Manager, Zach Curtis 
([email protected]) or Advance CTE's Policy Advisor, Steve Voytek 
([email protected]).
                                 ______
                                 
      Prepared Statement of the Association for Clinical Oncology
    The Association for Clinical Oncology (ASCO), the world's leading 
professional organization representing nearly 45,000 physicians and 
other professionals who treat people with cancer, thanks this 
subcommittee for its long-standing commitment to support federally 
funded research at the National Institute of Health (NIH) and National 
Cancer Institute (NCI). ASCO is extremely grateful for the $2.25 
billion increase for the NIH in fiscal year (FY) 2022. This strong 
commitment to scientific discovery will help the research community 
continue current momentum and sustain our Nation's position as the 
world leader in biomedical research. ASCO appreciates this opportunity 
to provide the following recommendations for FY 2023 funding to build 
on our Nation's investment in biomedical research:

  --National Institutes of Health (NIH): $49.048 billion
    --National Cancer Institute (NCI): $7.766 billion
      --Beau Biden Cancer Moonshot Initiative: $216 million

  --Centers for Disease Control and Prevention's (CDC) Division of 
        Cancer Prevention and Control (DCPC): $462.6 million
    --Cancer Registries Program: $61.4 million
                      the nih: a great investment
    In FY 2020, the NIH provided over $34 billion in extramural 
research to scientists in all 50 States and the District of 
Columbia.\1\ NIH research funding also supported more than 536,000 jobs 
and generated over $91 billion in economic activity in 2020.\2\
---------------------------------------------------------------------------
    \1\ National Institutes of Health; https://www.nih.gov/about-nih/
what-we-do/impact-nih-research.
    \2\ United for Medical Research; https://
www.unitedformedicalresearch.org/wp-content/uploads/2021/03/NIHs-Role-
in-Sustaining-the-U.S.-Economy-FINAL-3.23.21.pdf.
---------------------------------------------------------------------------
    The importance of federally funded biomedical research has never 
been clearer than during the COVID-19 pandemic as scientists from all 
corners of the country worked to quicky develop effective COVID-19 
vaccines. Researchers racing towards a vaccine were not starting from 
scratch; years of federally funded research led to the discovery and 
identification of practical uses for messenger RNA, or mRNA, as used in 
the Pfizer and Moderna vaccines. Prior to COVID-19, cancer researchers 
were using mRNA to trigger the immune system to target specific cancer 
cells. Building on previous scientific advancements, coupled with 
collaboration across Federal agencies, academic institutions, and the 
private sector, unprecedented flexibility, and reduction in regulatory 
red tape, the resulting vaccines came to market at a record pace. This 
remarkable achievement--built on years of research and scientific 
discovery--is a testament to the need for continued investment.
    Despite recent funding increases, the pandemic has resulted in 
stagnant research progress and low clinical trial accrual rates, 
stifling the progress of our biomedical research enterprise and 
weakening our clinical trials networks. While our research 
infrastructure is recovering, the funding levels we are requesting for 
FY 2023 would continue to aid the recovery from these setbacks and 
allow meaningful growth above biomedical inflation. The investment 
would also allow the extraordinary progress seen pre-pandemic to 
continue. Failure to sustain investment in research places health 
outcomes and the scientific leadership and economic growth of the 
country at risk.
               the nci: the need for a renewed commitment
    Over the last 30 years the cancer death rate has fallen 31 percent. 
This includes a 2.4 percent decline from 2017 to 2018--a record for the 
largest 1-year drop in the cancer death rate. However, even during a 
global pandemic, cancer remains the second most common cause of death 
in the United States. Almost 1.9 million new cancer cases will be 
diagnosed, and more than 609,000 people will die from cancer in 
2022.\3\
---------------------------------------------------------------------------
    \3\ American Cancer Society, Cancer Facts and Figures 2022; https:/
/www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-
statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-
figures.pdf.
---------------------------------------------------------------------------
    The NCI is the largest funder of cancer research in the world, with 
most of its funding directly supporting research at NCI and at cancer 
centers, hospitals, community clinics, and universities across the 
country. ASCO is grateful to Congress for the FY 2022 funding provided 
to the NCI. The increase is an important step towards increasing the 
amount of R01 grants the NCI is able to fund. Despite the FY 2022 
increase, however, the NCI's funding has not kept up with the growth of 
research grant applications as compared to other NIH Institutes or 
Centers. In 2021, the NCI was only able to fund 11 percent of viable 
applications, compared to 28 percent in 1997. Even after accounting for 
Cancer Moonshot funding, NCI's budget has not kept up with scientific 
opportunity. ASCO supports the NCI's 15 by 25 initiative, in which the 
Institute aims to fund 15 percent of grant applications by 2025. The 
NCI's Professional Bypass Budget, released in December 2021, indicated 
the Institute needs $7.766 billion in FY 2023 to stay on course to 
reach this goal.
    The Beau Biden Cancer Moonshot Initiative has provided a much 
needed, albeit temporary, predictable increase in funding for the NCI. 
In its 7 years, the Cancer Moonshot has initiated many new clinical 
trial networks and established an infrastructure to conduct cancer 
research and share resources on a massive scale. Funding for the 
Moonshot will expire after this fiscal year, however. To leverage the 
infrastructure created by the Cancer Moonshot requires sustained 
investments beyond FY 2023.
    President Biden has announced a reignited Moonshot, without 
requesting any additional funding for the NCI. In fact, the 
Administration's FY 2023 Budget included a cut to the NCI's budget. 
These cuts would jeopardize our Nation's existing biomedical research 
infrastructure and undercut ongoing efforts to advance scientific 
knowledge for the treatment of cancers, and other important basic and 
translational research. ASCO supports the President's reignited 
Moonshot goals ``to reduce the death rate from cancer by at least 50 
percent over the next 25 years, and improve the experience of people 
and their families living with and surviving cancer--and, by doing this 
and more, end cancer as we know it today.'' The toll COVID-19 will have 
on cancer incidences in the future is not yet known. It is clear 
already that the disruption of health services resulted in millions of 
people who missed or postponed screenings or follow-ups as well as 
patients already diagnosed who experienced treatment delays due to the 
pandemic. The consequences of this interruption in care will become 
evident in our cancer statistics in the years to come. The 
Administration's ambitious goals simply cannot be met without 
significant funding increases for NCI in anticipation of the end of the 
authorized Cancer Moonshot funding and the threat of a cancer incidence 
increase as a result of COVID-19.
                  bringing the research to the patient
    NIH-funded translational research and clinical trials have 
significantly improved the standard of care in many diseases. Clinical 
trials and translational research yield insight critical to the 
development of targeted therapies, which identify patients most likely 
to benefit from treatments and help patients who will not benefit avoid 
the cost and pain of treatment unlikely to help them. This is where 
science becomes practice-changing for patients in America.
    ASCO has developed the Targeted Agent and Profiling Utilization 
Registry (TAPUR(\TM\)) Study, which provides access to targeted 
therapies for patients aged 12 and older identified as candidates to 
benefit from those treatments because of a promising tumor biomarker 
target identified in their cancer. TAPUR evaluates use of these 
molecularly targeted anti-cancer drugs and collects data on clinical 
outcomes. As of May 2022, the TAPUR study has over 2,400 patients 
enrolled at 250 clinical sites in 28 States. Without Federal investment 
spurring the pipeline of new cancer treatments, studies such as TAPUR 
would not be possible.
    To maintain access to research for cancer patients, ASCO urges a 
substantial increase in funding for the National Clinical Trials 
Network (NCTN) and NCI Community Oncology Research Program (NCORP). 
These programs expand clinical research beyond the academic environment 
and allow access to clinical trials to a larger, more diverse patient 
population, by bringing trials to the community setting. Just last 
year, the NCI awarded 53 grants to researchers at 46 NCORP sites, 14 of 
which are designated as minority/underserved community sites, which 
have assembled more than 1,000 affiliates across the country to conduct 
research. The NCORP network now covers 44 States and the District of 
Columbia.\4\ An increase in NCI's budget would enable the Institute to 
maintain or increase the number of accruals to trials and cover the 
cost of conducting research.
---------------------------------------------------------------------------
    \4\ National Cancer Institute; https://ncorp.cancer.gov/about/.
---------------------------------------------------------------------------
                 harnessing data & reducing disparities
    A long-standing priority for ASCO is to ensure cancer treatments 
and care considers patient demographics and social determinants of 
health. While diverse, accessible clinical trials often offer the best 
clinical treatment option for cancer patients, trials are not always 
available, especially for smaller patient populations, such as 
pediatric or rare disease groups.
    As a compliment to inclusive trials, cancer providers and 
researchers also need accessible data to understand cancer at a broader 
level. The Centers for Disease Control and Prevention's (CDC) cancer 
programs play an indispensable role in the prevention, detection, and 
treatment of cancer. Approximately 50 percent of cancer deaths can be 
prevented and the substantial cost of the treatment of advanced disease 
could be reduced through the use of existing evidence-based prevention 
and early detection strategies supported by CDC's Division of Cancer 
Prevention and Control (DCPC).
    Unfortunately, Federal funding for DCPC has remained almost flat 
for many years. Between FY 2010 and FY 2022, DCPC funding increased by 
just $19.5 million, or 5.3 percent, from $370.3 million to $389.8 
million. Excluding funding for the WISEWOMAN heart disease program, 
which is housed within the DCPC, the FY10- FY22 increase is just $8 
million, or 2.9 percent. That's about $100 million less than if DCPC 
funding had merely kept up with inflation.
    To that end, ASCO joins the cancer community in requesting $462.6 
million for the DCPC, and $61.4 million for the CDC's Cancer Registries 
Program. Cancer registries are a critical tool for providers and 
researchers, providing cancer surveillance, identifying trends among 
different patient cohorts, illustrating the impact of early detection, 
and showing the impact of treatment advances on cancer outcomes. 
Registries allow providers to collect data in real time and improve 
cancer research, public health interventions and treatment protocols. 
While we work toward greater trial inclusion, registries help ensure we 
have data from underrepresented patient cohorts such as racial and 
ethnic minorities, women, children, and rural populations.
                 working towards cures: a new approach
    Modern cancer research delivers new treatments to patients faster 
than ever, thanks to continuing innovation in research and regulatory 
infrastructure. The continued investment Congress has made in cancer 
research helps make progress possible. ASCO is committed to partnering 
with Congress and the Administration to spur innovation and expediently 
get treatments to patients.
    As Congress and the Administration evaluate ways to improve our 
National biomedical research enterprise through such efforts as the 
creation of the Advanced Research Projects Agency-Health (ARPA-H), we 
urge lawmakers to leverage collaboration between the private market, 
biotech, health care companies, academic institutions, and government 
and regulatory agencies. Fostering public-private partnerships and 
standardization to accelerate discovery of clinically impactful 
products is vital to helping patients. Additionally, efforts to 
establish ARPA-H or otherwise reform the biomedical research enterprise 
and health innovation should ensure sustained and dedicated funding to 
achieve impactful translational research with demonstration of patient 
benefit. It should not impact the current or future resources of 
existing research enterprises.
    The new agency should be transparent about its selection criteria 
and decision-making process for its broad strategic goals and selection 
of individual research projects, including clear metrics to ensure the 
funds are being used to advance public health and meeting established 
deliverables. Furthermore, innovation should come from peer-reviewed 
science that provides evidence-based decision making for care, and the 
findings should be published in peer-reviewed publications. All 
patients should have access to clinical trials and the resulting 
treatments conducted with investment by the agency, insurance coverage 
and cost should not be a barrier to clinical trial participation and 
equitable care and the agency should implement strategies to encourage 
decentralization of trials and ensure diversity and equity in research.
    ASCO recognizes and appreciates the work of Congress and the 
Administration to establish ARPA-H and stands ready as a resource 
throughout its creation and growth. ASCO does not have a specific 
funding request for ARPA-H for FY 2023; we stand firmly by our 
principles that the agency's funding should not come at the expense of 
robust, predictable annual funding increases for the NIH, NCI, or other 
existing research agencies.
    ASCO again thanks the subcommittee for its continued support of 
cancer patients in the U.S. through funding for the NIH, NCI, and CDC. 
We look forward to working with all members of the subcommittee on an 
FY 2023 budget that continues to advance U.S. cancer research. Please 
contact Kristin Stuart at [email protected] with any questions.

    [This statement was submitted by Howard Burris, MD, FASCO, Chair of 
the Board, Association for Clinical Oncology.]
                                 ______
                                 
 Prepared Statement of the Association for Professionals in Infection 
                        Control and Epidemiology
    The Association for Professionals in Infection Control and 
Epidemiology (APIC) and the Society for Healthcare Epidemiology of 
America (SHEA) urge appropriators to prioritize investments in the 
following Federal programs:

------------------------------------------------------------------------
                                                       FY 2023  Funding
        LHHS  Programs                 Agency              Request
------------------------------------------------------------------------
   National Healthcare Safety                     CDC      $100 million
                       Network
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
        Antibiotic Resistance                     CDC      $397 million
          Solutions Initiative
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
 Advanced Molecular Detection                     CDC      $175 million
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
                             Center for ForecastinCDCnd     $50 million
            Outbreak Analytics
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Agency for Healthcare Research                AHRQ         $500 million
                   and Quality
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
         BARDA Broad Spectrum                 ASPR         $300 million
    Antimicrobials Program and
                              CARB-X Search
------------------------------------------------------------------------


    Although significant progress has been made to have fewer reported 
cases of COVID-19 in most States and hospitalizations decreasing, we 
must continue to take this pandemic seriously. Planning and investing 
for the next public health emergency must start today. While rapid 
advances were made in treatments and vaccines to combat the virus, 
severe gaps in healthcare were exposed and exploited by the virus. 
Further, during the pandemic, healthcare facilities saw significant 
increases in healthcare-associated infections (HAI) tracked by the 
National Healthcare Safety Network.\1\ Additionally, CDC highlighted 
reports of sporadic antibiotic resistant outbreaks in COVID-19 units 
and higher rates of hospital-onset infections.\2\ It is believed, 
nearly a decade worth of progress preventing these infections was lost 
during the pandemic.
---------------------------------------------------------------------------
    \1\ https://www.cdc.gov/hai/data/portal/covid-impact-hai.html.
    \2\ https://www.cdc.gov/drugresistance/covid19.html.
---------------------------------------------------------------------------
    As integral components of the Nation's public health 
infrastructure, these programs must be funded at levels demanded by the 
growing threat of existing and emerging infectious diseases. Moreover, 
these programs will be important to improve the quality of care 
delivered to Americans and crucial in preparing for the next public 
health emergency.
    We urge you to invest $100 million in the National Healthcare 
Safety Network (NHSN). As the CDC's domestic tracking and response 
system, NHSN equips healthcare facilities, public health departments, 
and Federal agencies with accurate and actionable data to identify 
emerging and persistent threats, such as COVID-19, HAIs, and antibiotic 
resistant infections (ARI), as well as to deploy targeted infection 
prevention interventions. NHSN is also the chosen platform for how 
hospitals and nursing homes submit their monthly healthcare personnel 
(HCP) COVID-19 vaccination data, to support CMS reporting requirements, 
as well as for Hospital Compare. NHSN has played a key role in the 
reduction in various HAIs over the 5 years prior to the pandemic (18 to 
42 percent).\3\ Within 2 months of the National emergency declaration 
for COVID-19,\4\ CDC swiftly adapted NHSN to track COVID-19 in nursing 
homes where outbreaks have been the most severe.\5\ CMS relies on NHSN 
data for public reporting and incentive payments for healthcare quality 
performance, with NSHN data contributing to at least $350 million in 
Federal savings.\6\ By leveraging electronic health records and 
commercial infection control surveillance systems, NHSN innovates our 
existing healthcare data infrastructure while bolstering our public 
health data infrastructure. The stagnation in Federal funding over the 
last 10 years cannot sustain the exponential expansion of NHSN from 300 
in 2005 to more than 37,000 participating healthcare facilities in 
2020--including hospitals, nursing homes, dialysis facilities, and 
ambulatory surgical centers (ASCs) across the country. An increased 
investment in NHSN would ensure CDC can provide adequate technical 
support to participants, modernize NHSN to produce faster data while 
reducing the administrative burden for healthcare facilities, and adapt 
NHSN to respond to the current and future pandemics. Through greater 
NHSN participation, CDC can leverage the data needed to establish 
reliable national benchmarks, allowing healthcare facilities to measure 
the progress of their HAI and ARI prevention efforts and ultimately 
optimize antibiotic prescribing practices and eliminate HAIs.
---------------------------------------------------------------------------
    \3\ https://www.cdc.gov/nhsn/pdfs/NHSN-FactSheet-
508.pdf?ACSTrackingID=USCDC_425-
DM47349&ACSTrackingLabel=Weekly%20Summary%3A%20COVID-19%20Healthcare%20
Quality%20and%20Worker%20Safety%20Information%20%E2%80%93%20February%201
%
2C%202021&deliveryName=USCDC_425-DM47349.
    \4\ https://www.federalregister.gov/documents/2020/03/18/2020-
05794/declaring-a-national-emergency-concerning-the-novel-coronavirus-
disease-covid-19-outbreak.
    \5\ https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/cms-covid19-req-
508.pdf
    \6\ https://www.cdc.gov/nhsn/pdfs/NHSN-FactSheet-
508.pdf?ACSTrackingID=USCDC_425-
DM47349&ACSTrackingLabel=Weekly%20Summary%3A%20COVID-19%20Healthcare%20
Quality%20and%20Worker%20Safety%20Information%20%E2%80%93%20February%201
%
2C%202021&deliveryName=USCDC_425-DM47349.
---------------------------------------------------------------------------
    We urge you to invest $397 million in the Antibiotic Resistance 
Solutions Initiative (ARSI). Even with the accelerated development of 
new antibiotics, therapeutics, and vaccines, the growing trend in 
antibiotic resistance underscores the urgency for the U.S. to increase 
its investments in ARSI. Antibiotic resistance undermines medical 
breakthroughs in life-savings drugs by quickly making new antibiotics 
obsolete and threatening the success of cutting-edge treatments for 
cancer, organ transplants, and other medical conditions that can be 
complicated by infections. In addition, during the pandemic an alarming 
number of Candida auris outbreaks emerged. This strain of yeast is 
highly resistant to antibiotics and can target long-term care 
settings.\7\ ARSI supports 50 State health departments, four large city 
health departments, and Puerto Rico to detect, respond, and contain 
antibiotic-resistant pathogens.\8\ CDC bridges the gap in local 
laboratory capabilities and data-driven responses to antibiotic-
resistant threats through ARSI's Antibiotic Resistance Lab Network, 
which equips the 55 States and localities with comprehensive lab 
capacity and facilitates coordination of activities through seven 
regional labs and the National Tuberculosis Molecular Surveillance 
Center.\9\ Prior to the pandemic, the aggressive strategies of ARSI 
have reduced deaths and hospitalizations from antibiotic resistance (18 
percent and 28 percent fewer since 2013, respectively).\10\ Boosting 
investments in ARSI would further strengthen the Nation's epidemiology, 
laboratory, and diagnostics capacity to combat emerging antibiotic 
resistance.
---------------------------------------------------------------------------
    \7\ https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2022/04/
20/mdhhs-announces-select-specialty-hospital.
    \8\ https://www.cdc.gov/drugresistance/solutions-initiative/ar-lab-
network.html.
    \9\ https://www.cdc.gov/drugresistance/pdf/cdc-ar-lab-network-
final-H.pdf.
    \10\ https://www.cdc.gov/drugresistance/pdf/threats-report/
Prevention-Works-More-Action-Needed-508.pdf.
---------------------------------------------------------------------------
    We urge you to invest $175 million in the Advanced Molecular 
Detection (AMD) Initiative. AMD supports the integration of genomic 
sequencing with bioinformatic and epidemiology to detect diseases 
faster, identify and respond to outbreaks sooner, and protect people 
from emerging and evolving disease threats. Through partnerships with 
State and local health departments, public health laboratories, and 
academic institutions, AMD increases access to the specialized 
technologies and expertise necessary to empower public health 
professionals at the frontlines to take action before disease-causing 
pathogens become more widespread. As the Nation responded to the to the 
COVID-19 pandemic, AMD was crucial to robustly tracking and combatting 
emerging variants of COVID-19 in real-time. An increased investment in 
AMD will better position the U.S. to respond more strategically and 
effectively to endemic COVID-19 and future pandemics.
    We urge you to invest $50 million in the CDC's new Center for 
Forecasting and Outbreak Analytics. The Center for Forecasting and 
Outbreak Analytics (CFA) is a new center established under the American 
Rescue Plan. The Center was created to improve the Nation's ability to 
prepare for and respond to infectious disease threats using data, 
modeling, and analytics. It will bring together next-generation public 
health data, disease experts, and public health emergency responders to 
meet the needs of policymakers. While a new program, CFA already had an 
impact during the COVID-19 pandemic by assembling models anticipating 
the omicron wave. Continuously investing in these types of innovative 
programs will allow policymakers to make better data-driven and timely 
decisions during the current and future public health emergencies.
    We urge you to invest $500 million for the Agency for Healthcare 
Research and Quality (AHRQ). As the lead agency for health services 
research and primary care research, AHRQ provide policymakers, health 
system leaders medical providers, and patients with evidence-based 
policies and practices to improve health care quality, safe, and value. 
AHRQ also funds research at academic medical centers and other research 
institutions, generating new knowledge and enhancing the effectiveness 
of interventions to promote patient safety, prevent HAIs, and improve 
patient outcomes. Greater investments in the evaluation of our 
healthcare delivery system are critical to closing the gaps in 
healthcare quality, spending, and outcomes.
    We urge you to invest $300 million for Broad Spectrum 
Antimicrobials and Combating Antibiotic-Resistant Bacteria 
Biopharmaceutical Accelerator (CARB-X) at the Biomedical Advanced 
Research and Development Authority (BARDA). Novel broad-spectrum 
antimicrobials are vital to ensure timely, appropriate treatment of 
infections, especially as antibiotics are becoming increasingly 
ineffective due to drug resistance. The BARDA Broad Spectrum 
Antimicrobials Program and CARB-X, programs within the office of the 
Assistant Secretary for Preparedness and Response (ASPR), have 
successfully supported the development of new FDA-approved antibiotics. 
An investment in these programs will sustain the Nation's pipeline of 
robust medical countermeasures to antimicrobial resistance.
    The ongoing COVID-19 pandemic has highlighted the importance of 
sustained investments in the Nation's infrastructure to protect combat 
emerging infectious disease threats. With the growing prevalence in AR, 
the challenges we face today will worsen without new investments. 
Preventing infections, improving antibiotic use, detecting threats, and 
implementing interventions are essential to ensuring public health. The 
societies thank you for this opportunity to submit testimony on behalf 
of clinicians and researchers who champion infection prevention and 
antibiotic resistance.
                                 ______
                                 
 Prepared Statement of the Association for Professionals in Infection 
Control and Epidemiology and the Society for Healthcare Epidemiology of 
                                America
    The Association for Professionals in Infection Control and 
Epidemiology (APIC) and the Society for Healthcare Epidemiology of 
America (SHEA) urge appropriators to prioritize investments in the 
following Federal programs:

------------------------------------------------------------------------
                                                        FY 2023 Funding
            LHHS Programs                  Agency           Request
------------------------------------------------------------------------
 National Healthcare Safety Network                CDC     $100 million
    Antibiotic Resistance Solutions                CDC     $397 million
                          Initiative
       Advanced Molecular Detection                CDC     $175 million
                                   Center for ForecCDCing an$50 million
                           Analytics
 Agency for Healthcare Research and            AHRQ        $500 million
                             Quality
BARDA Broad Spectrum Antimicrobials            ASPR        $300 million
                        Program and CARB-X Search
------------------------------------------------------------------------

    Although significant progress has been made to have fewer reported 
cases of COVID-19 in most States and hospitalizations decreasing, we 
must continue to take this pandemic seriously. Planning and investing 
for the next public health emergency must start today. While rapid 
advances were made in treatments and vaccines to combat the virus, 
severe gaps in healthcare were exposed and exploited by the virus. 
Further, during the pandemic, healthcare facilities saw significant 
increases in healthcare-associated infections (HAI) tracked by the 
National Healthcare Safety Network.\1\ Additionally, CDC highlighted 
reports of sporadic antibiotic resistant outbreaks in COVID-19 units 
and higher rates of hospital-onset infections.\2\ It is believed, 
nearly a decade worth of progress preventing these infections was lost 
during the pandemic.
---------------------------------------------------------------------------
    \1\ https://www.cdc.gov/hai/data/portal/covid-impact-hai.html.
    \2\ https://www.cdc.gov/drugresistance/covid19.html.
---------------------------------------------------------------------------
    As integral components of the Nation's public health 
infrastructure, these programs must be funded at levels demanded by the 
growing threat of existing and emerging infectious diseases. Moreover, 
these programs will be important to improve the quality of care 
delivered to Americans and crucial in preparing for the next public 
health emergency.
    We urge you to invest $100 million in the National Healthcare 
Safety Network (NHSN). As the CDC's domestic tracking and response 
system, NHSN equips healthcare facilities, public health departments, 
and Federal agencies with accurate and actionable data to identify 
emerging and persistent threats, such as COVID-19, HAIs, and antibiotic 
resistant infections (ARI), as well as to deploy targeted infection 
prevention interventions. NHSN is also the chosen platform for how 
hospitals and nursing homes submit their monthly healthcare personnel 
(HCP) COVID-19 vaccination data, to support CMS reporting requirements, 
as well as for Hospital Compare. NHSN has played a key role in the 
reduction in various HAIs over the 5 years prior to the pandemic (18 to 
42 percent).\3\ Within 2 months of the National emergency declaration 
for COVID-19,\4\ CDC swiftly adapted NHSN to track COVID-19 in nursing 
homes where outbreaks have been the most severe.\5\ CMS relies on NHSN 
data for public reporting and incentive payments for healthcare quality 
performance, with NSHN data contributing to at least $350 million in 
Federal savings.\6\ By leveraging electronic health records and 
commercial infection control surveillance systems, NHSN innovates our 
existing healthcare data infrastructure while bolstering our public 
health data infrastructure. The stagnation in Federal funding over the 
last 10 years cannot sustain the exponential expansion of NHSN from 300 
in 2005 to more than 37,000 participating healthcare facilities in 
2020--including hospitals, nursing homes, dialysis facilities, and 
ambulatory surgical centers (ASCs) across the country. An increased 
investment in NHSN would ensure CDC can provide adequate technical 
support to participants, modernize NHSN to produce faster data while 
reducing the administrative burden for healthcare facilities, and adapt 
NHSN to respond to the current and future pandemics. Through greater 
NHSN participation, CDC can leverage the data needed to establish 
reliable national benchmarks, allowing healthcare facilities to measure 
the progress of their HAI and ARI prevention efforts and ultimately 
optimize antibiotic prescribing practices and eliminate HAIs.
---------------------------------------------------------------------------
    \3\ https://www.cdc.gov/nhsn/pdfs/NHSN-FactSheet-
508.pdf?ACSTrackingID=USCDC_425-
DM47349&ACSTrackingLabel=Weekly%20Summary%3A%20COVID-19%20Healthcare%20
Quality%20and%20Worker%20Safety%20Information%20%E2%80%93%20February%201
%2C%
202021&deliveryName=USCDC_425-DM47349.
    \4\ https://www.federalregister.gov/documents/2020/03/18/2020-
05794/declaring-a-national-emergency-concerning-the-novel-coronavirus-
disease-covid-19-outbreak.
    \5\ https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/cms-covid19-req-
508.pdf.
    \6\ https://www.cdc.gov/nhsn/pdfs/NHSN-FactSheet-
508.pd1f?ACSTrackingID=USCDC_425-
DM47349&ACSTrackingLabel=Weekly%20Summary%3A%20COVID-19%20Healthcare%20
Quality%20and%20Worker%20Safety%20Information%20%E2%80%93%20February%201
%2C%
202021&deliveryName=USCDC_425-DM47349.
---------------------------------------------------------------------------
    We urge you to invest $397 million in the Antibiotic Resistance 
Solutions Initiative (ARSI). Even with the accelerated development of 
new antibiotics, therapeutics, and vaccines, the growing trend in 
antibiotic resistance underscores the urgency for the U.S. to increase 
its investments in ARSI. Antibiotic resistance undermines medical 
breakthroughs in life-savings drugs by quickly making new antibiotics 
obsolete and threatening the success of cutting-edge treatments for 
cancer, organ transplants, and other medical conditions that can be 
complicated by infections. In addition, during the pandemic an alarming 
number of Candida auris outbreaks emerged. This strain of yeast is 
highly resistant to antibiotics and can target long-term care 
settings.\7\ ARSI supports 50 State health departments, four large city 
health departments, and Puerto Rico to detect, respond, and contain 
antibiotic-resistant pathogens.\8\ CDC bridges the gap in local 
laboratory capabilities and data-driven responses to antibiotic-
resistant threats through ARSI's Antibiotic Resistance Lab Network, 
which equips the 55 States and localities with comprehensive lab 
capacity and facilitates coordination of activities through seven 
regional labs and the National Tuberculosis Molecular Surveillance 
Center.\9\ Prior to the pandemic, the aggressive strategies of ARSI 
have reduced deaths and hospitalizations from antibiotic resistance (18 
percent and 28 percent fewer since 2013, respectively).\10\ Boosting 
investments in ARSI would further strengthen the Nation's epidemiology, 
laboratory, and diagnostics capacity to combat emerging antibiotic 
resistance.
---------------------------------------------------------------------------
    \7\ https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2022/04/
20/mdhhs-announces-select-specialty-hospital.
    \8\ https://www.cdc.gov/drugresistance/solutions-initiative/ar-lab-
network.html.
    \9\ https://www.cdc.gov/drugresistance/pdf/cdc-ar-lab-network-
final-H.pdf.
    \10\ https://www.cdc.gov/drugresistance/pdf/threats-report/
Prevention-Works-More-Action-Needed-508.pdf.
---------------------------------------------------------------------------
    We urge you to invest $175 million in the Advanced Molecular 
Detection (AMD) Initiative. AMD supports the integration of genomic 
sequencing with bioinformatic and epidemiology to detect diseases 
faster, identify and respond to outbreaks sooner, and protect people 
from emerging and evolving disease threats. Through partnerships with 
State and local health departments, public health laboratories, and 
academic institutions, AMD increases access to the specialized 
technologies and expertise necessary to empower public health 
professionals at the frontlines to take action before disease-causing 
pathogens become more widespread. As the Nation responded to the to the 
COVID-19 pandemic, AMD was crucial to robustly tracking and combatting 
emerging variants of COVID-19 in real-time. An increased investment in 
AMD will better position the U.S. to respond more strategically and 
effectively to endemic COVID-19 and future pandemics.
    We urge you to invest $50 million in the CDC's new Center for 
Forecasting and Outbreak Analytics. The Center for Forecasting and 
Outbreak Analytics (CFA) is a new center established under the American 
Rescue Plan. The Center was created to improve the Nation's ability to 
prepare for and respond to infectious disease threats using data, 
modeling, and analytics. It will bring together next-generation public 
health data, disease experts, and public health emergency responders to 
meet the needs of policymakers. While a new program, CFA already had an 
impact during the COVID-19 pandemic by assembling models anticipating 
the omicron wave. Continuously investing in these types of innovative 
programs will allow policymakers to make better data-driven and timely 
decisions during the current and future public health emergencies.
    We urge you to invest $500 million for the Agency for Healthcare 
Research and Quality (AHRQ). As the lead agency for health services 
research and primary care research, AHRQ provide policymakers, health 
system leaders medical providers, and patients with evidence-based 
policies and practices to improve health care quality, safe, and value. 
AHRQ also funds research at academic medical centers and other research 
institutions, generating new knowledge and enhancing the effectiveness 
of interventions to promote patient safety, prevent HAIs, and improve 
patient outcomes. Greater investments in the evaluation of our 
healthcare delivery system are critical to closing the gaps in 
healthcare quality, spending, and outcomes.
    We urge you to invest $300 million for Broad Spectrum 
Antimicrobials and Combating Antibiotic-Resistant Bacteria 
Biopharmaceutical Accelerator (CARB-X) at the Biomedical Advanced 
Research and Development Authority (BARDA). Novel broad-spectrum 
antimicrobials are vital to ensure timely, appropriate treatment of 
infections, especially as antibiotics are becoming increasingly 
ineffective due to drug resistance. The BARDA Broad Spectrum 
Antimicrobials Program and CARB-X, programs within the office of the 
Assistant Secretary for Preparedness and Response (ASPR), have 
successfully supported the development of new FDA-approved antibiotics. 
An investment in these programs will sustain the Nation's pipeline of 
robust medical countermeasures to antimicrobial resistance.
    The ongoing COVID-19 pandemic has highlighted the importance of 
sustained investments in the Nation's infrastructure to protect combat 
emerging infectious disease threats. With the growing prevalence in AR, 
the challenges we face today will worsen without new investments. 
Preventing infections, improving antibiotic use, detecting threats, and 
implementing interventions are essential to ensuring public health. The 
societies thank you for this opportunity to submit testimony on behalf 
of clinicians and researchers who champion infection prevention and 
antibiotic resistance.
                                 ______
                                 
    Prepared Statement of the Association for Psychological Science
        aps recommendations for fiscal year 2023 appropriations
_______________________________________________________________________

  --The Association for Psychological Science (APS) supports a funding 
        level of at least $49 billion for the National Institutes of 
        Health (NIH) in fiscal year (FY) 2023. Robust funding for this 
        essential health-research agency is necessary to ensure that 
        the country has the critical scientific research findings 
        required to improve human health and well-being.
  --APS supports a funding level of at least $11 billion for the 
        Centers for Disease Control and Prevention (CDC) in FY 2023. As 
        COVID-19 becomes endemic and current and future disease-based 
        health threats loom, CDC must receive strong and reliable 
        funding to effectively carry out its programs.
  --The behavioral and social sciences are essential to improving human 
        health, which is why APS recommends Congress include report 
        language urging continued funding of no less than $38.9 million 
        for the NIH Office of Behavioral and Social Sciences Research, 
        which leads and coordinates behavioral and social sciences 
        research supported by NIH. Likewise, APS asks that Congress 
        fund and integrate behavioral science research at CDC as part 
        of its ongoing efforts to ameliorate the negative impacts of 
        social determinants of health.
_______________________________________________________________________
                statement of aps chief executive officer
    Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee, thank you for the opportunity to provide testimony as you 
consider funding priorities for FY 2023. I am Robert Gropp, Chief 
Executive Officer of APS. APS is a nonprofit scientific organization of 
25,000 scientists and students dedicated to advancing research 
psychology for the benefit of science and society. APS recognizes and 
appreciates the subcommittee's efforts to strengthen public health and 
health research.
 funding for the national institutes of health and its behavioral and 
                   social sciences research programs
    APS recommends a FY 2023 funding level of at least $49 billion for 
NIH. This level of support is also recommended by the Ad Hoc Group for 
Medical Research, a coalition of patient and voluntary health groups, 
medical and scientific societies, academic and research organizations, 
and industry that share a commitment to strengthening NIH. APS agrees 
with the hundreds of members of this coalition that NIH-funded research 
improves societal understanding of health science, prepares us to 
better combat health threats, and translates research into 
interventions and treatments that improve human health. In addition to 
funding priorities, APS is concerned about the following policy topic 
at NIH.
    Support for behavioral and social sciences research at NIH: The 
COVID-19 pandemic has provided us with many tragic examples of the ways 
in which behavioral and social factors are linked with individual and 
public health. APS members' research demonstrates that understanding 
these behavioral and social influences is as essential to preventing 
and responding to the pandemic-and other health issues-as is 
understanding their biochemical, physiological, and general medical 
underpinnings.
    Although all NIH institutes and centers support behavioral and 
social sciences research to some degree, NIH's Office of Behavioral and 
Social Sciences Research (OBSSR) plays a centrally important and unique 
role in coordinating these efforts across NIH, as well as leading 
important projects such as, most recently, accelerating COVID-19 
related testing, therapeutics, and vaccine research; understanding the 
psychosocial outcomes of the pandemic; and testing approaches for more 
effective health communication, especially as related to health equity. 
OBSSR has also played a leading role in understanding how to prevent 
injury and mortality caused by firearms and the violence related to 
them. Given the importance of strong support for OBSSR, in partnership 
with other organizations in the behavioral, brain, and population 
sciences, APS urges that the following report language be included in 
the FY 2023 Labor-HHS Report:

    Office of Behavioral and Social Sciences Research (OBSSR).--The 
        Committee commends OBSSR for effectively coordinating and 
        supporting essential basic, clinical, and translational 
        research in the behavioral, social, and population sciences to 
        advance the NIH mission. Recognizing the critical role of OBSSR 
        to integrate these sciences throughout the NIH research 
        enterprise via OBSSR's leadership and coordination, the 
        Committee encourages NIH to continue to support OBSSR at no 
        less than the FY 2022 funding level including a proportionate 
        increase in its FY 2023 budget as provided to the NIH by the 
        Committee. The Committee urges NIH to provide an update on 
        OBSSR's activities and progress in the fiscal year 2024 
        congressional justification.
funding for the centers for disease control and prevention, and policy 
                                 issues
    In support of the CDC Coalition, comprising organizations committed 
to strengthening the country's public health infrastructure and 
prevention programs, APS recommends a FY 2023 funding level of at least 
$11 billion for CDC programs in the Labor-HHS bill. The CDC is central 
to protecting the U.S. from the COVID-19 pandemic but also combatting 
chronic diseases; resolving the opioid, tobacco, e-cigarette, and 
obesity epidemics; and advancing other public health and prevention 
programs. Again, psychological science provides the understanding of 
human behavior that so often is the cause for these public health 
problems. Psychological science research also offers insights about how 
to support behavior changes that are the key to interventions that can 
contribute to improved behaviors and public health.
    APS further encourages your consideration of the following issue.
    Support for research on social determinants of health at CDC: APS 
is encouraged that Congress has made important investments in 
addressing social determinants of health (SDOH), which are defined by 
the Department of Health and Human Services as the conditions in the 
environments where people are born, live, learn, work, play, worship, 
and age that affect health, functioning, and quality of life. APS 
supports ongoing investment in CDC's efforts to address SDOH and 
stresses that fundamental and applied research in psychological science 
and other fields is crucial for defining and understanding the factors 
that affect health and developing evidence-based methods for their 
remediation. In support of the basic and applied behavioral and social 
sciences that lead to opportunities to improve well-being for all, APS 
also urges that the following language be included in the FY 2023 
Labor-HHS Report:

    Behavioral Research and Social Determinants of Health.--The 
        Committee continues to support investments to better understand 
        the behavioral and social determinants of health and urges the 
        CDC to fund and integrate knowledge from behavioral science 
        research as a part of the effort to develop new evidence-based 
        interventions to ameliorate social determinants' potential 
        negative effects. The Committee believes that behavioral 
        science research focused on understanding the social 
        determinants of health can increase uptake of and adherence to 
        healthy behaviors that help prevent chronic conditions such as 
        cancer, heart diseases, and diabetes.
                         summary and conclusion
    The thread shared by these two requests is that knowledge gained 
from psychological science is essential to improving human health and 
well-being. To illustrate, I respectfully direct you to the APS Global 
Collaboration on COVID-19, which has brought together psychological 
scientists and other experts to make recommendations on how our field 
can be applied for these purposes. This collaboration has identified 
that psychological and other behavioral science could have been better 
applied throughout the COVID-19 crisis, that these fields remain poised 
to contribute to COVID-19 and future health threats, and that new 
research and research funding are urgently needed to best prepare our 
country for future crises. I would be pleased to share further 
information on this effort with any interested Members of the 
subcommittee at your convenience.
    Thank you for your ongoing commitment to supporting scientific 
research, education, and training that improve health and well-being 
and reduces disease in the United States and around the world. The one 
million deaths in the U.S as a result of the COVID-19 pandemic, among 
many other things, have been a heartbreaking reminder of the links 
between human behavior and health; strong support for the important 
Department of Health and Human Services programs referenced here will 
improve our chances of ensuring that such a crisis exacerbated by human 
behavior never occurs again.

    [This statement was submitted by Robert Gropp, Chief Executive 
Officer, 
Association for Psychological Science.]
                                 ______
                                 
  Prepared Statement of the Association of American Cancer Institutes
    The Association of American Cancer Institutes (AACI), representing 
104 premier academic and freestanding cancer centers across the United 
States and Canada, appreciates the opportunity to submit this statement 
for consideration by the subcommittee. AACI submits this request for 
the Department of Health and Human Services budget for the National 
Institutes of Health (NIH) as the subcommittee considers Fiscal Year 
(FY) 2023 funding. AACI requests a $4.1 billion increase for the NIH 
for FY 2023, bringing the recommended funding level for the NIH to $49 
billion. This proposed level of NIH funding would ensure that academic 
cancer centers can continue to discover and deliver potentially 
lifesaving new therapies for patients with cancer. AACI also requests 
at least $7.766 billion in FY 2023 for the National Cancer Institute 
(NCI).
    As Congress moves into the FY 2023 budget planning process, we 
wanted to share our priorities related to the budget.
                          aaci cancer centers
    AACI cancer centers are beacons of discovery, largely funded by the 
NIH and NCI. In order to ensure continued progress, these agencies rely 
on stable, predictable Federal funding to invest in groundbreaking 
cancer research.
    Cancer centers develop and deliver state-of-the-art therapies and 
provide comprehensive care to patients--from prevention to 
survivorship. These centers are at the forefront of the National effort 
to eradicate cancer, yet progress in cancer research is complex. The 
pace of discovery and translation of novel basic research to new 
therapies can be accelerated by an appropriate and predictable 
investment in Federal cancer funding.
                                payline
    Uncertainty surrounding research project grants (R01s) and a 
decline in cancer center resources often drives promising scientists to 
explore opportunities abroad or outside of the biomedical research 
community. For most academic cancer centers, the majority of NCI grant 
funds are used to sustain shared core resources that are essential to 
basic, translational, clinical, and population research, or to provide 
matching dollars that allow departments to recruit new cancer 
researchers to a university and support them until they receive their 
first grants. It is imperative that we enable America's scientists to 
master their craft.
    We noted in FY 2020 that R01 grants for established and new 
investigators were being funded to the 10th percentile, up from the 8th 
percentile in FY 2019. In FY 2021, the grants were funded to the 11th 
percentile,\1\ a slight increase. However, in FY 2022, R01 grants 
flatlined at the 11th percentile for another year.\2\ We request that 
Congress build on past by making a strong investment in the NCI in FY 
2023. Steady increases from the FY 2022 11th percentile rate are 
essential to achieving the goal set by former NCI Director Dr. Ned 
Sharpless, to reach the 15th percentile by FY 2025. To continue in this 
direction, we are hopeful that Congress will adopt the NCI Director's 
Professional Judgment Budget Proposal of $7.766 billion for FY 2023.
---------------------------------------------------------------------------
    \1\ https://www.cancer.gov/grants-training/nci-bottom-line-blog/
2021/funding-from-congress-allows-nci-to-raise-grants-payline.
    \2\ https://www.cancer.gov/grants-training/nci-bottom-line-blog/
2022/budget-increase-funds-a-growing-nci-grants-portfolio.
---------------------------------------------------------------------------
                               conclusion
    Now is the time for Congress to invest in biomedical research in 
general--and cancer research in particular. According to the American 
Cancer Society, there will be an estimated 1.9 million new cancer cases 
diagnosed in the United States in 2022.\3\ Fortunately, improvements in 
early detection, cancer staging, and surgical techniques, as well as 
the development of innovative therapies, have contributed to better 
outcomes for patients with cancer. We join our colleagues in the 
biomedical research community in recommending that the subcommittee 
recognize the NIH as a national priority by enacting a final FY 2023 
spending package that includes $49 billion for the NIH and $7.766 
billion for the NCI.
---------------------------------------------------------------------------
    \3\ https://www.cancer.org/content/dam/cancer-org/research/cancer-
facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-
facts-and-figures.pdf.
---------------------------------------------------------------------------
    A robust Federal investment in NCI-Designated Cancer Centers and 
academic cancer centers will allow the cancer research community to 
continue accelerating progress against cancer. We must continue to 
build on this momentum or else we stand to lose an entire generation of 
potentially lifesaving research.

    [This statement was submitted by Jennifer W. Pegher, Executive 
Director, 
Association of American Cancer Institutes.]
                                 ______
                                 
   Prepared Statement of the Association of American Medical Colleges
    The AAMC (Association of American Medical Colleges) is a nonprofit 
association dedicated to improving the health of people everywhere 
through medical education, health care, medical research, and community 
collaborations. Its members comprise all 155 accredited U.S. and 16 
accredited Canadian medical schools; approximately 400 teaching 
hospitals and health systems, including Department of Veterans Affairs 
medical centers; and more than 70 academic societies. Through these 
institutions and organizations, the AAMC leads and serves America's 
medical schools and teaching hospitals and the millions of individuals 
employed across academic medicine, including more than 191,000 full-
time faculty members, 95,000 medical students, 149,000 resident 
physicians, and 60,000 graduate students and postdoctoral researchers 
in the biomedical sciences. In 2022, the Association of Academic Health 
Centers and the Association of Academic Health Centers International 
merged into the AAMC, broadening the AAMC's U.S. membership and 
expanding its reach to international academic health centers.
    The COVID-19 pandemic is only one illustration of how sustained 
support for the research, education, and patient care missions of 
medical schools and teaching hospitals, with a strong commitment to 
community collaborations, is essential to ensure a resilient health 
care infrastructure prepared to respond to both novel and existing 
threats. For FY 2023, the AAMC recommends the following for Federal 
priorities essential in assisting medical schools and teaching 
hospitals to fulfill their missions that benefit patients, communities 
and the Nation: at least $49.048 billion for the National Institutes of 
Health (NIH), in addition to any funding for the Advanced Research 
Projects Agency for Health (ARPA-H); $500 million for the Agency for 
Healthcare Research and Quality (AHRQ); $1.51 billion for the Health 
Resources and Services Administration (HRSA) Title VII health 
professions and Title VIII nursing workforce development programs, and 
$718.8 million for the Children's Hospitals Graduate Medical Education 
(CHGME) program; and at least $11 billion for the Centers for Disease 
Control and Prevention (CDC).
    The AAMC appreciates the subcommittee's longstanding, bipartisan 
efforts to strengthen these programs. To enable the necessary support 
for the broad range of critical Federal priorities, the AAMC urges 
Congress to approve a funding allocation for the Labor-HHS subcommittee 
that enables full investment in the priorities outlined below. To this 
end, the AAMC joined nearly 400 organizations representing the 
diversity of Labor-HHS stakeholders in a May 10 letter reiterating the 
need for a robust funding allocation for the Labor-HHS-Education 
subcommittee. The AAMC also supports the president's proposal to 
supplement the annual HHS investments with mandatory funding to support 
ongoing pandemic preparedness.
    National Institutes of Health. Congress's longstanding bipartisan 
support for medical research has contributed greatly to improving the 
health and well-being of all, highlighted, for example, by the central 
role medical research has played in combatting COVID-19. As illustrated 
over the last 2 years, the foundation of scientific knowledge built 
through NIH-funded research drives medical innovation that improves 
health through new and better diagnostics, improved prevention 
strategies, and more effective treatments. Over half of the life-saving 
research supported by the NIH takes place at medical schools and 
teaching hospitals, where scientists, clinicians, fellows, residents, 
medical students, and trainees work together to improve the lives of 
Americans through research. This partnership is a unique and highly 
productive relationship that lays the foundation for improved health 
and quality of life and strengthens the Nation's long-term economy.
    The AAMC thanks Congress for a seventh straight year of bipartisan 
support that resulted in the inclusion of $45 billion for medical 
research conducted and supported by the NIH in the fiscal Year2022 
omnibus spending bill. Additionally, the AAMC thanks the subcommittee 
for recognizing the importance of retaining the salary cap at Executive 
Level II of the Federal pay scale in fiscal year 2022.
    In fiscal year 2023, the AAMC joins nearly 400 partners in 
supporting the Ad Hoc Group for Medical Research recommendation that 
Congress provide at least $49.048 billion in program level funding for 
the NIH, which would represent an increase of $4.1 billion over the 
comparable fiscal year 2022 funding level (an increase of $3.5 billion 
or 7.9 percent in the NIH appropriation plus funding from the 21st 
Century Cures Act for specific initiatives). Importantly, the Ad Hoc 
Group strongly urges lawmakers to ensure that any additional funding 
the subcommittee opts to provide for ARPA-H supplement our $49 billion 
recommendation for NIH's base budget, rather than supplant the 
essential foundational investment in the NIH. In addition, the 
coalition supports the president's proposal to supplement NIH's budget 
with additional mandatory funding to speed the pace of pandemic 
response and readiness.
    Securing a reliable, robust budget trajectory is key in positioning 
the agency--and the patients who rely on the research it funds--to 
capitalize on the full range of research in the biomedical, behavioral, 
social, and population-based sciences. We must continue to strengthen 
our Nation's research capacity, solidify our global leadership in 
medical research, ensure a research workforce that reflects the racial, 
gender, and geographic diversity of our citizenry, and inspire a 
passion for science in current and future generations of researchers.
    In addition to our strong support for a robust increase in NIH's 
base funding, we look forward to working with lawmakers and the 
administration to fulfill the goals of ARPA-H as it gets underway. The 
nation's medical schools and teaching hospitals are hubs of innovation 
in research and care delivery, and the AAMC looks forward to engaging 
with lawmakers and the administration on opportunities to advance a 
bold and productive medical research agenda in harnessing our shared 
commitment to innovation and scientific discovery.
    Agency for Healthcare Research and Quality. Complementing the 
medical research supported by NIH, AHRQ sponsors health services 
research designed to improve the quality of health care, decrease 
health care costs, and provide access to essential health care services 
by translating research into measurable improvements in the health care 
system. The AAMC joins the Friends of AHRQ in recommending at least 
$500 million in funding for AHRQ in FY 2023.
    Health Professions Funding. The Health Resources and Services 
Administration (HRSA) Title VII and Title VIII programs have helped the 
country combat COVID-19, despite the challenges the pandemic posed for 
grantees. Many grantees pivoted their curricula to educate our health 
workforce during this public health challenge. There were unexpected 
costs to provide personal protective equipment (PPE) for in-person 
clinical training or switching to a virtual learning experience.
    Simultaneously, the pandemic underscored the need to increase and 
continuously reshape our health workforce. These programs have proven 
successful in recruiting, training, and supporting public health 
practitioners, nurses, geriatricians, mental health providers, and 
other frontline health care workers critical to addressing COVID-19. 
Additionally, HRSA has tasked grantees with utilizing innovative models 
of care, such as training providers in telehealth, to improve patients' 
access to care during the pandemic.
    The COVID-19 pandemic pulled back the curtain on the pervasive 
health inequities facing disadvantaged and underserved communities, and 
gaps in care for our most vulnerable patients, including an aging 
population that requires more health care services. The HRSA Title VII 
and Title VIII programs educate current and future providers to serve 
these ever-growing needs, while preparing providers for the health care 
demands of tomorrow. A diverse health care workforce improves access to 
care, patient satisfaction, and health professionals' learning 
environments. Studies show that HRSA Title VII and Title VIII programs 
increase the number of underrepresented students enrolled in health 
professions schools, heighten awareness of factors contributing to 
health inequities, and attract health professionals who are more likely 
to treat underserved patients.
    Further, the HRSA health professions and nursing workforce programs 
are structured to advance new delivery systems and models of care, such 
as those promoting interprofessional teams and integrating mental 
health services with primary care. Whether developing a new curriculum 
to address emerging and ongoing public health crises, such as substance 
use disorders, or collaborating with community leaders in educating 
providers to deliver culturally competent care, the Title VII and Title 
VIII programs help ensure our health workforce is at the forefront of 
meeting all patients' health needs. The AAMC joins the Health 
Professions and Nursing Education Coalition (HPNEC) in recommending 
$1.51 billion for these critical workforce programs in fiscal year 
2023. Additionally, the AAMC supports the president's proposal for at 
least $50 million to fund the recently enacted Dr. Lorna Breen Health 
Care Provider Protection Act (Public Law 111-105). Funding from the 
American Rescue Plan allowed HRSA to support several programs to 
prevent burnout in the health care workforce and promote clinician 
well-being, but HRSA received far more high-quality applications than 
resources allowed the agency to support.
    In addition to Title VII and Title VIII, HRSA's Bureau of Health 
Workforce also supports $718.8 million in FY 2023 for the CHGME 
program, which provides critical Federal graduate medical education 
support for children's hospitals to train the future primary care and 
specialty care workforce for our Nation's children. We also encourage 
Congress to provide robust funding to HRSA's Rural Residency Programs 
to expand training opportunities in rural areas through funding to 
develop new rural residency programs or separately accredited rural 
training track programs.
    The AAMC encourages Congress to provide long-term sustained funding 
for the National Health Service Corps (NHSC) through its mandatory and 
discretionary mechanisms. We were appreciative of the $800 million in 
supplemental funding for the NHSC in the American Rescue Plan (H.R. 
117-2), and we support an appropriation for the NHSC that would fulfill 
the needs for current Health Professions Shortage Areas.
    Centers for Disease Control and Prevention. The AAMC joins the CDC 
Coalition in a recommendation of at least $11 billion for the CDC in FY 
2023. In addition to ensuring a strong public health infrastructure and 
protecting Americans from public health threats and emergencies, CDC 
programs are crucial to reducing health care costs and improving 
health.
    Within that total, the AAMC joins nearly 300 national, State, and 
local medical, public health, and research organizations in supporting 
the president's proposed $35 million to increase funding for firearm 
safety research supported by CDC. The AAMC also supports the 
administration's proposal to double firearm morbidity and mortality 
prevention research funding at NIH to $25 million in FY 2023 and to 
provide $250 million to CDC for a new community violence intervention 
initiative.
    Also within the CDC total, the AAMC supports increased or new 
funding for:
  --Data Modernization Initiative (DMI): $250 million
  --Center for Forecasting and Outbreak Analysis (CFA): $50 million
  --Climate and Health Program: $110 million
  --Advanced Molecular Detection (AMD) program: $175 million
    Additional Programs. The AAMC also supports at least $474 million 
for the Hospital Preparedness Program within the Office of the 
Assistant Secretary for Preparedness and Response (ASPR), in addition 
to $40 million to continue the regional preparedness programs created 
to address emerging and other special pathogens, including funding for 
regional treatment centers, frontline providers, and the National 
Emerging Pathogen Training and Education Center (NETEC).
    Once again, the AAMC appreciates the opportunity to submit this 
statement for the record and looks forward to working with the 
subcommittee as it prepares its fiscal year 2023 spending bill.
                                 ______
                                 
    Prepared Statement of the Association of Farmworker Opportunity 
                                Programs
    Chair Murray and Ranking Minority Member Blunt:
    Thank you for the opportunity to present to you and your 
subcommittee the testimony of the Association of Farmworker Opportunity 
Programs (AFOP) in support of the Nation's 57-year commitment to 
providing eligible agricultural workers the opportunity to achieve the 
American Dream for themselves and their families. As you begin work on 
your fiscal year 2023 Labor-Health and Human Services-Education 
appropriations bill, AFOP encourages you to build on the foundations 
laid by the highly successful programs described below by adequately 
funding them in the coming fiscal year: National Farmworker Jobs 
Program (NFJP), United States Department of Labor (DOL) Employment and 
Training Administration ($109,000,000); and Susan Harwood Training 
Grants, DOL Occupational Safety and Health Administration 
($13,787,000). Not only do these programs maximize the Federal 
Government's investment in them, but they also generate for employers 
the qualified and healthy workers essential to their growth. These 
programs also dramatically change peoples' lives for the better, often 
in rural areas, allowing them to enjoy economic success and participate 
more fully in our great nation. Thank you for supporting these very 
effective programs and the excellent results they bring for society's 
most vulnerable. National Farmworker Jobs Program
    NFJP is the bedrock of the Nation's commitment to helping 
agricultural workers upgrade their skills in and outside agriculture, 
providing employers with what they increasingly say they need: 
hardworking, well-trained, skilled workers. Administered by DOL, NFJP 
provides funding through a competitive grant process to 54 community-
based organizations and public agencies nationwide that assist workers 
and their families to attain greater economic stability. One of DOL's 
most successful employment training programs, NFJP helps agricultural 
workers acquire the new skills they need to start careers that offer 
higher wages and a more stable employment outlook. In addition to 
employment and training services, the program provides supportive 
services that help farmworkers retain and stabilize their current 
agriculture jobs, as well as enable them to participate in up-training 
and enter new careers. NFJP housing assistance helps meet a critical 
need for available quality agricultural worker housing and supports 
better economic outcomes for workers and their families. NFJP also 
facilitates the coordination of services through the American Job 
Center network for agricultural workers so they may access other 
services of the public workforce system.
    The agricultural workers who come to NFJP seek training to secure 
and excel in the in-demand jobs employers say they find challenging to 
fill. In doing so, the workers establish the financial foundation that 
allows them and their families to escape the chronic unemployment and 
underemployment they face each year. Many NFJP participants enter 
construction, welding, healthcare, and commercial truck-driving. Others 
train for the solar/wind energy sector, culinary arts, and for 
positions such as machinists, electrical linemen, and a variety of 
careers in and outside of agriculture. To be eligible for NFJP, workers 
must be low-income, depend primarily on agricultural employment, and 
provide proof of American citizenship or work authorization. 
Additionally, male applicants must have registered with the Selective 
Service.
    Agricultural workers are some of the hardest working individuals in 
this country, enduring tremendous physical and financial hardships in 
providing the produce Americans eat every day. Yet, agricultural 
workers remain among the Nation's most vulnerable employees and job 
seekers, facing significant barriers to work advancement, including:
  --The average agricultural worker family of four earns just $20,000 
        per year, well below the National poverty line.
  --English-language fluency is a substantial challenge for many.
  --More than half the children of migratory agricultural workers drop 
        out of school, and, among all agricultural workers, the median 
        highest grade completed is 9th grade (National Agricultural 
        Workers Survey).
  --Due to poverty and their rural locations, most agricultural workers 
        have extremely limited access to transportation.
    Despite these barriers, NFJP continues to be one of the most 
successful Federal job training programs, exceeding each of DOL's 
performance goals. In 2020 alone, NFJP service organizations provided 
more than 20,000 agricultural workers with services, according to DOL. 
Extrapolating, these NFJP providers have served over 200,000 
agricultural workers and their family members over the last 10 years. 
Funding program this year at $109,000,000_the level set in the House 
Education and Labor Committee-approved WOIA reauthorization bill (H. R. 
7309)--would allow NFJP to train an even greater number of dependable, 
capable workers to take on the Nation's most challenging jobs. Also, 
consistent appropriations for youth agricultural workers (ages 14- to 
24-years) will allow this cohort, so often overlooked and ignored by 
anti-poverty programs, to stay in school, and, if not in school, to 
avail themselves of crucial training to get a good job and establish 
themselves as productive and successful members of society.
                  agricultural worker health & safety
    AFOP also supports appropriations for OSHA's Susan Harwood grant 
program, through which AFOP has augmented pesticide safety training 
with curricula to help workers recognize and avoid the dangers of heat 
stress so common in the fields. In supporting this funding, you can arm 
the Nation's agricultural workers with the knowledge they need to keep 
themselves safe on the job. The NFJP network of some 236 trainers in 35 
States trains agricultural workers on how to protect against pesticide 
poisoning. Trainers then follow up with agricultural workers to assess 
knowledge gained and retained, and changes in labor practice. Since 
1995, more than 620,000 agricultural workers have become certified as 
trained in safety precautions, and hundreds of thousands of family 
members, children, and community agencies have also received safety 
training. The network collaborates with universities, community 
organizations, local governments, and businesses to maximize its 
unparalleled access to agricultural workers and their families. By 
reaching agricultural workers with safety training, the network's 
trainers offer access to other services and create a ripple effect of 
positive impact_improving the quality of life for agricultural workers 
and their families_which is what NFJP organizations do best.
    Thank you for supporting these worthy programs. AFOP stands ready 
to assist you in any way as you proceed with your very important work.

    [This statement was submitted by Daniel J. Sheehan, Executive 
Director, 
Association of Farmworker Opportunity Programs.]
                                 ______
                                 
     Prepared Statement of the Association of Independent Research 
                               Institutes
    The Association of Independent Research Institutes (AIRI) thanks 
the subcommittee for its long-standing and bipartisan leadership in 
support of the National Institutes of Health (NIH). We continue to 
believe that science and innovation are essential if we are to improve 
our Nation's health, sustain our leadership in medical research, and 
remain competitive in today's global information and innovation-based 
economy. AIRI urges the subcommittee to provide NIH with at least $49 
billion in base funding in fiscal year (FY) 2023. AIRI also commends 
Congress for continuing to reject harmful policies such as reducing 
support for facilities and administrative (F&A) costs or investigator 
salary support on NIH grants. In addition, AIRI looks forward to 
working with the subcommittee and the Biden Administration to explore 
how the newly established Advanced Research Project Agency for Health 
(ARPA-H) can support high-risk, high-reward research to accelerate the 
pace of biomedical innovation. AIRI urges the subcommittee to ensure 
that any funding provided for ARPA-H supplements, and does not 
supplant, the NIH's base budget funding. The promise of ARPA-H rests on 
the foundational research that NIH supports through its base budget.
    AIRI is a national organization of more than 80 independent, non-
profit research institutes that perform basic and clinical research in 
the biological and behavioral sciences. AIRI institutes vary in size, 
with budgets ranging from a few million to hundreds of millions of 
dollars. In addition, each AIRI member institution is governed by its 
own independent Board of Directors, which allows our members to focus 
on discovery-based research while remaining structurally nimble and 
capable of adjusting their research programs to emerging areas of 
inquiry. Investigators at independent research institutes consistently 
exceed the success rates of the overall NIH grantee pool, and they 
receive nearly 10 percent of NIH's peer-reviewed, competitively awarded 
extramural grants.
    AIRI thanks the subcommittee for providing an increase of $2.03 
billion for NIH in the FY 2022 omnibus appropriations package. The 
subcommittee's support of NIH is strongly demonstrated by these much-
needed funds for life-saving biomedical research. However, there is 
still much more to do. NIH is tackling vast, interdisciplinary problems 
such as cancer, Alzheimer's Disease, emerging infectious diseases, and 
the opioid crisis, among others. In addition, NIH's instrumental role 
in developing new vaccines to combat the COVID-19 pandemic reminds us 
that now is not the time to pull back on needed investments in the 
Nation's biomedical research ecosystem. Continued budget certainty is 
needed for the agency to predictably fund new and ongoing grants and 
consider new initiatives necessary to improving human health and 
ensuring that we are prepared for the next public health crisis. To 
ensure cutting-edge research at independent research institutes is not 
disrupted, AIRI strongly supports a topline of $49 billion for NIH in 
FY 2023.
    AIRI looks forward to working with Congress and the Biden 
Administration to examine how the establishment of ARPA-H can push the 
research enterprise to take on high-risk, high-reward research efforts. 
If successful, ARPA-H has the potential to address grand challenges in 
public health that were previously thought to be impossible to solve. 
However, we still do not fully understand many of the basic mechanisms 
underlying diseases and public health challenges facing the Nation 
today, such as cancer, Alzheimer's, and addiction, among others. 
Funding for fundamental research is still crucial to address these 
issues, and AIRI urges the subcommittee to ensure that basic research 
discovery funded by the NIH can adequately inform the transformative, 
applied research that ARPA-H has the potential to carry out.
    Not only is NIH research essential to advancing health, it also 
plays a key economic role in communities nationwide. In FY 2021, NIH 
invested $35.73 billion, over 80 percent of its budget, in the 
biomedical research community. This investment supported more than 
552,444 jobs nationwide and generated nearly $94.18 billion in economic 
activity across the U.S.\1\ AIRI member institutes are particularly 
relevant in this regard, as they are located across the country, 
including in many smaller or less-populated States that do not have 
major academic research institutions. In many of these regions, 
independent research institutes are major employers and local economic 
engines, and they exemplify the positive impact of investing in 
research and science.
---------------------------------------------------------------------------
    \1\ NIH's funding information and economic impact data comes from 
United for Medical Research's 2022 Update on NIH's Role in Sustaining 
the U.S. Economy, https://unitedformedicalresearch.org/annual-economic-
report/.
---------------------------------------------------------------------------
    The NIH model for conducting biomedical research, which involves 
supporting scientists at independent research institutes, medical 
centers, and universities provides an effective approach to making 
fundamental discoveries in the laboratory that can be translated into 
medical advances that save lives. AIRI member institutions are private, 
stand-alone research centers that set their sights on the vast 
frontiers of medical science. However, AIRI member institutes are 
especially vulnerable to reductions in the NIH budget, as they do not 
have other reliable sources of revenue to make up the shortfall.
    AIRI member institutes' flexibility and research-only missions 
provide an environment particularly conducive to creativity and 
innovation. Independent research institutes possess a unique 
versatility and culture that encourages them to share expertise, 
information, and equipment across research institutions, as well as 
neighboring universities. These collaborative activities help minimize 
bureaucracy and increase efficiency, allowing for fruitful partnerships 
in a variety of disciplines and industries. Also, unlike institutes of 
higher education, AIRI member institutes focus primarily on scientific 
inquiry and discovery, allowing them to respond quickly to the research 
needs of the Nation.
    The U.S. has the most robust medical research enterprise in the 
world, but our leadership in biomedical research is being challenged by 
the investments being made in the research capacity of other nations, 
such as China. While the most recent funding increases to the NIH 
budget will greatly help sustain biomedical research in the U.S., it is 
important to continue providing stable funding to uphold our biomedical 
excellence.
    AIRI deeply thanks the subcommittee for its important work 
dedicated to ensuring the health of the Nation, and we appreciate this 
opportunity to urge the subcommittee to continue the success of NIH by 
providing $49 billion for the NIH's base budget in FY 2023 and 
reaffirming that any funding for ARPA-H supplements the base budget 
funding to strengthen our Nation's investment in life-saving medical 
research.
                                 ______
                                 
       Prepared Statement of the Association of Minority Health 
                          Professions Schools
              summary of fiscal year 2023 recommendations
_______________________________________________________________________
Health Resources and Services Administration:
  --$1.51 billion for the Health Resources and Services Administration 
        (HRSA) Title VII health professions and Title VIII nursing 
        workforce development programs.
    --$47.42 million for HRSA's Minority Centers of Excellence
    --$47.95 million for HRSA's Health Careers Opportunity Program.
    --$2 million for HRSA's Minority Faculty Loan Repayment Program.
    --$67 million for HRSA's Scholarships for Disadvantaged Students 
            (SDS).
    --$67 million for HRSA's Area Health Education Center (AHEC) 
            Program
Centers for Disease Control and Prevention
  --$74 million for the Racial and Ethnic Approaches to Community 
        Health (REACH) Program
National Institutes of Health
  --$49 billion for the National Institutes of Health
    --$1 billion for the National Institute on Minority Health and 
            Health Disparities (NIMHD).
  --$300 million for the Research Centers at Minority Institutions 
        (RCMI)
    --$200 million in new, annual research funding dedicated 
            specifically targeted at enabling historically black health 
            professions schools to support research that reverses 
            health status disparities among minority Americans.
    --$100 million for NIH's Extramural Research Facilities program
    --$50 million to reinvigorate the NIMHD's Research Endowment 
            Program (REP)
Office of the Secretary
  --$72 million for the Office of Minority Health at the Department of 
        Health and Human Services.
  --$5 billion in new funding designated for Historically Black Health 
        Professions Institutions for the improvement and development of 
        health care infrastructure.
Department of Education
  --$100 million for the Strengthening Historically Black Graduate 
        Institutions (HBGI) Program.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to submit testimony 
and thank you for your leadership in addressing challenges facing the 
health workforce, health disparities, and medically underserved 
communities. I am Dr. Kathleen Kennedy, Malcolm Ellington Professor of 
Health Disparities Research and Dean, College of Pharmacy Xavier 
University of Louisiana and the Chair of the Association of Minority 
Health Professions Schools (AMHPS), which was established in 1976 to 
promote a national minority health agenda by addressing the needs of 
the health workforce and improving health status in medically-
underserved communities. Speaking to you today against the backdrop of 
the continued COVID-19 pandemic with hope on the horizon, we have 
learned valuable lessons over the past 2 years, but we know that there 
is more work to be done. The pandemic has pulled back the curtain on 
what many of AMHPS institutions know and work towards everyday: the 
pitfalls and shortcomings of minority health. Given the recent deluge 
of media coverage surrounding this disheartening topic, the country is 
primed and ready to act in a meaningful way. Our funding 
recommendations are robust and we realize ambitious, however there have 
rightfully been discussion concerning the devastating effect of the 
pandemic on people of color and the need to address this effect for any 
future pandemic. To be as clear we can be, there must be more robust 
investment on minority health and disparities. To achieve this we know 
that it will require the steadfast leadership of health equity 
champions. We stand ready to work with you and your colleagues to 
facilitate these efforts.
    AMHPS is comprised of the 12 historically black medical, dental, 
pharmacy, and veterinary schools in the United States. The members are 
two schools of dentistry at Howard University and Meharry Medical 
College; four schools of medicine, at Charles R. Drew University, 
Howard University, Meharry Medical College, and Morehouse School of 
Medicine; five schools of pharmacy, at Florida A&M University, Howard 
University, Texas Southern University, Hampton University, and Xavier 
University; and one school of veterinary medicine, at Tuskegee 
University. Today, the association assists its member institutions in 
the expansion and enhancement of educational opportunities in the 
health professions for minorities and disadvantaged students and 
disadvantaged people. AMHPS continuously adheres to is founding call 
and honors its threefold mission to improve the health status of blacks 
and other minorities; improve the representation of blacks and other 
minorities in the health professions; strengthen our institutions and 
programs and to strengthen other programs throughout the Nation, which 
in turn will improve the role of minorities in the provision of health 
care.
    Health disparities across racial and ethnic groups in the U. S. 
have been well documented over the last several decades and have 
remained remarkably persistent in spite of the changes in many facets 
of the society over that period. Moreover, the benefits of increasing 
diversity in the health professions to reduce such disparities have 
been studied at length, are based on empirical data, and are well 
understood by the medical community. Examples of these benefits 
include:
  --Minority physicians are more likely to practice in medically 
        underserved areas and care for patients regardless of their 
        ability to pay.
  --Minority physicians are more likely to choose primary care 
        practices.
  --Evidence suggests that improving cross-cultural communication 
        between doctors and patients and providing patients with access 
        to a diverse group of doctors improve adherence, satisfaction 
        and health outcomes.
  --There is evidence that the intellectual, cultural sensitivity, 
        competency, and civic development of students is enhanced by 
        learning in a diverse educational environment.
  --A diverse health workforce encourages a greater number of 
        minorities to enroll in clinical trials designed to alleviate 
        health disparities.
    There is little left to discover or dispute with respect to the 
benefits of achieving greater racial and ethnic diversity of the 
Nation's health professionals--the attention has once again shifted to 
identifying the most effective and sustainable methods to do so. While 
there are many national campaigns underway to increase diversity in all 
medical and health professions schools particularly during this period 
of enrollment growth, it is imperative that we further recognize and 
leverage the public value of Historically Black Health Professions 
Schools.
    The daunting news that Blacks Americans in the U.S. are 
disproportionately suffering and dying from the novel coronavirus 
(COVID-19) unfortunately was not a tremendous surprise to those of us 
who regularly monitor and understand health status disparities in this 
nation. There are well-known health status challenges faced daily by 
Black Americans and minority health care providers, it also represents 
a surrogate for the glaring lack of health infrastructure in medically 
under-served communities. At AMHPS institutions, we have long been and 
remain committed to addressing these very same disparities in whatever 
way that we can, with an eye first and foremost towards the communities 
with the greatest need across our country.
    Ironically, as a result of their mission focus the financial models 
of historically black health professions schools are uniquely 
disadvantaged compared to most of their peer institutions. Unlike 
subspecialty-oriented, research-intensive institutions--with higher 
margin clinical services, an integrated hospital system, substantial 
research enterprises, sizeable endowments, and a critical mass of 
wealthy donors--these institutions are faced with an unprecedented set 
of adverse factors that challenge their financial viability. 
Consequently, they are disproportionately dependent on the various 
Federal programs that support their core purpose.
    Specifically, these programs include: the Title VII Health 
Professions Training Programs administered by the Health Resources and 
Services Administration (HRSA) of the Department of Health and Human 
Services (HHS); the Research Centers at Minority Institutions (RCMI), 
the Extramural Research Facilities; the Research Endowment; and Centers 
of Excellence programs administered the National Institutes of Health's 
National Institute on Minority Health and Health Disparities; and the 
Historically Black Graduate Institution (HBGI) program administered by 
the Office of Postsecondary Education of the U.S. Department of 
Education (DOE).
    President Biden recently signed the John Lewis NIMHD Research 
Endowment Revitalization Act to revitalize this important initiative, 
and it is our expectation that NIMHD will act swiftly to reinvigorate 
the research endowment program so minority-serving institutions can 
participate in this competitive opportunity to build their research 
endowments in a manner consistent with the statutory goal of assisting 
them in achieving a research endowment that is comparable to the 
endowments of other schools in their health professions discipline. The 
NIMHD Research Endowment Program (REP) allows academic institutions to 
build research infrastructure and recruit, train, and maintain a 
diverse faculty and student body. Robust funding would allow active and 
former NIMHD Centers of Excellence to continue their historic focus on 
research to close the gap between the burden of illness and premature 
mortality experienced more commonly by communities of color, as well as 
other medically underserved populations. It would also help improve 
access to grants to fund research projects, as well as hire staff and 
provide scholarships for students who come from underserved 
communities. To ensure successful implementation, we are asking for the 
Committee to allocate robust funding to NIMHD for this program.
    Madam Chair, unfortunately, over the past several years funding for 
diversity-focused programs has deteriorated in varying degrees. Absent 
a monumental overall investment the financial position and academic 
viability of historically black health professions schools will 
deteriorate rapidly. The front loaded investment in health professions 
training programs, graduate programs in biomedical sciences and public, 
and safety net providers is more cost effective than absorbing 
uncompensated care originating from minority and underserved 
communities. Now is the time for targeted investments in historically 
black health professions schools to ensure a steady pipeline of 
minority healthcare providers, biomedical scientists, and other health 
practitioners prepared to support and advance the delivery of high 
quality, culturally appropriate, evidence-based health care. Thank you 
all again for the opportunity to share the priorities of the 
Association of Minority Health Professions Schools.

    [This statement was submitted by Kathleen B. Kennedy, Pharm.D., 
Chair, 
Association of Minority Health Professions Schools, Inc.
                                 ______
                                 
Prepared Statement of the Association of Schools and Programs of Public 
                                 Health
    On behalf of the Association of Schools and Programs of Public 
Health (ASPPH), thank you for the opportunity to submit outside witness 
testimony concerning Fiscal Year (FY) 2023 appropriations for agencies 
and programs impacting the academic public health community. ASPPH is 
the leading voice of academic public health and we are focused on 
growing the high-quality public health workforce of the future. We 
represent 137 schools and programs of public health accredited by the 
Council on Education for Public Health (CEPH). Our membership includes 
over 10,800 faculty and over 72,000 students. ASPPH strives to 
strengthen the capacity of members by advancing leadership, excellence, 
and collaboration in public health education, research, and practice.
    We want to thank the subcommittee for its steadfast support of 
public health programs that span the fiscal Year23 Labor, Health and 
Human Services, Education and Related Agencies (Labor-HHS-ED) 
appropriations bill. In addition to the ongoing demands of our public 
health system, the current pandemic has challenged the public health 
community's response to protect the American people and global 
populations. Your subcommittee has continued to provide the critical 
financial resources to advance those efforts. With our Nation reaching 
the 1 million death toll due to COVID-19, we underscore strong 
investments in public health initiatives at a time we need it the most. 
This pandemic is far from over.
    As you draft the Labor-HHS-ED appropriations bill, please consider 
ASPPH's funding recommendations that support the mission of our 137 
academic institutions. These agencies and programs provide the 
essential resources to advance evidence-based approaches to public 
health threats and prepare future generations of public health 
practitioners. These investments will lead to tangible public health 
outcomes that will benefit the Nation and the world.
    Our FY 2023 funding recommendations for the leading HHS public 
health agencies are aligned with many other organizations in the public 
health community:
    National Institutes of Health (NIH): We are grateful for bipartisan 
support for continuous increases to the NIH budget and join several 
organizations in supporting $49.0 billion for ongoing work of 
Institutes and Centers, an increase of $4.1 billion or 9 percent above 
the fiscal Year2022 enacted level. Public health research is a critical 
component of the NIH's research portfolio. In addition, we support $1.0 
billion for the second-year appropriation of the Advanced Research 
Projects Agency for Health (ARPA-H), which is the same as the FY 2022 
appropriation that remains available into FY 2023. Within NIH, we 
support at least $110.0 million for NIH Fogarty International Center, 
an increase of $23 million or 26 percent above the FY 2022 enacted 
level. The investment in Fogarty is an investment in the health of all 
Americans by providing support for vital global research and training 
to both prevent newly emerging infectious agents from becoming domestic 
calamities and to help us reduce the rising rate of noncommunicable 
diseases and the health impact of chronic conditions around the world.
    Health Resources and Services Administration (HRSA): Programs 
within HRSA are essential to ensuring an adequately trained public 
health workforce. We support $9.8 billion, an increase of $1.2 billion 
or 14 percent above the FY 2022 enacted level. Specifically, within 
HRSA we request:
    HRSA Public Health Workforce Loan Repayment Program: $200 million 
for a new program that provides up to $150,000 in loan repayment in 
return for service in a State, local, Tribal or territorial health 
department. In 2010 Congress authorized this critical program, but it 
has not been funded at the necessary level to make an impact. 
Therefore, student loan debt is a major obstacle to students seeking 
careers in governmental public health due to low-paying, entry-level 
jobs that are available in health departments. Loan repayment will 
allow our Nation to strengthen the capacity of the public health 
workforce, at this critical moment, with the next generation of 
professionals who have the educational training in public health and 
related disciplines. This is a vital program will help public health 
graduates make significant contributions to advance the field of public 
health practice, particularly in preparation for the next public health 
crisis
    HRSA Public Health Training Centers: at least $15.0 million, an 
increase of $5.3 million or 55 percent above the fiscal Year2022 
enacted level. The Public Health Training Center Program is the 
Nation's only comprehensive training system to ensure workers in 
healthcare, behavioral health, public health and other fields have the 
skills needed to respond to increasingly complex public health 
challenges and protect the Nation's health.
    Centers for Disease Control and Prevention (CDC): As public health 
experts predict an increase in as many as 100 million COVID-19 cases in 
the coming months, we urge stronger investments in CDC to protect the 
health of our communities. Additionally, due to years of underfunding, 
many programs at the CDC have lacked necessary resources to address the 
various health challenges our Nation continuously grapples with. Robust 
support for the CDC budget is critical to enable proper tools for the 
agency to carry out its prevention mission and ensure translation of 
research on the community level. We support $11.0 billion, an increase 
of $2.6 billion or 31 percent above the FY 2022 enacted level. 
Specifically, within the CDC we support:
    CDC Center for Forecasting and Outbreak Analytics: $50 million to 
continue this new CDC center that was initially funded through the 
American Rescue Plan Act. The center supports the President's National 
Security Memorandum-1 which called for the establishment of a national 
capability that would support the U.S. Government and our partners with 
advanced analytics, disease modeling and outbreak analytics. The center 
will bring together next-generation public health data, expert disease 
modelers, public health emergency responders, and high-quality 
communications to meet the needs of decision makers. We strongly 
encourage the Committee to facilitate the center's continuous work with 
schools of public health and other academic institutions to engage the 
Nation's expertise in disease modelling, public health data analysis, 
research, and training to build workforce capacity in this emerging 
field.
    CDC Climate and Health: $110 million, an increase of $100 million 
above the FY 2022 enacted level. CDC's Climate and Health Program 
supports state, Tribal, local, and territorial public health agencies 
as they prepare for the health impacts of a changing climate. Academic 
public health institutions are engaged in essential research and 
training to establish and support a workforce of public health 
professionals with competencies to understand and address the impacts 
of climate change on public health. ASPPH has developed a climate 
framework that will enable all of our member institutions to make an 
impact on public health climate issues in collaboration with local, 
State and the Federal Government. We urge the Committee to include 
funding to support academic public health partners to expand research, 
strengthen public health workforce education and training, and foster 
practice-based partnerships to design and implement mitigation and 
adaption strategies related to climate change.
    CDC Prevention Research Centers: $37.0 million, an increase of 
$10.0 million or 37 percent above the FY 2022 enacted level. The PRCs 
are a national network of academic research centers committed to 
conducting prevention research. They are leaders in translating 
research results into policy and public health practice. PRCs work 
closely with community members to establish health priorities and 
develop applicable research projects that address local public health 
needs. These partners collaborate with health departments, educational 
boards, and the private sector to form long-term relationships that 
make PRCs the leaders in community based participatory research. In the 
past, for every $1 the PRCs received from CDC, they were able to 
generate an average of $4.85 in research funds from other sources. As a 
result, PRCs are able to conduct hundreds of public health research 
projects every year to address issues such as cancer, smoking, obesity, 
diabetes, cardiovascular and many other conditions.
    CDC Academic Preparedness Centers: $20 million, an increase $11.8 
million or 144 percent above the FY 2022 enacted level. ASPPH endorses 
supporting not fewer than 10 centers at institutions of higher 
education, including schools of public health, and other nonprofit 
private entities, to establish a network of academic preparedness 
centers. The centers will coordinate preparedness and response 
activities with governmental health departments, healthcare providers, 
and coalitions to translate research findings into evidence-informed 
and evidence-based practices, support training needs, and provide 
technical assistance and expertise. This framework of a national 
network of centers will strengthen the connection between academic 
public health and public health departments and health care systems to 
proactively address future public health threats. In previous years, 
annual appropriations for this program exceeded $30 million and 
supported 21 academic preparedness centers at schools of public health.
    CDC Injury Control Research Centers: $15.0 million, an increase of 
$6.0 million or 67 percent above the FY 2022 enacted level. The CDC's 
Injury Control Research Centers (ICRCs) are on the scientific front 
line conducting cutting-edge, multidisciplinary research on the causes, 
outcomes, and prevention of injuries and violence. The ICRC Program 
forms a national network of nine comprehensive academic research 
centers, including some within schools of public health, that focus on 
three core functions-research, outreach, and training. ICRC research 
focuses on issues of local and national importance, including opioids, 
firearm safety, sexual violence, suicide prevention, adverse childhood 
experiences, and traumatic brain injury.
    CDC NIOSH Education & Research Centers: $34.0 million, an increase 
of $3.0 million or 10 percent above the FY 2022 enacted level. These 
centers provide state-of-the-art interdisciplinary training for the 
next generation of occupational safety and health practitioners and 
researchers. To protect American workers, safety training must 
continually evolve to keep up with technological advances, 
globalization, new and emerging risks, and occupational health 
disparities associated with the changing demographics of the U.S. 
workforce.
    CDC NIOSH Agriculture, Forestry & Fishing Centers: $30.5 million, 
an increase of $3.0 million above the 2022 enacted level. The 
Agriculture, Forestry, and Fishing sector has approximately 2.3 million 
workers, who experience the highest fatal occupational injury rate at 
21.5 deaths per 100,000 full-time workers, almost twice the rate of the 
average workforce. These centers facilitate the most important research 
to develop the most effective intervention strategies, and translate 
those findings to achieve sustained safety improvements in workplace 
practice.
    Agency for Healthcare Research and Quality (AHRQ): AHRQ is the only 
Federal agency that funds research at universities and other research 
institutions specifically on health systems. This includes research 
that takes into account the ``real-life'' patient who has complex 
comorbidities, as well as intersections with other aspects of the 
health care system. We support $500 million for AHRQ, an increase of 
$150 million or 43 percent above the FY 2022 enacted level.
    Again, ASPPH appreciates the opportunity to submit this statement 
for the record and we stand ready to assist you and your staff with 
additional information and resources from across our institutions.

    [This statement was submitted by Timothy E. Leshan, Chief External 
Relations & Advocacy Officer, Association of Schools and Programs of 
Public Health.]
                                 ______
                                 
    Prepared Statement of the Association of Science and Technology 
Centers, the Association of Children's Museums, and the Association of 
                        Science Museum Directors
    Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee:
    Thank you for accepting this statement submitted by the Association 
of Science and Technology Centers (ASTC), the Association of Children's 
Museums (ACM), and the Association of Science Museum Directors (ASMD). 
We are the membership organizations for science and technology centers 
and museums, for children's museums, and for science and natural 
history museum leaders. Our networks of several hundred institutions in 
all 50 States and in nearly 50 countries around the world traditionally 
engage almost 100 million people annually in the United States. Our 
members and their institutions and are increasingly serving as 
community hubs for increased understanding of--and engagement with--
science and technology among all people and for serving the needs and 
interests of children by providing exhibits and programs that stimulate 
curiosity and motivate learning.
    Our place-based organizations are leading institutions in the 
efforts to promote education in science, technology, engineering, and 
mathematics (STEM), developing rich, innovative, and effective science-
learning experiences. We are helping to create the future STEM 
workforce and inspiring people of all ages about the wonders and the 
meaning of science in their lives. Our members are trusted and valued 
by their communities: a recent national public opinion poll, showed 
that 95 percent of voters would approve of lawmakers who acted to 
support museums and 96 percent of voters want Federal funding for 
museums to be maintained or increased (Museums and Public Opinion, 
Wilkening, S. and AAM, 2018).
    These past 2 years have been especially challenging for our 
community as all of our members, who traditionally receive about half 
of their operating income from revenue of people coming through their 
doors, experienced prolonged closure of their facilities. Even as they 
have reopened to the public, attendance and revenue may take several 
years to recover. At the same time, our member institutions continued 
to serve their communities and their missions, engaging their regions 
with STEM and youth engagement, supporting science learning and serving 
their communities in myriad other ways. Indeed, one of the most 
inspiring aspects of the past 2 years is how our member organizations 
have shown up for their communities and worked closely with local 
residents and organizations to advance conversation and action on the 
most urgent local priorities.
    For example, a year ago ASTC and ACM joined with a coalition of 
other national organizations to launch Communities for Immunity 
(www.communitiesforimmunity.org), an initiative supported by the 
Centers for Disease Control and Prevention and the Institute of Museum 
and Library Services to activate museums, libraries, and Tribal 
organizations to boost vaccine confidence in their communities. 
Building upon the high degree of trust that the public has in these 
cultural institutions, Communities for Immunity has been able to 
effectively engage vaccine hesitant members of their communities.
    As the Nation hopefully emerges from the immediacy of the pandemic, 
this example of action by the museum and library community demonstrates 
how these trusted institutions embedded in their communities offer an 
opportunity to advance community conversation and action on national 
and international challenges in locally resonant ways.
    astc, acm, and asmd requests for fiscal year 2023 appropriations
    We appreciate the support that the subcommittee has provided for 
the Nation's science and education agencies, including support for 
programs of particular interest to ASTC, ACM, and ASMD.
    In general, we stress the need for inclusive programs that include 
support for informal education as much STEM learning--including but not 
limited to school-aged youth--happens outside of formal schooling. 
Research has consistently shown that learning experiences outside of 
the formal classroom are vitally important to youth's future interest 
and capacity in STEM (National Research Council, 2006, 2009, 2015).
National Institutes of Health
    The Science Education Partnership Awards (SEPA) program builds 
relationships between the biomedical research community and educational 
organizations--including science centers--that improve life science 
literacy. In addition, there is growing awareness of the importance of 
public engagement as a core aspect of several major initiatives that 
intersect with societal interests and public concerns, such as the 
BRAIN Initiative and the All of Us Research Program.
    We strongly urge the subcommittee to appropriate at least $21 
million for the Science Education Partnership Awards (SEPA), based at 
the National Institute of General Medical Sciences (NIGMS).
    In addition, we would welcome language that supports incorporating 
public engagement with science as an element of NIH funding programs 
more widely, including especially for initiatives that have significant 
public impact.
Institute of Museum and Library Services
    As the primary Federal agency supporting all types of museums, the 
Institute of Museum and Library Services (IMLS) provides critical 
funding to museums through the Office of Museum Services (OMS)--as well 
as to libraries and to Tribal and other cultural institutions. This 
includes crucial resources for informal science activities at science 
centers and museums throughout the country.
    Throughout the pandemic, OMS has provided critical leadership to 
the museum community through its CARES Act and American Rescue Plan 
grants, and the agency has been providing science-based information and 
recommended practices to reduce the risk of transmission of COVID-19 to 
staff and visitors engaging in the delivery of museum services.
    The current appropriations level has allowed OMS to fund only a 
small fraction of the grant applications received that have been rated 
highly by peer reviewers. Increased funding for OMS would allow the 
office to increase its grant capacity for museums, funds which museums 
will need to help recover from the pandemic and continue to serve their 
communities.
    We urge you to provide at least $54.5 million for the Office of 
Museum Services at the Institute of Museum and Library Services (IMLS).
    We also ask for the subcommittee to include funding for the agency 
to explore establishing a roadmap to strengthen the structural support 
for a museum Grants to States program administered by OMS, as 
authorized by the Museum and Library Services Act, 20 U.S.C. Section 
9173(a)(4), in addition to the agency's current direct grants to 
museums. Unlike state library grants, IMLS does not have the ability to 
rapidly deploy resources for addressing state-defined needs and expand 
the reach of museums and enhance their ability to serve their 
communities.
Department of Education
    The U.S. Department of Education has significant opportunity to 
complement its expanding support for schools and school systems--with 
concurrent support for out-of-school learning include summer, 
afterschool, and informal education.
    The pandemic has shown how important robust afterschool and summer 
learning programs are to working families and our most vulnerable 
students, and how vital resources are to support these programs to 
ensure they are available and effective for the children and youth who 
need them.
    Specifically, we request that you support an increase of $500 
million for the Nita M. Lowey 21st Century Community Learning Centers 
program in FY 2023, which would bring the budget to $1.789 billion.
    We continue to thank the subcommittee for all its support of a 
robust science and education budget. You have demonstrated your support 
for crucial programs that promote STEM education for our Nation's 
students. Like our organizations, you recognize these are vital 
investments in our future, and we thank you in advance for taking 
action accordingly.
    Our two organizations--along with the broader museum community--
stand ready to be of service to your work. We are always happy to 
provide examples of the ways that museums are contributing to their 
communities and helping to advance local, regional, and national 
priorities. With our networks of hundreds of community-based 
institutions, these examples can be in or near each Congressional 
district.
    Founded in 1973, the Association of Science and Technology Centers 
(ASTC) is a network of nearly 700 science and technology centers and 
museums, and allied organizations, engaging more than 110 million 
people annually across North America and in almost 50 countries. With 
its members and partners, ASTC works towards a vision of increased 
understanding of--and engagement with--science and technology among all 
people. www.astc.org. Association of Science and Technology Centers, 
818 Connecticut Avenue, NW, Seventh Floor, Washington, DC 20006, 
[email protected].
    The Association of Children's Museums (ACM) champions children's 
museums worldwide. With more than 460 members in 50 States and 19 
countries, ACM leverages the collective knowledge of children's museums 
through convening, sharing, and dissemination. 
www.childrensmuseums.org. Association of Children's 
Museums, 2550 South Clark Street, Suite 600, Arlington, VA 22202, 
[email protected].
    The Association of Science Museum Directors (ASMD) is a non-profit, 
professional association of natural history and science museum 
directors. Our community of science museum leaders gathers to share 
experiences and discuss issues related to the advancement of our 
respective organizations to benefit society and the planet. www.asmd-
us.org. Association of Science Museum Directors, 2413 S. Whittier 
Avenue, Springfield, IL 62704-4655, [email protected].

    [This statement was submitted by Christofer Nelson, President and 
CEO, 
Association of Science and Technology Centers, Arthur G. Affleck, III, 
Executive 
Director, Association of Children's Museums, and Bonnie Styles, 
Executive Director, Association of Science Museum Directors.]
                                 ______
                                 
 Prepared Statement of the Association of State and Territorial Health 
                               Officials
    On behalf of the Association of State and Territorial Health 
Officials (ASTHO), I respectfully submit this testimony on FY23 
appropriations for the U.S. Department of Health and Human Services 
(HHS). The Association of State and Territorial Health Officials 
(ASTHO) is a national nonprofit representing State and territorial 
public health agencies. ASTHO's members--the chief public health 
officials of these agencies--are dedicated to formulating and 
influencing sound public health policy and assuring excellence in 
public health practice. ASTHO is requesting $11 billion for the Centers 
for Disease Control and Prevention (CDC), $824 million for the Public 
Health Emergency Preparedness Cooperative Agreement (PHEP), $170 
million for the Preventive Health and Health Services Block Grant 
(Prevent Block Grant), $1 billion for Public Health Infrastructure and 
Capacity, $153 million for Social Determinants of Health, and $250 
million data modernization efforts at CDC. Under the Assistant 
Secretary for Preparedness and Response (ASPR), ASTHO requests $474 
million for the Hospital Preparedness Program (HPP). Additionally, we 
ask for $9.2 billion in discretionary funding for the Health Resources 
and Services Administration (HRSA).
    Before I expand on the details of these program requests, ASTHO, 
and our members are grateful for the tireless work you and your staff 
do to support governmental public health. Despite heroic efforts to 
protect Americans' health, we have lost one million lives and 15 
million lives globally to COVID-19. These deaths weigh on us all, and 
especially on those charged with protecting the health of all 
Americans. While we are grateful for emergency supplemental 
appropriations to address the COVID-19 pandemic, Congress must provide 
long-term, sustained, and increased discretionary funding to support 
the public health workforce, modernize our data systems, and build 
laboratory capacity, among other priorities. We must also acknowledge 
that huge sums of this emergency funding could have been avoided with 
ongoing, predictable funding that meets the needs of State, 
territorial, and local public health departments. The emergency 
supplemental funding is narrow, specific, and time-limited. Public 
health departments are anticipating that without a change, of course, 
there will be an enormous funding cliff in two to 3 years. Federal 
resources account for nearly half of all State and territorial health 
department funding. In addition to a global pandemic, our members face 
opportunities and challenges each day in their jurisdictions, including 
data modernization, public health technology, public health worker 
burnout, mental and behavioral health crises, and rare hepatitis cases 
in children. These issues may change in urgency over the next year, but 
the same health departments will be there to prepare, prevent, and 
protect all Americans. ASTHO remains concerned that emergency public 
health funding will not make up for decades of underfunding and the 
ongoing COVID-19 response.
    America's State and territorial public health departments work in 
partnership with CDC toward this goal, and we respectfully request $11 
billion in overall funding for this agency. CDC plays a vital role in 
supporting communities to expand the capacity of our Nation's front 
line of public health defense: our country's state, Tribal, 
territorial, and local public health departments.
    An essential program that remains vital support for public health 
preparedness and response is the Public Health Emergency Preparedness 
Cooperative Agreement (PHEP) at CDC. ASTHO requests $824 million for 
the Public Health Emergency Preparedness Cooperative Agreement (PHEP) 
to sustain and improve governmental public health programs. This 
program was established after a dark day in American history: Sept. 11, 
2001. Data show that PHEP has contributed to public health preparedness 
in the Nation's 62 State, local, and territorial public health 
departments. Also, as a result of recent increases in funding for this 
program, CDC was able to provide increased funds to some city-level 
grantees, allowing them to expand their public health preparedness 
capabilities. Grantees rigorously evaluate their capacity to prepare 
for public health emergencies.
    In addition to the PHEP program, States bolster their 
infrastructure activities with the Preventive Health and Health 
Services Block Grant (Prevent Block Grant). ASTHO respectfully requests 
$170 million for this program. For more than 30 years, the Prevent 
Block Grant has served as an essential funding source for State and 
territorial health agencies. In 1999, funding peaked at $194.9 million. 
Since then, it has dropped by 17.9 percent, not including adjustments 
for inflation. Programs funded by the Prevent Block Grant cannot be 
supported or expanded through other funding mechanisms. States and 
territories use these flexible dollars to offset funding gaps in 
programs that address the leading causes of death and disability. In 
some cases, this funding serves as seed funding for innovative projects 
a State or territorial health department wishes to provide to meet 
community health goals not funded through other means.
    State and territorial public health departments have traditionally 
operated under a boom-and-bust cycle regarding how they are funded. The 
``boom'' occurs during a public health emergency, such as the COVID-19 
pandemic, when policymakers increase public health funding to mobilize 
a response. ASTHO is grateful for the $3 billion in emergency funding, 
however, this one-time funding must be met by sustained resources in 
order to make a lasting and real improvement to our Nation's public 
health system. It is then followed by the ``bust,'' or return to 
chronic underfunding of agencies when the acute public health threat 
subsides and the crisis is deemed to be ``solved.'' ASTHO respectfully 
requests $1 billion for Public Health Infrastructure and Capacity at 
CDC. This funding will support efforts within agencies that build 
capacity to detect and respond to threats both domestically and 
globally while improving and supporting activities in core public 
health capabilities, including assessment, policy, preparedness and 
response, community partnership, communications, equity, 
accountability, and performance management. Moreover, funding will 
support agencies in their efforts to invest in a highly trained 
workforce that is ready to help emerging public health threats. It is 
also essential to ensure that funding is disease-agnostic, flexible, 
and sustainable to support the transition from sporadic influxes of 
funding that accompany the response to public health emergencies.
    State and territorial health agencies are uniquely situated to 
lead, develop, and coordinate interventions seeking to bring economic 
and community sectors together to create conditions that foster vibrant 
health. Social and economic conditions--often referred to as the Social 
Determinants of Health (SDOH) (e.g., housing, employment, food 
security, education, and transportation)--significantly influence 
individual and community health. It is also understood that these 
factors are estimated to contribute significantly to a person's health 
outcomes, while traditional healthcare only accounts for 10-20 percent. 
Therefore, knowing that investing in programs that address the root 
causes of negative health outcomes is a force multiplier; it not only 
improves Americans' health but saves the healthcare system costs and 
burden. ASTHO, therefore, supports providing $153 million in funding to 
support the implementation of a Social Determinants of Health program 
at CDC with goals to align and streamline SDOH programs across CDC, 
grow capacity to address SDOH in our communities, provide funding to 
address the SDOH of those who are most at risk and disproportionately 
affected by adverse social and economic conditions, and bolster the 
catalog and science base and disseminate these to communities. An 
increase in funding will support the expansion of activities that 
address social determinants of health in State, local, Tribal, and 
territorial jurisdictions that including expanding and implementing 
accelerator plans and building the evidence base to better understand 
health disparities.
    Along with Partner Organizations, ASTHO Supports the Data: 
Elemental to Health Campaign. We called on Congress to provide the 
first-ever dedicated funding for public health data systems and build a 
21st-century public health data superhighway. Thanks to the work of 
this subcommittee, Congress answered the call and has provided annual 
funding and necessary injections of supplemental funding through the 
CARES Act and the American Rescue Plan for CDC's public health Data 
Modernization Initiative (DMI). For FY23, we request $250 million for 
data modernization efforts at CDC. DMI is committed to building a 
world-class data workforce and data systems ready for the next public 
health emergency. We need robust, sustained, yearly funding to complete 
the foundational investment in DMI and ensure we are providing 
resources for public health systems and infrastructure, including at 
State and local health departments, to keep pace with evolving 
technology.
    Under the Assistant Secretary for Preparedness and Response (ASPR), 
ASTHO is requesting $474 million for the Hospital Preparedness Program 
(HPP) and the coalitions that serve their communities to operate and 
coordinate activities across the local, State, regional, and Federal 
levels to ready healthcare delivery systems for disasters and 
emergencies. These include developing mechanisms for effective patient 
movement, communicating situational awareness, and providing resource-
sharing across disparate healthcare entities. HPP allows individual 
healthcare facilities and healthcare coalitions to access a truly 
national response network, enabling the system to save lives and 
protect Americans from 21st-century health security threats and is the 
only source of Federal funding for this work.
    Additionally, we request $9.2 billion in discretionary funding for 
the Health Resources and Services Administration (HRSA). We sincerely 
appreciate your support for HRSA and the significant increases provided 
in FY22. Robust funding for HRSA is critical to supporting all HRSA's 
activities and programs, which are essential to protect the health of 
our communities. Additional funding will allow HRSA to fill preventive 
and primary health care gaps, support urgent and long-term public 
health workforce needs and build upon the achievements of HRSA's more 
than 90 programs and more than 3,000 grantees.
    Thank you for considering these funding requests. We stand ready to 
work with Congress to address the countless public health challenges 
and opportunities impacting our Nation's health. If you have any 
questions or require additional information, please do not hesitate to 
contact a member of ASTHO's government affairs team: Carolyn McCoy 
([email protected]) or Jeffrey Ekoma ([email protected]).

    [This statement was submitted by Michael Fraser, PhD, MS, CAE, 
FCPP, Chief Executive Officer, Association of State and Territorial 
Health Officials.]
                                 ______
                                 
    Prepared Statement of the Association of University Centers on 
                              Disabilities
         the association of university centers on disabilities
    The Association of University Centers on Disabilities (AUCD) is a 
membership organization that supports and promotes a national network 
of university-based interdisciplinary programs. Network members consist 
of 143 centers, including 67 University Centers for Excellence in 
Developmental Disabilities (UCEDD), 60 Leadership Education in 
Neurodevelopmental Disabilities (LEND) programs; and 16 Eunice Kennedy 
Shriver Intellectual and Developmental Disability Research Centers 
(IDDRC). AUCD's mission is to advance policies and practices that 
improve the health, education, social, and economic well-being of all 
people with developmental and other disabilities, their families, and 
their communities by supporting our members in research, education, 
health, and service activities that achieve our vision. AUCD's network 
of programs are located in every State and territory and are all part 
of universities or university medical centers. AUCD's programs excel in 
basic and applied research, training, information dissemination, 
creation of model demonstration programs, systemic reform, and policy 
analysis. Given that these programs work collaboratively, innovations 
from one program can be rapidly implemented in communities throughout 
the country. AUCD's programs serve as a bridge between the university 
and the community, bringing together the resources of both to achieve 
meaningful systemic change.
    university centers for excellence in developmental disabilities
    The University Centers for Excellence in Developmental Disabilities 
(UCEDD): UCEDDs are interdisciplinary centers authorized in the 
Developmental Disabilities Assistance and Bill of Rights Act of 2000 
(DD Act) (Section 156 of Public Law 106-402, Subtitle D). The UCEDDs 
are located in every State and territory, with some States having 
multiple UCEDDs to serve the unique needs of the state. The funding 
supports the basic infrastructure costs of operation for each UCEDD. 
Each center leverages the investment to secure additional funding to 
carry out the purpose of the DD Act. The 67 UCEDDs provide training, 
technical assistance, service, research, and information sharing to 
people with disabilities, their families, State and local government 
agencies, and providers with a focus on building the capacity of 
communities and creating improvements in the service delivery system 
for people with Intellectual and Developmental Disabilities (I/DD) and 
other disabilities. The UCEDDs have directly improved services and 
supports in the States and territories in the areas of early 
intervention, healthcare, public health, community-based services, 
education, employment, housing, assistive technology, emergency 
response and transportation.
leadership education in neurodevelopmental disabilities (lend) programs
    The Leadership Education in Neurodevelopmental and Related 
Disabilities (LEND) Programs are authorized in The Autism 
Collaboration, Accountability, Research, Education and Support Act 
(Autism CARES Act) (Public Law 116-60). The LEND programs are located 
in 44 States, with an additional six States and three territories 
reached through program partnerships, (without additional Federal or 
State aid). LEND programs operate within universities and collaborate 
with university hospitals and/or academic health centers to provide 
advanced interdisciplinary training to enhance the clinical expertise 
and leadership skills of professionals in a broad array of professional 
disciplines in the identification, assessment, and intervention of 
children and youth with neurodevelopmental and other related 
disabilities. The training programs have an explicit focus on training 
professionals to provide culturally and linguistically relevant care 
and to recruit diverse students and professionals into the programs. In 
FY 2020, 24 percent of long-term trainees in the LEND programs were 
from underrepresented racial groups and 13 percent were Hispanic or 
Latino. LEND programs also include self-advocates and family members as 
trainees and faculty to ensure trainees interact with people with lived 
experiences and to increase the leadership skills of self-advocates and 
family members as part of an interdisciplinary care team. The LEND 
programs have pivoted in response to the COVID-19 emergency. Critical 
clinical services have transitioned to a mix of telehealth and in-
person formats, providing access to assessment, support, and treatment. 
A real-time transition to the provision of training either remotely or 
in a hybrid model proved an added benefit of building maternal and 
child health leaders with experience in telehealth to support the 
population of people with neurodevelopmental disabilities.
   eunice kennedy shriver intellectual and developmental disability 
                        research centers (iddrc)
    The Intellectual and Developmental Disabilities Research Centers 
(IDDRCs) were established in 1963. The IDDRC's represent the Nation's 
first and foremost sustained effort to prevent and treat disabilities 
through biomedical and behavioral research. The network of IDDRCs with 
AUCD membership consists of 16 Centers with current P30 core grant 
funding from the Eunice Kennedy Shriver National Institute for Child 
Health and Human Development (NICHD). Each IDDRC supports 40-100 
research projects on an annual basis that seek to advance the 
understanding of chromosomal conditions and biochemical processes as 
they relate to brain function and I/DD. IDDRCs contribute to the 
development and implementation of evidence-based practices by 
evaluating the effectiveness of biological, biochemical, and behavioral 
interventions; developing assistive technologies; and advancing 
prenatal diagnosis and newborn screening. They also provide invaluable 
research training, mentoring, and support to emerging leaders in 
clinical and research science.
       fiscal year 2023 appropriations requests and justification
    AUCD requests that Congress appropriate $47,173 million for the 
UCEDDs for FY 2023 within the Administration for Community Living (ACL) 
in the Labor-HHS-Education appropriations bill. The increased funding 
will ensure the UCEDDs meet the requirements of the DD Act and that 
people with disabilities are fully included and accounted for as States 
and territories respond to the significantly increased demand for 
assistance due to the pandemic. In FY 2020, the UCEDDs reached 13 
million people through community training and technical assistance 
activities and trained 6,242 professionals that work with people with 
disabilities. In FY 2021, the number of requests for technical 
assistance to UCEDDs increased by 44 percent and the number of 
technical assistance products developed for the UCEDDs increased by 83 
percent. These increases are a direct result of the impact of the 
pandemic on the systems supporting people with disabilities and are not 
sustainable without additional assistance. As regulatory and service 
systems continue to evolve once the public health emergency expires, 
the support needs of people with I/DD and their families will not 
decline. In addition, the increased funding will enable the UCEDDs to 
fund a new round of competitive grants focused on increasing diversity, 
equity and inclusion by partnering with minority-serving institutions 
and will also support other UCEDD activities and programs to promote 
opportunities for people with I/DD to exercise self-determination, be 
independent, and be included in all aspects of community life.
    AUCD requests that Congress appropriate $57,344,000 for Autism and 
other Developmental Disabilities for FY 2023 and of this amount 
appropriate $40,000,000 for LENDs (in report language) within Health 
Resources and Services Administration (HRSA) in the Labor-HHS-Education 
appropriations bill. The increased funding will ensure the LEND 
programs can address the significant unmet needs and disparities in 
evaluation, diagnosis, and treatment as well as supporting LENDs to 
recruit and support more autistic adults as faculty advocates and as 
trainees, with an emphasis on expanding LEND curriculum to include and 
address adult life needs and healthcare. Furthermore, while we are 
grateful the number of LEND programs were expanded from 52 to 60 in 
June of 2021, this was done with no increase in funding. All funded 
programs were subject to a 3.3 percent cut in their allocated funds to 
accommodate the expansion. We are hopeful the LEND programs will see 
their funding restored in FY 2023.
    AUCD requests that Congress appropriate $1.816 billion for the 
NICHD within the National Institutes of Health (NIH) (a 7.9 percent 
increase from FY 2021). AUCD additionally requests a proportional 
increase of 7.9 percent for IDDRCs within the NICHD in the Labor-HHS-
Education appropriations bill.
    The increased funding for NICHD is essential to building upon the 
cutting-edge research and collaboration of the IDDRC network to better 
understand the neural and biomolecular underpinnings of I/DD to better 
inform treatments and interventions. Previous increases in NICHD 
funding have not resulted in increases to the IDDRCs. This research is 
more important given the reality that people with I/DD are experiencing 
more severe symptoms of COVID-19 and die at disproportionately higher 
rates than people without disabilities.
    other programs that support and serve children and adults with 
                              disabilities
    AUCD supports the proposed increases in the President's budget for 
programs that support and serve people with disabilities, such as 
special education, post-secondary education, and vocational 
rehabilitation programs; programs that improve the health of children 
and adults with disabilities; and programs that generate new knowledge 
and promote its effective use to strengthen opportunities for an 
inclusive life in the community. We are specifically supportive of the 
President's proposed increases for the following programs:
  --Transition Programs for Students with Intellectual Disabilities 
        (TPSID) and related technical assistance centers (NCC and 
        NDTAC) to promote college programs for students with 
        intellectual disabilities;
  --Projects of National Significance (PNS), innovative demonstration 
        projects to monitor progress on key policy priorities for 
        people with I/DD;
  --The National Institute on Disability Independent Living and 
        Rehabilitation Research (NIDILRR), the Federal Government's 
        primary disability research organization, which funds programs 
        that generate new knowledge and promote its effective use to 
        strengthen individual and community capacity for inclusion; and
  --The National Center on Birth Defects and Developmental Disabilities 
        (NCBDDD) strives to advance the health and well-being of people 
        with disabilities by preventing birth defects, promoting better 
        understanding of developmental disabilities, and improving the 
        health of people with disabilities.
    AUCD and AUCD's member centers frequently secure grants from these 
programs. For example, the PNS fund three national long-term data 
collection projects that help policymakers, service providers, and 
people with I/DD and their families to make the most informed policy 
and individual decisions related to healthcare and employment. All 
three of the National longitudinal studies are conducted by AUCD's 
members. The studies include a study of the evolution of integration 
and inclusion of people ID/DD in society and more than 20 years of 
studies about community integration and employment for people with I/
DD.
                                 ______
                                 
    Prepared Statement of the Association of University Programs in 
                     Occupational Health and Safety
    On behalf of the Association of University Programs in Occupational 
Health and Safety (AUPOHS), we respectfully request that the Fiscal 
Year 2023 Labor, Health, and Human Services Appropriations bill include 
no less than $375,300,000 for the National Institute for Occupational 
Safety and Health (NIOSH), including no less than $34,000,000 for the 
Education and Research Centers (ERCs), $30,500,000 for the Agriculture, 
Forestry, and Fishing (AgFF) Program, and a $3,000,000 increase over 
the FY22 level for the Total Worker Health(r) (TWH) Program.
    As you have no doubt heard from other testimonies, far too many 
Americans still lose their lives on the job. In 2020, a worker died 
every 111 minutes from injuries they got on the job (BLS 2020). This 
includes our first responders, who can be struck and killed by drivers 
while helping victims of a roadside traffic accident; our construction 
workers, who may fall from an inadequately guarded roof edge; our 
farmers who may be engulfed in flowing grain, and our shop owners and 
employees who may be asked to work late nights without proper security 
and become victims of violence. Although it is harder to measure, we 
also estimate that an additional 145 people die every day in America 
from work-related disease--developing cancers from hazardous chemicals 
that they encounter at work, or heart disease from chronically 
stressful work environments. In addition to work-related deaths, we 
also have a high burden of nonfatal workplace injury and illness. 
Leading up to the pandemic, 2.8 million workers were seriously injured 
on the job every year and one-third of those injured workers required 
time off to recover before they could return to work. This not only 
costs the Nation's businesses more than $1.1 billion a week on serious, 
nonfatal workplace injuries (Liberty Mutual 2020) but also causes great 
harm to workers and their families if their workers' compensation 
systems fail to provide adequate care or wage replacement.
    The pandemic has amplified all these issues for the American 
workforce. More than 3,600 of our health care workers died from COVID-
19 in the first year of the pandemic, and we know that many of these 
deaths are attributable to the extreme shortage of protective gear 
encountered in medical settings (Lost on the Frontline 2021). That is 
to say, these deaths were preventable. In just the first months of the 
pandemic, 16,233 workers in meat and poultry processing facilities were 
infected with COVID-19 (CDC 2020); these were also workers who 
sacrificed their health and wellbeing in order to keep essential goods 
and services moving. We owe an immense debt to all of our essential 
workers, and as such, we have an opportunity to better serve these 
workers moving forward. By designing safer workplaces that reduce the 
risk of exposure to future variants, answering workers' questions about 
vaccines and making them accessible, and by researching, designing, and 
preparing programs to bolster workers' mental health as we come to 
terms with what we have experienced these past few years, we can serve 
our essential workers.
    NIOSH is the primary Federal agency responsible for conducting 
research that leads to actions and policies that prevent work-related 
illness and injury by promoting safe work practices and work 
environments as well as worker health and wellbeing. NIOSH is also the 
Federal agency charged with certifying and approving Personal 
Protective Equipment (PPE), including the masks that are necessary to 
protect U.S. workers from inhalation exposures to chemical and 
biological agents, including viruses. During the pandemic, NIOSH 
accelerated the approval process for establishing the safety and 
quality of new masks and other PPE. NIOSH continues to fund and promote 
critical research for a changing workforce and work practices, an 
important service for employers and employees in the face of the 
current pandemic and other disasters. NIOSH has, for example, deployed 
teams across the country in response to industry requests for 
assistance, including more than 15 meatpacking plants that experienced 
outbreaks. NIOSH has contributed key leadership and expertise, 
providing Federal guidance and decision tools for industries including 
construction, manufacturing, food and agriculture, mass transit, 
transportation and trucking, restaurants and bars, childcare 
facilities, schools, among others, including recent guidance for 
businesses to safely return to work and/or expand operations.
    The NIOSH-supported extramural Centers, including the Education and 
Research Centers (ERCs), Centers in the Agriculture, Forestry, and 
Fishing (AgFF) Program, and the Total Worker Health(r) (TWH) Centers of 
Excellence, have responded rigorously to the pandemic and supported 
NIOSH to rapidly respond to the needs and safety of the Nation's 
workforce. These Centers have been proactive in providing resources, 
employer assistance, over 100,000 hours of outreach training, and 
research that are helping to drive improvements in our rapid response 
to emerging occupational safety and health issues. The work the Centers 
have undertaken during this pandemic underscores the need for increased 
funding for NIOSH and the Centers. As workplaces rapidly evolve, 
changes continue to present new health and safety risks to workers, 
which need to be addressed promptly through occupational health and 
safety research and training.
    The eighteen university based ERCs provide local, regional, and 
national resources for all those in need of occupational health and 
safety assistance. Collectively, the ERCs provide graduate- and post-
graduate level education and research training in the occupational 
health and safety disciplines. The ERCs prepare a workforce of 
occupational safety and health professionals to every Federal Region in 
the U.S. who are trained to identify and mitigate vulnerabilities from 
all sources, including increased readiness to respond to chemical, 
biological, radiological, or nuclear attacks. Occupational health and 
safety professionals work with emergency response teams to minimize 
disaster losses, as exemplified by their lead role in minimizing 
hazards among workers involved in clean-up and restoration of the 
extreme devastation caused by Hurricanes Harvey, Irma, and Maria in 
Texas, Florida, Puerto Rico, and the U.S. Virgin Islands. In 2020, the 
ERCs responded rapidly to provide employers across the country with 
accessible, concise information on the workplace implications of COVID-
19 and are now providing local and national online and telephonic 
advising programs for businesses as they seek to reopen safely.
    NIOSH leads the research and outreach efforts on the Nation's most 
dangerous worksites that often impact lives in rural parts of America. 
The NIOSH AgFF Program was established by Congress in 1990 (P.L. 101-
517) in response to evidence that agricultural, forestry, and fishing 
workers suffer substantially higher rates of occupational injury and 
illness than other workers. Agricultural workers are more than six 
times more likely to die on the job than workers in other sectors 
combined, averaging 566 fatalities per year, and nearly 5 in 100 
agricultural workers incur recordable nonfatal injuries each year. Our 
food security depends on a healthy agricultural workforce--an essential 
sector that has been hit particularly hard during the pandemic. Today, 
the NIOSH AgFF initiative includes 10 regional Agricultural Centers and 
one national Children's Farm Safety and Health Center. The AgFF program 
is the only substantive Federal effort to ensure safe working 
conditions in this vital production sector. The program also conducts 
research and outreach to ensure the safety of our Nation's 86,000 
workers in forestry and logging, an industry with a fatality rate more 
than 30 times higher than that of all our Nation's workers. The AgFF 
Centers have had a significant impact on protecting safety and health 
of agricultural workers. For example, increased use of rollover 
protective structures (ROPS or roll bars) and seatbelts on tractors has 
reduced overturn-related deaths. Partnering with fishing communities, 
the AgFF Centers developed comfortable lifejackets to wear at work, 
which have increased chances of survival in the event of a fall 
overboard. The lifesaving, cost-effective work of the AgFF program is 
not replicated by any other agency. USDA's National Institute of Food 
and Agriculture interacts with experts at NIOSH to learn about cutting-
edge research and new directions in this area. As the majority of AgFF 
workers; self-employed farmers, ranchers, and fishermen; are exempt 
from State and Federal OSHA protections, NIOSH and the AgFF Centers 
fill a critical role in training and educating of AgFF workers.
    NIOSH also supports 10 Total Worker Health (TWH) Centers of 
Excellence that conduct multidisciplinary research and test practical 
solutions to emerging challenges that impact the safety, health, 
wellbeing, and productivity of the American workforce. The TWH Centers 
conduct solutions-focused research in partnership with employers and 
employees and partner with government, business, labor, and community 
to improve the health and productivity of the workforce. The TWH 
Centers' research, education, and outreach activities occur in 
workplaces, such as hospitals, factories, offices, construction sites, 
and small businesses, resulting in immediate and measurable 
improvements in health and safety. These Centers have been heavily 
relied upon by employers and employees to address the impact of the 
current pandemic not only from an infectious disease perspective but 
also to address the impact on mental health, stress, burnout, and 
resiliency of essential workers, workers abruptly working remotely, and 
those furloughed or laid off. The TWH Centers are an investment in the 
American economy, helping valued employees return home safe and healthy 
at the end of a productive workday.
    While funding for the ERC, AgFF, and TWH Centers is crucially 
important to maintain resources, staff, and long-term capacity in 
occupational safety and health research at the State and regional 
level, we also emphasize that the overall NIOSH funding level is also 
critical. The requested increase in the NIOSH topline funding level 
supports NIOSH intramural research, including the NIOSH personal 
protective equipment program, which develops and monitors N95s and 
advanced respiratory protection systems; disaster response research; 
mental health research; Per- and Polyfluoroalkyl Substance (PFAS) 
research; and research on substance use disorders related to work. 
Increased NIOSH topline funding also enables reinstating reduced 
extramural funding levels for innovative investigator-initiated awards.
    We urge you to recognize the critical contribution of NIOSH, 
including the ERCs, the AgFF Program, and the TWH Program to the health 
and productivity of our Nation's workforce. Thank you for the 
opportunity to submit testimony.
                                 ______
                                 
                  Prepared Statement of Autism Speaks
    Thank you for the opportunity to submit testimony in support of 
autism funding within the National Institutes of Health (NIH), the 
Centers for Disease Control and Prevention (CDC), Health Resources and 
Services Administration (HRSA), Department of Education (DOE), and 
other agencies under your jurisdiction. For Fiscal Year 2023 we request 
that the Committee increase its investment in autism-related 
activities. Specifically, we request that you fund autism activities at 
least at $33.1 million at CDC and $64.6 million for Autism and 
Developmental Disorders activities (which includes a $7.5 million 
increase in research funding and a $2.755 million increase for the 
Leadership Education in Neurodevelopmental and Related Disabilities 
(LEND) program) at HRSA. In addition, we request that the Committee 
strongly urge the NIH to invest in autism research consistent with the 
budget recommendation included in the Interagency Autism Coordinating 
Committee's (IACC) Strategic Plan and for all agencies to invest in 
research that addresses health equity challenges and disparities that 
persist in the autism community.
    My name is Stuart Spielman, and I am the Senior Vice President for 
Advocacy at Autism Speaks. Autism Speaks is dedicated to promoting 
solutions, across the spectrum and throughout the life span, for the 
needs of individuals with autism and their families. We do this through 
advocacy and support; increasing understanding and acceptance of people 
with autism; and advancing research into causes and better 
interventions for autism spectrum disorder and related conditions.
    We are grateful for the bipartisan leadership that both the Chairs 
and Ranking Members of the full committee and subcommittee have 
provided in supporting investments in autism research, training, and 
services over many years. As you consider this year's requests, we look 
again to your leadership to build on the significant progress that has 
been made and provide investments to meet the tremendous needs that 
continue to exist.
    For Fiscal Year 2023 we request that the Committee invests in 
autism-related activities to align the Federal investment in autism-
related activities with the budget recommendation of the 2016-2017 IACC 
Strategic Plan for Autism Spectrum Disorder. While the NIH, DOE, CDC, 
and HRSA are the largest funders of autism-related research, training, 
and services, multiple other agencies fund important autism-related 
efforts as well. We urge the subcommittee to use the recommendations 
and strategic objectives of the IACC, the congressionally created body 
responsible for advising the Federal Government on autism-related 
investments, to guide investment across all agencies.
    Much of the progress in autism research that has been made is due 
to your work and support. The research you have supported has been 
remarkably important in better understanding the biology of autism, the 
numbers of individuals across the country with an autism spectrum 
disorder diagnosis, and the types of interventions and supports that 
can benefit the autism community. In many ways, it is because of this 
progress that we know that so much more needs to be done. Here are just 
a few examples of questions that research can answer:
  --How can we develop personalized interventions and therapies to 
        mitigate the co-morbid health conditions that occur in higher 
        rates among autistic individuals?
  --How can we promote evidence-based supports and services to assist 
        the 70,000 autistic youth who every year transition out of 
        school-age services?
  --Even though autism can be diagnosed at 15 months, the average age 
        of diagnosis remains at about 4 years old, and even later in 
        low-income communities. What evidence-based practices can we 
        use to help diagnose autism earlier across the board?
  --Research indicates that autistic individuals, women in particular, 
        are at greater risk for suicide. How can we adapt existing 
        suicide screening and intervention models to better reach 
        individuals at risk?
  --Learning opportunities were lost during the pandemic. How can we 
        ensure that educational loss during breaks in education are 
        better understood and addressed for children, teenagers, and 
        young adults with autism?
  --There is a dearth of research on issues affecting autistic adults. 
        What can be done to not only better understand service and 
        support needs, but also why autistic adults have higher 
        premature death rates and poorer health outcomes than the rest 
        of the population?
  --How does autism affect aging and related health conditions and how 
        can we ensure that autistic adults are receiving appropriate 
        mental health assessments as they age?
    Recent research has shown that while we have made progress in 
identifying all children with autism earlier, timely access to needed 
services remains a major challenge. Children with autism spectrum 
disorder have nearly 4 times higher odds of unmet health care needs 
compared to children without disabilities, and Black autistic children 
are twice as likely to have unmet healthcare needs than their non-
Hispanic white counterparts. Black and Latinx children experience 
delays in diagnosis that result in the loss of valuable treatment time. 
It is imperative that a greater investment in research is made to help 
bridge these gaps and ensure that culturally competent interventions 
and services are available in every community.
    The scale of the challenges faced by our community require urgent, 
increased, and sustained investment. The IACC recommended in its most 
recent Strategic Plan a doubling by 2020 of 2015 levels of investment 
in autism research. Even with this investment, the IACC stated that the 
``increases recommended by the IACC would not be sufficient to 
accomplish all of the research goals identified by the plan.'' The 
total annual cost of autism in the United States has been estimated to 
be at least $236 billion. By contrast, it has been estimated that 
combined autism research funding among Federal and private sources is 
less than 1 percent of that amount--a tiny fraction of the estimated 
annual total cost of autism. Additional research investments can 
improve outcomes and help reduce those costs through early 
identification, improved interventions, and greater availability of 
supports and services.
    Because of the Committee's previous work and the decisions made by 
the agencies funded through this bill, there are opportunities to build 
on existing investments. For example:
  --The National Institute on Deafness and Other Communication 
        Disorders (NIDCD) FY 2022 Budget Justification highlighted 
        research to help address communication challenges for autistic 
        individuals. They note that 30 percent of autistic individuals 
        over age 5 are functionally non-speaking yet are an under-
        represented group in research. Research the NIDCD is funding is 
        intended to develop effective interventions and improve 
        clinical practice for autistic individuals with communications 
        challenges.
  --The CDC receives only enough funding to monitor the prevalence of 
        children with autism spectrum disorder in 11 States. Providing 
        an overall funding level of at least $33.1 million in fiscal 
        Year2023 would allow more States to participate in the ADDM 
        Network, giving them invaluable information to drive efforts at 
        the State and local levels and providing a better national 
        dataset; allow for more study of the prevalence of autism 
        across the lifespan; and continue support and enhancement of 
        the ``Learn the Signs. Act Early'' program on child 
        development.
  --HRSA has been funding extraordinarily important research efforts to 
        help address significant issues, like developing clinical 
        medical standards and challenges related to the transition to 
        adulthood. An overall funding level of $64.6 million for Autism 
        and Developmental Disorders in FY23 (to include an increase of 
        $7.5 million in research and a $2.755 million increase for 
        LEND) would greatly enhance HRSA's ability to fund research to 
        help bridge the gaps in these and myriad other areas.
    We hear every day from individuals and families in the autism 
community about their successes, challenges, and everything in between. 
They have shared their experiences during the pandemic, telling us 
about their struggles to receive learning supports and meet basic needs 
like food and housing. An analysis of private health insurance claims 
data has shown that a greater percentage of people with autism, alone 
or with intellectual or developmental disability, died from COVID-19 
than people with no chronic conditions. The damage done by the pandemic 
makes the need for a greater investment in the community even more 
compelling. The research that you have funded has brought a range of 
lasting changes and significant improvements. We are at a pivotal 
moment. Now is the time to address the significant gaps we know persist 
so that every person on the spectrum can achieve their full potential.

    [This statement was submitted by Stuart Spielman, Senior Vice 
President, 
Advocacy, Autism Speaks.]
                                 ______
                                 
         Prepared Statement of the Big Cities Health Coalition
    On behalf of the Big Cities Health Coalition (BCHC), we 
respectfully request that the subcommittee provide the highest possible 
funding for the U.S. Centers for Disease Control and Prevention (CDC), 
central to protecting the public's health, for Fiscal Year 2023. Our 
key CDC programmatic priorities include those most critical to our 
members: immunization, epidemiology and laboratory capacity, public 
health data modernization, workforce, infrastructure and capacity, 
opioid overdose prevention, violence prevention, public health 
preparedness, and addressing the social determinants of health.
    BCHC is comprised of health officials leading 35 of the Nation's 
largest metropolitan health departments, who together serve more than 
61 million--or about one in five--Americans. Our members work every day 
to protect and promote the public's health. We thank you for your 
continued leadership and support for our Nation's public health 
workforce and systems.
    As the subcommittee members recognize, sustained annual funding is 
necessary to build public health capacity for the next pandemic, as 
well as the everyday work that helps keep communities as healthy and 
safe as possible.
       national center for immunization and respiratory diseases
National Immunization Program
    We respectfully request $1.1 billion in FY 2023 for the National 
Immunization Program. The CDC Immunization Program funds 50 States, six 
large, BCHC member cities, and eight territories for vaccine purchase 
and immunization program operations. Increased and sustained investment 
is needed to modernize immunization information systems (IIS), 
establish State-to-state IIS data sharing, increase and sustain a 
network of adult immunization providers reporting data into IIS, and 
engage with communities to build vaccine confidence and minimize 
disparities among people of color and those at heightened risk for 
acute outcomes from vaccine-preventable diseases. BCHC also supports 
the creation of a Vaccines for Adults program that is essential to 
reduce vaccination coverage disparities, improve outbreak control, and 
enhance and maintain the infrastructure needed for responding to future 
pandemics, as well as routine, annual infectious disease.
      national center for emerging and zoonotic infectious disease
Epidemiology and Lab Capacity
    We respectfully request $800 million in FY 2023 for the 
Epidemiology and Lab Capacity (ELC) program, which is a single vehicle 
for multiple programmatic initiatives that go to 50 State health 
departments, six large, BCHC member cities, Puerto Rico, and the 
Republic of Palau. ELC provides critical support to and for 
epidemiologists and laboratory scientists who are instrumental in 
discovering and responding to various food, water, and vector-borne 
outbreaks, as well as funding vital improvements in health informatics. 
Despite ELC's vital role in responding to the pandemic, annual funding 
levels are not adequate to maintain public health preparedness or 
address routine challenges, particularly at the city or county level. 
An increase to ELC would enable increased support to local health 
departments to provide for their jurisdiction-specific needs, which 
should be sent directly to large, urban jurisdictions directly, 
wherever and whenever possible. Further, ELC dollars sent to the States 
should be better tracked through CDC reporting structures and shared 
publicly to contribute to Agency transparency and ensure funds are in 
fact supporting big city epidemiology activities.
                   public health scientific services
Public Health Data Modernization Initiative (DMI)
    We respectfully request $250 million in FY 2023 for the DMI that is 
working to create modern, interoperable, and real-time public health 
data and surveillance systems at the State, local, Tribal, and 
territorial levels. These efforts will ensure our public health 
officials on the ground are prepared to address any emerging threat to 
public health-whether it be COVID-19, measles, a foodborne outbreak 
like E. coli, or another crisis. COVID-19 exposed the gaps in our 
public health data systems and since then Congress has provided funding 
for DMI through the CARES Act and American Rescue Plan Act. These 
investments have been critical, but the public health surveillance 
systems must live beyond COVID-19 and be ready for any and all future 
threats. This requires long-term, sustained investment that is not just 
to build capacity at the Federal and State level, but also at health 
departments in cities and counties across the country. Access to 
timely, accurate data at all jurisdictional levels is perhaps our most 
enduring public health challenge.
Public Health Workforce
    We respectfully request $106 million in FY 2023 for CDC's public 
health workforce and career development programs, the same as the 
President's budget request. The public health workforce is the backbone 
of our Nation's governmental public health system at the county, city, 
state, and Tribal levels. Investments must be made to build back and 
develop the next generation of the public health workforce, as well as 
attract and retain diverse candidates with varied skill sets. These 
funds support CDC's fellowship and training programs including the 
Public Health Associate Program and the Epidemic Intelligence Service 
that extend the capacity of health departments and key partners at all 
levels of government.
              cross-cutting activities and program support
Public Health Infrastructure and Capacity
    We respectfully request $1 billion in FY 2023 for a public health 
infrastructure and capacity investment. The pandemic exposed the deadly 
consequences of chronic underfunding of basic public health capacity. 
Because public health is largely funded by disease or condition, there 
has been little investment in cross-cutting capabilities that are 
critical for effective prevention and response infrastructure, such as 
equity; policy development and support; communications; community 
partnership and engagement; organizational competencies; transparency 
and accountability; and emergency preparedness and response.
    Governmental public health infrastructure requires sustained 
investments over time, and we believe this is an important start. 
Building a response in real time, such as during the COVID-19 pandemic, 
is not the way to best protect our Nation's health. BCHC is grateful 
for the inclusion of funding in the FY 2022 Omnibus package and urge an 
ongoing investment to ensure that our governmental public health system 
is prepared not just for the next pandemic, but also to strengthen the 
health of our communities every day.
Center for Forecasting Epidemics and Outbreak Analytics
    We respectfully request $50 million in FY 2023 for the Forecasting 
Center that was established with American Rescue Plan Act funding to 
facilitate the use of data, modeling, and analytics to improve pandemic 
preparedness and response. This is the same as the President's budget 
request. Local health departments do not have sufficient capacity to do 
such activities on their own and would greatly benefit from the 
information and tools developed by the Forecasting Center. Therefore, 
sustained funding is required to maintain the center's functionality 
over time. Such resources could be critical to other public health 
crises such as the dueling community epidemics of violence and opioid 
overdose.
           national center for injury prevention and control
Opioid Overdose Prevention and Surveillance
    We respectfully request $713 million in FY 2022 for Opioid Overdose 
Prevention and Surveillance in line with the President's request. 
Overdoses are increasing in almost all of our Nation's communities, 
erasing gains of recent years. CDC's funding to health departments 
through the Overdose Data to Action (OD2A) program has been a critical 
resource for prevention of opioid and polysubstance use but must be 
expanded to include more big cities to ensure that substance use 
prevention continues to stem the tide of overdose and death. Funded 
prevention efforts include harm reduction and linkage to care 
initiatives with a focus on health equity and reducing stigma. Local 
health departments also need to be able to use these funds to purchase 
Naloxone; SAMHSA-funded purchasing is insufficient in supporting 
distribution. There is no one Federal funding stream that supports 
Naloxone purchase at the local level. Finally, we also encourage the 
committee to include directive language to ensure these dollars reach 
the local level in those communities that are not directly funded, as 
well as have CDC and HHS better track and report publicly state 
expenditures.
Gun Violence Prevention Research
    We respectfully request $35 million in FY 2023 for Gun Violence 
Prevention Research and the same as the President's budget request. 
Firearm violence is a serious public health problem in the United 
States that impacts the health and safety of all Americans and 
continues to be an acute issue in our Nation's largest cities. 
Significant gaps remain in our knowledge about the problem and ways to 
best prevent it; we need to continue and expand the research. 
Addressing these gaps is an important step toward keeping individuals, 
families, schools, and communities safe from firearm violence and its 
deadly consequences. The public health approach to violence prevention 
includes working to define the problem, identifying risk and protective 
factors, developing and testing prevention strategies, and then, 
assuring widespread adoption of targeted programs. Additional funds in 
FY 2023 would be used to fund a new grant program to implement a menu 
of evidence-based, evidence-informed, and emerging strategies to 
prevent firearm-related injuries and deaths in high-risk urban and 
rural communities.
Community Based Violence Intervention Initiative
    We respectfully request $250 million in FY 2023 for a Community 
Violence Intervention initiative as proposed in the President's budget 
request to implement evidence-based community violence interventions 
locally. BCHC whole-heartedly supports such an investment and believes 
it is critically important to have both funds at, and engagement of, 
the CDC's National Center for Injury Prevention, to complement efforts 
funded through the Department of Justice. Violence, like many public 
health challenges, is preventable. Yet, the majority of public 
investments are used to address the aftermath of violence, too often 
through systems that can cause further harm. By making investments in 
public health strategies within communities that are most impacted by 
violence, cities can work across sectors to shift from an overreliance 
on the criminal justice system and move from reimagining to realizing 
community safety.
                  center for preparedness and response
Public Health Emergency Preparedness Cooperative Agreements
    We respectfully request $1 billion in FY 2023 for the public health 
emergency preparedness (PHEP) grant program. PHEP provides funding to 
strengthen local and State public health departments' capacity and 
capability to effectively respond to public health emergencies, 
including terrorist threats, infectious disease outbreaks, natural 
disasters, and biological, chemical, nuclear, and radiological 
emergencies. PHEP funding has been cut by over 30 percent in the last 
decade. Recent events, such as the response to the COVID-19 pandemic, 
demonstrate the need to invest in these programs to rebuild and bolster 
our country's public health preparedness and response capabilities. 
America's public health preparedness systems are stretched to the brink 
and will need increased, predictable base funding for years to rebuild 
and improve. We also encourage the committee to include directive 
language to ensure these dollars reach the local level in those 
communities that are not directly funded, as well as have CDC better 
track and share publicly state expenditures.
  national center for chronic disease prevention and health promotion
Social Determinants of Health
    We respectfully request $153 million in FY 2023 for the Social 
Determinants of Health (SDOH) program in line with the President's 
request. CDC's SDOH program was initially funded in FY 2021 to 
coordinate CDC's activities and to begin to provide tools and resources 
to public health departments, academic institutions, and nonprofit 
organizations to address the social determinants of health in their 
communities. Local and State health and community agencies lack funding 
and tools to support these cross-sector efforts and are limited in 
doing so by disease-specific Federal funding. Given appropriate funding 
and technical assistance, more communities could engage in 
opportunities to address social determinants of health and preventable 
inequities in health outcomes. Contact: Chrissie Juliano, MPP, 
Executive Director, Big Cities Health Coalition.
                                 ______
                                 
           Prepared Statement of the Bipartisan Policy Center
    BPC is dedicated to finding bipartisan solutions to improve child 
care for children, families, educators, providers, and the broader 
economy. We know high-quality child care builds a strong foundation for 
young children and fundamentally supports the growth of their cognitive 
and social emotional development. There are more than 19 million 
children, or 27 percent of the U.S. population, under age 5 living in 
U.S. households and it is essential to both child development and a 
strong economic recovery that Congress ensure each of these children 
have access to high-quality child care.\1\ In order to achieve this, we 
urge the subcommittee to address critical areas of need in the fiscal 
year (FY) 2023 Labor, Health and Human Service, Education and Related 
Agencies appropriations bill.
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    \1\ Child population by age group in the United States | KIDS COUNT 
Data Center.
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    This testimony addresses two high-priority issues crucial to stable 
and thriving high-quality child care in our country. First is that the 
cost of care, which often exceeds what many parents can afford, 
freezing families out of the market without any high-quality care 
options to the most vulnerable populations. Second, the Nation is 
facing a shortage of safe and healthy child care facilities. While 
investments in facilities are critical, they are often not feasible for 
providers who are operating within a broken system and razor-thin 
profit margins. Consequently, providers do not have the capital to fund 
investments that prioritize the facility-related repairs, upgrades, 
renovations, and maintenance that meet modern safety and professional 
standards. Without the support of Congress, child care businesses will 
be unable to provide the necessary investment in facilities and 
parents, especially those in rural areas, will be denied access to the 
care they need. BPC believes it is essential to address both needs 
concurrently or the demand on child care will be overwhelmed by the 
lack of supply. For these reasons, BPC urges the subcommittee to double 
the discretionary funding for the Child Care Development Block Grant 
program (CCDBG), increase the Preschool Development Grant program (PDG) 
to $450 million, and provide $5 billion in dedicated funding to 
retrofit existing, and build new, child care facilities for FY 2023.
                     economic impact of child care
    As this subcommittee considers the FY23 allocations for child care 
programming, BPC urges it's members to weigh the impact lack of access 
to child care has on the Nation's post-pandemic economic recovery 
versus the costs of Federal support for increasing said access. While 
fundamental to the development of young children, access to child care 
as the Nation transitions away from remote work flexibilities can 
either serve as a barrier or present opportunities for employment. A 
BPC parent poll found 66 percent of parents said finding child care 
impacts the number of hours they can work, 50 percent said it affects 
whether they can search for a job, and 68 percent said it impacts 
whether they can stay in the workforce.\2\ In BPC's 2021 report ``Child 
Care in 35 States: What we know and don't know'' found that over 3.4 
million children (31.2 percent) with all available parents in the work 
force do not have access to a formal child care slot.\3\ The gap was 
higher in rural areas of the country and among women demonstrated by 
the fact that 1.3 million fewer mothers were employed in September 2021 
compared to before the pandemic began.\4\ Our survey data shows the gap 
is highest among women with children under two. If the child care gap 
is not addressed, based on lost income to parents, businesses, and 
taxpayers, BPC estimates an economic loss across 35 States over the 
next 10-years to be between $142.51 and $217.02 billion.\5\ This 
estimation is not adjusted for inflation and could be more severe.
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    \2\ https://bipartisanpolicy.org/blog/child-care-poll/.
    \3\ https://bipartisanpolicy.org/report/child-care-gap/.
    \4\ https://www.washingtonpost.com/politics/2021/11/08/why-havent-
us-mothers-returned-work-child-care-infrastructure-they-need-is-still-
missing/.
    \5\ https://bipartisanpolicy.org/download/?file=/wp-content/
uploads/2021/11/BPC-Economic-Impact-Report_R01-1.pdf.
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                             ccdbg and pdg
    Increases for both CCDBG and PDG would provide added stability and 
capacity to serve a greater number of qualifying families in need 
through high-quality care. Not adjusted for inflation, if Congress were 
to double the discretionary funding for CCDBG, BPC estimates that the 
U.S. Department of Health and Human Services (HHS) will likely be able 
to double the number of eligible children served. In addition to a 
greater investment for CCDBG, the increased funding for PDG will allow 
HHS to expand funding for the 28 States, Puerto Rico, and Guam which 
currently receive grants, as well as provide funding for almost all 
remaining States not currently funded.
    BPC also urges Congress to authorize HHS and the Department of 
Education to allow Large Tribes to apply for PDG funding. Large Tribes, 
including the Muscogee Creek Nation of Oklahoma, are responsible for 
overseeing access to and delivery of early learning programming for as 
many as 53,354 children aged 0-4 years--a number greater than some 
States--yet are still not eligible for PDG support. Moreover, a 2018 
report published by the Office of the Administration for Children and 
Families (ACF) found nearly one-third of American Indian and Alaska 
Native (AI/AN) young children live in households at or below the 
Federal poverty line.\6\ Additionally, only one-fifth of AI/AN young 
children were reported to have access to and attended an early care and 
learning program within a three-month period. BPC believes it is 
critical Congress address its systemic underfunding for AI/AN 
populations which begins with ensuring Large Tribes have equitable 
access to PDG funding.
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    \6\ https://www.acf.hhs.gov/sites/default/files/documents/opre/
14005_acf_opre_aian_ec_needs_brochure_v7_072418_508b.pdf.
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                         child care facilities
    Approximately 129,000 center-based child care programs serve nearly 
7 million children in the United States, and 1 million in-home 
providers care for 2.7 million children.\7\ It is imperative that the 
physical spaces where kids learn, play, and grow contribute to their 
cognitive development and social, emotional, and physical well-being. 
However, many children might not have access to services that promote 
early learning. Instead, young children may be exposed to health and 
safety issues including lead, mold, dust, or other environmental 
pollutants that could cause long-term health developmental 
consequences.
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    \7\ National Survey of Early Care and Education of 2012 (NSECE 
2012) | The Administration for Children and Families (hhs.gov).
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    As of 2018, the Environmental Protection Agency (EPA) reported that 
approximately 500,000 child care facilities are not regulated for lead 
in drinking water.\8\ Additionally, an investigation by HHS Office of 
the Inspector General found that across 10 States, 96 percent of child 
care centers inspected during unannounced visits had one or more 
potentially hazardous conditions and noncompliance with health and 
safety requirements.\9\ This is made worse because young children have 
frequent hand-to-mouth activity, meaning that potentially toxic or 
harmful substances within the facility have a high likelihood of being 
ingested. Other safety hazards include easily accessible electrical 
outlets, lead paint, unsafe play equipment, and open windows and 
gates.\10\
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    \8\ 3Ts for Reducing Lead in Drinking Water | US EPA.
    \9\ https://oig.hhs.gov/oei/reports/oei-03-16-00150.pdf.
    \10\ CIFBldgInfrastructureReport.pdf (cedac.org).
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    Due to razor-thin profit margins and a broken system where child 
care services have historically been undervalued, most providers do not 
have the ability to upgrade facilities and provide a competitive wage 
and increase access to meet the National need. Absent the necessary 
fiscal supports, providers will be unable to make facility-related 
repairs, upgrades, and renovations to meet safety standards. This lack 
of capital is compounded by the fact that more than 90 percent of child 
care businesses are women-owned and over half of the industry in 
minority-owned.\11\ This lack of access to capital is further 
exacerbated by gender- and race-based discriminatory small business 
lending practices and results in parents left with no other options 
other than to place their children in a potentially dangerous setting.
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    \11\ https://cdn.advocacy.sba.gov/wp-content/uploads/2016/09/
07141514/Minority-Owned-Businesses-in-the-US.pdf.
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    BPC estimates a total of $25 billion over a 5-year period is needed 
to address critical facilities needs. Beginning with $5 billion for FY 
2023, an estimated $14 billion of the $25 billion is needed to renovate 
existing facilities across the country to bring them up to professional 
standards with the remaining $11 billion contributing to increasing the 
supply of new facilities. This will result in 12,600 new center- and 
home-based child care facilities, an additional 656,000 additional 
child care slots, and has the potential to reduce the number of 
children without access to care by 12 percent.
    Increasing child care funding in FY 2023 is vital to the economic 
and social fabric of our Nation. After 2 years of living through 
endless challenges, unprecedented barriers to delivery of care, and 
exacerbated by the COVID-19 pandemic, the Nation recognizes the value 
of child care and the important role Congress plays in supporting 
families. Congress must provide a stable foundation for the child care 
system which is a pillar of a strong national recovery. We appreciate 
the subcommittee's bipartisan leadership and dedication to child care 
over the past 2 years and look forward to working together to improve 
our systems in order to better serve children and families.
                                 ______
                                 
           Prepared Statement of Blue Mountain Heart to Heart
    Chairwoman Murray, Ranking Member Blunt, and members of the 
subcommittee, my name is Everett Maroon and I serve as the Executive 
Director of Blue Mountain Heart to Heart (BMHTH), a nonprofit located 
in Walla Walla, Kennewick, and Clarkston, Washington, serving people 
living HIV/AIDS and people living with substance use disorder (SUD). I 
am pleased to submit testimony on behalf of the people I serve, my 
staff, my Board of Directors, and as a member of a large coalition of 
public health, HIV, viral hepatitis, and harm reduction organizations, 
to urge Congress to appropriate in fiscal year 2023 $150 million for 
the Infectious Diseases and the Opioid Epidemic program at the Centers 
for Disease Control and Prevention (CDC) in the Department of Health 
and Human Services (HHS). This funding would help to save lives and 
address the urgent overdose crisis by providing support and expanding 
access to effective overdose prevention and harm reduction services 
provided by syringe services programs (SSPs).
    No other public health intervention has been as thoroughly studied 
and examined in the last twenty-five years as SSPs. Notably, harm 
reduction work conducted at SSPs both satisfies classic public health 
objectives of primary, secondary, and tertiary health improvement 
(e.g., reduce the incidence of bloodborne pathogens, reduce the 
sequelae associated with needle use, and increase entry into treatment, 
respectively), and advances our understanding of real-time changes 
affecting our clients -front-line work that helps local and State 
public health jurisdictions ensure their work is relevant and useful. 
At BMHTH our strategic plan also includes reducing overdose and 
overdose death, and our hard work is showing success.
    By every metric, the environment in which SSP clients find 
themselves is collapsing. They report to my staff and me that they have 
shifted from prescribed opiates to heroin, and now to fentanyl in the 
form of counterfeit oxycontin. Synthetic opioids appear to be driving 
much higher rates of overdose and contributing more often now to 
overdose death. In Washington State, an analysis of 2020 data on 
accidental overdose showed fentanyl was present in 70 percent of the 
toxicology results on autopsy. Meanwhile the median age of overdose 
death in Washington State has dropped to 29, indicating that many young 
people probably have died from their drug use before realizing how 
serious their substance use had become.
    Earlier this month a young woman walked into a local SSP program 
and told me that she had overdosed on fentanyl the night before. I told 
her I was very glad to see her, since that was the case. She asked for 
naloxone. I gave her four kits of the reversal medication so she could 
bring some back to her friends who also use fentanyl and who live about 
90 minutes away. She mentioned that when she ``came to'' in the 
emergency department at the Walla Walla hospital, the doctor left her 
room quickly, crying. He returned shortly thereafter and explained that 
she was the first fentanyl overdose he'd been able to revive after 
losing six others--almost one person per day in his ER alone--in the 
preceding week.
    It is incredibly important for your subcommittee to understand how 
urgent the overdose crisis is right now, not just in Washington State, 
but across our Nation. Naloxone distribution is essential, and getting 
it to the communities most at risk is paramount. A 5-year SAMHSA grant 
in Washington State that concluded in August 2021, in which BMHTH 
participated, showed that 1 in 7 naloxone kits given to clients at SSPs 
was used to attempt an overdose reversal. Robust naloxone distribution 
is part of Washington State's current national drug control strategy as 
well as part of the Washington State opioid crisis response plan. SSPs 
like mine have saved lives and made a significant difference in our 
regions and we need more support now. Comprehensive services to 
increase access to drug treatment and recovery are also necessary, but 
we must save people's lives first so that they have the chance to 
benefit from these interventions.
    As a rural health provider who for the past 2 years has battled 
syndemic crises in HIV, hepatitis C, COVID-19, and the overdose crisis, 
I sincerely request that Congress provide the $150 million requested 
for the health of our communities in central and southeast Washington 
State and nationwide. We are exhausted, but steadfast in our commitment 
to keeping our community members alive and helping them on the pathway 
to health. I have met and talked to grandmothers who became addicted 
after knee replacement surgery, veterans who became addicted after 
three tours of duty in Iraq and surviving a shrapnel injury, nurses who 
started stealing medications because they'd experienced too much stress 
in the emergency department, a middle-aged man whose parents had 
injected him with heroin as a child to make him quiet down ... my list 
of stories is harrowing, and sadly, it is growing. We need real relief 
and support now.
    In Washington, our Attorney General has doggedly sued opioid 
distributors and manufacturers and won settlements. We hope that these 
gains will help fund life-saving services, but alone they won't restore 
our communities to their condition prior to the current crisis. Worse, 
COVID-19 has disrupted the ability of many community-based 
organizations to order naloxone while at the same time more fentanyl 
appeared in the drug market. There must be a robust Federal response to 
this unprecedented crisis both to save lives and build back our 
communities. Congress has the resources necessary to halt these 
dramatic losses and start needed healing.
    In the meantime, as of April 30, 2022, we have reports of more than 
230 overdose reversal attempts in southeast Washington with our 
naloxone distribution program, a trend that would bring us to 658 by 
the end of this year. In 2021 we saw 301 naloxone reversals. I cannot 
state clearly enough how quickly the environment is disintegrating with 
more than a doubling of overdoses expected based on current trends. The 
data are shown in the table below.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    As a service provider who provides harm reduction, low-barrier 
treatment, intensive case management, field-based counseling, law 
enforcement-assisted diversion, and jail-based opioid treatment, I have 
attempted to fill many of the gaps I see in my rural region of 
Washington State. I am doing everything in my power to support people 
at risk of overdose and death, but I am faced with limited Federal 
funding for SSPs and overdose prevention; work restrictions on 
providers of treatment medications that make finding local providers 
difficult; a fractured health care sector in my region; and a 
skyrocketing overdose rate.
    We know that people accessing SSPs are five times as likely to get 
into treatment and three times as likely to lower their drug use by 
frequency or quantity. A 2019 SSP survey conducted by the University of 
Washington showed that more than three quarters of SSP participants 
were somewhat or very interested in treatment. I urge you to please 
help me get them the life-saving care that they need now by fully 
funding the CDC's Infectious Diseases and Opioid Epidemic at $150 
million in FY 2023. Thank you so much for your time and consideration 
of my testimony.

    [This statement was submitted by Everett Maroon, Executive 
Director, Blue Mountain Heart to Heart, Walla Walla, WA.]
                                 ______
                                 
     Prepared Statement of the Brain Injury Association of America
    As the Nation's oldest and largest brain injury advocacy 
organization, the Brain Injury Association of America (BIAA) is 
submitting written testimony in support of increased funding for fiscal 
year 2023 appropriations for Federal programs that impact approximately 
2.87 million Americans who are treated annually in emergency 
departments and hospitals for a traumatic brain injury (TBI) and their 
families, who are generally the primary caregivers. While BIAA 
appreciates your support for additional funding for FY 2022 to the U.S. 
Department of Health and Human Services' (HHS) Administration for 
Community Living (ACL) TBI Programs, the total program amount does not 
support funding for all States and territories to participate in that 
program designed to improve access to rehabilitation and community 
services as intended by the Traumatic Brain Injury (TBI) Program 
Reauthorization Act of 2018.
    In addition, BIAA supports full funding for the National Concussion 
Surveillance System administered by the CDC's National Center for 
Injury Prevention and Control (NCIPC) in order to know the extent of 
concussions or mild TBI in this country so that we can better recognize 
and treat related symptoms. BIAA has also been a long supporter of the 
ACL's National Institute on Disability, Independent Living, and 
Rehabilitation Research (NIDILRR) program authorized by the Workforce 
Innovation and Opportunity Act (WIOA) of 2014, which funds research 
conducted by the TBI Model Systems. Specifically, BIAA urges:
  --$19 million additional funding for the ACL TBI State Partnership 
        Program to provide funding to all States, territories and 
        District of Columbia;
  --$5 million additional funding for the CDC's NCIPC to establish and 
        oversee a National Concussion Surveillance System as authorized 
        by the TBI Program Reauthorization Act of 2018; and
  --$6.6 million to expand the NIDILRR TBI research capacity through 
        the ACL TBI Model Systems (TBIMS) in order to increase the 
        number of TBIMS from 16 to 18 ($2.5 million each; and to expand 
        TBIMIS collaborative research projects for additional research 
        on TBI as a chronic condition ($1 million).
    A TBI can happen to anyone at any time and can lead to physical, 
cognitive, and psychosocial or behavioral impairments ranging from 
balance and coordination problems to loss of hearing, vision or speech. 
Fatigue, memory loss, concentration difficulty, anxiety, depression, 
impulsivity and impaired judgment are also common after brain injury. 
Even ``mild'' injuries or concussions can have devastating consequences 
that require intensive treatment and long-term care. Often called the 
``silent epidemic,'' brain injury affects people in ways that are 
invisible. The injury can lower performance at school and at work, 
interfere with personal relationships and bring financial ruin.
    The annual estimated cost to society exceeds $60 billion, and 
consumers mistakenly believe employer health plans or the government 
will pay for needed services in a health crisis. In reality, insurance 
policies are geared to wellness and routine care, strictly limiting the 
type, amount, and length of rehabilitation and post-acute brain injury 
services available to most people. Therefore, families and individuals 
living with brain injury generally look to public programs to address 
these gaps in service delivery.
    The following personal story explains all to well what can happen:
    ``I was in a really bad car accident on December 23rd, 2017. I 
still to this day have little to no memory of what happened, only from 
what I was told. It happened around 11pm, my ex-boyfriend was driving 
my car and somehow ran off the road, hit a tree, the car flipped the 
whole way around, I was immediately unconscious, he tried to drive away 
but the car was totaled. He took me out of the car and laid me on the 
side of the road while I was unconscious and bleeding internally, and 
he ran away, basically leaving me there for dead. A man in a nearby 
house heard what happened, came outside and saw me, called 911, my 
heart stopped beating 3 different times, I had to be airlifted to 
Hershey, I was immediately put into an induced coma which lasted 2 
weeks.
    I broke my spine, broke my neck, fractured my sternum and suffered 
a severe traumatic brain injury, I also had a minor stroke while I was 
in the coma which affected my whole right side. I lost my voice 
completely because I was on a ventilator for longer than your supposed 
to be, I had several skull fractures. I was then transferred to Hershey 
rehab hospital which I stayed for 3 months. Had to learn pretty much 
everything all over again. How to walk, write, spell, bath myself, 
dress myself, feed myself. I came home sometime in March of 2018, 
continued therapy. I'm still struggling with severe headaches, neck 
pain, everything that comes with a brain injury. That happened when I 
was 26, I'm 30 now. I was given very little hope of survival, but I'm 
still here, still alive, telling my story.''
    The causes vary from child abuse; motor vehicle crashes, falls, 
military-related injuries, violence, industrial injuries, and sports-
related injuries. No one is immune from this disability. Yet, there are 
few resources to support families and caregivers with assistance in 
early recovery and through the rehabilitation process, let alone long-
term care needs. The ACL TBI State Partnership Grant Program is the 
only program that assists States in building and expanding service 
capacity to address the complex needs associated with brain injury that 
generally require the coordination of multiple systems (e.g., medical, 
rehabilitation, education, vocational, behavioral health, and Medicaid/
Medicare) and payers (e.g., insurance, Workers' Comp, State and Federal 
programs). Twenty-eight States are currently funded by the ACL TBI SPP 
for 5 years. We are requesting additional funding so that all States, 
territories and District of Columbia may receive funding to address 
gaps in services within their States.
    CDC's National Injury Center initiated a pilot study as a first 
step in implementing a national surveillance system to determine the 
extent of mild brain injury or concussions in this country. Most 
individuals with a concussion are treated in an emergency department or 
physician's office and may not be reported in other data systems that 
capture the number of Americans who are hospitalized with moderate to 
severe TBI. Subsequently, Congress included $5 million authorization to 
implement the National Concussion Surveillance System within the TBI 
Program Reauthorization Act of 2018.
    NIDILRR supports innovative projects and research in the delivery, 
demonstration, and evaluation of medical, rehabilitation, vocational, 
and other services designed to meet the needs of individuals with TBI 
through TBI Model Systems grants. Each TBI Model System contributes to 
the TBI Model Systems National Data and Statistical Center (TBINDSC), 
participates in independent and collaborative research, and provides 
valuable information and resources. This research is critical to help 
TBI providers to better deliver services that result in good outcomes.
    The Brain Injury Association of America was founded in 1980 by 
individuals who wanted to improve the quality of life for individuals 
who had sustained brain injuries and their families. Today, the 
Association encompasses a nationwide network of more than 40 state 
affiliates sharing in the mission of creating a better future through 
brain injury prevention, research, education and advocacy. We urge you 
to consider increasing funding to the ACL TBI Program; the ACL NIDILRR 
program to expand TBI research; and to CDC to establish a National 
Concussion Surveillance System.
    Thank you for your continued support. Should you wish additional 
information, please do not hesitate to contact me at:Susan H. Connors, 
President/CEO, Brain Injury Association of America, Email 
[email protected].

    [This statement was submitted by Susan H. Connors, President/CEO, 
Brain 
Injury Association of America.]
                                 ______
                                 
                   Prepared Statement of Bridgercare
    Dear Chairwoman Murray and Ranking Member Blunt:
    As Executive Director of Bridgercare, I appreciate the opportunity 
to submit testimony in support of expanding the budget for the Title X 
family planning program (Office of Population Affairs, funded within 
the Health Resources and Services Administration account). We recognize 
and appreciate Chairwoman Murray's strong record of advocacy and 
leadership in fighting for family planning services and urge this 
subcommittee to take necessary action to move the program forward in 
this year's bill by appropriating the full $400 million requested by 
the Biden administration.
    Bridgercare is a nonprofit Title X clinic in Bozeman, Montana that 
has served our community for 50 years. Our mission is to provide 
excellent, affordable reproductive and sexual healthcare and education 
in a safe, supportive, empowering atmosphere. We serve over 5000 
patients a year, around half of whom receive care on our sliding fee 
scale where patient fees are based on income. We provide a wide range 
of services from annual wellness exams, to STI testing and treatment, 
to cancer screenings, genetic cancer counseling, pregnancy testing, 
gender-affirming care, behavioral health counseling, and more. And as 
of April of this year, we will steward Montana's Title X program in 
place of the State health department through a new statewide nonprofit, 
Montana Family Planning.
    Title X is the only Federal program solely dedicated to providing 
family planning services to people in the United States regardless of 
income. It was enacted with broad bipartisan support in 1970: sponsored 
by then-Representative George H.W. Bush and signed into law by 
President Nixon. Prior to Trump administration changes to the program 
in 2019, Title X served more than 4,000,000 patients across the 
country, and about 18,000 in Montana (a significant number in a State 
with a population of a little over a million). Title X clinics are 
invaluable resources in communities, serving a population of patients 
who often don't otherwise interact with the health care system. In 
2016, 60 percent of women who received contraceptive services at a 
Title X-supported provider had no other interaction with the medical 
system that year.\1\
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    \1\ Ruth Dawson, ``What Federal Policymakers Must Do to Restore and 
Strengthen a Title X Family Planning Program That Serves All,'' 
Guttmacher Institute (March 2021)
    https://www.guttmacher.org/gpr/2021/03/what-federal-policymakers-
must-do-restore-and-strengthen-title-x-family-planning-program.
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    However, changes to the Title X program in 2019 decimated the 
National network--Montana was no exception. Between 2018 and 2020, the 
amount of patients served by Montana Title X clinics decreased by a 
staggering 53 percent.\2\ We lost four clinics out of a network of 27. 
What this means in real terms is that thousands of Montanans were left 
without access to quality, affordable reproductive health care. Our 
desire to see the Title X program made whole again, and expanded, in 
Montana was a big factor in Bridgercare competing the state for 
stewardship of the program.
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    \2\ Brittni Frederiksen, Ivette Gomez, and Alina Salganicoff, 
``Rebuilding Title X: New Regulations for the Federal Family Planning 
Program,'' Kaiser Family Foundation (November 2021)
    https://www.kff.org/womens-health-policy/issue-brief/rebuilding-
title-x-new-regulations-for-the-federal-family-planning-program/.
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    Since being awarded the Title X grant for Montana by HHS, we've 
already had five clinics reach out asking to join our network, and are 
well on our way to rebuilding Title X in Montana--we intend to grow the 
number of Montanans served by 10-15 percent each year for the next 5 
years. Further, we'll develop a stronger administrative structure to 
respond to the diverse needs of providers across the State; we'll 
allocate dollars through clear, transparent means and ensure that Title 
X funds achieve their maximum possible return on investment in Montana. 
We'll focus on bolstering Title X services in rural, frontier, and 
Tribal communities and adolescent, Indigenous, and other underserved 
populations.
    Expanding the Federal Title X program budget to $400 million will 
likely coincide in a larger disbursement to Montana's Title X program, 
helping us to increase support for our subrecipients in every part of 
our state, and bolster investments in expanding reproductive health 
care access to historically underserved communities. We hope that this 
subcommittee will seize this opportunity to invest in quality, 
affordable reproductive health care for millions of people across the 
country. For more information, please contact: Stephanie McDowell, at 
[email protected].
    We thank you for your consideration of this request.
    Sincerely.

    [This statement was submitted by Stephanie McDowell, Executive 
Director, Bridgercare.]
                                 ______
                                 
                       Prepared Statement of CAST
    Since 1984, CAST (originally the Center for Applied Special 
Technology) has worked tirelessly to ensure that our Nation is one 
where learning has no limits for any individual. We pioneered Universal 
Design for Learning (UDL), a framework for inclusive design of learning 
and training environments that harnesses technology and instructional 
practices to remove barriers to learning in digital as well as physical 
settings. UDL is now incorporated in key Federal education, career 
training, and workforce laws.\1\ UDL provides principles and guidelines 
to support innovation and success by expanding and strengthening 
preschool to post-secondary education as well as career training 
opportunities, including access to Science, Technology, Engineering and 
Math (STEM) for all individuals across the Nation.
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    \1\ See: Public Law 110-315, Public Law 113-228, Public Law 114-95, 
Public Law 115-224, National Education Technology Plan 2021, U.S. 
Department of Education.
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    Our aim is to create a level playing field where all learners have 
equitable opportunities to succeed by expanding access and opportunity 
to education and employment for all individuals, including those 
historically marginalized due to race, language, income, or disability. 
UDL encourages the design of flexible learning environments that 
anticipate learner variability and provide alternative routes or paths 
to success. UDL acknowledges that variability across all learners is 
the norm rather than the exception.
    In support of its important portfolio of projects that include 
investments at the Federal level, in fiscal year 2023, CAST makes two 
recommendations for the U.S. Department of Education:
    (1)  Include funding for a pilot to comprehensively develop and 
systemically embed the UDL framework across multi-State/multi-district/
Tribal government [K-4 classrooms] as part of in-person, hybrid, or 
virtual learning environment(s) for a minimum of 3 years. The pilot 
will utilize the evidence-based principles, flexible scaffolds, and 
supports of UDL and will be awarded to States/districts/Tribal 
governments to support the full access of students with disabilities to 
the general curriculum, and to support all learners at-risk due to 
experiencing barriers to learning because of language, literacy, 
socioeconomic factors, or disability.
    (2)  Fund education programs to sufficiently support States in 
their efforts to train personnel and educate all K-12 students. Key 
programs are:
(A) Elementary and Secondary Education
    --Title I: $36.5 billion for students to access a quality 
            education, and
    --Title II: $2.5 billion to support teacher professional learning 
            and student access to literacy, evidence-based instruction 
            and practices including UDL.
    --Results for the Nation (LEARN): $192 million to improve English 
            Language Arts.

Examples of UDL funded in K-12 schools (via ESSA's Title I/II and/or 
combined Federal and State funding).
California:
  --The California Coalition for Inclusive Literacy has trained more 
        than 30 County Office of Education staff to become UDL coaches 
        in five counties across the State.
  --The Far North Literacy Consortium in Northern California works with 
        five counties to implement UDL district-wide in rural areas of 
        the state.
  --With joint funding from the National Science Foundation Co-Organize 
        Your Learning (CORGI) enhances engagement and learning through 
        a Google application (app) designed for students and teachers 
        to use and collaboratively answer questions requiring higher 
        order reasoning.
New Hampshire:
  --The NH UDL Innovation Network brings CAST together with 70 schools 
        and 500 educators across the State. Participants engage with a 
        small team from their school to learn what UDL is and how to 
        apply it in their K-12 learning environments. Through 
        collaborative school-based instructional rounds, online 
        learning, statewide workshop days, and team-supported 
        reflective practice, participants work to transform their 
        classrooms for greater access and to support student agency.
(B) Individuals with Disabilities Education Act (IDEA):
    --Part B Section 611: $16.2 billion-to place the IDEA on a glide 
            path to full funding (or 40 percent of the per pupil 
            expenditure promised to districts when the IDEA was first 
            passed in 1975).
    --Part D-National Activities: To provide the infrastructure to 
            implement programs for students with disabilities through 
            professional development, technical assistance, and more. 
            Recommendations are:
      -- State Personnel Development: $39 million.
      -- Technical Assistance and Development: $49 million.
      -- Personnel Preparation: $300 million
      -- Parent Training and Information Centers: $45 million
      -- Media and Technology: $32 million

Examples of UDL funded under IDEA Part D:
    --The National Center on Accessible Education Materials (AEM 
            Center) provides technical assistance, coaching, and 
            resources to increase the availability and use of 
            accessible educational materials and technologies for 
            learners with disabilities across the lifespan. The 
            Center's Quality Indicators provide practitioners, 
            administrators, researchers, policymakers, and parents/
            caregivers with actionable steps toward increasing the 
            availability and use of accessible materials and 
            technologies from early learning through postsecondary 
            education and workforce development.
    --The Center on Inclusive Software for Learning has created and 
            launched Clusive, a free, flexible, adaptive, and 
            customizable digital learning environment. Students can use 
            Clusive to read assigned or free-choice books and articles, 
            build their own personal library, and take advantage of 
            Clusive's growing public library. Clusive helps learners 
            build self-awareness through discovering, choosing, and 
            using preferences that help build learning skills.
(C) Career and Technical Education (CTE):
    --State Grants and National Programs: $1.6 billion so States can 
            develop career training pathways responsive to the needs of 
            business and of learners that include a diverse population 
            who may experience barriers such as poverty, low literacy, 
            language and/or disability.

Examples of UDL in CTE: CAST's work with States, school districts and 
private partners increases access to well-designed curriculum and 
career training incorporating UDL that is especially focused on diverse 
youth and young adult learners. Two recent examples are:
    --Outdoor Recreation Pathways (Tillotson Foundation): The project 
            brings together outdoor recreation industry professionals, 
            students, and educators to develop competencies and outline 
            a CTE pathway into high-wage high-demand careers in this 
            emerging field for youth in New Hampshire.
    --BioFab Explorer: BioFab Explorer is a free educational resource 
            developed in partnership with industry members from the 
            Advanced Regenerative Manufacturing Institute (ARMI)/Biofab 
            USA, as well as in collaboration with CTE educators and 
            their students in New Hampshire. This free career 
            exploration resource is meant to attract high school 
            students into biomanufacturing. Biofab Explorer embeds UDL 
            by providing learners with several pathways through the 
            content and allowing everyone to build a customized user 
            experience. Information is presented through multiple 
            modalities to provide users with choices that best meet 
            their needs.
(D) Vocational Rehabilitation:
    --Demonstration and Training Programs: $40.8 million for grants to 
            spur innovative approaches and new partnerships that 
            address long-term barriers as well as novel challenges that 
            limits employment of individuals with disabilities.
    CAST appreciates the subcommittee's consideration and urges a 
continuing investment in educational innovations that incorporate 
effective implementation of UDL while prioritizing the need to include 
UDL as part of the infrastructure of workforce and CTE faculty training 
makes sense.
    As the subcommittee considers funding for career training and 
employment, CAST makes the following recommendation for the U.S. 
Department of Labor (DOL): Provide increased investments in research as 
well as career-exposure and training for eligible youth, young adults 
and adults who may experience barriers due to educational access/
completion, literacy and/or disability. Key programs are:
    (A) Office of Disability Employment Policy:
    --Research and Demonstration: $9 million to continue to develop, 
            influence and expand employment-related policies and 
            practices so that every youth, young adult, and adult with 
            a disability gains access to career training and STEM 
            career experiences.
    (B) YouthBuild: $145 million to support grants that provide work-
based pre-apprenticeships, in support of unemployed youth and those who 
left high school prior to graduation.
    (C) Job Corp: $1.6 billion to ensure participants receive training 
that reflects the labor market's need for in-demand skills conveyed by 
up-to-date industry standards including creating proactive and 
innovative partnerships that further modernize its training and connect 
industry leaders to a diverse student body.

Examples of UDL funded by DOL:
    --CEE-STEM: An Online STEM Career Exploration and Readiness 
            Environment for Opportunity Youth is a web-based STEM 
            Career Exploration and Readiness Environment to promote 
            STEM understanding and knowledge as a part of classroom and 
            career training for out of school youth. CAST, UMass 
            Amherst College of Education, and YouthBuild USA developed 
            the CEE-STEM project and utilized the UDL framework to 
            create a personalized and portable digital tool for youth 
            to explore STEM careers, demonstrate STEM learning, reflect 
            on STEM career interests, and take actions to move ahead 
            with STEM career pathways of interest. Going beyond the 
            pilot, a customized version of the tool was also developed- 
            to align with alternative careers, industries, or 
            educational environments, and allows use of the e-portfolio 
            for other purposes and populations. The e-portfolio was 
            also piloted in two high school CTE settings and a 
            registered pre-apprenticeship setting.
    --The Wisconsin Regional Training Partnership supports the 
            implementation of CAST's UDL e-portfolio in pre-
            apprenticeship programs in Wisconsin and Minnesota to help 
            prepare and assess preparedness for the Industrial 
            Maintenance Technician apprenticeship pathway. Partners are 
            Jobs for the Future and SPR under the Apprenticeship 
            Inclusion Models grant funded by the Office of Disability 
            Employment within DOL.
    CAST urges the subcommittee to further invest in programs that 
expand the use of the UDL framework. In doing so, Congress would 
increase the capacity of States, districts, schools and career training 
programs to provide more robust professional learning and other needed 
technical assistance so that teachers have the tools and resources they 
need to teach and provide educational support to all learners. It is 
imperative that all youth and young adults, including first-time career 
seekers or those desiring new opportunities, have access to workforce 
development and career pathway strategies and programs that are 
designed from the beginning with their learning variability in mind.
    CAST appreciates the opportunity to provide testimony to the 
subcommittee for the fiscal Year2023 appropriations bill. We look 
forward to working with you as you develop a final appropriations bill 
that recognizes UDL as an integral component to K-16 education, and to 
increasing and sustaining a well-trained and vital workforce. Sherri 
Wilcauskas, [email protected], www.cast.org
                Prepared Statement of the CDC Coalition
    The CDC Coalition is a nonpartisan coalition of organizations 
committed to strengthening our Nation's prevention programs. We 
represent millions of public health workers, clinicians, researchers, 
educators and citizens served by CDC programs. We believe Congress 
should support CDC as an agency, not just its individual programs. We 
urge a funding level of at least $11 billion for CDC's programs in FY 
2023 to help ensure the agency has adequate resources for its many 
important programs to improve the public's health. We appreciate the 
increases provided for some CDC programs in FY 2022 and we urge 
Congress to continue efforts to build upon these investments and 
increase funding to strengthen all of CDC's programs.
    CDC serves as the command center for the Nation's public health 
defense system against emerging and reemerging infectious diseases as 
well as man-made and natural disasters. From playing a leading role in 
aiding in the surveillance, detection and mitigation of the COVID-19 
pandemic in the U.S. and globally, to monitoring and investigating 
other disease outbreaks, to pandemic flu preparedness, CDC is the 
Nation's--and a global--expert resource and response center, 
coordinating communications and action and serving as the laboratory 
reference center. CDC serves as the lead agency for bioterrorism and 
public health emergency preparedness and response programs and must 
receive sustained support for these critical programs. We urge you to 
provide adequate funding for the Public Health Emergency Preparedness 
grants which provide resources to our State and local health 
departments to help them protect communities in the face of public 
health emergencies. We also urge you to provide adequate funding for 
CDC's infectious disease, laboratory and disease detection capabilities 
to ensure we are prepared to tackle both ongoing COVID-19 pandemic and 
other public health challenges and emergencies that will likely arise 
during the coming fiscal year.
    We thank you for your support for important public health 
infrastructure programs including the Public Health Infrastructure and 
Capacity program which will provide flexible funding to strengthen core 
public health infrastructure and capacity needs at all levels of 
government, the Public Health Workforce and Career Development program 
to ensure the Nation has a strong and well-trained workforce and Public 
Health Data Modernization Initiative is helping to build a world-class 
and modern data infrastructure system to ensure all systems can 
communicate and share data seamlessly with one another to adequately 
respond to the next public health emergency.
    Injuries are the leading causes of death for people ages 1-45. 
Unintentional and violence-related injuries, such as older adult falls, 
firearm injury, child maltreatment and sexual violence, account for 
nearly 27 million emergency department visits each year. CDC reports 
that in 2019, the total economic cost of both fatal and nonfatal 
injuries totaled $4.2 trillion. In 2021, drug overdoses killed more 
than 100,000 individuals nationwide. CDC provides States with resources 
for opioid and other drug overdose prevention programs and to ensure 
that health providers to have information to improve opioid prescribing 
and prevent addiction and abuse. In 2022, there were 45,222 firearm-
related fatalities in the U.S. We thank Congress for providing CDC with 
dedicated funding for firearm morbidity and mortality prevention 
research and strongly urge you to increase funding in FY 2023 to $35 
million at CDC. The National Center for Injury Prevention and Control 
must be adequately funded to conduct research, prevent injuries, 
address the Nation's drug overdose epidemic and help save lives.
    In 2020, 696,962 people in the U.S. died from heart disease, the 
Nation's number one cause of death. More males than females died of 
heart disease in 2020, while more females than males died of stroke 
that year. Stroke is the fifth leading cause of death and is a leading 
cause of disability. In 2020, 160,264 people died of stroke, accounting 
for about one of every 19 deaths. Annually, heart disease and stroke 
cost the U.S. an estimated $378 billion in health care and lost 
productivity. CDC's Heart Disease and Stroke Prevention Program; 
WISEWOMAN; Division of Nutrition, Physical Activity, and Obesity; and 
Million Hearts improve cardiovascular health and we urge you to provide 
adequate funding for these important lifesaving programs.
    More than 1.9 million new cancer cases and over 609,000 deaths from 
cancer are expected in 2022. The amount spent on cancer related 
healthcare is expected to grow from $183 billion in 2015 to $246 
billion in 2030--an increase of 34 percent. CDC funds all 50 States, 
DC, 7 Tribes and Tribal organizations and 7 U.S. territories and 
Pacific Island jurisdictions to develop comprehensive cancer control 
plans. The National Breast and Cervical Cancer Early Detection Program 
helps millions of low-income, uninsured and medically underserved women 
access lifesaving breast and cervical cancer screenings and provides a 
gateway to treatment and the Colorectal Cancer Control Program improves 
screening rates among targeted, low-income populations aged 50-75 
years.
    Cigarette smoking causes more than 480,000 deaths each year. CDC's 
Office of Smoking and Health funds important programs and education 
campaigns such as the Tips From Former Smokers campaign which has 
already helped more nearly one million individuals quit smoking and 
millions more to make a serious quit attempt. Congress must continue to 
support these and other programs to reduce the enormous health and 
economic costs of tobacco use in the U.S.
    Of the more than 37 million Americans living with diabetes, more 
than 8.5 million cases are undiagnosed. Diabetes is the leading cause 
of kidney failure, nontraumatic lower-limb amputations, and new cases 
of blindness among adults in the U.S. and the total direct and indirect 
costs associated with diabetes were $327 billion in 2017. We urge you 
to provide adequate resources for CDC's Division of Diabetes 
Translation and the National Diabetes Prevention Program which fund 
critical diabetes prevention, surveillance and control programs.
    CDC provides national leadership in helping control the HIV 
epidemic by working with community, state, national, and international 
partners in surveillance, research, prevention and evaluation 
activities. CDC estimates that about 1.2 million Americans are living 
with HIV with more than 13 percent undiagnosed. Prevention of HIV 
transmission is the best defense against the AIDS epidemic. Sexually 
transmitted diseases continue to be a significant public health problem 
in the U.S. Nearly 26 million new infections occurred in 2018. STDs, 
including HIV, cost the U.S. healthcare system almost $16 billion 
annually in direct lifetime medical costs.
    The National Center for Health Statistics collects data on chronic 
disease prevalence, health disparities, emergency room use, teen 
pregnancy, infant mortality and causes of death. The health data 
collected through the Behavioral Risk Factor Surveillance System, Youth 
Risk Behavior Survey, Youth Tobacco Survey, National Vital Statistics 
System, and National Health and Nutrition Examination Survey must be 
adequately funded.
    CDC's REACH program helps communities address serious disparities 
in infant mortality, breast and cervical cancer, cardiovascular 
disease, diabetes, HIV/AIDS and immunizations by supporting community-
based interventions and we urge the committee to provide continued 
funding for these important activities.
    We thank the committee for its investment in the Social 
Determinants of Health program and urge you to increase funding for the 
program to ensure that public health departments, academic institutions 
and nonprofit organizations are supported to address the SDOH that 
contribute to high health care costs and preventable inequities in 
health outcomes.
    CDC oversees immunization programs for children, adolescents and 
adults, and is a global partner in the ongoing effort to eradicate 
polio worldwide. Childhood immunizations provide one of the best 
returns on investment of any public health program. For every dollar 
spent on childhood vaccines to prevent 13 diseases, more than $10 is 
saved in direct and indirect costs. Over the past 20 years, CDC 
estimates childhood immunizations have prevented 732,000 deaths and 322 
million illnesses. We urge you to provide adequate funding for the 
Section 317 Immunization program and other efforts to prevent vaccine-
preventable disease.
    Birth defects affect one in 33 babies and are a leading cause of 
infant death in the U.S. Children with birth defects that survive often 
experience lifelong physical and mental disabilities. Approximately one 
in six U.S. children is living with at least one developmental 
disability and one in four adults live with a disability. The National 
Center on Birth Defects and Developmental Disabilities conducts 
programs to prevent birth defects and developmental disabilities and 
promote the health of people living with disabilities and blood 
disorders.
    CDC's National Center for Environmental Health funds programs to 
control asthma, protect from threats associated with climate change and 
reduce, monitor and track exposure to lead and other environmental 
health hazards. Increased funding for all NCEH programs is critical to 
protecting the public from environmental health hazards and reducing 
illness, disease, injury and even death.
    To meet the many ongoing public health challenges facing the 
Nation, including those outlined above, we urge you to provide at least 
$11 billion for CDC's programs in FY 2023.

    [This statement was submitted by Don Hoppert, Director of 
Government 
Relations, American Public Health Association.]
                                 ______
                                 
  Prepared Statement of the Centers for Disease Control and Prevention
    Dear Chairwoman Murray, Ranking Member Blunt and Members of the 
subcommittee:
    The Tourette Association of America (TAA) would like to take this 
opportunity to thank the members of the subcommittee for the 
opportunity to submit written testimony and for considering our request 
for funding for Fiscal Year 2023 (FY23). The Centers for Disease 
Control and Prevention (CDC) play a pivotal role in educating the 
public. To that end, the Tourette Syndrome Public Health Education and 
Research Program at the CDC is critically important to the TS and Tic 
Disorder community. We respectfully request that you increase funding 
to a $2.5 million appropriation for the program in FY23 Labor, Health 
and Human Services (LHHS), Education and Related Agencies 
Appropriations. The program on Tourette Syndrome is administered within 
the National Center on Birth Defects and Developmental Disabilities 
(NCBDDD) at the CDC, in partnership with the TAA. This program was 
established by Congress in the Children's Health Act of 2000 (Public 
Law 106-310 Title 23) and is the only such program that receives 
Federal funding for Tourette Syndrome (TS) public health education. The 
program has been flat funded since Fiscal Year 2015. The additional 
$500,000 would fund: (1) a systemic literature review to determine 
prevalence of TS and tic disorders, (2) a systematic literature review 
to document cost and impact of TS and tic disorders, (3) small grants 
to pilot innovative approaches at Centers of Excellence (CoE) in 5-7 
States to address priority needs including health equity, transition, 
and suicide prevention among families affected by TS and tic disorders 
through CoEs, and (4) two new Continuing Medical Education (CME) 
modules to serve U.S. providers to increase providers' ability to 
identify, diagnose and treat tics and tic disorders. With your support 
at the increased level of $2.5 million, CDC can ensure critically 
necessary progress continues in the areas of public education, research 
and diagnosis for TS and Tic Disorders.
    The TAA is the premier national non-profit organization working to 
make life better for all people affected by TS and Tic Disorders. We 
have served in this capacity for 50 years. Tics are involuntary, 
repetitive movements and vocalizations. They are the defining feature 
of a group of childhood-onset, neurodevelopmental conditions known 
collectively as Tic Disorders and individually as Tourette Syndrome, 
Chronic Tic Disorder (Motor or Vocal Type), and Provisional Tic 
Disorder. People with TS and Tic Disorders often have substantial 
healthcare costs across their lifespan for healthcare visits, special 
educational services, medication, and psychological and behavioral 
counseling. In a recent survey conducted by the TAA (2018 TAA Impact 
Survey: https://tourette.org/research-medical/impact-survey/), 63 
percent of parents struggle to cover the high costs of services for 
their child such as counseling, appointments and tutoring; 34 percent 
of parents report they lost their job or they are not able to work as 
often due to the increased caregiver duties of having a child living 
with TS; and, 18 percent of parents are not able to afford medications 
and/or desired medical care for their child. A recent Coronavirus 
impact survey, conducted by TAA (https://tourette.org/coronavirus-and-
tourette-syndrome/), found that 82 percent of respondents said their 
tics or other symptoms worsened during the pandemic.
    The CDC Tourette Syndrome Website (https://www.cdc.gov/ncbddd/
tourette/data.html) on data and statistics States that data suggest 
roughly 50 percent of children and teens with TS are not diagnosed. 
Studies including children with both with diagnosed and undiagnosed TS 
have estimated that 1 out of every 162 children (0.6 percent) have TS. 
However, these numbers do not include children with Chronic or 
Provisional Tic Disorders. The estimated combined total of all school-
aged children with TS or another related Tic Disorder is approximately 
1-in-100. Factoring in lifelong prevalence, we estimate 1 million 
adults and children are living with Tourette Syndrome or another Tic 
Disorder in the United States today. These statistics outline the need 
for additional research on prevalence. Diagnosis is often complicated. 
Among children diagnosed with TS, 83 percent have been diagnosed with 
at least one additional mental, behavioral, or developmental condition 
according to the CDC website. These co-occurring conditions include 
Attention Deficit-Hyperactivity Disorder (ADHD), Obsessive Compulsive 
Disorder (OCD), Autism, Oppositional Defiance Disorder, anxiety, 
depression, learning difficulties among others and can significantly 
impact the lives of those affected by TS. In fact, in TAA's 2018 Impact 
Survey, 42 percent of children felt that dealing co-occurring 
conditions was one of the biggest challenges in managing TS. In 
addition, 32 percent of children and 51 percent of adults have 
considered suicide or participated in self-harming behaviors. This 
underscores the need to increase the diagnosis rate so physicians, 
teachers and parents can ensure that adequate support services are in 
place. The CDC TS Program works to ensure primary care, family doctors 
or pediatricians are equipped with the additional knowledge necessary 
either to diagnose or to refer a patient for optimal treatment.
    Education professionals often do not receive detailed instruction 
on how to assess and accommodate students who may have TS and Tic 
Disorders. A study published in the Journal of Developmental & 
Behavioral Pediatrics and written in partnership between the CDC and 
the Tourette Association of America, ``Impact of Tourette Syndrome on 
School Measures in a Nationally Representative Sample'', found children 
with Tourette were more likely to have an individualized IEP, have a 
parent contacted about school problems and have incomplete homework as 
compared to children without Tourette or a Tic Disorder. Additionally, 
most children with Tourette Syndrome had other mental, behavioral, or 
emotional disorders or learning and language disorders. In TAA's 2018 
Impact Survey, 83 percent of children felt that TS negatively impacted 
their school experience and education and 69 percent of parents noted 
their child having an individualized education plan (IEP) or 504 plan 
in place at their school. Educators spend a significant amount of time 
with their students providing more opportunities to assess symptoms and 
behavior over a longer period of time. By increasing their knowledge 
base and understanding of Tourette Syndrome, Tic Disorders and 
associated co-morbidities, educators can refer students for medical 
assessment and can also better serve the needs of this population whose 
challenges are unique to the disorder. Educators can then begin to work 
more closely with medical providers to develop effective, 
individualized education plans.
    TS and Tic Disorders are greatly misunderstood and often suffer 
from misinformation and stigma. For example, coprolalia, the 
involuntary utterance of obscene and socially unacceptable words and 
phrases, is an extreme and rare symptom often sensationalized by the 
media. Less than 10 percent of those diagnosed have this symptom, it is 
not required for diagnosis, and does not persist in many cases. The CDC 
TS Public Health, Education and Research Program provides important 
information on symptoms/diagnostic criteria on their website and 
through the outreach program educating the public and parents on 
Tourette Syndrome and Tic Disorders to ensure a better understanding 
which can lead to better diagnosis, earlier treatment and a better 
understanding.
    Delayed diagnosis or the lack of diagnosis can increase health care 
costs, increase education costs and delay important treatment and 
therapy for the patient. Comprehensive Behavior Intervention for Tics 
(CBIT) is a non-medicated treatment consisting of three important 
components: training the patient to be more aware of his or her tics 
and the urge to tic; training patients to do competing behavior when 
they feel the urge to tic; and, making changes to day-to-day activities 
in ways that can be helpful in reducing tics. CBIT is now recognized as 
a first line treatment by the American Academy of Neurology: https://
www.aan.com/Guidelines/Home/GuidelineDetail/958. The CDC Tourette 
Syndrome Public Health, Education and Research Program strives to 
increase the understanding and awareness among these critically 
important medical and education professionals to increase the 
percentage of school aged children with TS who are diagnosed, improve 
the timeframe from symptoms to diagnosis and educate them about 
treatment options like CBIT.
    We appreciate the opportunity to submit testimony and appreciate 
your thoughtful consideration of our request. TAA urges you to provide 
continued funding for Fiscal Year 2023 for the Tourette Syndrome Public 
Health Education and Research Program at CDC's National Center for 
Birth Defects and Developmental Disabilities at the increased level of 
$2.5 million.
                                 ______
                                 
               Prepared Statement of Choose Healthy Life
              summary of fiscal year 2023 recommendations
_______________________________________________________________________

  --Please provide the National Institutes of Health (NIH) with at 
        least $49 billion to facilitate continued growth in rare 
        disease research activities.
    --Please provide proportional increases for the individual NIH 
            institutes and centers, and $660 million for the National 
            Institute on Minority Health and Health Disparities (NIMHD) 
            consistent with the administration's budget request.
    --Please provide a separate, meaningful increase to advance and 
            adequately support the emerging Advanced Research Projects 
            Agency for Health (ARPA-H).
  --Please provide the Centers for Disease Control and Prevention (CDC) 
        with at least $11 billion to support public health efforts.
    --Please provide proportional increases for the individual CDC 
            centers, please continue to support the Ending the HIV 
            Epidemic Initiative, and please provide the Social 
            Determinants of Health program with $150 million consistent 
            with the administration's budget request.
  --Provide the Health Resources and Services Administration (HRSA) 
        with a funding level of at least $9.8 billion
  --Please continue to provide meaningful funding to support ongoing 
        COVID-19 response activities.
  --Please establish a faith and community-based Health Equity 
        Innovation Fund of at least $100 million. The fund will provide 
        resources to organizations that created a health workforce to 
        address COVID-19 in underserved communities and now need 
        resources to sustain that workforce as it addresses the 
        underlying health inequities that led to the disproportionate 
        morbidity and mortality the communities faced during the 
        pandemic.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to present the 
written testimony of Choose Healthy Life. On behalf of the communities 
we serve, we deeply appreciate the FY 2022 research and public health 
funding for COVID, for infectious diseases, for health equity, and for 
chronic conditions. As you work with your colleagues on FY 2023 
appropriations, please continue to invest in public health and support 
organizations conducting innovative faith-based and community outreach.
About Choose Healthy Life
    Choose Healthy Life (CHL) is a Black church initiative that ensures 
churches--the oldest and most trusted institutions in the Black 
community--receive the necessary resources, training, and support to 
address COVID-19 and other health inequities by making available health 
services to hard-to-reach communities.
    With funding from the Quest Diagnostics Foundation, in January 
2021, CHL established a full-time faith-based health workforce 
initially in fifty (50) Black churches in five major cities focused on 
administering COVID-19 testing and vaccination.
    Based on the early success of the program, CHL churches were 
visited by both VPOTUS and FLOTUS, and in August 2021, CHL received 
funding from HRSA and grew its workforce to 120 churches across 13 
States and the District of Columbia.
    Since launch, CHL has conducted nearly 2,500 testing/vaccination 
events and administered over 90,000 COVID-19 tests and vaccinations 
through its churches.
    Choose Healthy Life, founded by Debra Fraser-Howze, is guided by 
its 10-member National Black Clergy Health Leadership Council that is 
co-chaired by Rev. Al Sharpton (National Action Network) and Rev. 
Calvin O. Butts III (The Abyssinian Baptist Church, Harlem, NY).
    Advising the clergy is an acclaimed Medical Advisory Board that 
includes former HHS Secretary Dr. Louis Sullivan, former CDC Director 
Dr. Tom Frieden, our Nation's first female medical doctor to serve in 
congress Dr. Donna Christensen, Co-founder of the Black Coalition 
Against COVID-19 Dr. Reed Tuckson and the Nation's top obesity medicine 
expert Harvard Medical School's Dr. Fatima Cody Stanford. Choose 
Healthy Life demonstrates the power that comes from the union of 
bringing faith and science together to address health disparities.
    As the COVID-19 pandemic enters the endemic phase, CHL is pivoting 
its faith-based health workforce to focus on addressing key underlying 
health inequities--specifically obesity, diabetes, hypertension, 
maternal and mental health.
    As stated by CDC Director Dr. Rochelle Walensky, ``Your model of 
establishing in each church a full-time public health navigator ... 
trained and charged with providing access to COVID-19 testing and 
vaccinations in the immediate short-term while addressing other health 
disparities in the long term ... is a sustainable, scalable, and 
transferable approach to address public health disparities and 
inequities in the Black community ... it will serve us well far beyond 
the pandemic.''
About Health Disparities & CHL Support
  --Healthcare outcomes in the Black community lag far behind 
        healthcare outcomes in comparison to the White population:
  --Adults are 30 percent more likely to be obese
  --60 percent more likely to be diagnosed with diabetes
  --Men are 30 percent and women 60 percent more likely to have high 
        blood pressure, with women twice as likely to have stroke
  --Women are 40 percent more likely to die of breast cancer
  --Twice as likely to die from COVID-19 and less likely to be 
        vaccinated
About The Black Clergy Action Plan to Eliminate COVID-19 and Address 
        Health Equity
  --The Black church is the oldest and most trusted institution in the 
        Black community and has the power to influence and drive change
  --Establishes a health workforce in the Black Church to deliver 
        vaccinations, testing, and to provide health services through 
        local partners to those most in need
  --Ensures that Churches are funded to sustain and build out its 
        health services offering and effectively measure local impact
  --Raises awareness and educate the Black clergy and community about 
        COVID-19 and other health disparities
  --Establish a network of trusted health navigators in the Black 
        church to develop and execute a Community Solutions Action Plan 
        (CSAP) to effectively measure local impact
  --Proactively engages high-risk communities through COVID-19 testing/
        vaccination campaigns with the goal of stopping the spread of 
        the virus and establishing pandemic preparedness
  --Informs, educates and addresses health inequities that exist within 
        the community (i.e. obesity, diabetes, and hypertension) 
        through preventative health care and wellness outreach
About the Health Equity Innovation Fund
    The Health Equity Innovation Fund will provide resources to 
organizations that created a health workforce to address COVID-19 in 
underserved communities and now need resources to sustain that 
workforce as it addresses the underlying health inequities that led to 
the disproportionate morbidity and mortality the communities faced 
during the pandemic. Many of these organizations sprung to life from 
within the community with private support to immediately address the 
pandemic. They have been results oriented, culturally competent, and 
directed by trusted leaders in the community. Too often the government 
provides resources to address challenges in underserved communities 
during a time of crisis and then abandons them after the crisis is 
over. The government needs to invest in those that are having an impact 
to ensure that they are sustainable into the future.

    [This statement was submitted by Debra Fraser-Howze, Founder & 
President, Choose Healthy Life.]
                                 ______
                                 
           Prepared Statement of the Chronic Disease Alliance
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Provide the National Institutes of Health (NIH) with at least $49. 
        Billion, a $3.5 billion increase over FY 2022.
    --Please provide proportional increases for individual NIH 
            Institutes and Centers.
    --Please provide additional, distinct funding for the emerging 
            Advanced Research Projects Agency for Health (ARPA-H) at 
            NIH, which would facilitate implementation of this 
            important program without supplanting ongoing NIH research 
            activities.
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least $11 billion, a $2.55 billion increase over FY 2022.
    --Please provide CDC's National Center for Chronic Disease 
            Prevention and Health Promotion (NCCDPHP) with systematic 
            and meaningful annual increases to bring total funding up 
            to $3.75 billion over the next 3 years.
    --Please provide $6 million for the Chronic Disease Education and 
            Awareness (CDEA) Program at CDC and NCCDPHP.
_______________________________________________________________________

    Thank you for the opportunity to submit testimony on behalf of the 
Chronic Disease Alliance and the National patient organization that 
support Chronic Disease Day. Chairwoman Murray, Ranking Member Blunt, 
and distinguished members of the subcommittee, we extend our thanks for 
the significant investments in HHS through the FY 20222 omnibus 
package, particularly the annual increases for NIH and CDC. As you work 
with your colleagues on appropriations for FY 2023, please continue to 
invest in programs that serve the chronic disease community, most 
notably NCCDPHP at CDC. Thank you again for your leadership on health 
funding issues and for the opportunity to present the views of the 
chronic disease community.
                       about chronic disease day
    Chronic diseases account for 7 of the top 10 causes of death in 
America and more than 90 percent of our annual healthcare spending. 
Hundreds of thousands of Americans who suffer from unpreventable 
chronic conditions need access to care. But the deadliest and costliest 
chronic diseases are also the most preventable. We promote actionable 
resources to lower the rate of preventable chronic diseases so that our 
healthcare system can better support individuals with unpreventable 
chronic conditions and invisible illnesses.
               about chronic disease & invisible illness
    Chronic Disease Day is an opportunity for legislators to pledge to 
address issues that impact across the entire chronic disease community. 
These issues include funding needed medical research and public health 
programs and advancing legislation that supports a patient's ability to 
access the care they need. While we reflect on recent progress and 
opportunities for further advancement around July 10th, our community 
of supporters work year-round to educate policymakers about 
contemporary issues and to use our stories and collective voice to 
advocate for issues that impact across the chronic disease community.
    NIH and CDC both play key roles in preventing and addressing 
chronic illness. There is tremendous opportunity for the chronic 
disease community with increased funding, particularly innovative and 
impactful public health efforts led by CDC and NCCDPHP, such as the 
emerging CDEA program. There is also tremendous overlap between chronic 
conditions and health disparities, and we encourage robust resources 
for efforts to promote health equity, such as those led by NIH's 
National Institute on Minority Health and Health Disparities and CDC's 
Social Determinants of Health Program.

    [This statement was submitted by Clorinda Walley, President, Good 
Days, 
Chronic Disease Alliance
                                 ______
                                 
         Prepared Statement of the Coalition for Clinical and 
                         Translational Science
            fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --CCTS joins the broader medical research community in asking 
        Congress to provide the National Institutes of Health (NIH) 
        with at least a $3.5 billion funding increase for FY22, to 
        bring total agency funding up to a minimum of $49 billion 
        annually.
    --Please provide the Clinical and Translational Science Awards 
            (CTSA) program at the National Center for Advancing 
            Translational Sciences (NCATS) with at least a $35 million 
            increase in dedicated line-item funding for FY23 to bring 
            annual support for the program up to a minimum of $641 
            million.
    --Please provide separate, additional funding to further support 
            and implement the Advanced Research Projects Agency for 
            Health (ARPA-H).
    --Please provide the Cures Acceleration Network (CAN) at NCATS with 
            $90 million in dedicated funding for FY23.
    --Please provide the Institutional Development Awards (IDeA) 
            program and the Research Centers in Minority Institutions 
            (RCMI) program at NIH with meaningful proportional funding 
            increases for FY23.
  --CCTS joins the broader public health community in requesting $500 
        million for the Agency for Healthcare Research and Quality 
        (AHRQ).
  --CCTS joins the broader public health community in requesting $11 
        billion for the Centers for Disease Control and Prevention 
        (CDC).
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the strong support for the full 
spectrum of medical research demonstrated through the FY22 omnibus 
appropriations package. Particularly, thank you for maintaining line-
item funding for the Clinical and Translational Science Awards (CTSA) 
program, for providing a meaningful annual funding increase for CTSAs, 
and for the detailed instructions regarding utilization of CTSA funds 
and the central role of CTSA hubs. The value, importance, and impact of 
the CTSA program (as well as full-spectrum research at NIH) has been 
highlighted by our ability to quickly develop treatments, vaccines, 
diagnostic tools, and health information to quickly respond to the 
ongoing COVID-19 pandemic, and through ongoing work to promote health 
equity and enhance care delivery in rural and underserved communities. 
As you work with your colleagues on FY 2023 appropriations, CCTS and 
the broader stakeholder community encourage you to continue to support 
the full spectrum of medical research and provide increased funding for 
key clinical and translational research programs, including CTSAs.
       about the coalition for clinical and translational science
    The Association for Clinical and Translational Science, Clinical 
Research Forum, the CTSA PIs, and the related stakeholder community 
work together through the Coalition for Clinical and Translational 
Science (CCTS) to speak out with a unified voice on behalf of the 
clinical and translational research community. CCTS is a nationwide, 
grassroots network of dedicated individuals who seek to educate 
Congress and the administration about the value and importance of 
clinical and translational research, and research training and career 
development activities. Our goals are to ensure that the full spectrum 
of medical research is adequately funded, the next generation of 
researchers is well-prepared, and the regulatory and public policy 
environment facilitates ongoing expansion and advancement of the field 
of clinical and translational science.
    about the ctsa program and the full spectrum of medical research
    The CTSA Program was established to disseminate medical and 
population health interventions to patients and populations more 
quickly, and to enable research teams, including scientists, patient 
advocacy organizations and community members, to tackle system-wide 
scientific and operational problems in clinical and translational 
research that no one team can overcome in isolation. The CTSA program 
honors the promise of the Cures Act by improving research 
infrastructure and accelerating the rate at which breakthroughs in 
basic science are translated to innovations with a tangible benefit to 
patients.
    The goals of the CTSA program include; (1) train and cultivate the 
translational science workforce, (2) engage patients and communities in 
every phase of the translational process, (3) promote the integration 
of special and underserved populations in translational research across 
the human lifespan, (4) innovate processes to increase the quality and 
efficiency of translational research, particularly of multisite trials, 
(5) advance the use of cutting-edge informatics.
    The CTSA Program supports a national network of ``hubs'' at 
academic research centers across the country that work collaboratively 
to improve the translational research process to get more treatments to 
more patients more quickly. The hubs collaborate locally and regionally 
to catalyze innovation in research training, tools, and processes. 
Approximately 60 medical research institutions across the Nation 
currently receive CTSA program funding, and these hubs work together to 
speed the translation of research discovery into improved patient care 
and public health. Resources appropriated to these hubs allow the 
network to expand to include additional sites, advance science, and 
directly invest in the health workforce of the communities where they 
are located.
    The full spectrum of translational science takes the fruits of 
basic and pre-clinical research and translates them into effective 
clinical care and public health measures, with a focus on having impact 
on health. In order to maximize efficiency and patient-centeredness, 
this research must be done collaboratively and in a systematic way. 
This team-science approach focuses on outcomes and patient/health 
system benefits, rather than the advancement of science for the sake of 
science. While we appreciate that the administration's FY 2023 budget 
request includes line-item funding for CTSAs, we are concerned that a 
cut is recommended and more concerned by supporting Statements that 
seem to indicate a change in focus for the CTSA program from core hub 
support to more traditional project-based activities.
    Most crucially, the appropriations committees have included 
detailed committee recommendations in the past that have facilitated 
meaningful advancements for the full spectrum of medical research, the 
CTSA program, and career development for early-stage investigators and 
we hope similar recommendations advancing full spectrum research and 
team science as well as maintaining the integrity of the CTSA line-item 
will be provided for FY 2023.
A Few Recent Examples of CTSA Program Efforts
            University of Wisconsin
    Within two weeks of the pandemic (March 2020) the UW-M CTSA-
collaborated with community partners and practice-based research 
networks (PBRNs),to make available anonymous statewide electronic 
health records data on 3.5 million residents to develop and disseminate 
reports of areas at high risk of severe COVID-19 complications. Over 
150 reports were shared with State and local health departments and 
health systems throughout the state. Report requestors used information 
to gain enhanced awareness of the communities they serve and aid in 
COVID-19 response planning including preparing for potential surges, 
focusing outreach and collaborative efforts, assessing resource 
distribution, and identifying communication priorities and gaps. The 
CTSA made interactive maps and tools available at https://nhp.wisc.edu/
covid-19/. Regional variations in vaccine acceptance and access were 
identified as an important barrier to control the pandemic. To address 
this problem, the UW-M CTSA developed an interactive COVID-19 Relative 
Mortality Risk and Barriers to Vaccination Tool. This tool aids vaccine 
intervention efforts that are appropriate for the community. The tool 
is available at the same URL: https://nhp.wisc.edu/covid-19/.
            Stanford University
    Our CTSA's Clinical and Translational Research Unit (CTRU) provided 
both clinic and laboratory services for the NIH RECOVER: A Multi-site 
Observational Study of Post-Acute Sequelae of SARS-CoV-2 Infection 
(PASC) in Adults. This study is a research initiative from the National 
Institutes of Health seeking to understand, prevent, and treat PASC, 
including Long COVID. Under PI Dr Upi Singh, Stanford in one of leading 
recruitment sites in this national consortium of USA research 
organizations, with 290 participants enrolled during the reporting 
period. The CTRU performs participant visits along side other clinics 
at Stanford and receives and processes all biospecimens collected at 
Stanford.
    As a result of CTSA infrastructure, in under 48 hours of the March 
16th, countywide shelter-in-place, CTSA bioinformatics Faulty Lead, Dr. 
Shah, led a ``data science response'' in which data related to COVID-19 
patients were made available for Stanford researchers. CTSA Faculty 
leaders also rapidly deployed protocols for the conduct of numerous, 
multi-center clinical trials for COVID-19. They formed the COVID-19 
Clinical Research Review Program (Chair: Ken Mahaffey) to adjudicate 
the complexities of conducting multiple trials at the same time. They 
reviewed 630 study requests since March 16th, 2020. This committee is 
still in place.
    CTSA Faculty leaders, rapidly deployed protocols for the conduct of 
numerous, clinical research protocols impacted by COVID-19. They formed 
the COVID-19 Clinical Human Subjects Research Committee (Chairs: Mary 
Chen and Pooneh Fouladi) to adjudicate over 250 request. This committee 
is still in place. Faculty Lead of CTSA BERD, Dr. Desai, developed an 
Adaptive Master Trial, able to add promising treatment arms in real-
time and drop arms early for futility.
            Tufts University
    Since 2008, Tufts CTSI has provided outstanding resources and 
services to support full-spectrum translation to our community. We also 
have continually developed, demonstrated, and disseminated innovations 
to improve and accelerate clinical and translational research. Beyond 
supporting Hub research teams and incorporating these approaches into 
our internal operations and service delivery, we are a national leader 
in setting quality and efficiency standards and establishing clinical 
and translational science best practices.
    Our mature resource and service infrastructure and proclivity for 
innovation allow us to respond rapidly and effectively to emerging 
public health needs. At the start of the COVID-19 pandemic, in days, we 
redeployed our resources and services, working closely with Tufts 
Medical Center leadership. Our Clinical and Translational Research 
Center became the hospital's primary unit for COVID-19 research, with 
activation of two large Remdesivir inpatient studies in less than two 
weeks, other COVID treatment and vaccine studies, and a Tufts CTSI-
initiated treatment trial for niclosamide, led by Dr. Selker and 
supported by a CTSA supplement. The Tufts CTSI MIT Center for Clinical 
and Translational Research helped design and produce novel personal 
protective equipment and facilitated dissemination around the world. We 
established a National COVID-19 Survivors Registry and a database 
enabling a COVID-19 biorepository. The Tufts CTSI Pilot program funded 
off-cycle COVID-19 research, and our Center for Research Process 
Improvement led a hospital-wide process to prioritize research studies 
and resource deployment. These represent a few of many examples of the 
breadth of our resources and services provided and the high degree of 
speed, flexibility, and collaboration of our teams when facing a public 
health emergency.

    [This statement was submitted by Harry P. Selker, MD, MSPH, 
Chairman, 
Clinical Research Forum and Linda B. Cottler, PhD, MPH, FACE, 
President, Association for Clinical and Translational Science.]
                                 ______
                                 
         Prepared Statement of the Coalition for Health Funding


 
 
------------------------------------------------------------------------
Centers for Disease Control & Prevention..  At least $11 billion
National Institutes of Health.............  No less than $49 billion
Food & Drug Administration................  $3.653 billion
Indian Health Service.....................  No less than $49.8 billion
Health Resources & Services Administration  No less than $9.8 billion in
                                             discretionary funds
Agency for Health Research Quality........  No less than $500 million
------------------------------------------------------------------------


    The Coalition for Health Funding--an alliance of over 80 health 
organizations representing more than 100 million patients and 
consumers, health providers, professionals and researchers--welcomes 
the opportunity to submit this statement for the record about the 
importance of health funding. Together, our member organizations speak 
with one voice before Congress and the administration in support of 
federally funded health programs with the shared goal of improved 
health and well-being for all. Each member organization has individual 
funding priorities within the Department of Health and Human Services 
(HHS), but we all believe that to truly improve public health, we need 
strong, sustained, predictable funding for all Federal agencies and 
programs across the continuum. The past 2 years have taught us many 
things about the state of our public health infrastructure, which is 
why it is so critical that investments are made to ensure we strengthen 
areas such as research, prevention, and treatment programs. While we 
work to end the current pandemic, annual sustained public health 
investment will help ensure we are not only better prepared for the 
next one, but importantly also protecting the overall health and 
security of our Nation.
    HHS agencies play different yet interconnected roles in addressing 
our Nation's mounting health demands. COVID-19 has shown all Americans 
that our government works best when well-resourced agencies play 
complementary roles in defending and strengthening public health. 
Americans have seen first-hand the work that the National Institutes of 
Health did to fund certain vaccine technologies that Operation Warp 
Speed took through the development process and that the Food and Drug 
Administration (FDA) approved in record time to save American lives. 
With emergency funding, uninsured Americans have been able to access 
testing financed through the Health Resources and Services 
Administration (HRSA). The Centers for Disease Control and Prevention 
(CDC) routinely assessed available data to provide regular guidance to 
the public on COVID-19 safety protocols. And the Agency for Health 
Research Quality continues to deliver real world evidence on how we can 
better respond to the pandemic.
    We know that our response to COVID-19 was not entirely a success. 
Our public health agencies were not as prepared for the pandemic as 
they could have been. But instead of seeing that as a reason to deny 
critical funding for these essential agencies, the Committee should see 
this as an opportunity to rebuild our public health agencies through 
robust funding and ensure that public health practitioners across the 
country have what they need to combat the next pandemic while managing 
the current one. We now know that pandemics are not science fiction. 
They are not the past. They are our present, and they will be our 
future. Shortchanging public health and health research programs--or 
cutting health programs at the expense of others--leaves Americans 
vulnerable to health threats and does nothing to prevent these problems 
from arising in the first place.
    Emergency funding to combat COVID-19 does not replace consistent, 
sustained year-over appropriations. Partially this is because we must 
stay vigilant in the face of the next pandemic. But we also must combat 
other serious health and economic threats from chronic and emerging 
diseases, environmental exposures, preventable conditions, workforce 
shortages, and health disparities. Pre-existing conditions contributed 
significantly to our COVID crisis, some of which are preventable, many 
of which are manageable. We saw firsthand the impact of workforce 
shortages and are continuing to deal with the fallout. Biomedical 
research, treatment, prevention, and health promotion programs are 
critical to success moving forward. Our public health infrastructure 
must be equipped to handle the myriad challenges that it faces beyond 
the extraordinary circumstances of the pandemic. In fiscal year (FY) 
2022, discretionary health spending was only $108 billion, or 7 percent 
of all discretionary Federal spending. Of this, a little less than half 
supported medical research at the NIH, and the remainder supported all 
other public health activities--disease prevention & response, health & 
safety security, workforce development, and access to primary and 
preventive care. Having learned from the past 2 years that these areas 
of spending cannot be afterthoughts; we urge you to fund them 
accordingly. To that end, we are calling for the following levels of 
investment for specific public health agencies in FY23.

  --CDC: At least $11 billion
  --NIH: No less than $49 billion
  --FDA: $3.653 billion
  --IHS: No less than $49.8 billion
  --HRSA: No less than $9.8 billion in discretionary funds
  --AHRQ: No less than $500 million

    To achieve these necessary targets, appropriators must also raise 
the 302(b) allocation for the Labor-HHS-Education subcommittee to 
address its important needs. The era of budget sequestration hollowed 
out many of the very public health agencies we depended on to combat 
COVID-19. What the current pandemic would have looked like with 
appropriately funded agencies we will never know, but if we take our 
recent experience seriously, we will not face the same fate with the 
next pandemic. That's why the Coalition for Health Funding partnered 
with the Campaign to Invest in America's Workforce, Committee for 
Education Funding, and Coalition on Human in bringing together nearly 
370 organizations to urge appropriators to raise the subcommittee's 
allocation in FY23 to at least $239.59 billion.
    We hope in your ongoing deliberations on FY 2023 and beyond you 
will recognize that emergency funding during the acute phase of a 
pandemic does not eliminate the need for sustained long-term funding to 
the very agencies we trust explicitly with American lives. They need 
the resources to develop the next generation of tools necessary to 
protect the public's health from other health threats and to ensure the 
solvency of Medicare's Trust Fund moving forward, which is of 
particular salience given the role Medicare plays in the health care of 
those who need it most We look forward to working with the subcommittee 
in these endeavors and hope you will turn to the Coalition for Health 
Funding as a resource in the future.

    [This statement was submitted by Erin Will Morton, Executive 
Director, Coalition for Health Funding.]
                                 ______
                                 
      Prepared Statement of the Coalition on Adult Basic Education
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee:
    My name is Sharon Bonney, and I am the CEO of the Coalition on 
Adult Basic Education (COABE). COABE is the leading professional 
association for adult education, and we represent the 79,000 adult 
educators and leaders around the country. Our teachers and leaders 
provide numeracy, literacy, digital literacy, work readiness, soft 
skills, high school equivalency and numerous wraparound services to 
more than 725,000 adult learners nationwide. With over 2,200 WIOA Title 
II programs around the country, adult education serves the Nation's 
most vulnerable adults.
    COABE is appreciative of the $15.5 million increase Congress 
provided to the Adult Basic Education State Grants program under Title 
II of the Workforce Innovation and Opportunity Act (WIOA) for fiscal 
year (FY) 2022. Because of this funding, adult educators across the 
country will be able to better serve adult learners and provide them 
with the skills needed for the workplace. Our programs provide these 
skills to 725,000 adult learners throughout the country, but there are 
millions of Americans who need our services: 43 million adults are low-
skilled in literacy and 62.7 million adults are low-skilled in numeracy 
in the United States.
    Adult education programs provide an economic boost to participants. 
According to a recent Economic Mobility Corporation study, ``unemployed 
residents with prior U.S. work experience who enrolled in an 
employment-focused English course boosted their earnings by an average 
of more than $7,100 annually 2 years after starting the program, 
compared with unemployed non-English speakers who weren't in the 
program.'' Additionally, COABE estimates that for every dollar invested 
in adult education, the surrounding community receives $60 back in 
increased income, property taxes and savings on legal system and 
welfare expenses.
    Given this clear evidence of the economic boost adult education 
programs provide to participants and communities, demand for these 
programs is high. As a result, there are waiting lists in every State 
for these programs. The pandemic has further challenged programs as 
more adults have found that they need to enhance their literacy, 
numeracy and digital skills to compete for jobs in the workplace, and 
yet these very adults might not have access to technology and broadband 
to enable them to participate in these programs.
    Adult education programs have been working hard to deliver high-
quality education throughout the pandemic. These programs have turned 
to online and hybrid delivery services. But greater investment in 
technology, classroom space and professional development is critical. 
If funded at proper levels, adult education programs can play a 
significant role in the country's recovery from the pandemic by 
providing millions of adult learners with necessary workforce and life 
skills.
    Adult education provides learners with opportunities to which they 
may not otherwise have access. Learners often tell stories of how adult 
education changed their lives. I want to share the thoughts of two 
participants from Missouri and Washington that exemplify the power of 
adult education:

    ``I have been living in this beautiful country for 16 years. In 
        2015, my life changed. I made the decision to go back to school 
        and try to get my HSE credential... I'm the first Spanish 
        student finishing the course and getting the HSE diploma from 
        the Spanish program, which was implemented in 2015, and I'm so 
        proud of my achievement.''
      -- Jose Viveros Barcenas, St. Charles Community College Adult 
            Education and Literacy, Cottleville, Missouri

    ``The program was a great experience, and I learned a lot. I was 
        willing to expand what I learned in high school and the classes 
        were smaller, so I got more one on one with the teachers. I was 
        going for my GED and ended up with my diploma and now my 
        associates. I encourage anyone that wants to get their high 
        school diploma to go through HS21+. It is a great learning 
        experience, with great instructors.''
      -- Raymond Silva, Skagit Valley College, Mount Vernon, Washington

    We are encouraged by President Biden's FY 2023 Budget proposal, 
which included an increase of $10 million for the Adult Basic Education 
State Grants program. However, given the demand for these services and 
the opportunity they provide learners, we would urge Congress to exceed 
the President's proposed increase and provide $810 million for adult 
education in the final fiscal Year2023 appropriations bill.
    Thank you for your consideration. Please let me know if COABE can 
be of any further assistance during the appropriations process.
                                 ______
                                 
    Prepared Statement of the Congressional Fire Services Institute
    Dear Chair Murray and Ranking Member Blunt:
    On behalf of the Nation's fire and emergency services, we write to 
urge your continued support for a vital program addressing the health 
and safety of our Nation's firefighters. As you consider the Fiscal 
Year (FY) 2023 Labor, Health and Human Services, Education, and Related 
Agencies Appropriations bill, we urge you to provide $5.5 million for 
the National Firefighter Registry.
    Studies have indicated a strong link between firefighting and an 
increased risk of several major cancers. However, certain studies 
examining cancer risks among firefighters have been limited by the 
scarcity of important data and relatively small sample sizes that have 
an underrepresentation of women, minorities, and volunteer 
firefighters. As a result, public health researchers are unable to 
fully examine and understand the broader epidemiological cancer trends 
among firefighters. The National Firefighter Registry is an important 
resource to better understand the link between firefighting and cancer, 
potentially leading to better prevention and safety protocols.
    During the 115th Congress, both the House and Senate unanimously 
approved the Firefighter Cancer Registry Act (Public Law 115-194). This 
bipartisan legislation created a specialized national registry to 
provide researchers and epidemiologists with the tools and resources 
needed to improve research collection activities related to the 
monitoring of cancer incidence among firefighters.
    Over the past several years, the registry has been able to make 
great strides, including developing an enrollment system to ensure 
information security and ease of access for users; obtaining the Office 
of Management and Budget's approval for the enrollment questionnaire; 
and compiling brochures, videos, and quarterly newsletters to maintain 
communication with the fire service regarding the status of the 
registry.
    However, the registry has also faced new challenges due to evolving 
Federal requirements for data security and storage--in addition to the 
steps that remain to continue the launch of the registry and keep its 
vital work moving forward. To ensure that the National Firefighter 
Registry does not face delays with regard to the collection and 
analysis of data pertaining to cancer in the fire and emergency 
services, we are requesting $5.5 million in FY 2023.
    Thank you for your consideration, and your continued leadership and 
support for America's fire and emergency services.
    Sincerely,

    Congressional Fire Services Institute
    International Association of Arson Investigators
    International Association of Fire Chiefs
    International Association of Fire Fighters
    International Fire Service Training Association
    International Society of Fire Service Instructors
    National Fallen Firefighters Foundation
    National Fire Protection Association
    National Volunteer Fire Council
    Congressional Fire Services Institute/International Association of 
Arson Investigators/
    International Association of Fire Chiefs/International Association 
of Fire Fighters/
    International Fire Service Training Association/International 
Society of Fire 
Service Instructors/
    National Fallen Firefighters Foundation/National Fire Protection 
Association/
    National Volunteer Fire Council

    [This statement was submitted by Michaela Campbell, Director of 
Government 
Affairs, Congressional Fire Services Institute.]
                                 ______
                                 
  Prepared Statement of the Consortium of Social Science Associations
    On behalf of the Consortium of Social Science Associations (COSSA), 
I offer this written testimony for inclusion in the official committee 
record. For fiscal year 2023, COSSA urges the Committee to appropriate:
  --$49.048 billion for the National Institutes of Health;
  --$11 billion for the Centers for Disease Control and Prevention, 
        including $210 million for the National Center for Health 
        Statistics;
  --$500 million for the Agency for Healthcare Research and Quality;
  --$814 million for the Bureau of Labor Statistics;
  --At least $815 million for the Institute of Education Sciences; and
  --$161 million for the Department of Education's International 
        Education and Foreign Language programs.
    First, allow me to thank the Committee for its long-standing, 
bipartisan support for scientific research. Strong, sustained funding 
for all U.S. science agencies is essential if we are to make progress 
toward improving the health and economic competitiveness of the Nation. 
As you know, the need for increased investment in science has become 
even more pronounced over the past 2 years in response to the COVID-19 
pandemic.
                     national institutes of health
    COSSA joins the more than 345 organizations in support of at least 
$49.048 billion for the National Institutes of Health (NIH) base budget 
in fiscal year 2023. COSSA appreciates the subcommittee's leadership 
and its long-standing bipartisan support of NIH, especially during 
difficult budgetary times. We also appreciate the Congress's interest 
in innovating and pushing the agency forward through support for high-
risk, high-reward endeavors. It is critical that efforts to accelerate 
discovery in new, creative ways work in tandem with-not at the expense 
of-robust, sustainable support for fundamental and curiosity-driven 
research.
    To that end, COSSA urges the subcommittee to ensure that funding 
for the new Advanced Research Projects Agency for Health (ARPA-H) 
supplement the $49.048 billion recommendation for NIH's base budget, 
rather than supplant the investments NIH makes to biomedical and 
behavioral research across its institutes and center. To be truly 
transformative, increased investment is needed on all fronts.
    In addition, as the COVID-19 pandemic has underscored, it is 
behavior change-not only medical intervention--that can help us gain 
control in the days and weeks immediately following an outbreak. From 
psychological research behind the merits of mass social distancing to 
understanding cultural variations in risk perception as we tailor 
communication about vaccine safety, the social and behavioral sciences 
have been an essential part of the response. We must learn from this 
experience and invest in our future preparedness by better committing 
to understanding the human behavior and social systems at play.
    To that end, COSSA urges the subcommittee to ``right-size'' NIH's 
Office of Behavioral and Social Sciences Research (OBSSR), housed 
within the Office of the NIH Director. This critical office coordinates 
basic, clinical, and translational research in the behavioral and 
social sciences in support of the NIH mission, and co-funds highly 
rated grants in the behavioral and social sciences in partnership with 
individual institutes and centers. We are appreciative of the $10 
million increase provided to OBSSR in the final fiscal year 2022 
appropriations bill; however, behavioral and social science research at 
NIH remains grossly underfunded. For example, OBSSR's fiscal year 2022 
budget of $38.9 million represents only 1.5 percent of the total budget 
of the NIH Office of the Director; under the President's proposal, this 
would drop to 1.1 percent.
    In addition, it is estimated that NIH funds roughly $700 million in 
research related to behavioral and social science annually across its 
institutes and centers; however, about 62 percent of that is also 
classified as neuroscience research, leaving around $430 million 
annually for non-neuroscience related social and behavioral studies. 
This amounts to only 1.1 percent of the entire NIH budget annually. 
Given all we have learned from the pandemic over the last few years, 
research on the social influences of health are needed now more than 
ever. In addition, understanding behavioral influences on health is 
needed to battle the leading causes of morbidity and mortality, namely, 
obesity, heart disease, cancer, AIDS, diabetes, age-related illnesses, 
accidents, substance abuse, and mental illness. We urge the Senate to 
emphasize support for OBSSR and direct NIH to finally support the 
office at levels commensurate with the need for these critical 
insights.
               centers for disease control and prevention
    COSSA urges the subcommittee to appropriate $11 billion for the 
Centers for Disease Control and Prevention (CDC), including $210 
million for CDC's National Center for Health Statistics (NCHS). Social 
and behavioral science research plays a crucial role in helping the CDC 
carry out its mission by informing the CDC's behavioral surveillance 
systems, public health interventions, and health promotion and 
communication programs that help protect Americans and people around 
the world from disease. One needs only to look at the varied responses 
across different communities to COVID-19 guidance and policies 
surrounding social distancing, mask-wearing, and vaccination to 
understand the critical role understanding the social aspects of public 
health plays in keeping Americans safe and healthy.
    In addition, as the Department of Health and Human Services' 
principal statistical agency, NCHS produces data on all aspects of our 
health care system, including opioid and prescription drug use, 
maternal and infant mortality, chronic disease prevalence, health care 
disparities, emergency room use, health insurance coverage, teen 
pregnancy, and causes of death. As a result of the rising costs of 
conducting surveys and years of flat or near-flat funding, NCHS has had 
to focus nearly all of its resources on continuing to produce the high-
quality data that communities across the country rely on to understand 
their health. Additional funding would allow NCHS to respond to rising 
costs, declining response rates, and an ever-more complex health care 
system and capitalize on opportunities surrounding advances in 
statistical methodology, big data, and computing to produce better 
information more quickly and efficiently, while reducing the reporting 
burden on local data providers.
               agency for healthcare research and quality
    COSSA urges the subcommittee to appropriate $500 million for the 
Agency for Healthcare Research and Quality (AHRQ), which would allow 
AHRQ to rebuild portfolios terminated as a result of years of cuts and 
expand its research and training portfolio to address our Nation's 
pressing and evolving health care challenges. AHRQ funds research on 
improving the quality, safety, efficiency, and effectiveness of 
America's health care system. It is the only agency in the Federal 
Government with the expertise and explicit mission to fund research on 
improving health care at the provider level (i.e., in hospitals, 
nursing homes, and other medical facilities). Its work is 
complementary-not duplicative-of other HHS agencies and requires robust 
support, especially given the critical role hospitals and group care 
settings have played in the COVID-19 pandemic.
                       bureau of labor statistics
    COSSA urges the subcommittee to appropriate $814 million for the 
Bureau of Labor Statistics (BLS) for its core programs. BLS produces 
economic data that are essential for evidence-based decision-making by 
businesses and financial markets, Federal and local officials, and 
households faced with spending and career choices. The BLS, like every 
Federal statistical agency, must modernize in order to produce the gold 
standard data on jobs, wages, skill needs, inflation, productivity and 
more that our businesses, researchers, and policymakers rely on so 
heavily. The requested funding level would allow BLS to continue to 
support evidence-based policymaking, smart program evaluation, and 
confident business investment.
                    institute of education sciences
    COSSA requests at least $815 million for the Institute of Education 
Sciences (IES) in fiscal year 2023. Within the Department of Education, 
IES supports research and data to improve our understanding of 
education at all levels, from early childhood and elementary and 
secondary education, through higher education. Research further 
examines special education, rural education, teacher effectiveness, 
education technology, student achievement, reading and math 
interventions, and many other areas. IES-supported research has 
improved the quality of education research, led to the development of 
early interventions for improving child outcomes, generated and 
validated assessment measures for use with children, and led to the 
establishment of the What Works Clearinghouse for education research, 
highlighting interventions that work and identifying those that do not. 
With increasing demand for evidence-based practices in education, 
adequate funding for IES is essential to support studies that increase 
knowledge of the factors that influence teaching and learning and apply 
those findings to improve educational outcomes.
         international education and foreign language programs
    The Department of Education's International Education and Foreign 
Language programs play a major role in developing a steady supply of 
graduates with deep expertise and high-quality research on foreign 
languages and cultures, international markets, world regions, and 
global issues. COSSA urges a total appropriation of $161 million ($141 
million for Title VI and $20 million for Fulbright-Hays), which would 
help make up for lost investment and purchasing power over many years 
of flat-funding. In addition to broadening opportunities for students 
in international and foreign language studies, such support would also 
strengthen the Nation's human resource capabilities in strategic areas 
of the world that impact our National security and global economic 
competitiveness.
    Thank you for the opportunity to present this testimony on behalf 
of the social and behavioral science research community.

    [This statement was submitted by Submitted by Wendy Naus, Executive 
Director, Consortium of Social Science Associations.]
                                 ______
                                 
     Prepared Statement of the Council of Academic Family Medicine
    The member organizations of the Council of Academic Family Medicine 
(CAFM) are pleased to submit testimony on behalf of programs under the 
jurisdiction of the Health Resources and Services Administration (HRSA) 
and the Agency for Healthcare Research and Quality (AHRQ). CAFM 
collectively includes family medicine medical school and residency 
faculty, community preceptors, residency program directors, medical 
school department chairs, research scientists, and others involved in 
family medicine education. We urge the Committee to appropriate at 
least $59 million for the Primary Care Training and Enhancement 
program, authorized under Title VII, Section 747 of the Public Health 
Service Act HRSA. In addition, we recommend the Committee fund the AHRQ 
at a level of at least $500 million in discretionary spending and 
specifically fund $5 million dedicated to AHRQ's Center for Primary 
Care Research.
    More than 44,000 primary care physicians will be needed by 2035, 
and current primary care production rates will be unable to meet the 
demand, according to the authors of Annals of Family Medicine 
(Petterson, et al Mar/Apr 2015). The primary care training and 
enhancement programs and AHRQ research conduct research to enhance our 
Nation's workforce and health infrastructure, improving primary care to 
produce better health outcomes and reduce costs.
Primary Care Training and Enhancement--Title VII
    The Primary Care Training and Enhancement Program (Title VII, 
Section 747 of the Public Health Service Act) has a long history of 
funding training of primary care physicians. As experimentation with 
new or different models of care continues, departments of family 
medicine and family medicine residency programs will rely further on 
Title VII, Section 747 grants to help develop curricula and research 
training methods for transforming practice delivery. Future training 
needs include: training in new clinical environments that include 
integrated care with other health professionals (e.g. behavioral 
health, care coordination, nursing, oral health); development and 
implementation of curricula to give trainees the skills necessary to 
build and work in inter-professional teams that include diverse 
professions; and development and implementation of curricula to develop 
leaders and teachers in practice transformation. Moreover, new 
competencies are required for our developing health system. This 
program has not received an increase in funding since FY2020, just at 
the time that the COVID-19 pandemic has highlighted many of the 
failings of the current health care and public health infrastructure. 
The PCTE program can help address these flaws. For example, additional 
funding is needed for both residencies and medical school departments 
to help address faculty retention, public health competencies, recruit 
and retain students into primary care, develop new curriculum related 
to the pandemic, address health equity concerns and to increase full 
scope primary care physicians.
    In this time of increasing primary care need, we urge you to 
recognize the importance of maintaining and expanding funding for 
programs that support the primary care workforce. Title VII funding for 
primary care training is an evidence-based investment in the future 
care of the Nation.
    A 2021 report by The National Academy of Sciences, Engineering and 
Medicine identified the problems with under-funding Title VII programs 
finding that despite the demonstrably better patient outcomes that have 
resulted from Title VII investments, Title VII funding remains only a 
tiny fraction of the total GME funding; reduced to less than 10 percent 
since the 1960s.\1\ Primary care health professions training grants 
under Title VII are vital to the continued development of a workforce 
designed to care for the most vulnerable populations and meet the needs 
of the 21st century. We urge your continued down payment for this 
program and an increase in funding levels to $59 million in FY 2023 to 
allow for a robust competitive funding cycle. This funding level will 
help continue important Title VII programs who use primary care 
training funding to develop innovative programs and curricula related 
to interdisciplinary training in rising new competencies.
---------------------------------------------------------------------------
    \1\ National Academies of Sciences, Engineering, and Medicine 2021. 
Implementing High-Quality Primary Care: Rebuilding the Foundation of 
Health Care. Washington, DC: The National Academies Press. https://
doi.org/10.17226/25983.
---------------------------------------------------------------------------
    We also ask for the following report language to accompany the 
increased funding level: The Committee includes $59 million, an 
increase of $10 million over the FY 2022 level, for Primary Care 
Training and Enhancement programs, which support training and direct 
financial assistance for future primary care clinicians, teachers, and 
researchers. This additional funding is to allow for a robust grant 
competition, to support programs within academic administrative units 
related to expanding the number of medical students choosing primary 
care careers. To stimulate this supply, it's important to reach as many 
allopathic and osteopathic primary care medical school departments as 
possible to explore innovations in training, more research into 
increasing primary care production, and dissemination of best 
practices.
Agency for Health Care Research and Quality (AHRQ)
    Primary care clinical research (PCR) is a core function of AHRQ. 
Primary care research includes: translating science into patient care, 
better organizing health care to meet patient and population needs, 
evaluating innovations to provide the best health care to patients, and 
engaging patients, communities, and practices to improve health. AHRQ 
has proved to be uniquely positioned to support best practice primary 
care research and to help disseminate the research nationwide. However, 
reduced levels of AHRQ funding in the past have exacerbated disparities 
in funding primary care research. Important primary care research 
initiatives have been unfunded in recent years such as research for 
patients with Multiple Chronic Conditions (MCC) and the statutorily 
authorized Center for PCR.
    We greatly appreciate the inclusion of increased funding in the FY 
2022 omnibus package, and hope we can increase that further in FY 2023. 
With funding for FY 2022 of $350,400,000 million, including $2 million 
dedicated to the Center for Primary Care Research within it, AHRQ is in 
a unique position to further PCR as well as the implementation science 
to identify how to deploy new knowledge into the hands of primary care 
providers and systems in communities. However, more funding is needed 
to accomplish these goals. The President's FY 2023 budget request 
includes $10 million in funding for primary care research in general. 
We ask that $5 million be provided as a line item to the Center for 
Primary Care Research within AHRQ to help coordinate and direct primary 
care research funding at AHRQ. For this reason, we are supporting 
additional overall funding increases for FY 2023 as well as specific 
funding for the Center for Primary Care Research of $5 million to help 
coordinate and direct primary care research funding at AHRQ. We hope 
additional funding will continue and expand the following goals: (1) 
development of clinical primary care research and researchers (2) real-
world application of evidence, (3) the process of practice and health 
system transformation, (4) how high functioning primary care systems 
and practices should look, (5) how primary care practices serving rural 
and other underserved populations adapt and survive, and (6) how health 
extension systems serve as connectors of research institutions with 
practices and communities.
    In 2020, the RAND Corporation published a report appropriated by 
Congress and commissioned by AHRQ that assessed federally funded PCR 
since 2012 regarding gaps and to recommend improvements. The report 
emphasized the significant role AHRQ plays in PCR. RAND made several 
recommendations, one of which was to provide targeted funds to create a 
proper hub for Federal PCR. This is important because PCR is a distinct 
science that differs from health services research. With the $5 million 
in dedicated funds for PCR, AHRQ could prioritize and coordinate 
investments in PCR directly improving the health and wellbeing of 
Americans. The National Academy of Medicine's report on Primary Care 
concurs with RAND's assessment on the importance of targeted funding 
for PCR, demonstrating the variety of stakeholders which share common 
ground on the importance of prioritizing PCR.\2\
---------------------------------------------------------------------------
    \2\ National Academies of Sciences, Engineering, and Medicine 2021. 
Implementing High-Quality Primary Care: Rebuilding the Foundation of 
Health Care. Washington, DC: The National Academies Press. https://
doi.org/10.17226/25983.
---------------------------------------------------------------------------
    A real-world example of successful AHRQ work supporting primary 
care practice and patient safety is funding to the Oregon Health & 
Science University, the Rural Practice-based Research Network helped 
lead Healthy Hearts Northwest by recruiting 100 primary care practices 
to develop team-based quality improvement infrastructure improvements 
in small to medium-size practices. The Evidence Now Initiative operated 
as health extension agents in Oregon's frontier communities. In another 
example, AHRQ funding has allowed the University of Missouri to build 
infrastructure for patient-centered outcomes research in three arenas. 
The first study evaluated the advantages and disadvantages of 
endovascular vs. open surgery for legs with inadequate blood flow. The 
second project focused on improved discharge plans from skilled nursing 
facilities through improved primary care connections. Missouri 
partnered with the AAFP to create a national research network to 
improve chronic pain for the third project.
    In conclusion, we support increased funding for AHRQ at the level 
of $500 million in discretionary spending for FY 2023 which would 
support important primary care and health services research efforts. We 
also support $5 million in new funding for the Center for Primary Care 
Research. CAFM looks forward to working with the subcommittee to 
protect HRSA's Primary Care Training and Enhancement Program and AHRQ--
both entities which enhance our Nation's primary care workforce and 
infrastructure.

    [This statement was submitted by Winston Liaw, MD, MPH, Chair, 
Academic Family Medicine Advocacy Committee, Council of Academic Family 
Medicine.]
                                 ______
                                 
      Prepared Statement of the Council of State and Territorial 
                            Epidemiologists
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee, thank you for the opportunity to submit this testimony 
for the record in support of at least $250 million in Fiscal Year 2023 
funding for the Data Modernization Initiative and the Center for 
Forecasting and Outbreak Analytics at the Centers for Disease Control 
and Prevention (CDC). My name is Janet Hamilton, I am the Executive 
Director of the Council of State and Territorial Epidemiologists 
(CSTE). CSTE represents public health epidemiologists nationwide 
working on the front lines to respond to emerging public health 
threats--including, recognizing and identifying the very first 
introductions of COVID-19, and then responding daily during the COVID-
19 pandemic.
    As you know, COVID-19 exposed deadly gaps in our Nation's public 
health data infrastructure. After years of neglect, our antiquated 
public health data systems were not prepared to handle the onslaught of 
a pandemic caused by a highly infectious virus. Instead, paper-based 
systems, phone calls, spreadsheets, and faxes requiring data entry by 
hand remain in widespread use and left us ill-equipped to combat the 
spread of the virus as it emerged and surged. Delayed detection and 
response had dire consequences. And, while COVID-19 is the most 
recent--and ongoing-threat that requires a robust public health 
response, it is not the only threat we face nor last public health 
threat we will face. As we submit this, a new emerging threat leading 
to unexplained hepatitis in children is emerging--illnesses 
(potentially due to adenovirus) can be severe, associated with 
hospitalization and liver transplants in some children. Led by the CDC, 
State and local health departments across the country need a nationwide 
public health surveillance system to detect emerging threats and 
facilitate immediate response to keep our population safe.
    Prior to the COVID-19 pandemic, CSTE initiated the call for 
improved public health surveillance systems. The pandemic only made it 
clearer that this goal cannot wait. With our partners at the Data: 
Elemental to Health Campaign we called on Congress to provide the first 
ever dedicated funding for public health data systems and to build a 
21st century public health data superhighway. Thanks to the work of 
this subcommittee, Congress answered the call and has provided annual 
funding as well as critical injections of supplemental funding through 
the CARES Act and the American Rescue Plan for CDC's public health Data 
Modernization Initiative--or DMI.
    The DMI is a commitment to building the world-class data workforce 
and data systems that support daily operations and are `response-ready' 
for the next public health emergency with capacity to surge and scale. 
We are grateful to this subcommittee for providing more than $1 billion 
to date for DMI through annual and supplemental appropriations. 
Unfortunately, it is not enough to meet our Nation's current or long-
term public health surveillance needs, which Data: Elemental to Health 
estimates will cost at least $7.84 billion over 5 years. In the 
immediate term, we need robust, sustained, annual funding for DMI to 
ensure we are providing resources for public health systems and 
infrastructure, including at State and local health departments, to 
keep pace with evolving technology.
    DMI is an enterprise approach and there are five key interconnected 
pillars essential for public health data modernization. They are:
    1. Electronic Case Reporting,
    2. The National Notifiable Disease Surveillance System (NNDSS),
    3. The Electronic Vital Records System,
    4. Syndromic Surveillance, and
    5. Laboratory Information Systems.
    We need electronic Case Reporting (or eCR) to give health care 
providers a means to seamlessly communicate with public health. eCR 
will help guarantee that when providers see patients--in any setting--
patient demographics, clinical information, and test results for 
reportable conditions (including, but by no means limited to COVID-19) 
are rapidly shared with State and local public health and then able to 
be seamlessly incorporated into CDC's National Notifiable Disease 
Surveillance System (NNDSS). eCR also assists with data completeness 
and rapidly understanding health inequities. DMI investments in eCR are 
already paying off. For example, race and ethnicity data received on 
case reports in pilot jurisdictions are over 90 percent complete which 
will support a more robust ability to appropriately address health 
disparities. More than 11,000 health care facilities were brought on 
board between January 2020 and February 2022. All 50 States, DC, and 
Puerto Rico, as well as 13 jurisdictions have received initial 
electronic case reports for COVID-19 ad more than 18 million COVID-19 
case reports have been sent electronically to public health agencies--
each representing a report that a health care provider did not have to 
enter manually!
    Resources are needed to make improvements in NNDSS and rapid data 
submission from States to CDC. For example, state, territorial, local, 
and Tribal health department staff serve as disease detectives 
contacting and interviewing cases gathering detailed information to 
learn how and where they may have become infected--are they part of a 
cluster or outbreak, or what co-factors may have led to a more severe 
illness? For example, during the Zika response, case investigations 
conducted by the local health department identified persons working on 
elevators were at increased risk of infection as standing water often 
collected in the bottoms of open-air elevator shafts serving as 
breeding location for mosquitos. After case investigations and 
interviews are conducted, resources are needed to provide those details 
to the CDC through NNDSS. Numerous similar examples exist for COVID-19 
where health department staff conduct outbreak investigations or 
identify clusters from genomic sequencing but are unable to 
electronically share those data with CDC's NNDSS due to agency 
infrastructure shortages. Additionally, right now, there are multiple 
jurisdictions who have the desire to provide more detailed COVID-19 
case information to CDC, but don't have the data work force and 
resources to update file structures and data processes to submit those 
data.
    We need an electronic lab test ordering and result process that 
supports the collection of information to launch a rapid public health 
response. Seamless electronic communication is critical--a health 
department forced to sort through mailed or faxed lab reports will not 
be able to respond promptly or adequately to an emerging threat. 
Investments here have also shown early success. Electronic laboratory 
reporting (ELR), which has now been implemented across the country, 
formed the backbone of our case surveillance for COVID-19, enabling 
States, localities, territories, Tribes and the Federal Government to 
have timely information to identify cases, where those cases lived, and 
basic information about their age. Without ELR we would never have been 
able to conduct control measures and know what was happening in 
virtually every jurisdiction. In many jurisdictions this information is 
automatically uploaded and ready for analysis within a day of the 
result.
    We need improvements to our electronic vital records systems to 
ensure real-time transmission of birth and death data for statistical 
and--critically during a pandemic--surveillance purposes. We must make 
sure systems are interoperable so physicians, coroners, medical 
examiners, and funeral directors can seamlessly report deaths through 
their existing electronic records systems--eliminating delays and 
reducing errors.
    Standards-based interoperability will also help identify threats as 
they emerge. As it stands, nearly one third of all emergency department 
visits are not reported to the National Syndromic Surveillance Program, 
which helps detect, monitor, control and prevent emerging diseases.
    These five pillars are interwoven, and each plays a key role in 
moving the United States from an outdated and burdensome patchwork of 
systems to a 21st Century public health data infrastructure that 
provides complete, accurate, and instantaneous data. Again, DMI is an 
enterprise-wide approach, which will support widespread and rapid 
access to public health data for all public health programs at all 
levels of government for all diseases and conditions. Just like a 
rising tide lifts all boats, a public health data superhighway improves 
all public health programs. Public health needs a coordinated and 
integrated approach to using data to deliver on mission, serve the 
public, and steward resources while respecting privacy and 
confidentiality. Currently, CDC has many siloed public health 
surveillance systems, many of which are not interoperable, which 
results in duplicated and redundant data entry. DMI will help break 
down those siloes and ensure all systems are integrated and 
interoperable.
    Equally important is a skilled workforce that includes 
epidemiologists, public health informaticists, data scientists, and 
other experts--all of whom work together so that the public health 
surveillance system is capable of detecting and monitoring current 
threats and ready for the next pandemic. The Administration has 
committed to strengthening our Nation's public health workforce, 
including epidemiologists and data scientists and we urge the committee 
to continue to provide resources towards this goal. This is an 
important step forward to grow and build the next-generation public 
health workforce and we hope to see the committee support continued 
funding to sustain this progress.
    Working hand-in-hand with DMI, CDC's newly established Center for 
Forecasting and Outbreak Analytics (CFA) will facilitate the use of 
data, modeling, and analytics to improve pandemic preparedness and 
response. The CFA is already doing critical work, including helping to 
inform government response to the spread of the Omicron variant of 
COVID-19 in late 2021.
    We do not have a science problem; we have a resource problem. The 
core data systems for a national infrastructure already exist they must 
be modernized and maintained so they can keep pace with new technology.
    CSTE applauds President Biden for proposing an unprecedented 
investment in CDC through his discretionary budget request. The 
President requested $10.675 billion for CDC. As part of this 
significant and well-warranted funding proposed increase, the President 
seeks to ``prioritizes investments that will modernize public health 
data collection, increase capacity to forecast and analyze future 
outbreaks, and operationalize lessons learned from the COVID-19 
response.'' We also support the President's proposal to invest $81.7 
billion in mandatory funding toward pandemic preparedness efforts, 
including $28 billion for CDC to invest in critical efforts, including 
public health infrastructure and DMI. We encourage Congress to make 
this proposal a reality.
    To make our public health systems work now, and in the future, we 
need regular, sustained annual funding for our public health 
surveillance. We respectfully request the subcommittee provide funding 
of at least $250 million for DMI and $50 million for CFA at CDC in 
Fiscal Year 2023.
    Thank you.

    [This statement was submitted by Janet Hamilton, MPH, Executive 
Director, Council of State and Territorial Epidemiologists.]
                                 ______
                                 
       Prepared Statement of the Council on Social Work Education
                department of health and human services
  --$25 million for the Minority Fellowship Program (MFP) at Substance 
        Abuse and Mental Health Services Administration
  --Heath Resources and Services Administration (HRSA):
    --$225.8 million for HRSA's Behavioral Health Workforce Education 
            and Training (BHWET) grant program;
    --$55.014 million for Scholarships for Disadvantaged Students;
    --$82 million for the Geriatrics Workforce Enhancement Program 
            (GWEP) and the Geriatrics Academic Career Award (GACA)
    --$15 million for continued support of a demonstration program to 
            strengthen the mental and substance disorders workforce;
  --$20 million for continued support of the Loan Repayment Program for 
        Substance Use Disorder Treatment Workforce
  --$49.048 billion for National Institutes of Health (NIH)
    --NIH report language on Office of Behavioral and Social Sciences 
            Research working groups
                        department of education
  --$13,000 for the maximum individual Pell Grant;
  --Experimental sites for paid internships for social work students
    CSWE is a nonprofit national association representing over 900 
accredited baccalaureate and master's degree social work programs, as 
well as individual social work educators, practitioners, and agencies 
dedicated to advancing quality social work education. We appreciate 
your efforts and leadership on issues that impact social work, social 
work education, and the wellbeing of individuals, families, and 
communities and social and economic justice.
    We encourage you to consider the following appropriations requests 
that will support social work programs and social work students in the 
fiscal year (FY) 2023 appropriations process. Pressing societal 
challenges and public health challenges like the twin pandemics of 
CoVID-19 and systemic racism, the opioid crisis and other substance-use 
issues, growing mental and behavioral health needs, workforce 
shortages, and rising higher education costs, are just some of the 
challenges facing social work students and practitioners. Your support 
of these appropriations requests will help meet these challenges.
    Federal funding helps strengthen the pipeline of social workers, 
addresses the needs of vulnerable and at-risk populations, and supports 
students, including those from disadvantaged backgrounds. Social work 
students go on to work in a diversity of fields including child 
advocacy, geriatrics, school social work, healthcare and other fields. 
As policymakers continue to focus on the social determinants of health, 
support for social workers, who are the workforce at the center of 
addressing these social factors, will be critical. CSWE's FY 2023 
requests (as detailed below) illustrate support for important programs 
that address vital health workforce needs, provide invaluable student 
aid, address the social determinants of health, and promote important 
health-care research. We respectfully ask for your support of these 
requests during the FY 2023 appropriations process.
    Substance Abuse and Mental Health Services Administration: $25 
million for the Minority Fellowship Program (MFP). For more than 45 
years, MFP has been increasing the number of professionals preparing 
for leadership roles in mental health and substance use fields and 
working to reduce health disparities and improve behavioral health-care 
outcomes for racial and ethnic populations. CSWE urges the committee to 
include $25 million for the MFP in FY 2023.
    CSWE requests the following report language be included in the FY 
2023 Labor-H report: The Committee believes that among the many 
consequences of COVID-19, the increasing rates of burnout facing the 
mental and behavioral health workforce has negatively impacted the 
resilience of the Nation's public health infrastructure. The pandemic 
has laid bare the need to strengthen the public health workforce 
pipeline and the need to provide educational opportunities to all who 
wish to pursue a career in mental and behavioral health care. The 
Committee urges the Minority Fellowship Program in the Substance Abuse 
and Mental Health Services Agency to explore ways in which to expand 
program eligibility, particularly for students who fall under the 
Temporary Protected Status (TPS) and Deferred Action for Childhood 
Arrival (DACA) programs. These students, the majority of whom have 
lived most of their lives in the United States, are an invaluable 
resource to bolster our public health infrastructure and mental and 
behavioral health care workforce.
    Health Resources and Services Administration: $225.8 million for 
HRSA's Behavioral Health Workforce Education and Training (BHWET) 
program. CSWE was pleased to see continuous investments for the BHWET 
program in the fiscal Year2022 Labor-HHS-ED appropriations bill. BHWET 
supports the recruitment and education of behavioral health-care 
providers, which is critical as the Nation continues to combat the 
pandemic, the opioid crisis, and substance use disorders. The number of 
training programs supported by BHWET has grown tremendously over the 
past several years, particularly amongst social workers. Social workers 
represent the most diverse health profession in the Nation and as 
efforts are taken to bolster the public health infrastructure, social 
workers represent a model for continued workforce growth and diversity. 
As the Nation's demand for well-equipped behavioral health-care 
providers continues to grow, we hope you will support $225.8 million 
for BHWET in FY 2023.
  --$55.014 million for Scholarships for Disadvantaged Students. This 
        program helps ensure that the United States has the pipeline of 
        health professionals to meet health needs of underserved 
        individuals and communities. Furthermore, this program provides 
        much needed opportunities for students from disadvantaged 
        backgrounds.
  --$51 million for the Geriatrics Workforce Enhancement Program 
        (GWEP). GWEP supports training and educating health 
        professionals, including social workers, as well as direct care 
        workers, and family caregivers in the care of older adults. It 
        is the only Federal program that focuses on developing a 
        health-care workforce that maximizes patient and family 
        engagement while improving health outcomes for older adults. 
        GWEPs are successfully integrating and equipping a primary care 
        workforce and family caregivers with the knowledge and skills 
        to care for older adults and build community networks to 
        address gaps in health care for seniors.
  --$15 million for continued support of a demonstration program to 
        strengthen the mental and substance disorders workforce.
  --$20 million for continued support of the Loan Repayment Program for 
        Substance Use Disorder Treatment Workforce.
    National Institutes of Health (NIH): $49 billion in FY 2023 for the 
National Institutes of Health. CSWE appreciates the continued support 
from Congress and the increased funding for NIH. To build on the 
advances in research, CSWE hopes you will support continued investments 
in biomedical and health-related research that incorporates the social 
and behavioral science research necessary to better understand and 
address the needs of high-risk populations including children, 
minority, and geriatric populations. Social and structural determinants 
of health play a large role in the health disparities that plague 
society. Social factors play a major role in people's health and as a 
result NIH needs to fund behavioral and social science research that 
tests innovations in the design of health care and integrate social 
care into health care and health care into social services. In 
addition, research must be funded that tests the effectiveness of these 
integrated services. NIH should expand research opportunities in this 
area to provide meaningful, comprehensive, and long-lasting 
improvements in health care delivery.
    CSWE requests the following report language be included in the FY 
2023 Labor-H report: The Committee believes that a more robust and 
focused NIH commitment to behavioral and social science research and 
training would yield significant improvements to the Nation's health 
due to the important connections between social and physical conditions 
and health. Many of the leading causes of health disparities in our 
Nation are related social and structural determinants of health like 
race, income, access to care, housing, and employment. In the shadows 
of the COVID-19 pandemic, addressing these health disparities continues 
to be key challenge in our efforts to improve health across all 
populations. The 2019 Consensus Study Report from the National 
Academies of Science, Engineering, and Medicine entitled ``Integrating 
Social Care into the Delivery of Health Care'' highlighted the growing 
need to understand how social factors play a major role in people's 
health. The Committee provides $10,000,000 for the Office of Behavioral 
and Social Sciences Research for grants, Notices of Special Interest 
(NOSI), and other funding mechanisms to support this work and urges NIH 
to consider how its programs in health services, translational, 
intervention, and implementation research are inclusive of social 
determinants of health research and researchers.
    Department of Education: $13,000 in FY 2022 for the maximum 
individual Pell Grant. Pell Grants are critical to ensuring access and 
affordability in higher education. CSWE also supports increasing the 
amount of Pell funding that is supported by mandatory spending. Student 
aid programs, particularly grant programs, represent important 
investments and help students avoid crushing debt burdens when they 
graduate.
  --Support for the Public Service Loan Forgiveness (PSLF) Program. 
        PSLF is an integral program to ensuring a pipeline of 
        professionals in public service serving in high-needs areas. 
        CSWE encourages Congress to continue support for this vital 
        program and programs like the Temporary Expanded Public Service 
        Loan Forgiveness (TEPSLF), which assists public service workers 
        who were enrolled in ineligible loan repayment programs. In 
        addition to continuing support for PSLF, CSWE asks Congress to 
        continue oversight of how the Department of Education is 
        implementing the program.
  --Support for Paid Internships for Social Workers. Social work 
        students are required to participate in at least 400 hours of 
        field experience and at the graduate level masters students are 
        required to complete at least 900 hours. These experiences are 
        critical to ensuring the development of a professional social 
        work workforce. Yet many times these experiences are unpaid. 
        CSWE requests the following report language be included in the 
        FY 2023 Labor-H report: The Committee directs the Department of 
        Education to consider the feasibility of using its Experimental 
        Sites authority for a pilot to use Federal Work Study and other 
        financial aid funding to support social work students involved 
        in internships and field experiences. The Department is 
        directed to provide a report to the Committees on Education and 
        Labor, and on Appropriations of the House of Representatives 
        and on the Committees on Health, Education, Labor, and Pensions 
        and on Appropriations of the Senate on its plan for an 
        Experimental Sites Initiative. Point of Contact: Otto Katt, 
        [email protected].
                                 ______
                                 
     Prepared Statement of the Creutzfeldt-Jakob Disease Foundation
    Chairwoman Murray, Ranking Member Blunt, and Members of the 
subcommittee:
    We appreciate the opportunity to submit this testimony in strong 
support for funding of the crucial prion disease work being undertaken 
by the Centers for Disease Control and Prevention in partnership with 
public health agencies around the country and the National Prion 
Disease Pathology Surveillance Center (NPDPSC). We request 
Congressional support in increasing the Prion Disease Surveillance 
appropriation through the CDC, Emerging and Zoonotic Infectious 
Diseases, by $1 million, for a total of $7.5 million.
                                overview
    Creutzfeldt-Jakob Disease (CJD), is a rare, 100 percent fatal, 
degenerative brain disease that causes rapidly progressive dementia. 
CJD is transmissible and presently has no treatment or cure. 
Approximately 1 in 6,200 individuals will die from this disease in 
their lifetime; however, the unreported and undiagnosed number of cases 
remains unclear.
    CJD is caused by the presence of an abnormal ``prion'' protein in 
the brain and is known as a prion disease. CJD/Prion disease 
surveillance receives modest support through the Centers for Disease 
Control and Prevention (CDC). We need your support to strengthen and 
continue the coordination of CJD and other prion disease surveillance 
activities and to assure the safety of the American public.
     variant cjd (vcjd), and bovine spongiform encephalopathy (bse)
    One form of this disease in humans, variant CJD (vCJD), is known to 
be caused by ingesting beef contaminated with Bovine Spongiform 
Encephalopathy (BSE), commonly known as ``mad cow'' disease. The most 
recent U.S. case of variant CJD was announced in 2013 and confirmed by 
the National Prion Disease Pathology Surveillance Center (NPDPSC) in 
2014. Limited BSE testing by the USDA adds another layer to the already 
deepening concerns regarding possible risks to humans. In recent years, 
the USDA has decreased random testing for BSE from 40,000 to 25,000 
tests per year (12,719 tests in 6 months, or 1 test per 3,302 live 
cows). Hence, surveillance of BSE in this country is largely dependent 
on demonstrating the lack of transmission to humans through human 
disease surveillance. The vCJD case identified by NPDPSC in 2014 
exemplifies the persistent risk for vCJD acquired in unsuspected 
geographic locations and highlights the need for continuing prion 
disease surveillance and awareness to prevent further dissemination of 
vCJD. The two most recent cases of vCJD in Europe are believed to be 
due to occupational exposure and several cases of vCJD have been 
transmitted between individuals via blood transfusions. Hence, vCJD 
risk is not confined to eating contaminated food.
                     chronic wasting disease (cwd)
    Emerging laboratory data show that Chronic Wasting Disease (CWD), a 
naturally occurring prion disease of deer and elk, could potentially 
transmit to humans and other mammals, posing a new threat to public 
health. Human surveillance through brain tissue examination is the only 
way to definitively diagnose human prion diseases, determine their 
origin, and determine whether the spread of CWD found in elk and deer 
in 30 States in the U.S. and in 4 Canadian provinces has become a human 
risk. A study in progress has reported that CWD was transmitted to 
macaques (primates that are genetically similar to humans) by feeding 
them contaminated deer meat. Unlike the BSE outbreak in cattle, CWD 
prions are highly infectious among its own species and the disease 
transmits by contact and through contaminated environment, including 
soil and plants, in free ranging and farmed animals. Additionally, 
multiple lines of experimental evidence indicate that sheep and cows 
are susceptible to CWD. Since CWD has been proven to cross several 
species barriers, this opens up the possibility of transmission to 
humans as well, either directly by eating contaminated venison or 
indirectly through infected domestic animals. Continued prion disease 
surveillance, particularly through examination of human brain tissue, 
is imperative to evaluate whether CWD has or can spread to humans.
    The NPDPSC, funded by the CDC and located at Case Western Reserve 
University in Cleveland, Ohio, is our line of defense against the 
possibility of an undetected U.S. human prion disease epidemic as 
experienced in the United Kingdom.
    Prion disease surveillance is funded at $6.5 million/year. That 
figure has increased by just $500,000 over the past 7 years, despite 
increasing costs of surveillance. Expenses have since risen for the 
resources required to perform adequate surveillance such as increasing 
number of cases as expected by the aging American population, 
increasing autopsy costs over time, screening for COVID19, and taking 
extra precautions necessary for COVID19. Without an increase in funding 
commensurate with these increased expenses, surveillance will be 
compromised.
Request:
    We ask for Congressional support in increasing prion disease 
surveillance's appropriation by $1 million, for a total of $7.5 
million. This would allow the NPDPSC to meet increasing autopsy costs 
and continue to develop more efficient detection methods while 
providing an acceptable level of prion surveillance. Reduction of 
funding or maintaining static funding to the NPDPSC would eliminate an 
important safety net to U.S. public health, making the U.S. the only 
industrialized country lacking prion surveillance, which in turn would 
jeopardize the export of U.S. beef. The increase in funding would allow 
the NPDPSC to expand its scope to address the growth in CWD among deer 
and elk, and explore whether CWD could spread to humans. Additionally, 
increasing prion disease surveillance in the U.S. increases 
surveillance at the National (CDC) and state (state public health 
departments) levels, which has been severely affected by competing 
concerns within the CDC division (e.g., COVID19).
Background:
    The NPDPSC is funded entirely by the CDC from funds allocated by 
Congress. The CDC traditionally keeps approximately half of the 
appropriation for epidemiologic surveillance projects and funding prion 
disease surveillance at the state level.
    Increasing the appropriation from $6.5M to $7.5M will allow the 
NPDPSC to persist and continue to develop more efficient detection 
methods while providing an acceptable level of prion disease 
surveillance. Acceptable national surveillance is not possible at a 
lower level of funding. The requested $1M addition to the appropriation 
(total of $7.5M) would enable the NPDPSC to maintain appropriate 
surveillance, tissue collection, diagnostics and diagnostic test 
development of prion disease cases from CWD endemic States to determine 
whether CWD is transmissible to humans and if so, what risk this poses 
to public health (e.g., transmission risks from human to human).
    The National Prion Disease Pathology Surveillance Center is the 
only laboratory-based organization in the U.S. that monitors human 
prion diseases and is able to determine whether a patient acquired the 
disease through the consumption of prion contaminated beef (``mad cow'' 
disease) or meat from elk and deer affected by chronic wasting disease 
(CWD).
    The NPDPSC also monitors all cases in which a prion disease might 
have been acquired by infected blood transfusion, from the use of 
contaminated surgical instruments, or from contaminated human growth 
hormone. Because standard hospital sterilization procedures do not 
completely inactivate prions that transmit the disease, these incidents 
put a number of patients under unnecessary risk and require costly 
replacement of contaminated surgical equipment.
    The NPDPSC also plays a decisive role in resolving suspected cases 
or clusters of cases of food-acquired and medically transmitted prion 
disease that are often magnified by the media, stirring intense public 
alarm. To date, the NPDPSC has examined approximately 8,000 suspected 
cases of suspected prion disease and has definitely confirmed presence 
and type of prion disease in more than 4,800 cases.
    The NPDPSC is the primary line of defense in safeguarding U.S. 
public health against prion diseases because the U.S., unlike other BSE 
affected countries such as the UK, the European Union, and Japan, does 
not have a sufficiently robust animal prion disease surveillance 
system.
    The NPDPSC offers assurances, to countries that import (or are 
considering importing) meat from the United States, that the U.S. is 
free of indigenous human cases of ``mad cow'' disease. In the past, 
South Korean and Chinese health officials resumed importation of U.S. 
beef to their country after a visit to the NPDPSC provided assurances 
regarding rigorous human prion surveillance.
    Since its inception in 1997, the NPDPSC has collected and stored 
approximately 8,000 brains and many more samples of cerebrospinal fluid 
from cases of suspected prion disease, making it the largest prion 
disease biobank in the world. Increased funding is required to continue 
to preserve these precious specimens for future international research 
efforts as well as to serve as reference materials to evaluate 
potential emerging prion diseases (e.g., chronic wasting disease).
    Thank you for the opportunity to submit this testimony.

    [This statement was submitted by Deborah R. Yobs, President/
Executive Director, CJD Foundation.]
                                 ______
                                 
              Prepared Statement of Cure Alzheimer's Fund
    Chairwoman Murry, Ranking Member Blunt, and members of the Senate 
Labor, Health & Human Services, Education, and Related Agencies (LHHSE) 
Appropriations subcommittee, I am Tim Armour, President, and CEO of 
Cure Alzheimer's Fund. I want to thank Congress for its ongoing 
commitment to, and support for, sustained and continued funding for 
Alzheimer's disease research at the National Institutes of Health 
(NIH), and to submit this written testimony to respectfully request at 
least an additional $226 million in Fiscal Year 2023 above the final 
enacted amount for Fiscal Year 2022 for Alzheimer's disease research at 
the NIH.
    Additionally, Cure Alzheimer's Fund respectfully requests at least 
an additional $60 million in total appropriations for the Brain 
Research through Advancing Innovative Neurotechnologies (BRAIN) 
Initiative. Because of the past investments this subcommittee has made 
in the BRAIN Initiative, and with its interest in increasing early 
detection and diagnosis of Alzheimer's disease, the tools developed by 
the BRAIN Initiative are becoming ever more important to the search for 
a cure for Alzheimer's disease.
    Cure Alzheimer's Fund is a national nonprofit, based in 
Massachusetts, that funds research with the highest probability of 
preventing, slowing, or reversing Alzheimer's disease. Since its 
founding in 2004, Cure Alzheimer's Fund has invested more than $145 
million in research through 615 grants across the United States and 
internationally.
    In my past testimony, I have highlighted several areas of novel 
research that Cure Alzheimer's Fund has supported. Many of these are of 
interest to Congress as well as shown through the Report Language 
accompanying the Appropriations bills. Things like Diabetes, Herpes, 
and the Exposome, and their impacts on the development of Alzheimer's 
disease are some of the areas of research that were highlighted in the 
Fiscal Year 2022 Appropriations Bill Report Language.
    These are all areas in which Cure Alzheimer's Fund has long 
supported early-stage research.
    As far back as 2010, Cure Alzheimer's Fund was investing in 
research into the relationship between Alzheimer's disease and 
Diabetes.
    Research conducted by Sam Gandy at the Icahn School of Medicine at 
Mount Sinai was focused on the gene for a protein called SorSC1. SocSC1 
has been independently linked to both Alzheimer's disease and Type II 
Diabetes. Cure Alzheimer's Fund research focused on better 
understanding the potential link between Alzheimer's disease and 
Diabetes.
    https://curealz.org/research/translational/studies-of-novel-ad-
genes/brain-structure-abeta-metabolism-and-behavior-in-mice-deficient-
in-diabetes-and-alzheimers-associated-sorcs1/.
    Cure Alzheimer's Fund is continuing this line of investigation by, 
among other efforts, supporting research in the lab of Dr. Miranda Orr 
at Wake Forest University exploring the impact of a high-fat diet and 
consequent metabolic syndrome on the onset of cellular senescence in 
neurons containing Alzheimer's tau pathology.
    In 2015, Cure Alzheimer's Fund supported research into the 
hypothesis that beta amyloid plaques form as part of the brain's immune 
response to pathogens like Herpes Simplex Virus. This was the beginning 
of research into the theory that Beta-Amyloid is part of the innate 
immune system; research that I have highlighted often in my submitted 
testimony.
    https://curealz.org/research/translational/studies-of-tau/abeta-
expression-protects-the-brain-from-herpes-simplex-virus/.
    This early-stage, novel theory research supported by Cure 
Alzheimer's Fund led to two journal articles published in Neuron in 
2018. These journal articles further established the link between 
pathogens like Herpes and Alzheimer's disease.
    https://curealz.org/news-and-events/evidence-of-the-link-between-
alzheimers-and-herpes-continues-to-grow/.
    https://www.cell.com/neuron/fulltext/S0896-6273(18)30526-9.
    https://www.cell.com/neuron/fulltext/S0896-6273(18)30421-5.
    Dr. Rob Moir at Massachusetts General Hospital originally had the 
idea that Beta Amyloid was part of the innate immune system and is an 
antimicrobial.
    Although Dr. Moir passed away in 2019, the research spurred by his 
idea continues today, and is an important area of research for Cure 
Alzheimer's Fund, this subcommittee, and Alzheimer's disease research 
in general.
    In my submitted testimony last year, I highlighted the research 
supported by Cure Alzheimer's Fund that is focused on the role 
particulate matter and pollution play in the development of Alzheimer's 
disease. These exposome influences are important to not only better 
understanding Alzheimer's disease pathology, but also to understanding 
environmental justice and social determinants of health and how the air 
we breathe can influence our cognitive health.
    https://curealz.org/research/translational-research/air-pollution-
and-app-processing/.
    The Fiscal Year 2022 Appropriations Bill Report Language also 
referenced increasing and improving diversity in clinical trials, 
improving diagnostic tools, and creating new tools for measurement of 
cognitive impairment.
    Although the early-stage research supported by Cure Alzheimer's 
Fund is not focused specifically on these areas, the work by Cure 
Alzheimer's Fund to diversify research and brain banks samples will 
inform these efforts.
    Knowing that having diversified samples available to researchers is 
vital to not only the work Cure Alzheimer's Fund is supporting, but 
also for other researchers working on other dementias and neurological 
conditions, Cure Alzheimer's Fund is working with the Brain Donor 
Project on a specific project to increase and improve outreach to 
underrepresented populations to increase brain donations. This project 
will help to create a more diversified brain bank with samples that 
will be available to all researchers working on all neurological 
conditions.
    https://curealz.org/research/foundational/biomarkers-diagnostics-
studies-of-risk-resilience/targeted-recruitment-of-underrepresented-
americans-for-brain-donation-registration/.
    The Fiscal Year 2022 Appropriations Bill Report Language also 
referenced the relationship between Alzheimer's disease and Down 
syndrome. These are also areas in which Cure Alzheimer's Fund has been 
supporting research. As this subcommittee is aware, individuals with 
Down syndrome are virtually certain to have Alzheimer's disease 
pathology and clinical symptoms by the time they are 50 years old 
because their genetic trisomy leads to overproduction of the amyloid 
precursor protein.
    In 2014, Cure Alzheimer's Fund hosted a webinar focused on the 
relationship between Down syndrome and Alzheimer's disease.
    https://curealz.org/news-and-events/alzstream-webinar-alzheimers-
and-down-syndrome/.
    Recent public discussion of the anti-amyloid immunotherapy Aduhelm 
brought renewed attention to the importance of including the Down 
syndrome community in research on Alzheimer's disease. Cure Alzheimer's 
Fund recently funded work in the lab of Dr. William Mobley and the late 
Dr. Steven Wagner at the University of California San Diego testing an 
anti-amyloid oral therapeutic in a mouse model recapitulating both Down 
syndrome and amyloid pathology; this therapeutic has received 
significant funding from the NIH Blueprint program and will enter 
clinical trials in the next 9 months. It is of high potential to the 
Down syndrome community.
    Cure Alzheimer's Fund has been supporting the research of Beth 
Stevens at Boston Children's Hospital. It may seem strange for an 
Alzheimer's disease organization to be supporting research at a 
pediatric hospital, but it is important work with insights into several 
neurological conditions including Alzheimer's disease and autism.
    Dr. Stevens is researching Microglia and the role Microglia play in 
synapse development and elimination. Microglia plays an important role 
in pruning synapses in early life. During brain development, 
insufficient synapse pruning can lead to autism spectrum disorders. 
However, overaggressive synaptic pruning in older adults can lead to 
cognitive decline.
    https://curealz.org/researchers/beth-stevens/.
    https://curealz.org/research/translational/studies-of-innate-
immune-pathology/early-role-of-microglia-in-synapse-loss-in-alzheimers-
disease/.
    This research shows how the drivers of neurological conditions are 
interrelated and that research into one condition could provide insight 
and answers to other conditions. This research also shows the value of 
the sustained and continuing investment in, and commitment to, 
Alzheimer's disease research made by this subcommittee. The commitment 
demonstrated by this subcommittee is providing NIH with the resources 
necessary for it to be able to invest in several novel targets 
simultaneously. And as I have described in this testimony, many of 
these novel targets are the result of early-stage research supported by 
private organizations like Cure Alzheimer's Fund.
    Groups such as Cure Alzheimer's Fund can provide vital initial 
research funding allowing researchers to prove their concepts and 
compile initial data sets. With this information, researchers are then 
able to approach NIH for larger-scale and longer-term funding. It is a 
great example of public-private partnerships that are proving to be 
very important to advancing Alzheimer's disease research, as well as 
other neurological conditions.
    This is only possible because of the commitment to Alzheimer's 
disease research shown by this subcommittee. Without adequate 
resources, NIH would not be able to pursue these different avenues of 
research; which are stated areas of interest to this subcommittee and 
Congress.
    It would be disheartening, with all the advancements that have been 
made in the last 10 years, if NIH was not able to continue its broad-
based research portfolio because of limited research funding. As 
progress is being made toward the goals of the National Alzheimer's 
Project Act, it is even more important for this subcommittee to 
continue to demonstrate its commitment to Alzheimer's disease research 
funding at NIH.
    Thank you for your continued support of Alzheimer's disease 
research, and for the opportunity to submit this written testimony and 
to respectfully request at least an additional $226 million above the 
final enacted level in Fiscal Year 2022 for Fiscal Year 2023 for 
Alzheimer's disease research at NIH, and at least an additional $60 
million in total appropriations for the BRAIN Initiative. Cure 
Alzheimer's Fund has worked closely with the subcommittee in the past 
and looks forward to being your partner as we work toward Alzheimer's 
disease research having the necessary resources to end this awful 
disease.
    Respectfully Submitted May 11, 2022.

    [This statement was submitted by Timothy Armour, President and CEO, 
Cure Alzheimer's Fund.]
                                 ______
                                 
              Prepared Statement of Dave Purchase Project
    Chairwoman Murray, Ranking Member Blunt, and members of the 
subcommittee, my name is Dr. Paul LaKosky and I serve as the Executive 
Director of Dave Purchase Project, the North American Syringe Exchange 
Network (NASEN), and the Tacoma Needle Exchange in Tacoma, Washington. 
I am pleased to submit testimony on behalf of these organizations and 
as a member of a large coalition of public health, HIV, viral 
hepatitis, and harm reduction organizations to urge Congress to 
appropriate $150 million for the Infectious Diseases and the Opioid 
Epidemic program at the Centers for Disease Control and Prevention 
(CDC) at the Department of Health and Human Services (HHS) to save 
lives and address the overdose crisis by supporting and expanding 
access to syringe services programs (SSPs).
    Named in honor of its late, pioneering founder, Dave Purchase, Dave 
Purchase Project houses the Nation's first legal syringe services 
program, created in 1988 at the height of the HIV epidemic in the 
United States. The program seeks to stop the spread of bloodborne 
pathogens, such as HIV and hepatitis C, among people who use drugs and 
to reduce the harm to individuals and communities associated with drug 
use. Although initially intended to address the spread of HIV, Dave 
Purchase Project now provides national leadership in its response to 
the opioid crisis. It also facilitates syringe services in Tacoma and 
throughout Pierce County, Washington.
    Dave Purchase Project also houses the North American Syringe 
Exchange Network (NASEN). In 1992, NASEN formed to support syringe 
services programs (SSPs) and to expand the network of organizations and 
individuals that advocate for these life-saving programs. NASEN is the 
first and largest supplier of low-cost harm reduction resources in the 
US. In 2021, NASEN acquired and distributed approximately $18 million 
in harm reduction resources to the approximately 400 SSPs in the US, 
Puerto Rico, and the US Virgin Islands. NASEN also provided support 
valued at $20,000 to 16 newly emerging and/or struggling SSPs through 
start-up grant packages. As the Executive Director of these 
organizations, I am familiar with providing direct services to people 
who use drugs in Washington State, and with the significant gaps and 
need for resources and services nationwide.
    The United States continues to experience a public health emergency 
related to overdose, with over 106,000 overdose deaths counted between 
November 2020 and November 2021 and deaths increasing by an alarming 45 
percent since January 2020. According to provisional CDC data, overdose 
deaths continue to accelerate in Washington, increasing by 28 percent 
in the latter half of 2021.
    Overdose deaths have increased more dramatically among Black people 
and communities of color. In 2020, Black people had the largest 
percentage increase in overdose mortality--48.8 percent. The Hispanic 
or Latino community experienced a 40.1 percent increase in overdose 
deaths as compared to white people who experienced a 26.3 percent 
increase. American Indians and Alaska Natives experienced the highest 
rate of overdose mortality of all ethnic groups in 2020, a mortality 
rate 30.8 percent higher than that of white people.
    SSPs are an essential component of preventing overdose deaths. 
Tacoma Needle Exchange provides sterile syringes, which helps prevent 
the spread of infectious diseases such as HIV, as well as services such 
as opioid overdose prevention and awareness training, naloxone training 
and distribution, wound care, and referrals for medication assisted 
treatment and other medical and social services. Our outreach staff 
meets people where they are and helps them address their needs in the 
safest and healthiest way possible, free of judgement and stigma.
    The following is but one example of what we do, and why we do it. 
In 2020 and 2021, in response to the housing crisis, we increased our 
outreach to individuals living houseless in encampments in Pierce 
County, WA. One of our outreach workers was able to connect to a 
disabled veteran who was experiencing active addiction and had been 
living houseless for several years. He was in rough shape as a result 
of an assault and had open, infected, wounds that required immediate 
attention. Our outreach worker cleaned and dressed the wounds and was 
subsequently able to get this individual a new tent in a safe location. 
He then referred the individual to our peer care navigator who was able 
to get the individual into medically assisted treatment for his opioid 
use disorder. The navigator was also able to secure a place to live for 
this individual in a tiny home village for veterans.
    SSPs are the most effective way to get naloxone into the hands of 
people who use drugs and who are most likely to be at the scene of an 
overdose. In 2020/2021, our team distributed approximately 19,000 doses 
of naloxone and 1,722 overdose reversals were reported back to us (and 
many more occurred that went unreported). People who use drugs are 
essential partners in preventing overdose fatalities and are best 
reached by SSPs. In fact, more than 99 percent of the reported overdose 
reversals were performed by community members--other drug users, family 
members, friends, bystanders--and not by first responders. With 
additional resources, SSPs could reach more people with naloxone, which 
would help reduce the dramatically increasing number of overdose 
deaths.
    Congress must respond to the overdose crisis, as well as work to 
prevent and reduce infectious diseases related to drug use, such as HIV 
and hepatitis C, by supporting and expanding access to SSPs. Infectious 
diseases associated with opioid and other drug use have dramatically 
increased across the U.S. Since 2010, the number of new hepatitis C 
infections has increased by 380 percent. Outbreaks of viral hepatitis 
and HIV among people who inject drugs continue to occur nationwide. The 
CDC has documented over 30 years of studies that show that SSPs reduce 
overdose deaths and infectious diseases transmission rates as well as 
increase the number of individuals entering substance use disorder 
treatment. These studies also confirm that SSPs do not increase illicit 
drug use or crime and save money.
    SSPs are among the only health care services trusted and used by 
people who use drugs and so can effectively engage this highly 
stigmatized population. SSPs help protect the community (including 
first responders) by ensuring safe disposal of syringes, reducing rates 
of infectious diseases, and can help providing a pathway to effective 
mental health and substance use treatment and other medical care.
    Unfortunately, the Nation has insufficient access to SSPs and the 
COVID-19 pandemic has decreased access to these life-saving services 
when the need for services has increased dramatically. NASEN's March 
2020 survey of 173 SSPs--almost 40 percent of SSPs nationwide--showed a 
43 percent decrease in SSP services as a result of COVID-19. A similar 
Drug Policy Alliance survey showed that 91 percent of respondents 
experienced an increase in clients in 2020. Funding shortfalls and 
increased need for services have persisted into 2022. As a result of 
increasing need coupled with decreased, limited resources, SSPs cannot 
reach the millions of people who could benefit from their life-saving 
services, including overdose prevention and access to critical health 
care.
    Federal funding would expand access to critical and effective SSP 
programs. NASEN's own data show that there are only approximately 400-
600 SSPs operating nationwide. The United States could easily use as 
many as 4000 programs--7-10 times the number in existence now. NASEN 
routinely provides program support packages with essential harm 
reduction supplies to organizations wishing to start SSPs. We 
consistently have a wait list of 25-30 organizations seeking 
assistance, no matter how many support packages we distribute.
    A study that assessed the startup costs of an individual program 
estimated that it would cost (in 2020 dollars) $490,000 for a small 
rural program and $2.1 million for a large urban program, resulting in 
an average start-up cost of $1.3 million per program. Based on these 
numbers, the requested funding could provide modest increases to 
currently operating SSPs to help address funding shortfalls and help 
expand the number of SSPs nationwide.
    Finally, expanding access to SSPs would reduce health care costs, 
including for infectious diseases treatment. Hepatitis C treatment can 
cost more than $30,000 per person, while HIV treatment can cost upwards 
of $560,000 per person. Averting even a small number of cases would 
save millions of dollars in treatment costs in a single year.
    The Infectious Diseases and Opioid Epidemic Program at CDC helps to 
eliminate infections related to injection drug-use and improve their 
prevention, surveillance, and treatment. It also strengthens and 
expands access to SSPs. In FY 2021, CDC provided technical assistance 
to help ensure high-quality, comprehensive services and best practices 
for SSPs.
    If Congress were to provide $150 million in FY23 funding, CDC could 
significantly expand SSPs at this critical time to help prevent 
overdose deaths, the spread of HIV and viral hepatitis, and connect 
people to life-saving medical care. It is urgent that Congress respond 
now and forcefully to this crisis or more lives will be lost to 
overdose and countless people will continue to contract infectious 
diseases that seriously compromise their personal health as well as the 
public health, creating long-term costs for all.
    Finally, on a personal note, I speak to you as a public health 
researcher and SSP supporter and provider, but also--and more 
importantly--as the older brother of someone who has struggled with 
addiction his entire adult life. My brother overdosed on fentanyl, but 
thankfully survived. Because he survived, in January 2022, after many 
months of transient homelessness and estrangement from my family, my 
brother entered a residential treatment facility for his substance use 
disorder. He stated he was tired of the isolation, the homelessness, 
and the constant feeling that he was vulnerable and worthless. Mostly, 
he said, ``I miss the family.'' This is not the first time he has been 
in treatment--and likely not the last. But with the support he receives 
from his treatment team, his recovery community, and my family, we see 
improvements in his personality and his outlook on life and, in 
fleeting moments, we catch glimmers of the sweet, gullible, brother he 
is when he is not using meth.
    Thank you for your time and consideration of my testimony. Please 
do not hesitate to contact me, Jenny Collier at 
[email protected], or Bill McColl at 
[email protected] if you have questions or need additional 
information.

    [This statement was submitted by Paul LaKosky, Ph.D., Executive 
Director, Dave Purchase Project, the North American Syringe Exchange 
Network, Tacoma Needle Exchange, and coalition partners.]
                                 ______
                                 
                   Prepared Statement of Duke Health
    Duke Health (the conceptual integration of the Duke University 
Health System, the schools of Medicine and Nursing, the Private 
Diagnostic Clinic, and other health and health research centers across 
Duke University) would like to express appreciation for Federal support 
provided to academic health centers across the United States. COVID-19 
has illustrated how vital the investments from this subcommittee are 
for strengthening a health care infrastructure in the United States 
that can research and develop new vaccines and therapeutics and provide 
high-quality care to patients at all times.
    Duke Health is committed to conducting innovative basic and 
clinical research, rapidly translating breakthrough discoveries to 
patient care and population health, providing a unique educational 
experience to future clinical and scientific leaders, improving the 
health of populations, and actively seeking policy and intervention-
based solutions to complex global health challenges. Reflecting Duke 
Health's mission of ``Advancing Health Together,'' this written 
testimony outlines Duke Health's biomedical research and health care 
priorities that represent sound investments in vital programs at HHS 
that make a difference in the lives of patients across the United 
States. Thank you for this opportunity to submit written testimony.
                  national institutes of health (nih)
    Duke Health is grateful for Congress' robust investments in NIH, 
which has kept the United States on the cutting edge of new biomedical 
advances. In fiscal year (FY) 2023, Duke Health supports a program 
level of at least $49.048 billion for the NIH base budget, which would 
represent an increase of $4.1 billion over the comparable FY 2022 
funding level (an increase of $3.5 billion or 7.9 percent in the NIH 
appropriation plus funding from the 21st Century Cures Act for specific 
initiatives). Duke Health strongly urges lawmakers to ensure that any 
funding for the new Advanced Research Projects Agency for Health (ARPA-
H) supplement our $49 billion recommendation for NIH's base budget, 
rather than supplant the essential foundational investment in the NIH.
    Duke Health appreciates the inclusion of $52 million in the FY 2022 
Consolidated Appropriations Act (Public Law 117-103) for the National 
Institute of Allergy and Infectious Disease to support Regional 
Biocontainment Laboratories (RBLs) for research, operation support, and 
training new researchers in biosafety-level (BSL) 3 practices. 
Continued Federal investment in the RBLs will strengthen the Nation's 
research on biodefense and emerging infectious disease agents and 
improve our response to future public health emergencies. For FY 2023, 
Duke Health respectfully requests $52 million to be shared among the 12 
research institutions to conduct research on developing tests for new 
antiviral compounds, vaccines, and point of care tests; support 
operations costs and purchase of equipment to keep the laboratories up 
to date and safe; and support personnel trained in biosafety level 3 
and 2 practices to ensure the highest level of expertise is brought to 
bear on these research needs that are critical for the security of the 
U.S.
    Duke Health also appreciates the Committee's support for the 
National Center for Advancing Translational Sciences (NCATS) Clinical 
and Translational Science Awards (CTSA) Program. In FY 2023, Duke 
Health urges the Committee to consider urging NCATS to make 
supplemental funding available to Minority Serving Institutions that 
partners with CTSAs to incentivize these partnerships. We also ask the 
Committee to urge NCATS to increase the cap for CTSA Program Hubs.
    Finally, Duke Health asks the subcommittee not to include language 
that would limit the use of nonhuman primates in research, which could 
cripple the search for treatments and cures for many human diseases, 
especially therapeutics and vaccines for COVID-19.
            centers for disease control and prevention (cdc)
    The CDC serves as the command center for the Nation's public health 
defense system against emerging and reemerging infectious diseases. 
Now, more than ever, investments in the Nation's public health 
infrastructure and public health defense systems are critical. Duke 
Health urges the subcommittee to provide at least $11 billion for the 
CDC in FY 2023. Within the CDC, Duke Health also requests the Committee 
consider including $10 million for the Sickle Cell Disease (SCD) 
surveillance program within the National Center for Birth Defects and 
Developmental Disabilities' Blood Disorder Division. Additional Federal 
funding for CDC's SCD Data Collection Program is also necessary to 
allow the program to be expanded to include additional States with the 
goal of covering the majority of the U.S. SCD population over the next 
5 years.
                 nih and cdc firearm violence research
    Duke Health is grateful for investments from Congress to support 
firearm violence research. As outlined in the FY 2023 NIH Budget 
Justification to Congress, violence is a widespread public health 
problem that has profound impacts on lifelong health, opportunity, and 
well-being. Duke Health asks the Committee to consider $35 million for 
the CDC and $25 million for the NIH to conduct public health research 
into firearm morbidity and mortality prevention. We also encourage 
Congress to explore opportunities for building out and further 
supporting this research at all other appropriate agencies, to ensure 
that federally funded research can explore the full scope of this 
public health issue.
          health resources and services administration (hrsa)
    Duke Health appreciates the subcommittee's continued investment in 
Title VII health professions training programs and Title VIII Nursing 
Workforce Development programs at HRSA. These programs help ensure a 
well-trained pipeline of health professionals to meet the increasing 
health needs facing the United States. These programs also increase the 
diversity and cultural competency of our Nation's health care 
workforce, which is increasingly important as the U.S. population grows 
and becomes more diverse. For FY 2023, Duke Health respectfully 
requests that the subcommittee provide $980 million to Title VII health 
professions programs, and $530 million to Title VIII Nursing Workforce 
Development programs. Title VII and Title VIII are the only Federal 
programs that support education/training opportunities for an array of 
aspiring and practicing health professionals, both facilitating career 
opportunities and bringing health care services to rural and 
underserved communities. Duke Health also supports the president's 
proposal to provide support for programs to address clinician burn-out 
and well-being, as authorized under Title VII and established in the 
recently enacted Dr. Lorna Breen Health Care Provider Protection Act.
    Duke Health urges the subcommittee to provide $23 million in FY 
2023 for the National Cord Blood Inventory (NCBI) at HRSA. This program 
is charged with building a genetically and ethnically diverse inventory 
of at least 150,000 new units of high-quality umbilical cord blood for 
transplantation. These cord blood units, as well as other units in the 
inventories of participating cord blood banks, are made available to 
physicians and patients for blood stem cell transplants through the 
C.W. Bill Young Cell Transplantation Program. Cord blood banks 
participating in the NCBI Program, including the Carolinas Cord Blood 
Bank in the Duke University School of Medicine, also make cord blood 
units available for preclinical and clinical research focusing on cord 
blood stem cell biology and the use of cord blood stem cells for human 
transplantation and cellular therapies.
    Blood stem cell transplantation is potentially a curative therapy 
for many individuals with leukemia and other life-threatening blood and 
genetic disorders. Each year, nearly 18,000 people in the U.S. are 
diagnosed with illnesses for which blood stem cell transplantation from 
a matched donor is their best treatment option. Often, the first-choice 
donor is a sibling, but only 30 percent of people have a fully tissue-
matched brother or sister. For the other 70 percent, a search for a 
matched unrelated adult donor or a matched umbilical cord blood unit 
must be performed. Umbilical cord blood units have the advantage of use 
without full matching which specifically meets the needs of patients of 
non-Caucasian ancestry. These patients have the lowest chance of 
finding a complete match, but can still have access to transplantation 
therapy using a partially matched banked umbilical cord blood donor 
unit.
    Duke Health respectfully requests the subcommittee provide $37 
million for the C.W. Bill Young Cell Transplantation Program through 
the NCBI at HRSA in FY 2023. The Carolinas Cord Blood Bank (CCCB) at 
Duke is a member bank of the NCBI of the C.W. Bill Young Cell 
Transplantation Program. The goal of this program is to increase the 
number of transplants for recipients suitably matched to biologically 
unrelated donors of bone marrow and umbilical cord blood. The CCBB is 
one of the largest cord blood banks in the world. Cord blood units that 
are banked at CCBB are listed on the National Marrow Donor Program 
(NMDP) Be the Match(r) Registry, an accumulated listing of donated cord 
blood units from participating banks that are available to provide 
donors for patients needing a hematopoietic stem cell transplant to 
treat cancer or certain genetic diseases.
    Thousands of mothers have donated their cord blood to the CCBB. 
Banked units are comprised of African-American, Hispanic-American, 
Asian-American, and Caucasian samples. This diversity helps patients of 
all racial and ethnic backgrounds find suitable matches for 
transplantation. The CCBB has distributed cord blood units for 
transplantation to several thousand patients since 1999. Cord blood 
recipients of CCBB units include children and adult patients facing 
life-threatening illnesses who need a ``stem cell'' transplant from an 
unrelated donor to provide them with healthy blood cells. Many of these 
patients have been affected by leukemia, lymphoma, severe aplastic 
anemia, or other fatal diseases of the blood or immune system, or 
certain inherited metabolic diseases. In addition to life-saving 
transplants, the CCBB also provides cord blood units for research. 
These units are made available to investigators for critical research 
in the area of cord blood and stem cell biology. The impact of funding 
has far reaching impacts, and Duke Health urges the subcommittee to 
support this request.
           agency for healthcare research and quality (ahrq)
    Duke Health urges the subcommittee to provide not less than $500 
million for the Agency for Healthcare Research and Quality in FY 2023. 
AHRQ supports research to improve health care quality, reduce costs, 
advance patient safety, decrease medical errors, and broaden access to 
essential services. As the lead Federal agency for funding health 
services research and primary care research, AHRQ is the bridge between 
cures and care, and ensures that Americans get the best health care at 
the best value. For example, funding from AHRQ supports patients with 
sickle cell disease, an inherited red blood cell disorder, often have 
intense pain that brings them to hospital emergency departments (EDs) 
for immediate treatment. Their care can be fragmented, with frequent 
hospitalizations and specialist care, infrequent follow-up with primary 
care doctors, and repeat ED visits. Funding from AHRQ supports 
activities at the Duke University School of Nursing to improve the care 
of these patients in the ED, particularly through the development and 
use of evidence-based decision support tools.
   substance abuse and mental health services administration (samhsa)
    Duke Health appreciates investments in the National Child Traumatic 
Stress Network (NCTSN) grant program at SAMHSA, especially efforts to 
provide additional funding for this program during COVID-19. For FY 
2023, Duke Health urges the subcommittee to provide $150 million for 
NCTSN, which matches the president's budget request.
    NCTSN, which is coordinated by the UCLA-Duke University National 
Center for Child Traumatic Stress, increases access to services for 
children and families who experience or witness traumatic events. This 
unique network of frontline providers, family members, researchers, and 
national partners is committed to changing the course of children's 
lives by improving their care and moving scientific gains quickly into 
practice across the U.S. In recent years, estimates from the NCTSN 
Collaborative Change Project (CoCap) have indicated that each quarter 
about 35,000 individuals--children, adolescents, and their families--
directly benefited from services through this Network. Since its 
inception, the NCTSN has trained more than one million professionals in 
trauma-informed interventions. Hundreds of thousands more are 
benefiting from the other community services, website resources, 
educational products, community programs, and more. Over 10,000 local 
and State partnerships have been established by NCTSN members in their 
work to integrate trauma-informed services into all child-serving 
systems, including child protective services, health and mental health 
programs, child welfare, education, residential care, juvenile justice, 
courts, and programs serving military and veteran families.
 office of the assistant secretary for preparedness and response (aspr)
    Duke Health requests that the subcommittee provide $11.5 million, 
fully authorized funding, for the Military and Civilian Partnership for 
the Trauma Readiness Grant Program for FY 2023 within ASPR. Originally 
known as MISSION ZERO, this critical program provides funding to ensure 
trauma care readiness by integrating military trauma care providers 
into civilian trauma centers. These partnerships allow military trauma 
care providers to gain exposure to treating critically injured patients 
in communities and keep their skills sharp to increase readiness for 
deployment. Additionally, they allow civilian trauma care providers to 
gain insight into best practices from the battlefield that can be 
integrated into civilian care. Building upon FY 2022's initial 
investment, fully funding this program will help to improve the 
Nation's response to public health and medical emergencies.
                                 ______
                                 
     Prepared Statement of the Dystonia Medical Research Foundation
            summary of recommendations for fiscal year 2023
_______________________________________________________________________

  --Provide $49 billion for the National Institutes of Health (NIH) and 
        proportional increases across its Institutes and Centers.
  --Continue dystonia research supported by NIH through the National 
        Institute on Neurological Disorders and Stroke (NINDS), the 
        National Institute on Deafness and other Communication 
        Disorders (NIDCD), and the National Eye Institute (NEI).
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least $11 billion to facilitate timely public health 
        efforts.
  --Please provide $6 million for the new Chronic Disease Education and 
        Awareness Program at CDC.
_______________________________________________________________________

    Dystonia is a neurological movement disorder that causes muscles to 
contract and spasm involuntarily. It affects men, women and children. 
Dystonia can be generalized, affecting all major muscle groups, and 
resulting in twisting, repetitive movements and abnormal postures or 
focal, affecting a specific part of the body such as legs, arms, hands, 
neck, face, mouth, eyelids and vocal cords. Currently, it is estimated 
that at least 300,000 individuals in North America suffer from 
dystonia, making it more common than Huntington's, muscular dystrophy, 
and ALS. There is no known cure for dystonia.
    In 1967 at the age of 10, I lost the ability to write with either 
hand. Five years later, my father (at the age of 53) and I were 
diagnosed with focal dystonia, affecting our hands, which spasm and 
twist when we attempt to write. My sister, her son, and my daughter 
were later given the same diagnosis. Unlike the others, with every 
passing year, my daughter's dystonia began to affect other regions. By 
19, she was unable to walk or feed herself. Later that year, she 
underwent deep brain stimulation (DBS) surgery which changed her life. 
She was later able to return to and graduate from college and now lives 
a relatively normal and active life.
    I realized at the time of my daughter's diagnosis that I needed to 
do more. I became a clinical trial participant at the NIH and 
volunteered for any studies that could help researchers in finding a 
cure and or better treatments. I also became a passionate advocate for 
dystonia research funding.
         dystonia research at the national institutes of health
    The Dystonia Medical Research Foundation urges the subcommittee to 
continue its support for natural history studies on dystonia that will 
advance the pace of clinical and translational research to find better 
treatments and a cure. In addition, we encourage Congress to continue 
supporting NINDS, NIDCD, and NEI in conducting and expanding critical 
research on dystonia.
    Currently, dystonia research at NIH is supported by the National 
Institute of Neurological Disorders and Stroke (NINDS), the National 
Institute on Deafness and Other Communication Disorders (NIDCD), and 
the National Eye Institute (NEI).
    Most of the dystonia research at NIH is supported by NINDS. NINDS 
has utilized several funding mechanisms in recent years to study the 
causes and mechanisms of dystonia. These grants cover a wide range of 
research including the genetics and genomics of dystonia, the 
development of animal models of primary and secondary dystonia, 
molecular and cellular studies in inherited forms of dystonia, 
epidemiology studies, and brain imaging. We continue to work with the 
leadership of NINDS on the recommendations stemming from our 2018 
meeting that focused on defining emerging opportunities in dystonia 
research.
    Key findings include (1) noting that the heterogeneity of dystonia 
poses challenges to research and therapy development. (2) There is more 
to be learned from genetic subtypes, along clinical, etiology, and 
pathophysiology axes. (3) In order to facilitate key advancements in 
research technology, there needs to be more research collaboration. (4) 
New research priorities should include the generation and integration 
of high-quality phenotypic and genotypic data. (5) Reproducing key 
features in cellular and animal models, both of basic cellular 
mechanisms and phenotypes, leveraging new research technologies. (6) 
Collaboration is necessary both for collection of large data sets and 
integration of different research methods.
    It is of great significance that several dystonia patient advocacy 
group, led by the Dystonia Medical Research Foundation, actively took 
part in the meeting and are working to ensure that Congress continues 
to support robust NIH funding.
    NIDCD and NEI also support research on dystonia. NIDCD has funded 
many studies on brainstem systems and their role in spasmodic 
dysphonia, or laryngeal dystonia. Spasmodic dysphonia is a form of 
focal dystonia which involves involuntary spasms of the vocal cords 
causing interruptions of speech and affecting voice quality. NEI 
focuses some of its resources on the study of blepharospasm. 
Blepharospasm is an abnormal, involuntary blinking of the eyelids which 
can render a patient legally blind due to a patient's inability to open 
their eyelids. We were pleased to see that Congress has encouraged both 
NIDCD and NEI to expand their research into both spasmodic dysphonia 
and blepharospasm.
    We thank the committee for the increase for NIH in fiscal year 
2022. We know firsthand that this will further NIH's ability to fund 
meaningful research that benefits our patients.
         cdc's chronic disease education and awareness program
    We strongly support and thank the subcommittee for support of the 
Chronic Disease Education and Awareness Program at CDC. This critical 
program would provide a dedicated pool of resources that could be 
deployed to support meritorious public health projects with 
stakeholders. This program seeks to provide collaborative opportunities 
for chronic disease communities that lack dedicated funding from 
ongoing CDC activities. Such a mechanism allows public health experts 
at the CDC to review project proposals on an annual basis and direct 
resources to high impact efforts in a flexible fashion.
                          patient perspectives
Blepharospasm
    I drive through Atlanta's brutal traffic when suddenly, my eyes 
clamp shut. I pry my left eye open with thumb and forefinger, steer 
with my right hand. My eyes open for a few seconds, then close with no 
warning. What is happening? Over the next few months, these spasms 
progress from eyes to lower face, neck, and shoulders. A year later I 
am diagnosed with Dystonia, a debilitating, little-known disease. A 
healthy 49-year-old mother of three, I now fight constant pain; can no 
longer work, drive or perform basic activities. Even walking our dog is 
a dangerous fall risk.
Spasmodic dysphonia
    Spasmodic dysphonia (SD), a focal form of dystonia, is a 
neurological voice disorder that involves ``spasms'' of the vocal cords 
causing interruptions of speech and affecting voice quality. My voice 
sounds strained or strangled with breaks where no sound is produced. 
When untreated, it is difficult for others to understand me. I receive 
injections of botulinum toxin into my vocal cords every 3 months for 
temporary relief of symptoms. This has worked well for me for over a 
decade. At the start of this year, my insurance coverage changed when 
my husband's company changed providers. As a result, I had to undergo 
an extensive review process and change methods for obtaining my 
medicine. The review lasted for four weeks. Multiple times during this 
time, my doctor and I were told that I had been denied coverage. We had 
to make numerous phone calls to encourage the company and specialty 
pharmacy to review my case again and again. These phone calls were 
extremely difficult as my voice deteriorated from the delay in 
treatment. The automated phone systems were the worst, but the 
representatives also had trouble understanding my broken voice and I 
had to repeat my information over and over. Finally, the company 
determined my treatment is medically necessary and has approved it for 
1 year. After a seven-week delay, I am scheduled for my injection and 
am looking forward to a period of spasm-free speaking.
    We are grateful to those persons who share their stories with the 
DMRF and other dystonia patient groups to help raise awareness of 
dystonia. The DMRF was founded in 1976 and since its inception, the 
goals have remained to advance research for more effective treatments 
of dystonia and ultimately find a cure; to promote awareness and 
education; and support the needs and wellbeing of affected individuals 
and their families.
    Thank you for the opportunity to present the views of the dystonia 
community, we look forward to providing any additional information.

    [This statement was submitted by Carole Rawson, Vice President of 
Public Policy, Dystonia Medical Research Foundation.]
                                 ______
                                 
               Prepared Statement of The Education Trust
    On behalf of The Education Trust, a national nonprofit that works 
to close opportunity gaps that disproportionately affect students of 
color and students from low-income families, thank you for the 
opportunity to present testimony on the Fiscal Year 2023 (FY23) Labor, 
Health and Human Services, Education, and Related Agencies (L-HHS-ED) 
Appropriations bill. We request that the L-HHS-ED bill make substantial 
investments in excess of prior, cap-limited years to ensure that 
essential education programs have the resources they need to ensure the 
greatest impact for students of color and students from low-income 
communities.
    While there are many programs under your jurisdiction that are 
critical to advancing equity, in FY23, The Education Trust is focused 
on the following:
  --Strengthening the Pell Grant program by increasing the maximum 
        award to keep pace with inflation, at a minimum, and ideally, 
        doubling the maximum award.
  --Supporting teachers and school leaders by including funding and 
        language supporting the following:
    --ESSA (Every Student Succeeds Act) Title I-A ($18.54 billion);
    --Incentives for States and localities to evaluate their education 
            funding formulas and policies and implement equitable 
            reforms ($100 million);
    --ESSA Title II-A ($3 billion);
    --the Teacher and School Leader Incentive Program (TSLIP) ($200 
            million);
    --the Supporting Effective Educator Development Program (SEED) 
            ($140 million);
    --HEA (Higher Education Act) Title II's Teacher Quality Partnership 
            (TQP) grants ($300 million); and
    --restoring funding to the School Leader Recruitment and Support 
            Program (SLRSP) ($40 million).
    --Maintain FY22 omnibus report language increasing equity in 
            advanced coursework.
  --Enabling enhanced preparation for teaching candidates at 
        Historically Black Colleges and Universities (HBCUs) and 
        Minority-Serving Institutions (MSIs) by allocating at least $40 
        million in funding for the Augustus F. Hawkins Centers of 
        Excellence Grant program.
  --Developing and strengthening evidence-based student success 
        programs by allocating $110 million in funding for the Post 
        Secondary Student Success Grant program.
  --Supporting student parents by allocating $500 million in funding 
        for the Child Care Access Means Parents in School (CCAMPIS) 
        program.
    We urge increased support by the Committee for these critical 
programs to help meet the needs of students of color and students from 
low-income communities.
Strengthening the Pell Grant Program
    The Pell Grant program is the cornerstone of Federal financial aid. 
The program benefits over 7 million students annually and continues to 
serve as the primary Federal investment designed to allow students from 
low-income backgrounds to access higher education. Over one-third of 
White students, two-thirds of Black students, and half of Latino 
students rely on Pell Grants every year.\1\ Pell Grant dollars are 
well-targeted to those in need: 83 percent of Pell recipients come from 
families with annual incomes at or below $40,000, including 44 percent 
with annual family incomes at or below $15,000.\2\
---------------------------------------------------------------------------
    \1\ Congressional Budget Office (CBO), January 2017 baseline 
projections for the Pell Grant program, http://bit.ly/2mLy0nk, Table 2; 
and Ed Trust calculation NPSAS:12 using PowerStats.
    \2\ Analysis of Federal Pell Grant Program Annual Data Report, 
available at https://www2.ed.gov/finaid/prof/resources/data/pell-
data.html.
---------------------------------------------------------------------------
Increase the Maximum Award
    The maximum Pell Grant award has failed to keep pace with the 
rapidly rising cost of college over the past several decades. In 1980, 
the maximum Pell Grant award covered 77 percent of the cost of 
attendance at a public university. Today, it covers just over 28 
percent, the lowest portion in over 40 years. Bold action must be taken 
to halt and reverse this damaging trend.
    We are appreciative of previous increases to the maximum award in 
prior appropriations bills, including the $400 increase in the Fiscal 
Year 2022 (FY22) omnibus, and we respectfully request that you continue 
to annually increase the maximum award amount. It is also worth noting 
that nearly 1,200 organizations have gone on record supporting the 
doubling of the Pell Grant.
    In FY23, Congress should, at minimum, increase the maximum award 
upward from $6,895 to keep pace with inflation. It is also time for 
Congress to implement an ambitious plan to reverse the downward trend 
of Pell's purchasing power through doubling the maximum award, 
including expanding the mandatory funding stream, ensuring that the 
maximum Pell award covers at least half of the cost of attendance at a 
public 4-year institution.
           supporting students, teachers, and school leaders
    Increase funding for ESSA's Title I-A; ESSA's Title II-A 
(Supporting Effective Instruction); the Teacher and School Leader 
Incentive Program (TSLIP), the Supporting Effective Educator 
Development (SEED) program, HEA's Title II Teacher Quality Partnership 
(TQP) grants; incentivize States and localities to evaluate their 
education funding formulas and policies and implement equitable 
reforms; and maintain FY22 report language supporting increasing equity 
in advanced coursework.
    The Education Trust, building on the prior $1 billion funding 
increase for Title I in the FY22 omnibus, supports another $1 billion 
funding increase in FY23 budget for ESSA's Title I-A program. However, 
it is important to note that most public education funding is 
distributed via State and local formulas. Therefore, any Federal 
funding increases of this size should be accompanied by levers that 
encourage States and districts to address the inequities inherent in 
those formulas. This is a tremendous opportunity to spark systemic 
reform of the status quo that sends $23 billion more to predominantly 
White school districts than predominantly non-White school districts. 
We urge the committee to think boldly about how make the overall 
education funding system more equitable, including inserting report 
language to that effect, and to include the $100 million designated for 
this purpose within the Biden-Harris administration's FY23 budget 
request in the L-HHS-ED Appropriations bill.
    Furthermore, research and experience show the powerful impact that 
teachers and school leaders have on student learning. ESSA's Title II-A 
program provides grants to States and districts that can be used to 
invest in and develop educators. These funds can be used to, among 
other things, address inequities in access to effective teachers and 
school leaders, provide professional development, and improve teacher 
recruitment and retention. States and districts can also apply for 
additional competitive grant dollars for programs like TSLIP and SEED, 
which are targeted at specific, evidence-based strategies for improving 
teacher and school leader effectiveness and increasing educator 
diversity. Additionally, HEA's Title II TQP grants, awarded to 
partnerships between high-need districts and teacher preparation 
programs at institutions of higher education, can be used to recruit 
underrepresented populations to the teaching profession. As Ed Trust's 
work continues to demonstrate the positive impact that diverse teachers 
and school leaders of color can have on the academic achievement of 
both students of color and White students, we remain supportive of 
Federal dollars to increase and bolster the diversity of the educator 
pipeline.
    Finally, research shows that Black, Latino and Native students, 
students with disabilities, and students from low-income families are 
underrepresented in advanced programs and courses (gifted and talented, 
advanced placement, international baccalaureate, honors courses, dual 
enrollment, etc.). We the inclusion of report language included in the 
FY22 omnibus that noted that funds under ESEA (Elementary and Secondary 
Education Act) may be used to implement open enrollment, automatic 
enrollment, and/or universal screening practices; to increase course 
access and success; to provide coaching and training for educators; to 
purchase materials; and/or cover exam fees for underrepresented 
students. The language also encouraged the Department to resume 
collecting data on passing rates for all Advanced Placement subject 
areas.
    Considering the Nationwide attention to the need to invest in 
educators, especially as schools work to counteract the negative 
impacts of the COVID-19 pandemic, Congress appropriated increases for 
most of these programs in FY22: $2.17B for the Title II-A grant, $85M 
for the SEED program, and $59.09M for HEA's Title II TQP grants, but 
unfortunately cut TSLIP by $27M down from $200M in FY21.
    At a minimum, in FY23, Congress should: increase Title I-A; 
allocate $100M to incentivize States and localities to evaluate their 
education funding formulas and policies and implement equitable 
reforms; increase Title II-A, TSLIP, SEED, and TQP beyond FY22 levels: 
$18.54B, $3B, $200M, $140M, and $300M, respectively, and maintain 
report language supporting increasing equity in advanced coursework.
Restore Funding for the School Leader Recruitment and Support Program
    Landmark research funded by the Wallace Foundation has found 
``virtually no documented instances of troubled schools being turned 
around without intervention by a powerful leader,'' and the School 
Leader Recruitment and Support Program is the only Federal program 
specifically focused on investing in evidence-based, locally driven 
strategies to strengthen school leadership in high-need schools. A 
seven-year study, concluded in 2019, of school districts that created 
pipelines to develop school leaders saw increasing gains in student 
achievement over time, showing how a sustained initiative can 
demonstrate positive effects on student learning.
    There is still a great deal of work to do, especially when it comes 
to identifying and efficiently preparing effective turnaround leaders, 
as well as sustainably supporting them to accelerate academic 
achievement, close gaps, and maintain improvement over time for all 
students and in every community. Developing strong leaders to build 
essential relationships with students and the communities they operate 
in is a fundamental necessity to help students finish the learning 
currently unfinished due to the COVID-19 pandemic. The SLRSP is a key 
lever for seeding the next generation of effective school leader 
development programs, promoting equity, advancing ongoing innovation, 
and sharing innovative lessons on transformational leadership with the 
broader field.
    In FY23, Congress should restore funding for the School Leader 
Recruitment and Support Program to $40M, the amount included in the 
FY23 President's Budget and a moderate increase from what was included 
in FY22 Senate Labor-HHS-ED Appropriations bill.
Increase funding for the Augustus F. Hawkins Centers of Excellence 
        Grant Program
    Research has shown that students of color benefit tremendously from 
having teachers of color, particularly one of the same racial 
background: they are less likely to be chronically absent or suspended 
from school, more likely to be recommended for gifted and talented 
programs, and low-income Black students who have a Black teacher for at 
least 1 year in elementary school are less likely to drop out of high 
school and more likely to consider college. And while students of color 
make up the majority of students in public schools, the diversity gap 
for teachers of color still exists across every State. For example, 
Virginia has taken steps to address their diversity gap by using their 
ARPA (American Rescue Plan Act) funds to ``provid[e] ongoing support to 
recruit, hire, and retain a diverse school staff'' including programs 
to induct and mentor new teachers of color and targeted student loan 
assistance programs for pre-service and in-service teachers of color.
    The nationwide impact of HBCUs, MSIs, Hispanic-Serving Institutions 
(HSIs), and Tribal Colleges and Universities (TCUs) on producing 
teachers of color cannot be overstated. HBCUs, TCUs, and MSIs, 
collectively, award only 11 percent of the Nation's bachelor's degrees 
in education, yet they produce more than 50 percent of the bachelor's 
degrees earned in education by Hispanic, Native Hawaiian and Pacific 
Islander students.\3\ HBCUs graduate approximately 50 percent of the 
Nation's African American teachers with bachelor's degrees.\4\ HSIs 
prepare 90 percent of Hispanic teachers, and along with other MSIs, 
constitute a vital pipeline to maintain diversity among our Nation's 
teachers.\5\
---------------------------------------------------------------------------
    \3\ Branch Alliance for Educator Diversity, ``Homepage,'' available 
at https://www.educatordiversity.org/.
    \4\ Jacqueline Jordan Irvine and Leslie T. Fenwick, ``Teachers and 
Teaching for the New Millennium: The Role of HBCUs,'' The Journal of 
Negro Education 80 (3) (2011): 197-208, available at http://
www.jstor.org/stable/41341128; National Association for Equal 
Opportunity in Higher Education: Comments to the Department of 
Education proposed rule changes for teacher preparation programs 
available at: http://nafeonation.org/wp-content/uploads/2015/01/
NADEC_Teacher_Prep_Regulations_Discussion_Document_2-2-15----.pdf.
    \5\ Hispanic Association of Colleges and Universities, ``Teacher 
Diversity,'' https://www.hacuadvocates.net/teacherdiversity?1.
---------------------------------------------------------------------------
    Considering the importance of these institutions, the increased 
needs they experience as result of graduating an outsized portion of 
the Nation's teachers of color, and the exacerbated nature of the 
current shortage of teachers of color due to the COVID-19 pandemic, we 
request that Congress build on the highly appreciated $8M investment 
made in the Augustus F. Hawkins Centers of Excellence grant program in 
the FY22 omnibus. Increasing Congress' investment would provide 
critical funding to these key institutions to provide increased and 
enhanced clinical experience and increased financial aid to prospective 
teachers of color, who face higher burdens in college access and 
affordability than their White peers. Finally, the FY23 President's 
Budget proposal recommended continued and additional funding for the 
program, and a recent House Dear Colleague letter in support of 
increasing funding to the program to $40 million garnered 34 signatures 
and is circulating in the Senate.
    In FY23, Congress should fund the Augustus F. Hawkins Centers of 
Excellence Grant Program at $40M.
                      supporting college students
Fund the Post Secondary Student Success Grant Program
    Despite the gains made in high school graduation rates over the 
past several decades, the fact remains that only six in 10 students 
earn a college degree after 6 years of undergraduate study, and Black 
and Hispanic individuals have a lower rate of degree attainment than 
their White and Asian-American peers. The COVID-19 pandemic has 
exacerbated this problem: college enrollment has declined by 5.1 
percent across the board since spring of 2020. These challenges present 
the possibility of long-term negative effects on students, their 
families, state and national economies, and the country.
    Congress, with the support of 14 organizations including Ed Trust, 
included a $5 million dollar investment in Post Secondary Student 
Success Grants in the FY22 omnibus. That is a positive development that 
we look forward to helping the Department implement, but we will need 
much more to reverse these damaging trends. Prior proposals from the 
Biden administration and both chambers of Congress understood the size 
and scope of the problem of low college completion rates, and we hope 
the committee will revisit those when deciding how much to invest 
moving forward. The FY23 President's Budget proposal included a request 
for $110M for this concept, as did a recent House Dear Colleague letter 
that garnered 26 signatures and is circulating in the Senate. We 
support that funding level for this appropriations cycle.
    In FY23, Congress should fund the Post Secondary Student Success 
Grant Program at $110M.
Fund the Child Care Access Means Parents in School (CCAMPIS) Program
    Over 20 percent of undergraduate students are parents of dependent 
children, and within that cohort, 1.7 million are single mothers. As 
detailed further in this letter from 51 organizations in support of 
this funding ask, including Ed Trust, increasing the funding for 
CCAMPIS would provide child care support for approximately 100,000 more 
student parents, giving them access to the child care services they 
need to get to and through college. This population is increasing year 
after year, and in a recent survey of over 20,000 student parents, 70 
percent indicated their current childcare provider was unaffordable. 
Furthermore, an upcoming report from Ed Trust will show that on 
average, a student parent would need to work anywhere from 30 to 90 
hours a week to cover child care and tuition costs at a public college 
or university.
    It is essential that Congress scale up the only program 
specifically designed to deliver on-campus child care to Pell-eligible 
student parents, which would dramatically enhance their chances of 
achieving educational success and financial stability.
    In FY23, Congress should fund the Child Care Access Means Parents 
in School (CCAMPIS) Program at $500M.
    Thank you for the opportunity to submit testimony. The Education 
Trust looks forward to working with Congress to allocate Federal funds 
in a way that addresses the critical equity gaps that our Nation's 
students from low-income backgrounds and students of color continue to 
face. We are happy to respond to any questions or concerns that you may 
have on these topics.
    Sincerely.

    [This statement was submitted by Denise Forte, Interim CEO, The 
Education Trust.]
                                 ______
                                 
              Prepared Statement of the Endocrine Society
    The Endocrine Society thanks the subcommittee for the opportunity 
to submit the following testimony regarding Fiscal Year (FY) 2023 
Federal appropriations for biomedical research and public health 
programs. The Endocrine Society is the world's oldest and largest 
professional organization of endocrinologists representing 
approximately 18,000 members worldwide. The Society's membership 
includes basic and clinical scientists who receive support from the 
National Institutes of Health (NIH) for research on endocrine diseases 
that affect millions of Americans, such as diabetes, thyroid disorders, 
cancer, infertility, aging, obesity and bone disease. Our membership 
also includes clinicians who depend on new scientific advances to 
better treat and cure these diseases. The Society is dedicated to 
promoting excellence in research, education, and clinical practice in 
the field of endocrinology. The impact of the coronavirus is a 
compelling illustration of why we must increase funding for the NIH and 
the Centers for Disease Control and Prevention (CDC) to protect public 
health. To support necessary advances in biomedical research to improve 
health, the Endocrine Society recommends the NIH receive funding of at 
least $50 billion for (FY) 2023; to facilitate the translation of these 
advances to improve public health, the Endocrine Society recommends the 
CDC receive funding of at least $11 billion; and to ensure that women 
have access to appropriate health services, we recommend that the Title 
X program be funded at $512 million. This request does not include 
additional emergency supplemental funds or new programs situated in NIH 
including the Advanced Research Projects Agency for Health (ARPA-H).
               endocrine research improves public health
    Sustained investment by the United States Federal Government in 
biomedical research has dramatically advanced the health and improved 
the lives of the American people. The United States' NIH-supported 
scientists represent the vanguard of researchers making fundamental 
biological discoveries and developing applied therapies that advance 
our understanding of, and ability to treat human diseases. Their 
research has led to new medical treatments, saved innumerable lives, 
reduced human suffering, and launched entire new industries.
    Endocrine scientists are a vital component of our Nation's 
biomedical research enterprise and are integral to the healthcare 
infrastructure in the United States. Endocrine Society members study 
how hormones contribute to the overall function of the body and how the 
glands and organs of the endocrine system work together to keep us 
healthy. Physiological functions governed by the endocrine system are 
essential to overall wellbeing: endocrine functions include 
reproduction, the body's response to stress and injury, sexual 
development, energy balance and metabolism, and bone and muscle 
strength.
       effective progress requires consistent support across nih
    Endocrinologists often study communication between different organs 
and how this influences disease, for example how hormones produced by 
adipose tissue influence the development of cancer or susceptibility to 
infections. Our members are therefore funded by many different 
Institutes and Centers (ICs) at NIH and appreciate the need to apply 
funding increases proportionally to all ICs and offices at NIH to 
effectively advance knowledge of complex biological systems and 
signaling pathways that impact multiple organs and diseases. We are 
concerned that when funding is applied disproportionally and at the 
expense of certain ICs, payline disparities increase and gaps in our 
understanding of important biological pathways emerge. Regular, 
sustainable, and proportional increases to all NIH ICs empower 
endocrinologists to develop novel interdisciplinary approaches that 
address public health priorities. For example:
  --While the National Institute of Diabetes and Digestive and Kidney 
        Diseases (NIDDK) is taking a leadership role in understanding 
        the pathophysiology and clinical course of COVID-19 induced 
        diabetes, NIDDK also partnered with the National Institute of 
        Allergy and Infectious Diseases (NIAID) and others to develop 
        community-engaged testing interventions among underserved and 
        vulnerable populations.\1\
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    \1\ https://www.niddk.nih.gov/research-funding/current-
opportunities/rfa-od-22-005.
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  --Endocrinologists funded by National Institute of Environmental 
        Health Sciences (NIEHS) in partnership with the National 
        Institute for Child Health and Human Development (NICHD) and 
        others are aiming to improve our understanding of how climate 
        change will impact public health, for instance via impacts on 
        fertility.\2\
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    \2\ Audrey J. Gaskins et al., 2021.
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  --Endocrine oncologists supported by the National Cancer Institute 
        (NCI) and NIEHS are contributing to our knowledge of how drugs 
        and consumer products can contribute to cancer risk in 
        offspring.\3,4\
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    \3\ https://www.endocrine.org/news-and-advocacy/news-room/featured-
science-from-endo-2021/drug-used-during-pregnancy-may-increase-cancer-
risk-in-mothers-adult-children.
    \4\ https://endocrinenews.endocrine.org/edc-exposure-during-
pregnancy-may-reduce-breast-cancer-protection/.
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  --Endocrine researchers funded by the National Institute of Mental 
        Health (NIMH) and Office of Research on Women's Health are 
        helping us better address gaps in understanding of how sex 
        differences contribute to mental illness in men and women.
           report language opportunities for fiscal year 2023
    Research on Transgenerational Health Effects: Diethylstilbestrol 
(DES) is an endocrine-disrupting chemical that was prescribed to women 
between 1940-1971 to prevent miscarriage, premature labor, and other 
pregnancy complications. Unfortunately, not only was DES ineffective in 
preventing these complications, but it also was linked to a rare cancer 
in women and can cause a variety of cancers and other health effects in 
the daughters and sons of exposed women. Research now suggests that the 
effects of exposures may persist and cause health effects in the 
grandchildren of exposed women and future generations. Recognizing the 
critical need for knowledge about the health effects of DES exposure, 
the NIH established the DES follow-up study, creating a coordinated 
longitudinal cohort that has made important discoveries about the 
health effects of DES exposure. We are now at a critical point in time 
to learn more about the persistence of health effects beyond the 
children of exposed women so that future generations have valuable 
information about their own health risks.
    We urge the subcommittee to therefore include report language 
asking NIH to report on plans for existing or new cohort studies that 
can address transgenerational effects of EDC exposures, including the 
continuance of the DES longitudinal cohort.
    Supporting the Physician-Scientist Workforce: Recognizing the 
challenges facing the physician-scientist biomedical research 
workforce, the NIH convened and charged a Physician-Scientist Workforce 
Working Group with analyzing the current composition and size of the 
physician-scientist biomedical workforce and making recommendations for 
NIH to take to help sustain and strengthen a robust and diverse 
physician-scientist workforce. In 2014, the NIH released a report which 
made nine recommendations to sustain and strengthen a robust and 
diverse physician-scientist workforce. We know that several Institutes 
and Centers (I/Cs) have created initiatives for their own researchers; 
however, there is a need for the NIH to comprehensively look at and 
report on outcomes, best practices, and any gaps that may remain.
    We urge the subcommittee to include report language asking NIH to 
provide an update on actions to bolster the physician-scientist 
workforce either by implementing the 2014 report's recommendations or 
otherwise, including outcomes data on the Medical Scientist Training 
Program (MSTP), and the Stimulating Access to Research in Residency 
(StARR) program.
    Special Programs Must Not Erode Support for Investigator-Initiated 
Research
    The Endocrine Society is enthusiastic about the potential for ARPA-
H to advance transformative public health interventions and develop new 
research platforms that deliver improved care to patients quickly and 
efficiently. Likewise, we appreciate the importance of pandemic 
preparedness. However, these investments must not come at the expense 
of the important investigator-initiated research that have been chiefly 
responsible for the numerous NIH-supported success stories and public 
health achievements. We therefore urge the Committee to provide at 
least $50 billion to the NIH base budget, with increases applied 
equally across all ICs and offices. Any additional funds for pandemic 
preparedness or ARPA-H should only complement, rather than supplant, 
these necessary investments in the future of biomedical research.
 adequate funding of cdc programs is necessary to protect the public's 
                                 health
    The CDC plays a critical role in protecting the public's health by 
applying new knowledge to the promotion of health and prevention of 
chronic diseases, including diabetes. The Division of Diabetes 
Translation administers the National Diabetes Prevention Program 
(National DPP), which addresses the increasing burden of prediabetes 
and Type 2 Diabetes in the United States. The National DPP creates 
public and private partnerships to provide evidence-based, cost-
effective interventions that prevent diabetes in community-based 
settings. Through structured lifestyle change programs at local YMCAs 
or other community centers, individuals with prediabetes can reduce the 
risk of developing diabetes by 58 percent in those under 60 and by 71 
percent in those 60 and older.\5\ In addition to supporting public 
health and prevention activities, CDC's Clinical Standardization 
Programs in the Center for Environmental Health are critical to 
improving accurate and reliable testing of hormones, appropriate 
diagnosis and treatment of disease, and reproduceable public health 
research. Adequate funding is critically important to ensure that CDC 
has the capacity to protect the public's health.
---------------------------------------------------------------------------
    \5\ The Diabetes Prevention Program (DPP) Research Group Diabetes 
Care. 2002 Dec;25(12):2165-71.
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  title x funding provides necessary services and reduces healthcare 
                                 costs
    Title X is an important source of funding for ensuring reproductive 
health benefits including both contraceptive and preventive services to 
women. In 2015, a study found that Title X-funded health centers 
prevented 822,000 unintended pregnancies, resulting in savings of $7 
billion to Federal and State governments. Offering affordable access to 
contraception can have a measurable impact on these costs. For every 
public dollar invested in contraception, short-term Medicaid 
expenditures are reduced by $7.09 for the pregnancy, delivery, and 
early childhood care related to births from unintended pregnancies, 
resulting in savings of $7 billion to Federal and State Governments.\6\ 
Title X is the main point of care for low income, under- or un-insured, 
adults and adolescents for affordable contraception, cancer screenings, 
sexually transmitted disease testing and treatment, and medically-
accurate information on family planning options. However, to provide 
these services to the over 4 million people who depend on Title X-
funded centers, Title X is significantly underfunded.
---------------------------------------------------------------------------
    \6\ Frost JJ, et al., Publicly Funded Contraceptive Services at 
U.S. Clinics, 2015, New York: Guttmacher Institute, 2017.
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                   fiscal year 2023 funding requests
    In conclusion, to avoid loss of promising research opportunities, 
allow budgets to keep pace with inflation, support our public health 
infrastructure, and assure high-quality, evidence-based, and patient-
centered family planning care, the Endocrine Society recommends that 
the subcommittee provide at least the following funding amounts through 
the FY 2023 Labor, Health and Human Services, Education, and Related 
Agencies appropriations bill:
  --$50 billion for the National Institutes of Health
  --$11 billion for the Centers for Disease Control and Prevention
  --$512 million for Title X
                                 ______
                                 
       Prepared Statement of the Entomological Society of America
    The Entomological Society of America (ESA) respectfully submits 
this statement for the official record in support of funding for 
vector-borne diseases (VBD) research at the U.S. Department of Health 
and Human Services (HHS). ESA joins the research community by 
requesting $49 billion in fiscal year (FY) 2023 for the National 
Institutes of Health (NIH) base program funding, including increased 
support for vector-borne disease (VBD) research at the National 
Institute of Allergy and Infectious Diseases (NIAID); $11 billion for 
the Centers for Disease Control and Prevention (CDC) base program 
funding, including investments in the budgets for VBD, global health, 
and core infectious diseases; and robust funding for the Institute of 
Museum and Library Services (IMLS), including $52 million for the 
Office of Museum Services.
    ESA urges the subcommittee to support VBD research programs that 
incorporate the entomological sciences as part of a comprehensive 
approach to addressing infectious diseases. These efforts can help 
mitigate the enormous impact that insect and arthropod carriers of 
disease, like mosquitoes and ticks, have on human health. NIH, the 
Nation's premier medical research agency, advances human health by 
supporting research on basic human and pathogen biology and by 
developing prevention and treatment strategies. Cutting-edge research 
in the biological sciences, including in the field of entomology, is 
essential for addressing societal needs related to environmental and 
human health. Many species of insects and arachnids, including ticks 
and mites, are carriers or vectors of an array of infectious diseases 
that threaten the health and well-being of people worldwide. This 
threat impacts citizens in every U.S. state and territory, as well as 
military personnel serving at home and abroad. The mosquitoes that 
carry and transmit diseases are responsible for more human deaths than 
all other animal species combined, including other humans.\1\ VBD can 
be particularly challenging to manage due to insect and arachnid 
mobility and their propensity to develop resistance to pesticides. 
Further, effective preventative treatments, including vaccines, are not 
available for most VBD.
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    \1\ https://www.gatesnotes.com/Health/Most-Lethal-Animal-Mosquito-
Week.
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    Within NIH, NIAID conducts and supports fundamental and applied 
research related to understanding, preventing, and treating infectious 
diseases. The risk of emerging infectious diseases grows as global 
travel increases in speed and frequency and as environmental conditions 
conducive to population growth of vectors continue to expand globally. 
Entomological research to understand and characterize the relationships 
between insect vectors and the diseases they transmit is essential to 
enable scientists to reliably monitor and predict outbreaks, prevent 
disease transmission, and rapidly diagnose and treat diseases. For 
example, NIAID-funded researchers are working on understanding how to 
increase protection after exposure to arthropod disease vectors and the 
pathogens they transmit that could cause Lyme disease and other tick-
borne infections. Using grant funding from NIAID, researchers from the 
Yale School of Medicine developed and trialed the first messenger RNA 
(mRNA) vaccine targeting ticks.\2\ Whereas previous efforts to develop 
vaccines against tick-borne disease in humans have targeted disease-
related pathogens, this new mRNA vaccine technology induces immunity 
against a salivary protein produced by the vector ticks themselves. 
This study published in November 2021 in Science Translational 
Medicine,\3\ showed that the mRNA vaccine administered to guinea pigs 
caused blacklegged tick bites to become inflamed and ticks to fall off 
too quickly to transmit the pathogen that causes Lyme disease. This 
novel and important research demonstrates that the new mRNA vaccine 
technology holds the potential to protect individuals not only against 
the pathogen that causes Lyme disease but numerous other tick-borne 
pathogens that are carried by the blacklegged tick.
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    \2\ https://www.smithsonianmag.com/smart-news/first-ever-mrna-
vaccine-for-lyme-disease-shows-promise-in-guinea-pigs-180979090/.
    \3\ https://pubmed.ncbi.nlm.nih.gov/34788080/.
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    Within the NIH, the nascent Advanced Research Projects Agency for 
Health (ARPA-H), a signature priority for the Biden Administration, 
represents an opportunity to catalyze health breakthroughs that cannot 
readily be accomplished through traditional research or commercial 
activity, which could include understanding and preventing emerging 
infectious diseases. ESA supports at least $4 billion for the ARPA-H to 
supplement, rather than supplant, the core investment of at least $49 
billion in NIH's base program level. Similarly, under NIH, the National 
Institute of Environmental Health Sciences (NIEHS) supports research 
and initiatives to address health concerns influenced by climate change 
or environmental agents, including VBD and zoonotic diseases. ESA 
supports at least $110 million for NIEHS to continue efforts to 
identify potential health effects associated with climate change and 
environmental factors and implement health adaptation plans.
    ESA requests robust support for CDC programs addressing VBD within 
the National Center for Emerging and Zoonotic Infectious Diseases 
(NCEZID) by supporting the Centers of Excellence on VBD, as authorized 
by the Kay Hagan Tick Act in 2019, and other work by the Division of 
VBD with at least $75.103 million per year, as is aligned with the FY 
2023 President's Budget Request, as well as the $20 million authorized 
by the Kay Hagan Tick Act for the Epidemiology and Laboratory Capacity 
(ELC) program to address VBD. CDC, serving as the Nation's leading 
health protection agency, conducts research and provides health 
information to prevent and respond to infectious diseases and other 
global health threats. Within the core infectious diseases budget of 
CDC, the Division of Vector-Borne Diseases (DVBD) aims to protect the 
Nation from the threat of viruses, bacteria, and parasites transmitted 
primarily by mosquitoes, ticks, and fleas. DVBD's mission is carried 
out by a staff of experts in several scientific disciplines, including 
entomology.
    CDC plays a key role in tracking new and emerging diseases, as well 
as in supporting health care professionals in identifying and 
diagnosing these diseases. From 2016 to 2017, there was a 46 percent 
increase in reported cases of a group of tick-borne diseases known as 
spotted fever rickettsioses (spotted fevers), which includes the 
notably fatal Rocky Mountain spotted fever (RMSF).\4\ Disability and 
death from RMSF are preventable if the antibiotic doxycycline is 
administered within the first five days of illness: without treatment, 
1 in 5 RMSF cases lead to death.\5\ Importantly, spotted fevers have 
non-specific symptoms, and fewer than 1 percent of the spotted fever 
cases reported in 2016-2017 had sufficient laboratory evidence for 
diagnosis. In response to this issue, the CDC has created a first-of-
its-kind education module that will help healthcare providers recognize 
the early symptoms of RMSF and distinguish it from other diseases, 
enabling affected patients to get the life-saving treatment they need 
as quickly as possible.\6\ CDC funding is crucial in the development of 
this and other educational tools that equip health care providers to 
effectively combat tick-borne diseases.
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    \4\ https://www.ncbi.nlm.nih.gov/pubmed/?term=30969821.
    \5\ https://www.cdc.gov/media/releases/2019/p0513-rocky-mountain-
spotted-fever-training.html.
    \6\ https://www.cdc.gov/rmsf/resources/module.html.
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    Using funding appropriated during the 2016 Zika crisis to help 
respond to that emergency and develop the necessary future workforce, 
CDC awarded $50 million to five universities for 5 years to establish 
regional Centers of Excellence (COE) to address existing and emerging 
VBD. The five centers, for which funding expired in 2021, generate 
research, education, outreach, and capacity to enable appropriate and 
timely local public health action for VBD throughout the U.S. The COE 
model requires collaboration between the research institutions and the 
local and regional departments of health (DOH), important relationships 
which have not generally arisen organically. This is critical given 
significant regional differences in vector ecology, disease 
transmission dynamics, and resources. Sustained funding for the COE is 
critical to continue essential efforts to help prevent and control VBD 
threats in the U.S.
    The Kay Hagan Tick Act also expands authorized support for the ELC 
program, critical to supporting State and local departments of health 
vector surveillance and management. For the last several years, the CDC 
has only been able to fund a third of the $50 million in requests they 
receive from States to meet these needs. ESA supports fully funding the 
$20 million authorized in the Kay Hagan Tick Act to support the ELC 
grants for VBD.
    ESA requests robust funding for IMLS, including no less than $52 
million for the Office of Museum Services in FY 2022. The services and 
funding provided by IMLS are critical in several areas--research 
infrastructure, workforce development, and economic impact. IMLS 
provides for the expansion of collections capabilities at American 
museums, which are key for the identification, documentation of 
locations, and classification of entomological species. The 21st 
Century Museum Professionals Program provides opportunities for diverse 
and underrepresented populations to become museum professionals, 
expanding participation in an industry with an annual economic 
contribution of $21 billion. Museums are critical to the public 
understanding of science through exhibits and programs, and in so 
doing, support science education as an integral part of the Nation's 
educational infrastructure. They also make significant long-term 
contributions to economic development in their local communities.
    Thank you for the opportunity to offer the Entomological Society of 
America's support for NIH, CDC, and IMLS research programs.
    ESA, headquartered in Annapolis, Maryland, is the largest 
organization in the world serving the professional and scientific needs 
of entomologists and individuals in related disciplines. Founded in 
1889, ESA is a non-partisan professional organization over 7,000 
members affiliated with educational institutions, health agencies, 
private industry, and government. Members are researchers, teachers, 
extension service personnel, administrators, marketing representatives, 
research technicians, consultants, students, pest management 
professionals, and hobbyists. For more information about ESA, please 
see http://www.entsoc.org/.

    [This statement was submitted by Jessica Ware, PhD, President, 
Entomological Society of America.]
                                 ______
                                 
             Prepared Statement of the Epilepsy Foundation
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Please provide $11 billion for the Centers for Disease Control and 
        Prevention (CDC) including:
    --$13 million for the National Center for Chronic Disease 
            Prevention and Health Promotion's Epilepsy program, an 
            increase of $2.5 million over FY 2022; and
    --$164 million for the CDC's Safe Motherhood & Infant Health 
            Program in order to support and help expand the Sudden 
            Unexpected Infant Death (SUID) & Sudden Death in the Young 
            (SDY) Case Registry; and
    --$5 million for the CDC's National Neurological Conditions 
            Surveillance System (NNCSS).
  --Please provide at least $49 billion for the National Institutes of 
        Health (NIH)'s base and ensure that any funding for the new 
        ARPA-H, or for other targeted programs like pandemic 
        preparedness, supplement the $49 billion recommendation for 
        NIH's base budget.
    --Please provide proportional increases for various NIH Institutes 
            and Centers, including the National Institute of 
            Neurological Disorders and Stroke (NINDS).
_______________________________________________________________________

    Thank you for the opportunity to submit testimony on behalf of the 
Epilepsy Foundation and the people with the epilepsies whom we serve. 
Chairwoman Murray, Ranking Member Blunt, and distinguished members of 
the subcommittee, we deeply appreciate the robust investments in public 
health and research programs over recent years which are helping us 
better understand and treat the epilepsies and better support people 
with epilepsy and their families day-to-day. As you and your colleagues 
work on appropriations for FY 2023, please continue this commitment and 
provide timely investments public health and research programs at the 
CDC and in the NIH. Thank you for your time and for your consideration 
of these requests.
                     about the epilepsy foundation
    The Epilepsy Foundation is the leading national voluntary health 
organization that speaks on behalf of the approximately 3.4 million 
living with epilepsy and seizures. We foster the wellbeing of children 
and adults affected by seizures through research programs, educational 
activities, advocacy, and direct services.
                          about the epilepsies
    Epilepsy is a disease or disorder of the brain which causes 
reoccurring seizures affecting a variety of mental and physical 
functions. It is a spectrum disease comprised of many diagnoses 
including an ever-growing number of rare epilepsies. There are many 
different types of seizures and varying levels of seizure control.
    3.4 million Americans live with active epilepsy including 470,000 
children and teenagers. Thirty to forty percent of people with epilepsy 
live with uncontrolled seizures despite available treatments. Delayed 
recognition of seizures and inadequate treatment increase a person's 
risk of subsequent seizures, brain damage, disability, and death. 
Epilepsy imposes an annual economic burden of $19.4 billion on the 
country.
Please provide $11 billion for CDC including $13 million for CDC's 
        Epilepsy program.
    The Institute of Medicine's (IOM) report on epilepsy, Epilepsy 
Across the Spectrum: Promoting Health and Understanding, identifies the 
Epilepsy Foundation and the CDC as leaders in addressing many of its 
national recommendations to eliminate stigma, improve awareness and 
education and better connect people with the epilepsies to health and 
community services. The CDC Epilepsy program is the only public health 
program specifically related to epilepsy with a national scope and 
community programs. Focus areas requiring continued and increased 
investment include:
  --Training for School Staff: In FY21, 6,090 school nurses and 177,120 
        school personnel have been trained on seizure recognition and 
        seizure first aid. On-demand training modules have been 
        developed to scale up training of these key, frontline 
        community members supporting students with seizures.
  --Seizure First Aid Certification: 14,690 people were certified in 
        seizure first aid in FY21, in partnership with multiple 
        healthcare professional groups serving minority communities. 
        Continued focus is needed on rural and ethnically and racially 
        diverse communities as nearly 40 percent of persons diagnosed 
        with epilepsy are Black or Hispanic and many people with 
        epilepsy in those communities have poorer health outcomes.
  --Professional Education in Epilepsy: To improve care in rural and 
        underserved communities, Project ECHO has educated more than 
        1,155 primary healthcare providers about managing epilepsy over 
        3 years, though more focus is needed on management of severe, 
        drug-resistant epilepsy and quality of care improvement 
        methods. In addition, seven Behavioral Health Outreach webinars 
        were developed as tools for ensuring access to epilepsy 
        knowledge and skills for behavioral and mental health 
        providers.
  --Reducing Barriers to Medication Adherence: By establishing a 
        regular screening process for identifying and addressing 
        barriers to medication adherence, an Epilepsy Learning 
        Healthcare System (ELHS) is addressing a key health disparity 
        in epilepsy. ELHS has produced 11 tools to help patients and 
        families overcome common barriers to adherence.
  --Supporting Mental Health Needs: Mental health screenings have been 
        implemented on the 24/7 Epilepsy & Seizures Helpline since 
        people with epilepsy are at increased risk for depression, 
        anxiety, and suicide. Several suicide interventions have been 
        successful. In addition, people with epilepsy are being 
        connected to self-management programs that prevent and decrease 
        depression.
    Also as part of the $11 billion for the CDC, please provide $164 
million for the CDC's Safe Motherhood & Infant Health Program in order 
to support and help expand the SUID & SDY Case Registry.
    SUDEP is the sudden, unexpected death of someone with epilepsy, who 
was otherwise healthy. It is the leading cause of death in people with 
uncontrolled seizures. Each year, it is thought that more than 1 in 
1,000 people with epilepsy die from SUDEP and this number increases 
drastically to 1 in 150 for people whose epilepsy is not controlled by 
treatment. But there are deficiencies and inconsistencies with how 
SUDEP-related deaths are tracked. While some strides are being made, 
the exact cause(s) of SUDEP are not known.
    Building on child death review programs at the National Center for 
Fatality Review and Prevention Case's Reporting System, the SUID 
portion was initiated in 2009 and in 2015, the SDY Case Registry 
component was added to include children and adolescents. A joint 
collaboration of the CDC and NIH, the SDY Case Registry increases the 
understanding of the prevalence, causes, and risk factors for infants, 
children, and young adults up to age 20, who die suddenly and 
unexpectedly including from SUDEP-informing strategies to prevent 
future deaths. The registry is present in 22 States and jurisdictions 
but this is capturing less than half of these deaths nationwide. 
Increased investment in the CDC's Safe Motherhood/Infant Health 
Program-where the Registry is housed-would allow more States to 
participate and in turn, yield more data to improve understanding and 
prevention.
The Foundation urges the Committee to include the following report 
        language:
    Sudden Unexpected Infant Death [SUID] and Sudden Death in the Young 
[SDY] Case Registry.-The Committee is aware that SUID is the leading 
cause of death of infants 1 month to 1 year of age in the United 
States. While there is no known way to prevent SUID, there are ways to 
minimize risk by collecting and analyzing data, such as that available 
through the SUID and SDY Case Registry. The SDY component of the Case 
Registry has been critical in improving data gathered on sudden deaths 
of children and youth up to age 20. This includes the ability to study 
and better understand Sudden Unexpected Death in Epilepsy (SUDEP) and 
sudden cardiac death in the young. Each year, it is thought that more 
than 1 in 1,000 children and youth with epilepsy die from SUDEP. It the 
leading cause of death amongst people with uncontrolled seizures and 
the exact cause(s) of SUDEP are not known. Accordingly, the Committee 
includes an increase within CDC's Safe Motherhood and Infant Health 
program for the Registry to expand the number of States and 
jurisdictions participating in monitoring and surveillance. 
Furthermore, the Committee includes funding for CDC to award grants or 
cooperative agreements to States, Tribes, and Tribal organizations for 
purposes of improving data collection related to SUID and sudden 
unexpected death in childhood, including by identifying, developing, 
and implementing best practices to reduce or prevent infant death, 
including practices to improve safe sleep, as well as unexpected death 
in youth in coordination with appropriate nonprofits.
Also as part of the $10 billion for the CDC, please provide $5 million 
        for the CDC's National Neurological Conditions Surveillance 
        System.
    In 2016, Congress authorized the CDC to establish the NNCSS and it 
first received funding in FY 2019. The CDC is initially focusing on MS 
and Parkinson's, in order to learn through the process before extending 
to other neurological conditions. Extending to additional neurological 
conditions such as the epilepsies is contingent on continued funding 
for this program so the Foundation requests $5 million for the NNCSS in 
FY 2023.
Please also provide at least $49 billion for the National Institutes of 
        Health (NIH)'s base and ensure that any funding for the new 
        ARPA-H, or for other targeted programs like pandemic 
        preparedness, supplement the $49 billion recommendation for 
        NIH's base budget along with proportional increases for various 
        NIH Institutes and Centers, including NINDS.
    As a result of sustained investment in NIH, the epilepsy research 
portfolio has grown from about $154 million in FY 2017 to $198 million 
in FY 2020. Much more can be done though, particularly in the area of 
bold cross-cutting initiatives and multi-center efforts. For FY 2023, 
we ask that the subcommittee include key committee recommendations, 
like the language below, to encourage additional epilepsy research in 
emerging areas.
                     national institutes of health
        national institute of neurological disorders and stroke
    Epilepsy Care.--The Committee congratulates NINDS and its sister 
institutes in the Inter-Agency Collaborative to Advance Research on 
Epilepsy (ICARE) for supporting fundamental brain research that has 
dramatically advanced the scientific understanding of the epilepsies 
over the last two decades. The Committee encourages NIH and other ICARE 
partners to increase their investments in health services and 
implementation science to ensure that the benefits of research are 
effectively translated to epilepsy care, and to work together to 
further coordinate their activities to improve systems of epilepsy 
care.
                                 ______
                                 
             Prepared Statement of Essential Access Health
    Dear Chairwoman Murray and Ranking Member Blunt:
    As Chief External Affairs Officer of Essential Access Health 
(Essential Access), I thank you for this opportunity to provide 
testimony in support of increased funding for the Title X Federal 
family planning program in the fiscal year (FY) 2023 appropriations 
bill. The Title X family planning program has been level-funded by 
Congress for eight straight fiscal years, as the need for family 
planning and sexual health services has increased and become more 
critical than ever. With increased need and the rising costs of 
providing care, level-funding is equivalent to a cut.
    Essential Access has been a Title X grantee since the program was 
established with strong bi-partisan support in 1970.
    For over 50 years, Essential Access has administered the Title X 
Federal family planning program in California--the largest and most 
diverse Title X system in the Nation. This year, Essential Access was 
also awarded a grant to re-introduce the Title X program in the State 
of Hawaii and address the dire need for family planning services 
statewide. On March 30, Essential Access was notified that we were 
awarded a 5-year service grant to continue serving as the sole Title X 
grantee in both States. While we are proud to continue working with a 
robust network of qualified providers, the award amounts received were 
significantly less than the requested amount of funding necessary to 
meet the needs of Title X patients and health care providers throughout 
California and the Hawaiian islands.
    The California Title X statewide program suffered a dramatic cut in 
funding. Our funding level for the next project period is $13.2 
million, a drastic reduction of $8 million. This is the largest Title X 
funding cut Essential Access has received in our 50-year history 
administering the program. The $2.1 million in funding support for the 
Title X program in Hawaii, does not meet the need for equitable, 
affordable, and high quality family planning services for the more than 
66,000 people estimated to be in need of Title X-supported services 
statewide. Hawaii did not receive any Federal resources to support 
family planning care between the summer of 2019 and January of 2022. 
This gap in Federal funding greatly reduced the capacity of the family 
planning safety-net across the State of Hawaii.
    Inadequate Title X funding is a direct consequence of the program 
receiving level-funding in the FY 2022 omnibus appropriations bill, 
despite strong support for significant increases from both chambers of 
Congress and the White House.
    Failure to increase Title X funding has had an immediate and dire 
impact. In addition to not being able to meet the need for Title X 
resources in Hawaii, some health centers in California did not receive 
any Title X funding and all remaining Title X-funded health centers in 
California's Title X provider network received a reduction.
    These unexpected cuts are compounded by increases in the cost of 
delivering care at a time when community health centers are already 
stretched thin by the pandemic and rising costs of providing care. 
Title X providers depend on these dollars to support staffing, 
infrastructure, outreach and education activities, quality improvement 
activities, and other wrap-around services.
    The impact of these cuts to Title X services will have a 
disproportionate effect on Californians and people of Hawaii with low-
incomes, people living in rural regions and urban health care deserts, 
and communities of color.
    Additional resources are urgently needed to meet the need for 
comprehensive family planning services in Hawaii and California, and 
across the country. I urge Congress to use the FY 2023 Labor, Health 
and Human Services, Education, and Related Agencies appropriations bill 
to make a strong statement in support of high-quality, equitable, and 
patient-centered family planning care and make it right for Title X by 
increasing program funding to $737 million.
    Thank you for the opportunity to submit this testimony. Contact Amy 
Moy at [email protected] if you have questions or need 
additional information.
    Sincerely.

    [This statement was submitted by Amy Moy, Chief External Affairs 
Officer, 
Essential Access Health.]
                                 ______
                                 
           Prepared Statement of Every Hour Counts Coalition
    As the Appropriations committee finalizes its fiscal year 2023 
Labor, Health and Human Services, Education and Related Agencies (LHHS) 
appropriations bill budget request, the Every Hour Counts Coalition 
respectfully calls on Congress to preserve and strengthen Federal 
investments in education programs that help build and improve quality 
expanded learning systems across the country. The critical Federal 
investments that have been made to support students and communities 
recovering from the COVID-19 pandemic in previous years must be met by 
continued investment in annual spending to fully support the needs of 
students in all communities.
    Every Hour Counts is a coalition of citywide intermediary 
organizations that are deeply engaged in building and improving 
expanded learning systems--coordinated groups of service providers, 
public agencies, funders, and schools. These systems provide critical 
support for local education programming by offering enrichment 
opportunities, raising funds to increase access, and promoting 
continuous improvement. Since its founding in 2005, Every Hour Counts 
has grown to 28 cities, representing longstanding partnerships with 
more than 3,500 schools, districts, and community-based organizations 
that provide quality after-school and summer programming. Every Hour 
Counts' partners and learning community members support initiatives 
that reach more than 500,000 students each year.
    Strong Federal investments in education programs help to make these 
effective partnerships work. While emergency funding provided by the 
American Rescue Plan Act and previous COVID-19 relief packages were 
crucial in meeting the immediate needs of the COVID-19 pandemic 
(including summer and expanded learning), investments in the fiscal 
year 2023 budget are vital to ensure the success of continued recovery 
efforts in the years to come. Our coalition knows firsthand that out-
of-school time instruction will continue to be a critical focus of 
long-term recovery and acceleration to address students' academic, 
social and emotional needs as the COVID-19 pandemic continues to affect 
students. Schools and districts cannot and should not be expected to 
meet every academic and non-academic need for their increasingly 
diverse student populations on their own. Therefore, we respectfully 
urge Congress to recognize the need to further invest in the following 
programs and initiatives:
     nita m. lowey 21st century community learning centers program
    The Nita M. Lowey 21st Century Community Learning Centers (21st 
CCLC) program is the only Federal funding stream dedicated to 
supporting local summer learning and after-school programs in every 
State. Today, more and more youth participate in after-school and 
summer programs across the country,\1\ and experts believe the quality 
of these programs is continually improving. These programs have been 
especially critical resources during the COVID-19 pandemic for working 
families and vulnerable student populations. Despite significant 
increases in the number of students enrolling in quality expanded 
learning programs, there continues to be substantial unmet demand for 
enrichment opportunities throughout the country, particularly for low-
income communities. For every child in an after-school program, two are 
waiting to get in, a discrepancy further amplified in rural and low-
income communities.\2\
    The much-needed increases to this program over recent years are 
helping serve nearly 2 million children and families in high-need 
communities across the country by increasing access to high-quality 
expanded learning programs and will continue to play a critical role in 
communities as students recover from the COVID-19 pandemic. Congress 
should push to maintain this positive momentum and continue increasing 
investments in these programs. Therefore, we respectfully ask that 
Congress support the 21st CCLC program by increasing its funding level 
to $1.39 billion, a $100 million compared to fiscal year 2022 funding 
levels.
                     full-service community schools
    Full-Service Community Schools address academic, social and health 
services for students, their families and community members in high-
poverty areas throughout the United States. These integral services 
help students overcome barriers to learning and have become even more 
crucial to the well-being of communities in the wake of the COVID-19 
pandemic.
    Every Hour Counts urges Congress to continue its commitment to 
these services by supporting President Biden's proposal of $468 million 
for the Full-Service Community Schools program. This support will 
ensure that vulnerable communities, including high-poverty rural areas, 
receive academic, social and health services to strengthen their 
recovery from the COVID-19 pandemic.
  improving academic achievement of the disadvantaged- title i, part a
    More than 90 percent of the Nation's school districts and nearly 60 
percent of all public schools across the country rely on Title I funds 
in order to ensure that high-need students meet challenging State 
academic standards. As schools and districts work towards implementing 
school improvement strategies, particularly in partnership with 
intermediaries and other community-based organizations, it is critical 
to provide robust investments in the Title I program to ensure that 
schools have the resources needed to serve all students, including 
their most high-need students. The COVID-19 pandemic has highlighted 
the disparities among schools that were properly equipped to support 
students during times of crisis and those that were not. Our nation 
needs to make the investments necessary to provide equitable resources 
to schools so that all students may receive proper opportunities to 
learn and grow.
    The Every Hour Counts coalition asks that Congress support 
President Biden's proposal for Title I. Making strong investments in 
communities with fewer resources is critical in ensuring that the needs 
of students are addressed in the years to come.
    supporting effective instruction state grants- title ii, part a
    The Title II, Part A program provides flexible funding to States 
and districts to support high-quality professional development for 
educators, including the after-school workforce and other school 
personnel, that positively affect teacher, school leader and educator 
effectiveness. , High-quality staff are necessary for after-school, 
summer and other expanded learning programs to be successful. Despite 
the fact that the after-school workforce is one of the fastest growing 
education sectors in many cities, most citywide systems do not have 
comprehensive strategies in place to recruit, train and support a 
qualified and diverse workforce. Every Hour Counts' community partners 
have been working together with schools and districts to provide joint 
professional development with in- and out-of-school personnel to help 
increase supports for these educators and in turn increase educational 
quality. Educators must receive high-quality training and supports to 
properly address the academic, social and emotional needs of students 
during the COVID-19 pandemic recovery. Comprehensive out-of-school time 
(OST) organizations have demonstrated that they are willing and able to 
rise to post-pandemic challenges--and they are already strategizing how 
to do so, but they need consistent, reliable funding and partnerships 
to help strengthen programming, solve challenges, and fill gaps.
    We encourage Congress to continue its support for this program in 
fiscal year 2023 by requesting that it be funded at $2.295 billion, the 
authorized funding level stipulated in the Every Student Succeeds Act 
(ESSA).
student support and academic enrichment grant program- title iv, part a
    The Student Support and Academic Enrichment (SSAE) Grant program 
provides formula grant funds to States and districts to support a host 
of activities that provide well-rounded educational opportunities, 
including those that increase student interest and engagement in 
science, technology, engineering and math (STEM) subjects, as well as 
activities to support safe and healthy students and activities to 
support the effective use of technology.
    Over the past 7 years, Every Hour Counts has been involved in 
multi-city demonstration projects that have aimed to advance and 
strengthen the connections between STEM learning in the classroom and 
expanded learning programs in order to increase access to these 
opportunities for all students, particularly those from traditionally 
underrepresented groups. Through a focus on joint professional 
development and collaborative instruction between teachers and expanded 
learning educators, we have been able to create a culture shift in 
communities to make STEM learning an expectation in quality expanded 
learning programs. Providing enrichment opportunities has been 
especially important as the Nation attempts to re-engage students 
returning from remote learning during the COVID-19 pandemic and as the 
country plans to strengthen its STEM pipeline to continue being a 
global leader in innovation and technology.
    We believe that this program will provide much needed funding to 
schools and districts to support the unique needs of their students and 
communities and therefore hope that Congress will demonstrate more 
support for it in fiscal year 2023. The Every Hour Counts coalition 
urges Congress to support this program by funding it at $1.6 billion, 
the authorized funding level stipulated by ESSA.
 the corporation of national and community service--americorps program
    AmeriCorps volunteers play a critical role in helping to increase 
student outcomes, build capacity and drive quality both in the 
classroom and in expanded learning settings. As tutors, mentors and 
role models volunteering in classrooms, after-school and summer 
learning programs across the country, AmeriCorps volunteers' days 
extend beyond the last bell. In many Every Hour Counts communities, 
AmeriCorps volunteers help us raise the bar on quality expanded 
learning programs and provide hands-on learning experiences to more 
students. During the COVID-19 pandemic, AmeriCorps volunteers have 
provided crucial supports to students and communities that will 
continue during the pandemic recovery period. For example, the 
Minnesota AmeriCorps Emergency Response Initiative, launched at the 
start of the pandemic, focused on providing tutoring support to K-12 
students during the summer of 2021 and continued funding will ensure 
such programing exists.
    We respectfully urge Congress to further support these programs by 
requesting that the Corporation for National and Community Service be 
funded at $1.767 billion and the AmeriCorps State and National program 
be funded at $970 million in fiscal year 2023.
             the education innovation and research program
    The Education Innovation and Research (EIR) grant program provides 
funding to develop, implement and scale field-initiated innovations to 
improve achievement for underserved students. Crucially, the program 
places an emphasis on evidence-based practices and requires diligent 
evaluation of the innovations. The mission of the EIR program aligns 
closely to the mission of Every Hour Counts, and currently, Every Hour 
Counts works across sectors to build expanded learning systems across 
the country that engage students and improve academic and social-
emotional learning outcomes. At our Expanded-Learning Systems-Building 
Institute, for example, we used cross-sector collaboration to share 
best practices, resources and lessons learned to consider how to scale 
high-quality practices, develop program quality improvement and keep 
racial equity at the center of our work. The COVID-19 pandemic has 
demonstrated the importance of social emotional learning and the needs 
of the whole child. Addressing these needs is a crucial element of the 
U.S. Department of Education's pandemic recovery efforts and requires 
robust Federal investment.
    Every Hour Counts asks that Congress support President Biden's $514 
million proposal for EIR with respective set-asides of $73.3 million 
for STEM and SEL education activities. Building upon this investment 
will expand educational opportunities that support the ``whole child'' 
across a number of key programs.
    The Every Hour Counts coalition stands in strong support of the 
programs mentioned above which provide critical resources to schools 
and districts working in partnerships with us to improve educational 
outcomes for students across all communities. We urge Congress to 
support our Nation's youth through robust investments that will 
strengthen their recovery from the COVID-19 pandemic and guide them 
towards success.
    Please do not hesitate to contact me if you have any questions or 
if we can be of any further assistance.
    Sincerely.

    [This statement was submitted by Jessica Donner, Executive 
Director, Every Hour Counts.]
                                 ______
                                 
                   Prepared Statement of FASD United
    Madam Chair and subcommittee members, FASD United strongly supports 
an increase of at least $2 million for FY 2023 for this line item in 
CDC's budget, together with report language to strengthen federally 
supported initiatives to prevent, diagnose, and improve service 
delivery for FASD, the Nation's leading preventable cause of 
developmental disabilities and birth defects, and a leading cause of 
behavioral and learning problems. For many years, the line item has 
been labeled `` Fetal Alcohol Syndrome''. But the CDC typically uses 
the term ``Fetal Alcohol Spectrum Disorders'' or FASD as the umbrella 
term adopted in 2004 to describe the spectrum of developmental 
disabilities that result from prenatal alcohol exposure.
    We request the following specific report language for the CDC's 
National Center for Birth Defects and Developmental Disabilities ``to 
support expansion and strengthening of existing national community-
based and professional fetal alcohol spectrum disorder (FASD) networks 
to disseminate best practices and technical assistance on diagnosis, 
treatment, intervention, peer mentoring, and other essential 
services.''
                               background
    Prenatal alcohol exposure (PAE) of our children is a silent public 
health crisis within our families and communities. PAE is a major known 
cause of birth defects, brain damage causing neurodevelopmental 
impairments and learning problems--commonly known as Fetal Alcohol 
Spectrum Disorders (FASD).
    Recent CDC data show increasing use of alcohol during pregnancy 
with 14 percent (1 in 7 previously 1 in 9) pregnant people reporting 
current drinking of alcohol and about 5 percent or 1 in 20 pregnant 
people reporting binge drinking.
    How common is FASD in the U.S.? Until recently, we did not have 
reliable prevalence figures. However, a study on prevalence of FASD 
published in the February 2018 Journal of America Medical Association 
(JAMA. 2018;319(5):474-482) shows a more startling and more accurate 
picture of the problem. Researchers assessed 6,639 first graders in 
four U.S. regions and found up to 1 in 20 children with an FASD. They 
also suspected substantial under reporting of prenatal alcohol use and 
that ``we are missing kids''. So, these results are likely to be a 
conservative estimate on FASD prevalence in the U.S.
    Why was this prevalence study so important? First, researchers 
screened and did in-person assessments for FASD (other prevalence 
studies have been based on birth record reports and record reviews). 
Second, researchers learned that youth with this disability can be 
readily identified in U.S. mainstream populations. Third, neither race 
nor ethnicity and social economic status were significant factors--the 
youth with FASD mirrored the demographics of their community. Also 
important: this prevalence data is approaching two times higher than 
autism's prevalence, yet autism Federal funding is nearly 10 times 
greater. According to the National Institute on Alcohol Abuse and 
Alcoholism (NIAAA) Director Dr. George Koob, ``The findings of this 
study confirm that FASD is a significant public health problem, and 
strategies to expand screening, diagnosis, prevention, and treatment 
are needed to address it.''
    The study also confirmed that binge drinking is driving up the 
numbers of children with FASD. It provides useful data for targeted 
prevention efforts. Mothers of youth with FASD compared to a controlled 
population: (1) reported consuming significantly more drinks 3 months 
before pregnancy; (2) recognized that they were pregnant later; (3) had 
more first trimester alcohol consumption; (4) were more likely to binge 
with 5 or more drinks; (5) reported more drinking days in the past 30 
days; and (6) reported that their husbands/partners consumed 
significantly more drinks per drinking day during pregnancy.
    The above prevalence data, together with the increase in alcohol 
use during pregnancy, demands a renewed focus on the issue of binge 
drinking and other alcohol abuse and its harmful effects on our 
children.
    Insufficient Federal Investment in FASD. In 1998, Congress first 
authorized Federal FASD-related programs at $27 million annually 
(nearly $48 million in today's dollars). Since then, however, Federal 
funding for FASD-related programs has declined. Funding has flatlined 
for the Centers for Disease Control and Prevention (CDC) at $11 million 
for what is the most dedicated public health focus on FASD to support 
clinical and epidemiological research, public health initiatives and 
networks, and expansion of clinical interventions. Besides the $30 
million (FY 2022) for research through the National Institute of 
Alcohol Abuse and Alcoholism (NIAAA), the only other specific FASD 
funding is $1 million at the Health Resources and Services 
Administration (HRSA), Maternal and Child Health Block Grant, Title V 
SPRANS Set-Aside).
    There remains an alarming gap in FASD-related diagnostic and 
clinical resources. Among medical and behavioral health professionals, 
their inconsistent use or limited knowledge of diagnostic criteria and 
clinical guidelines result in many (if not most) children and adults 
living with FASD going undiagnosed or misdiagnosed. Families in every 
State, and especially in the child welfare system, struggle with FASD, 
and they cannot find systems of care that are familiar with or are 
equipped to diagnose and address FASD-related disabilities.
    Cost of FASD. Economic impact studies (J Addict Med 2018;12: 466-
473) show that the costs of FASD are significant, totaling $205 billion 
in the United States (health care, special education, residential care, 
productivity losses, and corrections). Costs to Tribal communities over 
an individual's lifetime with FASD can range from $850,000 to $4 
million, according to the National Congress of American Indians (NCAI; 
#REN-19-037). Yet, evidence shows these risks/costs can be 
significantly reduced by FASD-informed families, communities, and 
healthcare and other providers working together to create a system of 
early identification, stable environment with enduring relationships.
    The alarming increase in prenatal alcohol consumption (41 percent) 
due to the COVID pandemic, and the already soaring rates of FASD, 
justify additional Federal investment to strengthen CDC efforts to: 
expand prevention programs to heighten awareness of FASD and the risks 
associated with prenatal alcohol exposure; and increase existing 
national community-based FASD networks to expand access to diagnostic, 
treatment, intervention, and other essential services.
    CDC's FY 2023 Congressional Justification. Last year, the House-
passed FY 2022 Labor-HHS Appropriations bill included a $1 million 
increase (from $11 million to $12 million) for the CDC's line item for 
FASD programs, but unfortunately the conference agreement retained the 
flatlined amount of $11 million. With reference to the House-passed 
provision, the CDC included the following discussion in its FY 2023 
Congressional Justification:

      ``CDC appreciates the Committee's support of awareness and 
        prevention of fetal alcohol spectrum disorders (FASDs). CDC 
        uses a comprehensive approach to address FASDs and the 
        prevention of alcohol use during pregnancy. CDC conducts 
        activities related to assessing trends in alcohol and 
        polysubstance use in pregnancy and monitoring health care 
        provider behaviors related to alcohol screening and brief 
        intervention (SBI). CDC currently supports a network to reach 
        health care providers across the Nation to implement evidence-
        based strategies to reduce alcohol use during pregnancy and 
        develop and disseminate FASD training and educational 
        resources. In FY 2022, women of reproductive age within 67 
        health clinics across four health care systems have received 
        appropriate alcohol screening and brief intervention services. 
        In 2021, CDC also partnered with the MITRE Corporation to 
        develop five clinical decision support (CDS) tools on alcohol 
        SBI to help screen and offer evidence-based prevention 
        strategies to those at risk. In FY 2022, two of these CDS tools 
        were piloted to assess their use in a clinical setting.''
    Notably, CDC's justification went on to state: ``. . . in FY 2023, 
at level funding with FY 2022, CDC will continue to monitor trends in 
alcohol and polysubstance use in pregnancy and support partnership 
activities. In the absence of additional resources, CDC lacks capacity 
to expand prevention efforts and extend the reach of its national 
partnership network.'' (Emphasis added.)
    In conclusion, the enormity of the problem of FASD and its impact 
on families and communities in the United State and the increasing use 
of alcohol during pregnancy justify an increase in investment by the 
Federal Government. Thank you so much.
                                 ______
                                 
    Prepared Statement of the Federation of American Societies for 
                          Experimental Biology
    Dear Chair Murray and Ranking Member Blunt:
    On behalf of the 110,000 researchers of the Federation of American 
Societies for Experimental Biology (FASEB) from its 28 member 
societies, I am writing to recommend at least $50 billion for the 
National Institutes of Health's base in FY 2023.
    Federal investments in fundamental research have led to remarkable 
progress in the biological and biomedical sciences. Basic research was 
the groundwork for the speed--months instead of years--that led to the 
development of COVID-19 vaccines and also supports pre-clinical 
research involving the use of animal studies to achieve medical 
progress.
    Despite Congress' bipartisan support for investing in science, 
Federal funding for research has not kept pace, posing a threat to our 
Nation's competitiveness. We face a real threat of losing our edge in 
industries such as biotechnology if we do not prioritize increasing 
investments in science, research infrastructure such as core 
facilities, and building a diverse workforce.\1\ The U.S. spends less 
on research and development (R&D) than many countries. If the U.S. is 
to be prepared to respond to future threats, our scientific leadership 
must progress. According to Science Is Us, there is the added benefit 
of jobs. STEM supports 69 percent of U.S. gross domestic product, 
touches two out of three workers, and generates $2.3 trillion in tax 
revenue.\2\
---------------------------------------------------------------------------
    \1\ https://ncses.nsf.gov/pubs/nsb20201/executive-summary.
    \2\ STEM and the American Workforce. You've heard it before: STEM 
jobs--... | by Science is US | Medium.
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    The NIH is the Nation's largest public funder of biomedical 
research in the world, providing competitive grants to support the work 
of 300,000 scientists at universities, medical centers, independent 
research institutions, and companies nationwide. The biomedical 
discoveries, innovations, and treatments that NIH support are possible 
because of scientific research with animals which provide in-depth 
knowledge of entire biological systems and complex disorders affecting 
multiple organs. As required by the Food and Drug Administration, 
animal research is also essential during the preclinical stage of drug 
development to determine the safety and efficacy of potential drugs and 
therapies prior to human clinical trials.
    A recent example of NIH's effective ability to harness animal 
research and maximize its public-private partnerships, NIH collaborated 
with industry to develop a messenger RNA (mRNA) vaccine which was 
quickly adapted for COVID-19.\3\ The agency also accelerated the 
development and commercialization of COVID testing through the Radx 
initiative.\4\
---------------------------------------------------------------------------
    \3\ https://www.niaid.nih.gov/diseases-conditions/coronaviruses-
therapeutics-vaccines.
    \4\ https://www.nih.gov/research-training/medical-research-
initiatives/radx#overview.
---------------------------------------------------------------------------
    With these resources, NIH has accelerated progress across all areas 
of medical science, including regenerative medicine, cancer 
immunotherapy, and neurological health.\5,6,7\ The agency is also 
committed to supporting the next generation of our biomedical research 
enterprise.\8\
---------------------------------------------------------------------------
    \5\ NIH Regenerative Medicine Innovation Project, National 
Institutes of Health, Bethesda, MD.
    \6\ NCI's Role in Immunotherapy Research, National Cancer 
Institute, Bethesda, MD.
    \7\ The BRAIN Initiative Summary, National Institutes of Health, 
Bethesda, MD.
    \8\ NIH Grants and Funding, Next Generation Research Initiative, 
National Institutes of Health, Bethesda, MD.
---------------------------------------------------------------------------
    Though the NIH is in a stronger position than it was a few years 
ago, Congress must continue to increase biomedical research funding to 
continue pandemic preparedness efforts, not to mention the largest 12-
month increase in inflation since June 1982 at seven percent.\9\ Our 
nation is confronting public health threats, especially given global 
climate change that is negatively impacting biodiversity and one 
health--the intersection of biological science, earth sciences, and 
ecology. More research will be needed to address infectious diseases, 
and greater exposure to environmental threats that impact national 
security, public health, and economic progress. \10\ Additionally, 
having to operate under lengthy ``continuing resolutions'' over the 
last several fiscal years has impacted NIH's ability to provide 
predictable support to the research community due to not being able to 
fund new grants or projects until the agency received a final budget, 
and NIH has not been able to make all researchers set back by the 
pandemic whole.\11\
---------------------------------------------------------------------------
    \9\ https://www.bls.gov/news.release/cpi.nr0.htm.
    \10\ IPCC AR5 Climate Change 2014, Chapter 11: Human Health: 
Impacts, Adaptation, and Co-Benefits.
    \11\ Ad Hoc Group Statement on RISE Act Introduction and Research 
Relief Feb. 5, 2021.
---------------------------------------------------------------------------
    In the U.S., we continue to address the needs of a growing aging 
population and the serious disease of obesity.\12,13\ NIH research is 
developing therapies for a whole spectrum of age- related 
disorders.\14\ Obesity impacts 42 percent of the U.S. population and 
increases the likelihood of developing costly medical conditions such 
as diabetes, cancer, and heart disease.\15\ Additionally, minority 
populations experience a higher prevalence of these diseases.\16\
---------------------------------------------------------------------------
    \12\ https://www.census.gov/newsroom/press-releases/2018/cb18-41-
population-projections.html.
    \13\ NIDDK Health Information.
    \14\ Aging Well in the 21st Century: Strategic Directions for 
Research on Aging, National Institute on Aging, Bethesda, MD.
    \15\ CDC Obesity Data.
    \16\ Special issues regarding obesity in minority populations--
PubMed (nih.gov).
---------------------------------------------------------------------------
    Our recommendation of at least $50 billion allows NIH to continue 
support for the Next Generation Researchers Initiative; and expand dual 
purpose research in biomedicine and agriculture among NIH and other 
Federal agencies.\17\
---------------------------------------------------------------------------
    \17\ BILLS-116RCP68-JES-DIVISION-H.pdf (house.gov) (pg. 63).
---------------------------------------------------------------------------
    Respectfully Submitted.

    [This statement was submitted by Ellen Kuo, Associate Director, 
Legislative 
Affairs, Federation of American Societies for Experimental Biology.]
                                 ______
                                 
Prepared Statement of the Federation of Associations in Behavioral and 
                             Brain Sciences
    Chairwoman Murray, Ranking Member Blunt, and Members of the 
subcommittee:
    The Federation of Associations in Behavioral and Brain Sciences 
(FABBS) is grateful for the opportunity to submit testimony for the 
record in support of the National Institutes of Health (NIH) and the 
Institute of Education Sciences (IES) budgets for fiscal year 2023. 
FABBS represents twenty-seven scientific societies and over fifty 
university departments whose members and faculty share a commitment to 
advancing knowledge of the mind, brain, and behavior. For fiscal year 
2023, FABBS encourages your subcommittee to provide the National 
Institutes of Health (NIH) with a budget of at least $49 billion and 
the Institute of Education Sciences (IES) within the Department of 
Education a budget of $815 million.
                     national institutes of health
    FABBS thanks the subcommittee for the consistent increases to NIH 
in recent years. As a member of the Ad Hoc Group for Medical Research 
and the Coalition for Health Funding, FABBS recommends at least $49 
billion for NIH in fiscal year 2023 and suggests that any funding for 
other targeted programs supplement the base budget, rather than 
supplant the essential foundational investment in the NIH.
    FABBS members contribute to the NIH mission of seeking fundamental 
knowledge about the behavior of living systems and the application of 
that knowledge to enhance health, lengthen life, and reduce illness and 
disability.
  --Office of Behavioral and Social Science Research (OBSSR)
    FABBS members are especially grateful for the increase of over $9 
million to OBSSR included in the joint explanatory statement for the 
fiscal year 2022 appropriations legislation. This growth to the 
Office's baseline budget provides OBSSR with consistent and reliable 
funding to provide essential support across NIH Institutes and Centers 
(ICs).
    OBSSR coordinates and promotes basic, clinical, and translational 
behavioral and social science research at NIH and plays an essential 
role enhancing trans-NIH investments in longitudinal datasets, 
technology in support of behavior change, innovative research 
methodologies, and promoting the inclusion of behavioral science in 
initiatives in partnership with ICs. OBSSR co-funds highly rated grants 
that the ICs cannot fund alone.
    OBSSR is able to leverage investments across the NIH to broadly 
improve the quality and effectiveness of federally funded research. We 
encourage the committee to once again express its strong support for 
this integral office.
  --National Institute of Mental Health (NIMH)
    FABBS members are particularly interested in NIMH, which serves as 
the premier Federal agency responsible for developing a deeper 
understanding of and effective interventions to improve mental health 
and treat mental illness. We encourage you to provide robust funding 
for NIMH in fiscal year 2023 commensurate with any increase to the 
overall NIH budget so that the institute can build upon the significant 
achievements to advance the behavioral, biomedical, and social research 
mission and important initiatives to provide new insights and solutions 
to all.
    In your recent hearing reviewing the President's budget request for 
the Department of Health and Human Services, we were grateful to see a 
focus on mental health and bipartisan support for increases in mental 
healthcare funding related to both the 988 national suicide prevention 
lifeline and Certified Community Behavioral Health Clinics.
    To fully capitalize on these bipartisan committee priorities and 
improve the mental health of all Americans, we recommend that the 
committee continue to prioritize investments in the NIMH.
  --Eunice Kennedy Shriver National Institute of Child Health and Human 
        Development (NICHD)
    As a member of the Friends of NICHD, FABBS recommends that NICHD 
receive an increase in fiscal year 2023 commensurate with any increase 
to the overall NIH budget. NICHD has facilitated extraordinary 
achievements in brain and behavioral research with far reaching 
implications for public health, maternal, child, and family health, and 
learning and language development.
    For example, NICHD-funded researchers have recently:
    --Shown that infants of mothers in low-income households receiving 
            monthly cash payments were more likely to show faster brain 
            activity in a pattern associated with learning and 
            development at later ages.
    --Devised a procedure for amputations below the knee that allows 
            for sensory feedback from a prosthetic limb, and used 
            machine learning to improve the interface of brain-
            controlled prosthetics, making them easier to use.
    --Discovered that a certain plant compound could one day be 
            administered to expectant mothers as a treatment to improve 
            cognitive outcomes for people with down syndrome.
    --Surveyed child forensic interviewers to develop new benchmarks to 
            aid in preventing, treating, and reducing childhood abuse 
            and neglect.
         advanced research projects agency for health (arpa-h)
    FABBS appreciates the funding for ARPA-H included in fiscal year 
2022 appropriations, and we are grateful that this was independent of 
the NIH budget. As ARPA-H continues to take shape, we encourage the 
subcommittee to ensure that additional appropriations for the Agency 
supplement, rather than supplant, funding for NIH.
    FABBS was grateful for the opportunity to contribute to OSTP-NIH 
listening sessions on the proposed ARPA-H. We suggest that this new 
agency will be most effective if it takes a cross-disciplinary approach 
to questions that are not adequately addressed by the current 
organizational approach of NIH. These include investing in 
implementation science to bridge the gap between the latest scientific 
advances and medical practice.
  institute of education sciences (ies), u.s. department of education
    We are grateful for the subcommittee's work to ensure a funding 
increase for IES in the fiscal year 2022 omnibus spending agreement. As 
members of the Friends of IES, FABBS encourages the subcommittee to 
appropriate at least $815 million to IES in fiscal Year2023. This 
funding level will allow the Institute to build on the fiscal year 2022 
enacted budget to maximize its capacity to advance innovative research, 
develop the methodological skills of education researchers, and 
continue to support high-quality and trustworthy statistics and 
evidence-based resources.
    We are especially grateful that the fiscal year 2022 omnibus 
provided IES with independent control over staffing. This new 
flexibility is key to capitalizing on new investments, and allows the 
Institute to be nimble, taking on high-impact approaches to research 
and implementation. For example, during the COVID-19 pandemic, IES 
launched Operation Reverse the Loss to identify specific and actionable 
interventions that can reverse learning losses for clearly identified 
populations of students. Ongoing support for dedicated staff will allow 
IES to continue its important work studying the Nation's most urgent 
education questions and facilitating the implementation of new and 
effective strategies.
    The Institute recently commissioned a report on the future of 
education research from the National Academies of Science, Engineering, 
and Medicine (NASEM). The recommendations therein provide an exciting 
path forward for the agency, outlining approaches to move the field 
forward on issues of critical importance to education policy and 
practice and improve learner outcomes for all students. However, the 
report finds that ``Given the breadth of what IES is expected to 
accomplish as mandated in ESRA [the Education Sciences Reform Act], its 
funding for both programmatic activities and staffing has historically 
been limited in comparison to other Federal science, research, and 
statistical agencies with similar objectives [and] in order to achieve 
the overarching vision presented through these recommendations, IES 
will require additional investments.''
    Thank you for considering this testimony.
FABBS Member Societies:
    Academy of Behavioral Medicine Research, American Educational 
Research Association, American Psychological Association, American 
Psychosomatic Society, Association for Applied Psychophysiology and 
Biofeedback, Association for Behavior Analysis International, Behavior 
Genetics Association, Cognitive Neuroscience Society, Cognitive Science 
Society, Flux: The Society for Developmental Cognitive Neuroscience, 
International Congress of Infant Studies, International Society for 
Developmental Psychobiology, National Academy of Neuropsychology, The 
Psychonomic Society, Society for Behavioral Neuroendocrinology, Society 
for Computation in Psychology, Society for Judgement and Decision 
Making, Society for Mathematical Psychology, Society for 
Psychophysiological Research, Society for the Psychological Study of 
Social Issues, Society for Research in Child Development, Society for 
Research in Psychopathology, Society for the Scientific Study of 
Reading, Society for Text & Discourse, Society of Experimental Social 
Psychology, Society of Multivariate Experimental Psychology, Vision 
Sciences Society
FABBS Affiliates:
    APA Division 1: The Society for General Psychology; APA Division 3: 
Experimental Psychology; APA Division 7: Developmental Psychology; APA 
Division 28: Psychopharmacology and Substance Abuse; Arizona State 
University; Binghamton University; Boston College; Boston University; 
California State University, Fullerton; Carnegie Mellon University; 
Duke University; East Tennessee State University; Florida International 
University; George Mason University; George Washington University; 
Georgetown University; Harvard University; Indiana University 
Bloomington; Johns Hopkins University; Lehigh University; Massachusetts 
Institute of Technology; Michigan State University; New York 
University; North Carolina State University; The Ohio State University, 
Center for Cognitive and Brain Sciences; Pennsylvania State University; 
Princeton University; Purdue University; Rice University; Southern 
Methodist University; Syracuse University; Temple University; Texas A&M 
University; Tulane University; University of Arizona; University of 
California, Berkeley; University of California, Irvine; University of 
California, Los Angeles; University of California, Riverside; 
University of California, San Diego; University of Chicago; University 
of Delaware; University of Illinois at Urbana-Champaign; University of 
Iowa; University of Maryland, College Park; University of Michigan; 
University of Minnesota; University of Minnesota, Institute of Child 
Development; University of North Carolina at Greensboro; University of 
Oregon; University of Pennsylvania; University of Texas at Austin; 
University of Texas at Dallas; University of Virginia; University of 
Washington; Virginia Tech; Wake Forest University; Washington 
University in St. Louis; Western Kentucky University; Yale University

    [This statement was submitted by Juliane Baron, Executive Director, 
Federation of Associations in Behavioral and Brain Sciences.]
                                 ______
                                 
              Prepared Statement of Florida A&M University
    Chairman Leahy, Chairwoman Murray, Vice Chairman Shelby, Ranking 
Member Blunt, and Members of the Labor, Health and Human Services, and 
Education, and Related Agencies subcommittee, thank you for the 
opportunity to submit public testimony on the subcommittee's fiscal 
year 2023 appropriations bill. Florida A&M University (FAMU) is 
grateful for the historic support of Congress during the pandemic. 
Maintaining or enhancing funding is critical for programs of interest 
to the University and our students, including the Department of 
Education's Historically Black Colleges and Universities (HBCU) 
programs, the HBCU Capital Financing Program, and the Federal Pell 
Grants program. FAMU also supports two programs at the Department of 
Health and Human Services--the National Institutes of Health's Research 
Centers in Minority Institutions and the Health Resources and Services 
Administration's Health Careers Opportunity Program. These Federal 
programs provide significant support to the University, our students as 
well as other institutions of higher education across the Nation.
    Florida A&M University, based in the State capital of Tallahassee, 
Florida, was founded in 1887 with only 15 students and two instructors. 
Today, FAMU offers 95 degree programs to nearly 10,000 students. We are 
proud to be the highest ranked among public Historically Black Colleges 
and Universities (HBCU) for three consecutive years, according to the 
2022 U.S. News and World Report National Public Universities. The 
University is a leading land-grant research institution with an 
increased focus on science, technology, research, engineering, 
agriculture, and mathematics. As noted by Diverse Issues, FAMU is a top 
producer of African American undergraduate degrees and doctoral degrees 
in pharmacy and pharmaceutical sciences.
    Federal support is critical for institutions of higher education, 
particularly HBCUs, which are historically under-resourced. Robust 
Federal funding for programs that help to improve our institutions, 
broaden access for students, and enhance student success is paramount. 
The Department of Education HBCU programs help us achieve these goals 
and the Federal Pell Grant program is an imperative resource for our 
students as the majority of our students are Pell-eligible. 
Furthermore, the Department of Health and Human Services' research and 
career development programs that support minority students also benefit 
FAMU, our students, and the Nation. FAMU strongly supports the 
allocation of resources for these vital Federal programs.
Department of Education Historically Black Colleges and Universities 
        Programs
    FAMU strongly supports robust funding for the Department of 
Education HBCU programs under the Higher Education, Aid for 
Institutional Development Programs account. These programs, authorized 
under Title III of the Higher Education Act, provide critical support 
to higher education institutions that enroll large proportions of 
minority and financially disadvantaged students. One of the primary 
missions of the Title III programs has been to support the Nation's 
HBCUs. The Strengthening Historically Black Colleges and Universities 
program and the Historically Black Graduate Institutions program 
provide FAMU and other HBCUs with formula grants to help sustain our 
academic, administrative, and fiscal capabilities.
    The President's fiscal year 2023 budget requests $402.6 million for 
the Strengthening Historically Black Colleges and Universities program. 
These formula grants provide critical support to HBCUs that help to 
improve our facilities, develop faculty, support academic programs, 
strengthen institutional management, enhance our development and 
recruitment activities, and provide tutoring and counseling services to 
students.
    We support the President's fiscal year 2023 budget request of 
$102.3 million for the Strengthening Historically Black Graduate 
Institutions as well, which funds 5-year grants to provide scholarships 
for disadvantaged students, academic and counseling services to improve 
student success, and supports infrastructure and facilities 
improvements.
    FAMU, like other HBCUs, has a critical need for funding to support 
equipment upgrades and purchases, construction and renovation of our 
facilities, and the development of our academic programs. This includes 
a wide variety of projects to strengthen the University and its 
programs, such as expansion of our online education offerings to 
enhance pathways to degree attainment, upgrading our information 
technology infrastructure, construction of laboratories, research and 
education facilities, and upgrading our health sciences and technology 
equipment and facilities. Continued funding for these HBCU programs and 
other Aid for Institutional Development programs is essential to 
postsecondary institutions, like FAMU, that educate the Nation's 
minority students.
Department of Education Historically Black Colleges and Universities 
        Capital Financing Program
    FAMU supports the fiscal year 2022 House recommended allocation of 
$24.484 million for the Department of Education's HBCU Capital 
Financing Program, which provides low-cost capital to finance 
improvements to the infrastructure of the Nation's HBCUs. Specifically, 
the program provides accredited HBCUs with access to capital financing 
or refinancing for the repair, renovation, and construction of 
classrooms, libraries, laboratories, dormitories, instructional 
equipment, and research instrumentation.
    FAMU, like other HBCUs, has a critical need to upgrade and 
rehabilitate our aging facilities. This program makes capital available 
for HBCUs to improve our academic facilities, which will enhance the 
learning experience for our students. The funding requested would be 
used to pay the loan subsidy costs in guaranteed loan authority under 
the program. We urge the subcommittee to provide increased funding for 
fiscal year 2023, which will allow HBCUs to continue to refinance 
previous capital project loans, renovate existing facilities, or build 
new facilities in alignment with our peer institutions.
Department of Education Pell Grant Program
    FAMU supports robust funding for the Pell Grant program under the 
Department of Education's Student Financial Assistance account. The 
Federal Pell Grant program, authorized by Title IV of the Higher 
Education Act, is the largest source of Federal grant aid supporting 
college students. The Pell Grant Program provides need-based grants to 
low-income undergraduate students to promote access to postsecondary 
education.
    Over 60 percent of our enrolled students rely on Pell grants to 
attend our institution. As Pell Grants account for less than one-third 
of the average cost of attendance at public 4-year universities, we 
join many national education associations in requesting an increase in 
the maximum individual award to $12,990. By nearly doubling the award, 
Congress will provide critical support for economically disadvantaged 
college students as we continue to rebound from one of the most 
challenging periods in our Nation's history. We expect that our current 
and prospective students will be dependent on financial assistance, 
including Pell Grants, in order to continue pursuing their 
postsecondary education goals.
National Institutes of Health Research Centers in Minority Institutions
    FAMU supports funding at the fiscal year 2022 House recommended 
allocation of $88 million for the NIH National Institute on Minority 
Health and Health Disparities (NIMHD), Research Centers in Minority 
Institutions (RCMI) Program. The RCMI Program, established in 1985, 
supports critical infrastructure development and scientific discovery 
in historically minority graduate and health professional schools. The 
program serves the dual purpose of bringing more racial and ethnic 
minority scientists into mainstream research and promoting minority 
health research because many of the investigators at RCMI institutions 
study diseases, like COVID-19, that disproportionately affect minority 
populations. Notably, the employees at the FAMU community testing site 
were selected as the Tallahassee Democrat ``Person of the Year'' and 
have provided more than 630,000 tests and 25,000 vaccines to the Big 
Bend area since April 25, 2020.
    Since program inception, the FAMU RCMI Center has greatly benefited 
from this program, which has provided critical infrastructure to enable 
the College of Pharmacy and Pharmaceutical Sciences | Institute of 
Public Health to achieve national prominence and become a competitive 
biomedical research center nationally. The RCMI support of FAMU led the 
College to implement four doctoral tracks in pharmaceutical sciences, 
including pharmacology/toxicology, medicinal chemistry, pharmaceutics, 
and environmental toxicology. With RCMI support, our College of 
Pharmacy has graduated more than 60 percent of the African A merican 
doctoral recipients in the pharmaceutical sciences nationally.
Department of Health and Human Services, Health Resources and Services 
        Administration, Health Careers Opportunity Program
    FAMU supports the fiscal year 2022 House recommended allocation of 
$20.5 million for HRSA's Health Careers Opportunity Program (HCOP). 
First authorized in 1972, the HCOP competitive grant program aims to 
provide individuals from disadvantaged backgrounds an opportunity to 
develop the skills needed to successfully compete for, enter, and 
graduate from a health or allied health professions school. HCOP 
focuses on three key milestones of education: high school completion; 
acceptance, retention and graduation from college; and acceptance, 
retention and completion of a health professions degree program. The 
ultimate goal of the HCOP program is to diversify the health 
professions workforce by narrowing the educational achievement gaps 
between individuals from higher-income and lower-income households.
    The Health Careers Opportunity Program (HCOP) High School Summer 
Institute, conducted on FAMU's campus, is designed for high school 
students interested in pursuing a career in a health profession. The 
four-week program provides a wide-range of educational and social 
experiences for rising 10th, 11th and 12th grade students. The entire 
experience is designed to enhance participants' academic abilities, 
social skills, and other competencies to increase their competitiveness 
for admission to a post-secondary health professions program.
    The President's fiscal year 2023 budget increases funding for 
HRSA's Health Professions Training for Diversity Programs, including 
the HCOP. Continued funding is critical for these programs that help 
address the shortage of underrepresented minorities in health 
professions.
    We urge the subcommittee to support continued and/or enhanced 
funding for these critical education programs at the Departments of 
Education and Health and Human Services. We thank you for your 
continued support of Federal postsecondary initiatives that not only 
directly benefit the University and our students, but the region and 
the Nation as well. Thank you for your consideration.

    [This statement was submitted by Larry Robinson, President, Ph.D., 
Florida A&M University.]
                                 ______
                                 
  Prepared Statement of Florida Agricultural and Mechanical University
    Chairman Leahy, Chairwoman Murray, Vice Chairman Shelby, Ranking 
Member Blunt, and Members of the Labor, Health and Human Services, and 
Education, and Related Agencies subcommittee, thank you for the 
opportunity to submit public testimony on the subcommittee's Fiscal 
Year (FY) 2023 appropriations bill. Florida A&M University (FAMU) is 
grateful for the historic support of Congress during the pandemic. 
Maintaining or enhancing funding is critical for programs of interest 
to the University and our students, including the Department of 
Education's Historically Black Colleges and Universities (HBCU) 
programs, the HBCU Capital Financing Program, and the Federal Pell 
Grants program. FAMU also supports two programs at the Department of 
Health and Human Services--the National Institutes of Health's Research 
Centers in Minority Institutions and the Health Resources and Services 
Administration's Health Careers Opportunity Program. These Federal 
programs provide significant support to the University, our students as 
well as other institutions of higher education across the Nation.
    Florida A&M University, based in the State capital of Tallahassee, 
Florida, was founded in 1887 with only 15 students and two instructors. 
Today, FAMU offers 95 degree programs to nearly 10,000 students. We are 
proud to be the highest ranked among public Historically Black Colleges 
and Universities (HBCU) for three consecutive years, according to the 
2022 U.S. News and World Report National Public Universities. The 
University is a leading land-grant research institution with an 
increased focus on science, technology, research, engineering, 
agriculture, and mathematics. As noted by Diverse Issues, FAMU is a top 
producer of African American undergraduate degrees and doctoral degrees 
in pharmacy and pharmaceutical sciences.
    Federal support is critical for institutions of higher education, 
particularly HBCUs, which are historically under-resourced. Robust 
Federal funding for programs that help to improve our institutions, 
broaden access for students, and enhance student success is paramount. 
The Department of Education HBCU programs help us achieve these goals 
and the Federal Pell Grant program is an imperative resource for our 
students as the majority of our students are Pell-eligible. 
Furthermore, the Department of Health and Human Services' research and 
career development programs that support minority students also benefit 
FAMU, our students, and the Nation. FAMU strongly supports the 
allocation of resources for these vital Federal programs.
 department of education historically black colleges and universities 
                                programs
    FAMU strongly supports robust funding for the Department of 
Education HBCU programs under the Higher Education, Aid for 
Institutional Development Programs account. These programs, authorized 
under Title III of the Higher Education Act, provide critical support 
to higher education institutions that enroll large proportions of 
minority and financially disadvantaged students. One of the primary 
missions of the Title III programs has been to support the Nation's 
HBCUs. The Strengthening Historically Black Colleges and Universities 
program and the Historically Black Graduate Institutions program 
provide FAMU and other HBCUs with formula grants to help sustain our 
academic, administrative, and fiscal capabilities.
    The President's FY 2023 budget requests $402.6 million for the 
Strengthening Historically Black Colleges and Universities program. 
These formula grants provide critical support to HBCUs that help to 
improve our facilities, develop faculty, support academic programs, 
strengthen institutional management, enhance our development and 
recruitment activities, and provide tutoring and counseling services to 
students.
    We support the President's FY 2023 budget request of $102.3 million 
for the Strengthening Historically Black Graduate Institutions as well, 
which funds 5-year grants to provide scholarships for disadvantaged 
students, academic and counseling services to improve student success, 
and supports infrastructure and facilities improvements.
    FAMU, like other HBCUs, has a critical need for funding to support 
equipment upgrades and purchases, construction and renovation of our 
facilities, and the development of our academic programs. This includes 
a wide variety of projects to strengthen the University and its 
programs, such as expansion of our online education offerings to 
enhance pathways to degree attainment, upgrading our information 
technology infrastructure, construction of laboratories, research and 
education facilities, and upgrading our health sciences and technology 
equipment and facilities. Continued funding for these HBCU programs and 
other Aid for Institutional Development programs is essential to 
postsecondary institutions, like FAMU, that educate the Nation's 
minority students.
 department of education historically black colleges and universities 
                       capital financing program
    FAMU supports the FY 2022 House recommended allocation of $24.484 
million for the Department of Education's HBCU Capital Financing 
Program, which provides low-cost capital to finance improvements to the 
infrastructure of the Nation's HBCUs. Specifically, the program 
provides accredited HBCUs with access to capital financing or 
refinancing for the repair, renovation, and construction of classrooms, 
libraries, laboratories, dormitories, instructional equipment, and 
research instrumentation.
    FAMU, like other HBCUs, has a critical need to upgrade and 
rehabilitate our aging facilities. This program makes capital available 
for HBCUs to improve our academic facilities, which will enhance the 
learning experience for our students. The funding requested would be 
used to pay the loan subsidy costs in guaranteed loan authority under 
the program. We urge the subcommittee to provide increased funding for 
FY 2023, which will allow HBCUs to continue to refinance previous 
capital project loans, renovate existing facilities, or build new 
facilities in alignment with our peer institutions.
               department of education pell grant program
    FAMU supports robust funding for the Pell Grant program under the 
Department of Education's Student Financial Assistance account. The 
Federal Pell Grant program, authorized by Title IV of the Higher 
Education Act, is the largest source of Federal grant aid supporting 
college students. The Pell Grant Program provides need-based grants to 
low-income undergraduate students to promote access to postsecondary 
education.
    Over 60 percent of our enrolled students rely on Pell grants to 
attend our institution. As Pell Grants account for less than one-third 
of the average cost of attendance at public 4-year universities, we 
join many national education associations in requesting an increase in 
the maximum individual award to $12,990. By nearly doubling the award, 
Congress will provide critical support for economically disadvantaged 
college students as we continue to rebound from one of the most 
challenging periods in our Nation's history. We expect that our current 
and prospective students will be dependent on financial assistance, 
including Pell Grants, in order to continue pursuing their 
postsecondary education goals.
national institutes of health research centers in minority institutions
    FAMU supports funding at the FY 2022 House recommended allocation 
of $88 million for the NIH National Institute on Minority Health and 
Health Disparities (NIMHD), Research Centers in Minority Institutions 
(RCMI) Program. The RCMI Program, established in 1985, supports 
critical infrastructure development and scientific discovery in 
historically minority graduate and health professional schools. The 
program serves the dual purpose of bringing more racial and ethnic 
minority scientists into mainstream research and promoting minority 
health research because many of the investigators at RCMI institutions 
study diseases, like COVID-19, that disproportionately affect minority 
populations. Notably, the employees at the FAMU community testing site 
were selected as the Tallahassee Democrat ``Person of the Year'' and 
have provided more than 630,000 tests and 25,000 vaccines to the Big 
Bend area since April 25, 2020.
    Since program inception, the FAMU RCMI Center has greatly benefited 
from this program, which has provided critical infrastructure to enable 
the College of Pharmacy and Pharmaceutical Sciences | Institute of 
Public Health to achieve national prominence and become a competitive 
biomedical research center nationally. The RCMI support of FAMU led the 
College to implement four doctoral tracks in pharmaceutical sciences, 
including pharmacology/toxicology, medicinal chemistry, pharmaceutics, 
and environmental toxicology. With RCMI support, our College of 
Pharmacy has graduated more than 60 percent of the African American 
doctoral recipients in the pharmaceutical sciences nationally.
department of health and human services, health resources and services 
           administration, health careers opportunity program
    FAMU supports the FY 2022 House recommended allocation of $20.5 
million for HRSA's Health Careers Opportunity Program (HCOP). First 
authorized in 1972, the HCOP competitive grant program aims to provide 
individuals from disadvantaged backgrounds an opportunity to develop 
the skills needed to successfully compete for, enter, and graduate from 
a health or allied health professions school. HCOP focuses on three key 
milestones of education: high school completion; acceptance, retention 
and graduation from college; and acceptance, retention and completion 
of a health professions degree program. The ultimate goal of the HCOP 
program is to diversify the health professions workforce by narrowing 
the educational achievement gaps between individuals from higher-income 
and lower-income households.
    The Health Careers Opportunity Program (HCOP) High School Summer 
Institute, conducted on FAMU's campus, is designed for high school 
students interested in pursuing a career in a health profession. The 
four-week program provides a wide-range of educational and social 
experiences for rising 10th, 11th and 12th grade students. The entire 
experience is designed to enhance participants' academic abilities, 
social skills, and other competencies to increase their competitiveness 
for admission to a post-secondary health professions program.
    The President's FY 2023 budget increases funding for HRSA's Health 
Professions Training for Diversity Programs, including the HCOP. 
Continued funding is critical for these programs that help address the 
shortage of underrepresented minorities in health professions.
    We urge the subcommittee to support continued and/or enhanced 
funding for these critical education programs at the Departments of 
Education and Health and Human Services. We thank you for your 
continued support of Federal postsecondary initiatives that not only 
directly benefit the University and our students, but the region and 
the Nation as well. Thank you for your consideration.

    [This statement was submitted by Larry Robinson, Ph.D., President, 
Florida A&M University.]
                                 ______
                                 
        Prepared Statement of the Focused Ultrasound Foundation
    Thank you for the opportunity to comment on the National Institutes 
of Health (NIH) budget priorities for FY 2023. We provide this 
testimony in support of the investment in innovation in health and 
medicine, particularly transformative new therapies like focused 
ultrasound.
    We offer views from the perspective as the only 501(c)(3) medical 
research, education and advocacy organization solely dedicated to 
advancing the development and clinical adoption of focused ultrasound, 
a noninvasive therapeutic medical device technology, for the treatment 
of a wide range of medical conditions. FUSF was founded in 2006 by Dr. 
Neal Kassell, a world-renowned neurosurgeon who has authored more than 
500 publications and was named to the Blue Ribbon Panel of then Vice 
President Joe Biden's Cancer Moonshot initiative. Our mission is to 
accelerate the development and adoption of evidence-based focused 
ultrasound therapy to improve the lives of countless individuals with 
serious medical disorders, including essential tremor, Parkinson's 
disease, Alzheimer's, chronic pain, various cancers, uterine fibroids, 
depression--more than 150 indications in total. We aim to bring focused 
ultrasound treatments to patients as quickly as possible, to improve 
patient outcomes and lower healthcare costs.
    FUSF encourages NIH to seriously examine Federal research 
investment in transformative cross-cutting platform technologies that 
can offer new treatments across multiple diseases and conditions. An 
example of such a technology is focused ultrasound, which offers 
unparalleled versatility due to its more than 18 different biological 
mechanisms of action, including tissue destruction, anti-cancer immune 
response, neuromodulation, localized and targeted drug delivery, 
transient opening of the blood-brain barrier, and many others. While 
this field of medicine is still emerging, various existing focused 
ultrasound applications have demonstrated its potential. With increased 
NIH investment, we can build on this knowledge and expand applications 
for many other diseases and conditions.
    To ensure that NIH delivers on its mission to foster innovative 
research for the betterment of patients, reviewers and program managers 
must truly understand a broad array of science and technology and be 
willing to invest in cross-cutting therapies. Despite extensive 
evidence of efficacy for many conditions and the immense potential to 
transform treatments for many others, as well demonstrated improvement 
to patient outcomes and reduction of healthcare costs, focused 
ultrasound is not widely accessible. One reason is the lack of funding 
needed for translational research to bring these innovations to 
patients. The current nature of funding agencies organized by organ 
system and the cross-cutting nature of research in focused ultrasound 
often means that reviewers and program officers lack the expertise or 
interest to fund these proposals, instead funding more familiar work 
deemed more mainstream and less risky. Ensuring that NIH program 
managers and reviewers have a wide array of expertise in transformative 
and innovative technologies and value high-risk, high-reward 
investments will ensure much-needed diversification in our Nation's 
publicly funded research.
    FUSF also strongly suggests that NIH place a strong focus on 
addressing health and healthcare disparities. Women's health issues 
continue to be under-represented in terms of Federal research dollar 
allocation, with dire consequences. Endometriosis is an example of one 
chronic, debilitating condition that needs to be addressed. An 
irreversible disease known to cause a wide spectrum of physical and 
psychological symptoms from chronic pain to infertility to increased 
risk of suicide, endometriosis is regularly mis-diagnosed or diagnosed 
up to seven to 9 years after the onset of painful symptoms despite it 
impacting 10-20 percent of the overall female population and 5-50 
percent among women with infertility. These symptoms are extremely 
painful and uncomfortable and range from pain during intercourse and 
bowel movements to excessive bleeding. If this chronic pelvic pain is 
detected and treated early, laparoscopy surgery may be avoided in favor 
of a non-invasive procedure like focused ultrasound, saving patients 
from unnecessary and invasive surgery and our healthcare system from 
preventable expenditures.
    A non-invasive treatment would be a significant improvement over 
surgery and would reduce resulting opioid reliance as well as related 
costs. However, these advancements can't be realized unless funding for 
women's health issues is increased exponentially, particularly for 
debilitating conditions like endometriosis. In the case of 
endometriosis specifically, this is a significant unmet need as 
evidenced by the number of physicians and providers who are asking for 
a way to better diagnose and treat these patients. We must bring 
medical innovations to all patients and ensure both diversity and 
inclusion are incorporated throughout our research, treatment, and 
coverage systems.
    In sum, investing in transformative, cross-cutting research is 
critical during a time when scientific achievements are more numerous 
than ever. We must ensure that patients are at the center of our 
healthcare system, and that the goal of improved patient outcomes 
drives funding decisions across the government landscape. It is crucial 
that we invest in innovation to ensure patients everywhere can access 
current and future life-changing and often life-saving technology. 
Thank you very much for consideration of our comments.
                                 ______
                                 
        Prepared Statement of the Fred Hutchinson Cancer Center
    Fred Hutchinson Cancer Center (Fred Hutch) appreciates the robust 
and reliable funding Congress has provided for the National Institutes 
of Health (NIH) in the past, and strongly urges continued support for 
this vital funding moving into the future. Prioritizing NIH funding as 
a key national investment helps to establish the United States as a 
world leader in health innovation, biomedical research and scientific 
advancement, and empowers the education and careers of our next 
generation of scientific and health care leaders. Critical investments 
in the NIH lead to more discoveries and increased development of 
therapies, treatments, and cures, helping patients to live longer and 
healthier lives.
    For fiscal year (FY) 2023, Fred Hutch urges the subcommittee to 
support a program level of at least $49 billion in base funding for the 
NIH.
    Strong, bipartisan support from the Appropriations subcommittee on 
Labor, Health and Human Services, Education and Related Agencies 
(Labor-HHS) over the last seven budget cycles has helped NIH to thrive, 
yielding a significant number of scientific advances to improve health 
outcomes for patients. These scientific advancements include the 
lifesaving COVID-19 vaccines that are helping our world to progress 
beyond the pandemic. As the fiscal Year2023 appropriations process 
continues, Fred Hutch is committed to working with Congress and the 
Administration to further bipartisan support for increasing this vital 
national investment and to ensure NIH funding remains a top priority.
    As with scientific discovery, and aligning with changing needs of 
our region, 2022 marks an exciting evolution for Fred Hutch. On April 
1, 2022, Fred Hutchinson Cancer Research Center and Seattle Cancer Care 
Alliance came together into one, independent entity, to form Fred 
Hutchinson Cancer Center (Fred Hutch). This opportunity to clinically 
integrate world-class research with one of the top cancer care 
hospitals in the Nation will lead to greater advances in adult 
oncology--bringing the research bench to the bedside. We anticipate 
increased numbers of clinical trials, as well as increased access to 
groundbreaking research and clinical care.
    Fred Hutch is guided by the mission to eliminate cancer and related 
diseases that cause human suffering and death and is now integrated 
with the expert clinical care to directly help patients live longer and 
healthier lives. Our Nobel Prize winning discoveries began in the 1970s 
with Dr. E. Donnall Thomas' work in bone marrow transplantation, 
providing the first definitive and reproducible example of the power of 
the human immune system's ability to cure cancer. To date, performing 
more than 17,000 bone marrow transplants makes Fred Hutch one of the 
most respected and successful programs in the world.
    As the only Dedicated Cancer Center in the Pacific Northwest, 
serving patients in five northwestern States, Fred Hutch is actively 
identifying and working to fill gaps in cancer care by prioritizing an 
increasingly diverse patient population. It is our role to build caring 
relationships with all communities, and especially those experiencing 
disparities. Strategic outreach in traditionally underserved 
communities is one of the many ways Fred Hutch is developing 
relationships with our neighbors in all corners of our region.
    Mitigating Health Inequities in Clinical Trials. History 
demonstrates that racial and ethnic minorities have been 
underrepresented in clinical trials and genetic studies. People from 
racial and ethnic minorities hold a heavier burden of negative health 
and economic impacts, and studies show these same individuals have 
higher rates of cancer and are more likely to die from the disease. 
Greater inclusion helps to further sharpen precision medicine and 
ultimately brings us closer to achieving our mission to find cures for 
cancers and diseases in all people--and there is still a lot of work to 
be done to improve.
    While health inequities have had a disproportionate impact on 
racial and ethnic minorities in the United States for a long time, the 
COVID-19 pandemic brought these disparities into stark focus, 
highlighting social, political, economic, and environmental factors 
that play an important role in health disparities. In order to reduce 
these disparities and promote inclusion and participation of 
individuals from diverse groups in clinical trials, Fred Hutch 
leveraged the infrastructure already in place from coordinating the 
global vaccine trials for HIV for more than 20 years through the HIV 
Vaccine Trials Network (HVTN) to lead operations for the COVID-19 
Prevention Network (CoVPN), funded by the National Institute of Allergy 
and Infectious Diseases. The CoVPN included five large-scale COVID-19 
vaccine efficacy trials with more than 200 clinical trial sites across 
the world, which included more than 600,000 volunteers. As a result of 
this and ongoing work, the trials for CoVPN were some of the most 
diverse in history.
    Empowering Early Career Researchers and Other Health Experts. The 
focus on health equity underscores all work of Fred Hutch, which 
includes building a more diverse and innovative scientific and clinical 
workforce. Robust funding for the NIH not only bolsters important 
research programs--it secures the future of science. Increases in NIH 
funding enable initiatives to reduce barriers to academia and provide 
training and education for young scientists, as well as encourage more 
culturally inclusive research.
    Fred Hutch invests $2 million annually in science education 
programs and is currently in the process of expanding to allied health 
and other types of opportunities. Scientific internships at Fred Hutch 
range from high school and college, as well as mentorship and 
development resources for graduate students, postdoctoral fellows, and 
early-career faculty. The Science Education Partnership, which started 
in 1991, has paired researchers with more than 580 secondary school 
science teachers in Washington state through workshops and a summer 
professional development program.
    Recruitment and Retention of Exceptional Researchers. Fred Hutch 
opposes provisions such as directives to reduce salary support for 
extramural researchers, that would harm the appeal of academic 
research. Policies to cut salary support would undermine Fred Hutch's 
ability to recruit and retain the talented researchers that keep our 
U.S. institutions thriving. Emphasized in the current workforce 
climate, there are countless desirable options for researchers and 
health care experts to pursue and their retention is essential to 
maintain our Nation's innovation ecosystem.
    The partnership between the NIH and the research institutions and 
scientists across America is highly productive. The Federal Government 
has an irreplaceable role in supporting biomedical research, with no 
other entity willing or able to provide the broad and sustaining 
funding that leads to innovative breakthroughs. Fred Hutch depends on 
NIH funding to conduct basic, translational, clinical, public health, 
and infectious disease research, as well as the ability to respond 
rapidly and expertly to the needs of our Nation, such as during the 
COVID-19 pandemic. Sustained and robust funding for the NIH will 
contribute to our efforts to support future pandemics and numerous 
other global health challenges for the years ahead.
    With President Biden's announcement and reinvigoration of the 
Cancer Moonshot, Fred Hutch and the larger cancer community stand 
poised to accelerate work already underway. Increasing funding for NIH 
as well as the creation of the Advanced Research Projects Agency for 
Health (ARPA-H) will help to achieve our goals. Consistent with our 
mission and values, Fred Hutch will continue working to increase access 
to the highest quality cancer treatments and services for all patients. 
We will continue to hone scientific innovation, such as telehealth and 
data science, to increase prevention efforts across entire populations 
and also to connect with individual patients--in ways that ultimately 
improve cancer outcomes for everyone.
    Fred Hutch appreciates the Labor-HHS subcommittee for your 
continued leadership and dedication to ensuring the continued and 
robust funding for the NIH. Thank you for the opportunity to share our 
recommendation to provide at least $49 billion in fiscal Year2023 for 
the NIH base program, in addition to funding for ARPA-H. As our Nation 
continues to rebuild and looks ahead to prepare for potentially future 
pandemics, now is the time to rededicate the commitment to science and 
support for efforts to seize upon the abundance of scientific 
opportunities.

    [This statement was submitted by Thomas J. Lynch Jr., MD, President 
and 
Director, Fred Hutchinson Cancer Center.]
                                 ______
                                 
               Prepared Statement of the Friends of HRSA
    The Friends of HRSA coalition is a nonpartisan coalition of nearly 
170 national organizations representing tens of millions of public 
health and health care professionals, academicians and consumers 
invested in the Health Resources and Services Administration's mission 
to improve health outcomes and achieve health equity. We are pleased to 
submit our request of at least $9.8 billion for the Health Resources 
and Services Administration in FY 2023. We are grateful for the 
increases provided for HRSA programs in FY 2022 and for the emergency 
supplemental funding to battle the COVID-19 pandemic, but HRSA's 
discretionary budget authority is far too low to effectively address 
the Nation's current public health and health care needs. We urge 
Congress to continue efforts to build upon these investments to 
strengthen all of HRSA's programs.
    HRSA's 90-plus programs and more than 3,000 grantees support tens 
of millions of geographically isolated, economically or medically 
vulnerable people, in every State and U.S. territory, to achieve 
improved health outcomes by increasing access to quality health care 
and services; fostering a health care workforce able to address current 
and emerging needs; enhance population health and address health 
disparities through community partnerships; and promote transparency 
and accountability within the health care system. The agency is a 
national leader in improving the health of Americans by addressing the 
supply, distribution and diversity of health professionals and 
supporting training in contemporary practices, and providing high-
quality health services to populations who may otherwise not have 
access to health care.
    HRSA programs work in coordination with each other to maximize 
resources and leverage efficiencies. For example, Area Health Education 
Centers, a health professions training program, was originally 
authorized at the same time as the National Health Service Corps to 
increase the number of primary care providers at health centers and 
other direct providers of health care services for underserved areas 
and populations. AHECs play an integral role to recruit providers into 
primary health careers, diversify the workforce and develop a passion 
for service to the underserved among future providers.
    HRSA grantees also play an active role in addressing emerging 
health challenges. For example, HRSA's grantees provide outreach, 
education, prevention, screening and treatment services for populations 
affected by health emergencies such as the opioid epidemic. However, 
much of this work required additional funding to increase capacity in 
health centers, support National Health Service Corps providers to 
deliver relevant care and expand rural health services. Strong, 
sustained funding would allow HRSA to quickly and effectively respond 
to emerging and unanticipated future health needs across the U.S., 
while continuing to address persistent health challenges.
    HRSA programs and grantees are providing innovative and successful 
solutions to some of the Nation's greatest health care challenges 
including the rise in maternal mortality, the severe shortage of health 
professionals, the high cost of health care, and behavioral health 
issues related to substance use disorder--including opioid misuse. We 
recommend Congress build upon the important increases they provided for 
HRSA programs in FY 2022 and provide at least $9.8 billion for HRSA's 
total discretionary budget authority in FY 2023. Additional funding 
will allow HRSA to pave the way for new achievements and continue 
supporting critical HRSA programs, including:
  --HRSA supports more than 13,500 community health center sites which 
        provide high quality primary care services to nearly 29 million 
        people and reduce barriers such as cost, lack of insurance, 
        distance and language for their patients.
  --HRSA supports the health workforce across the entire training 
        continuum by strengthening the workforce and connecting skilled 
        professionals to communities in need. Programs such as the 
        Public Health Training Centers assess and respond to critical 
        workforce needs through training, technical assistance and 
        student support.
  --HRSA's maternal and child health programs support patient-centered, 
        evidence-based programs that optimize health, minimize 
        disparities and improve health promotion and health care access 
        for medically and economically vulnerable women, infants and 
        children.
  --HRSA's Ryan White HIV/AIDS Program provides medical care and 
        treatment services to over half a million people living with 
        HIV. Ryan White programs effectively engage clients in 
        comprehensive care and treatment, including increasing access 
        to HIV medication, which has resulted in 89.4 percent of 
        clients achieving viral suppression, compared to just 65.5 
        percent of all people living with HIV nationwide.
  --HRSA supports healthcare systems and programs that access and 
        availability of lifesaving bone marrow, cord blood and donor 
        organs for transplantation. Additionally, the Healthcare 
        Systems Bureau supports poison control centers, which 
        contribute to significantly decreasing a patient's length of 
        stay and save the Federal Government $1.8 billion each year in 
        medical costs and lost productivity.
  --HRSA supports community- and State-based solutions to improve rural 
        community health by focusing on quality improvement, increasing 
        health care access, coordination of care and integration of 
        services that are uniquely designed to meet the needs of rural 
        communities.
  --The Title X Family Planning program reduces unintended pregnancy 
        rates, limits transmission of sexually transmitted infections 
        and increases early detection of breast and cervical cancer by 
        ensuring access to family planning and related preventive 
        health services to millions of women, men and adolescents.
  --HRSA also supports training, technical assistance and resource 
        development to assist public health and health care 
        professionals to better serve individuals and communities 
        impacted by intimate partner violence.
  --HRSA is well positioned to respond to infectious disease outbreaks 
        and has been active in the COVID-19 pandemic response, awarding 
        billions of dollars to health centers to administer COVID-19 
        tests and reimbursing over $18 billion to providers for testing 
        and treatment provided to uninsured individuals.
    The nation faces a shortage of health professionals and a growing 
and aging population which will demand more health care. Additionally, 
the COVID-19 pandemic reaffirmed the critical nature of a robust 
workforce in responding to public health emergencies. HRSA is well 
positioned to address these issues and to continue building on the 
agency's many successes, but a stronger commitment of resources is 
necessary to effectively do so. We urge you to consider HRSA's central 
role in strengthening the Nation's health and support a funding level 
of at least $9.8 billion for HRSA's discretionary budget authority in 
FY 2023.

    [This statement was submitted by Jordan Wolfe, Manager of 
Government 
Relations, American Public Health Association.]
                                 ______
                                 
    Prepared Statement of the Friends of the Institute of Education 
                                Sciences
    Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee, thank you for the opportunity to submit written testimony 
on behalf of the Friends of IES, a coalition of scientific and 
professional societies, K-12 and higher education organizations, 
universities, and independent research organizations committed to 
supporting the mission of IES and the use of research and statistics. 
We recommend at least $815 million for the Institute of Education 
Sciences (IES) in the FY 2023 Labor, Health and Human Services, and 
Education Appropriations bill.
    IES is the independent and nonpartisan statistics, research, and 
evaluation arm of the U.S. Department of Education charged with 
supporting and disseminating rigorous scientific evidence on which to 
ground education policy and practice. As such, it serves as the 
critical Federal source for funding groundbreaking research in myriad 
aspects of teaching and learning, as well as rigorous analysis of 
educational programs and initiatives.
    Its four centers--the National Center for Education Statistics 
(NCES), National Center for Education Research (NCER), National Center 
for Special Education Research (NCSER), and National Center for 
Education Evaluation (NCEE)--work collaboratively to efficiently and 
comprehensively deliver rigorous research and high-quality data and 
statistics to educators, parents, and policymakers. Research supported 
by NCER and NCSER have been incorporated in classrooms to enhance 
instruction and support students' academic and non-academic outcomes. 
Recent examples include the Intelligent Tutoring System for the 
Structure Strategy, used by middle school students; Assessment-to-
Instruction, which has resulted in a partnership between Learning 
Ovations and Read Memphis that is supporting the literacy development 
of young readers; and IES-supported collaborative work that resulted in 
the development of the Washoe County School District Social and 
Emotional Competency Assessments.
    Our member organizations rely on IES to support vital research that 
addresses many of the most important issues in our Nation's schools. We 
are deeply thankful for the increases provided to IES in recent years 
to further invest in the education research and statistical 
infrastructure and to respond to the impact of COVID-19 in exacerbating 
pre-existing learning gaps.
    FY 2022 appropriations for IES represent less than one percent of 
the total discretionary funding for the Department of Education. 
Similar to the investment that the Federal Government makes in medical 
research at the National Institutes of Health to advance health 
outcomes, the investment in IES is essential to address persistent 
challenges in education. A recent report from the National Academies of 
Science, Engineering, and Medicine (NASEM) highlighted an observation 
regarding IES funding in the Federal research landscape: ``Given the 
breadth of what IES is expected to accomplish as mandated in ESRA, its 
funding for both programmatic activities and staffing has historically 
been limited in comparison to other Federal science, research, and 
statistical agencies with similar objectives.''(p. 3-3) \1\ Providing 
at least $815 million for IES in fiscal Year2023 would serve as one 
important step toward more fully supporting the education research and 
statistical infrastructure essential to education policy and practice.
---------------------------------------------------------------------------
    \1\ National Academies of Sciences, Engineering, and Medicine. 
2022. The Future of Education Research at IES: Advancing an Equity-
Oriented Science. Washington, DC: The National Academies Press. https:/
/doi.org/10.17226/26428.
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    IES remains constrained in its flexibility to fully fund emerging 
research areas and scale up promising interventions and resources. 
About one of every 10 grant proposals receives funding support, 
limiting the ability of IES to tackle pressing questions in education. 
With appreciation for the boost provided in FY 2022, additional funding 
for Research, Development, and Dissemination (RD&D) is essential to 
support needed research in foundational and emerging topics, including 
measures and assessments in career and technical education; the 
development and testing of education technology products that can 
personalize instruction; and approaches to teacher recruitment, 
retention, certification, assessment, and compensation. RD&D funding is 
critical to help improve education and better support the achievement 
of our Nation's students. Additional investment in RD&D is essential to 
the support of new high-risk, high-reward research with the potential 
for transforming education, along with the synthesis of research 
findings for use by all education stakeholders.
    The National Center for Education Statistics (NCES) is the primary 
Federal entity dedicated to collecting data related to education and is 
the only principal statistical agency dedicated to this mission. NCES 
works with stakeholders to provide relevant data through administrative 
and longitudinal surveys, but limited funding and staff resources over 
the past decade has resulted in constraining NCES in its capacity to 
meet the real-time data needs of researchers and policymakers. 
Additional funding for NCES would provide greater flexibility to 
develop surveys such as the School Pulse Panel and more quickly release 
important educational indicators. Restoring purchasing power NCES has 
lost over the past decade would also expand the agency's capacity to 
analyze data on timely education issues and link administrative 
education data to health and employment data for evidence-based 
policymaking and to understand the broader context of outcomes.
    NCES importantly provides the funding support and infrastructure 
for the Statewide Longitudinal Data Systems (SLDS) program, providing 
critical investment for States to link K-12, postsecondary, and 
workforce systems to gain a better understanding of education and 
workforce outcomes. This work is particularly important for questions 
of national interest, such as interest and persistence in STEM areas to 
develop needed workforce talent. IES is also emphasizing the research 
use of SLDS to measure the effects of interventions on long-term 
student outcomes and in examining the impact of State education policy 
actions in supporting learning recovery, such as the Additional Days 
School Year initiative in Texas. Additional resources for SLDS can 
support States in linking data across education and workforce systems.
    In addition to the research supported by the National Center for 
Education Research, the Regional Educational Laboratories (RELs) 
conduct applied research that is directly relevant to state and 
district administrators, principals and teachers. RELs also ensure that 
research is shared widely through its deep dissemination networks. 
During the pandemic, the RELs have provided a wide range of evidence-
based resources to guide teachers, school leaders, and State and local 
officials on COVID-19 response. This work is all driven by the State 
education agencies and other stakeholders in the regions. Additional 
funding is needed to research and support growing local and regional 
needs to respond to the impact of the pandemic on academic, social and 
emotional learning.
    The National Center for Special Education Research (NCSER) is the 
only Federal agency specifically designated to develop and provide 
evaluations for programs for students with disabilities, but currently 
has a budget that has remained relatively flat since FY 2014 and still 
below its FY 2010 funding level. Due to limited funding, NCSER did not 
run competitions in FY 2022 for its annual special education research 
and training grants.
    Research funded by NCSER has resulted in programs such as those 
that support youth with high functioning autism experiencing high 
levels of anxiety, individuals with Down syndrome learning to read, and 
students with learning disabilities studying to master math word 
problems. NCSER also provides special educators and administrators 
research-based resources that support the provision of a free 
appropriate public education and interventions to foster self-
determination in students with disabilities as they transition into 
adulthood.
    We also appreciate the inclusion of language in recent 
appropriations bills calling for the Department of Education to address 
how it will ensure adequate staffing levels, including in IES. We are 
particularly grateful for the inclusion of a new program administration 
line item within IES in the FY 2022 omnibus appropriations bill, which 
will provide additional flexibility for IES to hire staff to support 
the increased work that comes with added funding. A recent report from 
NASEM noted the specific staffing challenges that NCES has faced, 
seeing the attrition of more than 20 staff positions between FYs 2015 
and 2021. This has resulted in the discontinuation of 12 programs.\2\ 
We look forward to your continued oversight on this issue to ensure IES 
has the resources to employ the necessary staff to effectively carry 
out its mission.
---------------------------------------------------------------------------
    \2\ National Academies of Sciences, Engineering, and Medicine. 
2022. A Vision and Roadmap for Education Statistics. Washington, DC: 
The National Academies Press. https://doi.org/10.17226/26392.
---------------------------------------------------------------------------
    To this end, we recommend that the committee provide IES at least 
$815 million in FY 2023. With continued emphasis on evidence-based 
policy and practice as our Nation continues to recover from the 
pandemic, IES plays an essential role in responding to key research 
questions, disseminating data to inform decisions, and developing 
resources to guide learning and instruction. Sustained, robust 
investment in the education research and statistical infrastructure at 
IES is necessary to support the success of our Nation's students, 
teachers, and education leaders.

    [This statement was submitted by Felice J. Levine, Chair, Friends 
of the Institute of Education Sciences.]
                                 ______
                                 
  Prepared Statement of the Friends of the National Institute on Aging
    On behalf of the Friends of the National Institute on Aging 
(FoNIA), we are grateful for your leadership in advancing the mission 
of National Institutes of Health (NIH), and the research supported and 
conducted by the National Institute on Aging (NIA). FoNIA is a 
coalition of more than 50 academic, patient-centered and non-profit 
organizations supporting NIA's mission to understand the nature of 
aging and the aging process, and diseases and conditions associated 
with growing older in order to extend the healthy, active years of 
life.
    We are writing to request that Federal resources continue to be 
dedicated to sustaining and enhancing timely and promising aging 
research at NIA and across NIH.
    Specifically, FoNIA requests:
  --no less than $49 billion in fiscal year 2023 for base spending at 
        NIH for current institutes and operations, which corresponds 
        with the overall recommendation of the Ad Hoc Group for Medical 
        Research;
  --continued efforts in establishing the Advanced Research Projects 
        Agency for Health (ARPA-H) at NIH. However, investment in ARPA-
        H should not come at the cost of the existing NIH institutes 
        and centers conducting and supporting research on aging. We 
        support an increase of $4 billion for ARPA-H to supplement the 
        core investment.
  --a minimum increase of $226 million specific to research on 
        Alzheimer's disease and related dementias (ADRD). NIA is the 
        primary Federal agency supporting and conducting Alzheimer's 
        disease and related dementias research;
  --an increase of $60 million to support the Brain Research through 
        Advancing Innovative Technologies (BRAIN) Initiative.
    NIA sponsors and conducts the vast majority of Federal aging-
related research, and this pioneering science contributes significantly 
to the improved care and quality of life for all of us as we age. A key 
NIA priority is translating research into better and more efficient 
care through the development of effective interventions that are 
disseminated to health care providers, patients, and caregivers. These 
interventions for the prevention, early detection, diagnosis, and 
treatment of disease will help reduce the burden of illness for older 
adults and reduce the cost of care.
    In the area of dementia, NIA supports vital research where more 
scientific investigation is needed to improve AD/ADRD prevention, 
diagnosis, treatment and care; basic science approaches to illuminate 
neurodegenerative mechanisms/pathways; and computational/biological 
systems approaches to identify, model and predict the architecture and 
dynamics of the molecular interactions underlying AD/ADRD pathogenesis.
    NIH's Brain Research through Advancing Innovative Technologies 
(BRAIN) Initiative works to develop a dynamic picture of how neurons 
act, both individually and together in circuits. The initiative 
revolutionizes our understanding of the human brain and provides 
insight into how to treat, prevent and cure brain disorders. In 
addition to NIH, this public-private partnership involves other Federal 
agencies such as the National Science Foundation (NSF), Defense 
Advanced Research Projects Agency (DARPA), Intelligence Advanced 
Research Projects Activity (IARPA), the Food and Drug Administration 
(FDA) and the Department of Energy (DOE).
    Medical and health research and development investment accounts for 
5.9 percent of overall health spending in the U.S., or just under 6 
cents of each health care dollar according to a recent report by 
Research!America.\1\ The Science & Technology Action Committee also 
recently estimated that the U.S. should double its R&D investment by 
2026 in order to remain a global competitor in science, technology, 
engineering, and math.\2\ As the world's premier public funder of 
medical research, the NIH is a critical international leadership, and 
robust annual growth in support for NIH will be key to achieving these 
objectives.
---------------------------------------------------------------------------
    \1\ US Investments in Medical and Health Research and Development 
2016-2020. https://www.researchamerica.org/sites/default/files/
Publications/Research%21America-
Investment%20Report.Final.January%202022.pdf. Accessed 5/9/2022.
    \2\ Science & Technology Action Committee. (2022 January). Briefing 
Paper: A Roadmap for Investment in Science and Technology. https://
sciencetechaction.org/news-item/white-paper-a-roadmap-for-investment-
in-science-and-technology/.
---------------------------------------------------------------------------
    Lastly, NIH funding provides a vital economic boost to local 
economies. Most of NIH/NIA funding is distributed as grants to 
universities and other research institutions across the United States, 
and acts as an economic engine and multiplier in local and regional 
communities. According to United for Medical Research, total FY21 NIH 
research spending supported more than 552,000 American jobs and 
generated nearly $94.2 billion in economic activity, in all 50 
States.\3\
---------------------------------------------------------------------------
    \3\ NIH's Role in Sustaining the U.S. Economy 2022 Update. https://
unitedformedicalresearch.org/wp-content/uploads/2022/03/UMR_NIHs-Role-
in-Sustaining-the-U.S.-Economy-FY21.pdf. Accessed 4/28/22.
---------------------------------------------------------------------------
    Thanks to your support, NIH/NIA is continuing to accelerate 
scientific discoveries which will benefit us all as we age. Only 
through continued, and meaningful investments in NIH/NIA will it be 
possible to enhance the quality of care for older adults across the 
Nation.
    Thank you for your consideration of this funding request. Should 
you need additional information, feel free to contact me at 
[email protected].
    Sincerely.

    [This statement was submitted by Patricia M. D'Antonio, BSPharm, 
MS, MBA, BCGP, Chair, Friends of the National Institute on Aging.]
                                 ______
                                 
  Prepared Statement of the Friends of the National Institute on Drug 
                                 Abuse
    Thank you for the opportunity to submit testimony in support of the 
National Institute on Drug Abuse (NIDA). The Friends of the National 
Institute on Drug Abuse is a coalition working with about 150 scholarly 
organizations with a total membership of at least 2 million scholars, 
clinicians and educators who are committed to eliminating substance use 
disorders in society. We coordinate the opinions of the participating 
organizations, who also actively participate on their own to provide 
important information to policy makers to make decisions that will lead 
to the elimination of this disease which now is killing so many of our 
citizens. For example, former research which led to the creation of 
drugs such as naloxone and buprenorphine has provided important 
mechanisms which have prevented the death rate from being even much 
higher. We need more research in all areas of basic and clinical 
science to make additional advances.
    In the Fiscal Year 2023 Labor, Health and Human Services 
Appropriations bill, Friends of NIDA joins with the Ad Hoc Group for 
Medical Research in recommending a program level of at least $49.048 
billion for the base budget of the National Institutes of Health (NIH), 
which would represent an increase of $4.1 billion over the comparable 
Fiscal 2022 funding level. For the National Institute on Drug Abuse 
(NIDA), Friends of NIDA encourages the Committee to provide at least 
the President's recommended funding level of $1.843 billion, which 
would represent an increase of $248 million over the comparable Fiscal 
2022 funding level for the Institute.
    Friends of NIDA also supports the proposal included in the 
President's Fiscal Year 2023 budget to change the name of the National 
Institute on Drug Abuse to the National Institute on Drugs and 
Addiction.
    We also respectfully request the inclusion of the following NIDA 
specific report language.

      Opioid Initiative. The Committee continues to be concerned about 
        the high mortality rate due to the opioid epidemic and 
        appreciates the important role that research plays in the 
        various Federal initiatives aimed at this crisis. The Committee 
        is also aware of the most recent provisional data from the 
        Centers for Disease Control and Prevention that shows opioid 
        overdose fatalities were predicted to exceed 100,000 in the 12-
        month period ending in June 2021, with the primary driver being 
        the increased overdose deaths involving synthetic opioids, 
        primarily illicitly manufactured fentanyls. More research is 
        needed to find new and better agents to prevent or reverse the 
        effects caused by this class of chemicals and to provide 
        improved access to treatments for those addicted to these 
        drugs. To combat this crisis the Committee has provided within 
        NIDA's budget no less than $405,400,000 for the Institute's 
        share of the HEAL Initiative and in response to rising rates of 
        stimulant use and overdose, the Committee has included language 
        expanding the allowable use of these funds to include research 
        related to stimulant use and addiction.

      Methamphetamine and Other Stimulants. The Committee is concerned 
        that, according to provisional data released by the Centers for 
        Disease Control and Prevention, over 45,000 overdose deaths 
        involved drugs in the categories that include methamphetamine 
        and cocaine in the 12-month period ending in June 2021, an 
        increase of 25 percent in a single year. The sharp increase has 
        led some to refer to stimulant overdoses as the ``fourth wave'' 
        of the current drug addiction crisis in America following the 
        rise of opioid-related deaths involving prescription opioids, 
        heroin, and fentanyl-related substances. No FDA-approved 
        medications are available for treating methamphetamine and 
        other stimulant use disorders. The Committee continues to 
        support NIDA's efforts to address the opioid crisis, has 
        provided continued funding for the HEAL Initiative, and 
        supports NIDA's efforts to combat the growing problem of 
        methamphetamine and other stimulant use and related deaths.

      Barriers to Research. The Committee is concerned that 
        restrictions associated with Schedule I of the Controlled 
        Substance Act effectively limits the amount and type of 
        research that can be conducted on certain Schedule I drugs, 
        especially opioids, marijuana or its component chemicals, and 
        new synthetic drugs and analogs. At a time when we need as much 
        information as possible about these drugs and antidotes for 
        their harmful effects, we should be lowering regulatory and 
        other barriers to conducting this research. The Committee 
        appreciates NIDA's completion of a report on the barriers to 
        research that result from the classification of drugs and 
        compounds as Schedule I substances including the challenges 
        researchers face as a result of limited access to sources of 
        marijuana including dispensary products.

      COVID Pandemic and Impact on Substance Use Disorders. The 
        Committee is acutely aware of the risks that the ongoing COVID-
        19 pandemic poses to individuals with substance use disorders. 
        According to the Centers for Disease Control and Prevention, 
        drug overdose deaths accelerated during the pandemic, and were 
        predicted to exceed 100,000 in the 12-month period ending in 
        June 2021, the highest number of overdose deaths ever recorded 
        in a 12-month period. Moreover, research supported by the 
        National Institute on Drug Abuse found that individuals with 
        substance use disorders are at increased risk for COVID-19 and 
        its more adverse outcomes. The Committee commends NIDA for 
        conducting research on the adverse impact of the pandemic on 
        SUDs and encourages the Institute to continue to support 
        research on these issues.

      Raising Awareness and Engaging the Medical Community in Drug 
        Abuse and Addiction Prevention and Treatment. Education is a 
        critical component of any effort to curb drug use and 
        addiction, and it must target every segment of society, 
        including healthcare providers (doctors, nurses, dentists, and 
        pharmacists), patients, and families. Medical professionals 
        must be in the forefront of efforts to curb the opioid crisis. 
        The Committee continues to be pleased with the NIDAMED 
        initiative, targeting physicians-in-training, including medical 
        students and resident physicians in primary care specialties 
        (e.g., internal medicine, family practice, and pediatrics). 
        NIDA should continue its efforts in this area, providing 
        physicians and other medical professionals with the tools and 
        skills needed to incorporate substance use and misuse screening 
        and treatment into their clinical practices. The Committee 
        recommends that NIDA increase its support for the education of 
        scientists and practitioners to find improved prevention and 
        treatments for substance use disorders.

      Electronic Cigarettes. The Committee understands that electronic 
        cigarettes (e-cigarettes) and other vaporizing equipment are 
        increasingly popular among adolescents, and requests that NIDA 
        continue to fund research on the use and consequences of these 
        devices.

    In addition, we request the following report language within the 
Office of the Director account:

      The HEALthy Brain and Child Development (HBCD) Study. The 
        Committee recognizes and supports the NIH HEALthy Brain and 
        Child Development Study, which will establish a large cohort of 
        pregnant women and follow them and their children up to age 10 
        to characterize the influence of a variety of factors on 
        neurodevelopment and long-term outcomes. The study aims to 
        enroll approximately 7,500 women from 25 sites across the US, 
        including regions of the country significantly affected by the 
        opioid crisis. Participants will include women from the general 
        population of pregnant women to assess normative development; 
        those who have or are using opioids and/or other substances 
        during their pregnancy; and women from comparable environments 
        to the latter, but who have not used substances during their 
        pregnancy. This knowledge will be critical to help predict and 
        prevent some of the known impacts of pre- and postnatal 
        exposure to drugs or adverse environments, including risk for 
        future illicit substance use, mental disorders, and other 
        behavioral and developmental problems. The Committee recognizes 
        that the HBCD Study is supported in part by the NIH HEAL 
        Initiative, and NIH Institutes, Centers, and Offices (ICOs), 
        including OBSSR, ORWH, NIMHD, NIBIB, NIMHD, NIEHS, NICHD, 
        NINDS, NIAAA, NIMH, and NIDA, and encourages additional NIH 
        support for this important study.

      Marijuana Research. The Committee is concerned that marijuana 
        policies on the Federal level and in the States (medical 
        marijuana, recreational use, etc.) are being changed without 
        the benefit of scientific research to help guide those 
        decisions. NIH is encouraged to continue supporting a full 
        range of research on the health effects of marijuana and its 
        components, including research, to understand how marijuana 
        policies affect public health.

    Substance use disorders (SUD) are costly to Americans; it ruins 
lives, while tearing at the fabric of our society and taking a 
financial toll on our resources. Over the past three decades, NIDA-
supported research has revolutionized our understanding of SUD as a 
chronic, often-relapsing disorder -this new knowledge has helped to 
correctly emphasize the fact that SUD is a serious public health issue 
that demands strategic solutions.
    NIDA supports a comprehensive research portfolio that spans the 
continuum of basic neuroscience, behavior and genetics research through 
medications development and applied health services research and 
epidemiology. While supporting research on the positive effects of 
evidence-based prevention and treatment approaches, NIDA also 
recognizes the need to keep pace with emerging problems. We have seen 
encouraging trends in strategies to address these problems, but areas 
of continuing significant concern include the recent increase in 
fatalities due to synthetic fentanyl, as well as continued illicit use 
of prescription opioids. Our knowledge of how drugs work in the brain, 
their health consequences, how to treat people with SUDs, and what 
constitutes effective prevention strategies has increased dramatically 
due to research. However, because the number of individuals who are 
affected is still rising, we need to continue the work until this 
disease is both prevented and treated effectively and compassionately.
    We understand that the fiscal year 2023 budget cycle will involve 
setting priorities and accepting compromise, however, in the current 
climate we believe a focus on SUDs deserves to be prioritized 
accordingly. Thank you for your support for the National Institute on 
Drug Abuse.
                                 ______
                                 
               Prepared Statement of the Friends of NICHD
    I write on behalf of the Friends of NICHD, a coalition of more than 
100 organizations representing patients, providers, scientists, and 
caregivers who are united in our support for ensuring the health and 
well-being of women, children, families, and people with disabilities 
through research funded by the Eunice Kennedy Shriver National 
Institute of Child Health and Human Development (NICHD) and the 
National Institutes of Health (NIH). We urge the subcommittee to 
provide NICHD with $1.816 billion in Fiscal Year (FY) 2023, an increase 
of $133 million over FY 2022. We also respectfully ask the subcommittee 
to maintain its commitment to increasing funding for the National 
Institutes of Health (NIH) by providing $49 billion in fiscal Year2023 
and give special attention to ensuring that overall funding increases 
for the NIH are shared evenly across the agency.
    We are pleased to support the extraordinary work of NICHD to meet 
the objectives of its biomedical, social, and behavioral research 
mission, including research on child development before and after 
birth; women's health throughout the life cycle; maternal, child, and 
family health; learning and language development; reproductive biology; 
population health; and medical rehabilitation. By enacting our funding 
request, Congress can ensure that NICHD's base budget grows 
proportional to that of its counterpart institutes and the institute 
can build upon the initiatives detailed below to provide new insights 
and solutions to benefit women, children, and families in your 
districts and States.
    COVID-19: NICHD has played a key role in understanding the impact 
of the COVID-19 pandemic on the institute's populations, including 
pregnant and postpartum women, children and adolescents, people with 
intellectual and developmental disabilities, and people with physical 
disabilities and mobility impairments. This work includes intramural 
research studies, collaborations with other NIH institutes and centers, 
and major undertakings like the Gestational Research Assessments for 
COVID-19 (GRAVID) study and the Predicting Viral-Associated 
Inflammatory Disease Severity in Children with Laboratory Diagnostics 
and Artificial Intelligence (PreVAIL kIds), which are advancing our 
knowledge of understudied COVID-19 research questions. For instance, 
NICHD is leading research to understand long COVID in children and 
pregnant women, develop evidence-based COVID-19 mitigation measures to 
allow children with special health care needs to remain in school 
safely, and identify effective strategies to improve COVID-19 vaccine 
uptake. The institute also continues to advocate for inclusion of its 
key populations in major trans-NIH COVID-19 research programs funded by 
Congress.
    Maternal Mortality: The Pregnancy and Perinatology Branch, through 
networks including the Maternal-Fetal Medicine Units (MFMU) Network, 
supports research to improve the health of women before, during, and 
after pregnancy. Maternal mortality rates remain unacceptably high in 
the United States and significant racial and ethnic inequities persist. 
In recent years, NICHD has led the Implementing a Maternal health and 
PRegnancy Outcomes Vision for Everyone (IMPROVE) Initiative, which 
seeks to eliminate disparities among populations with greater rates of 
maternal mortality and morbidity. With additional funding, NICHD can 
support additional research to identify ways to improve maternal and 
infant health.
    Data on Pediatric Enrollment in NIH Trials: NIH requires 
investigators to submit deidentified demographic data on study 
participants, including age at enrollment. It is important for NIH to 
analyze and publicly report on this data to ensure that all 
populations, including children, benefit from research. This data 
should be used proactively NIH-wide to address recruitment issues in 
ongoing studies in real time and to drive forward the inclusion of 
individuals across the lifespan, including children. NICHD should play 
a leading role in the implementation of this policy vis-a-vis age.
    Infant and Childhood Health: Through the Best Pharmaceuticals for 
Children Act (BPCA), NICHD funds the study of old, off-patent drugs 
important to children but inadequately studied in pediatric 
populations. The BPCA NIH program has been successful in accomplishing 
its intended purpose, leading to updated pediatric labeling in 17 
drugs. However, the program has been flat funded at $25 million since 
it was originally authorized in 2002. This funding level is 
insufficient to meet needs, particularly when accounting for biomedical 
research inflation, and has prevented NIH from funding additional drug 
trials in children. Additionally, BPCA NIH has never received a direct 
appropriation from Congress as authorized by law but rather has been 
funded by contributions from NIH institutes and centers. We urge 
increased, dedicated support from Congress to ensure this program can 
fund additional studies to improve pediatric drug labeling to provide 
clinicians with needed guidance for drugs prescribed in children. We 
also strongly support NICHD's ongoing research into the causes and 
prevention strategies for the major causes of death in infancy and 
childhood, including sudden unexpected infant death, accidents, and 
suicide.
    Behavioral Health Research: NICHD supports a range of research on 
child development and behavior and has made great progress developing 
sophisticated tools to measure children's cognitive, emotional, and 
social functioning. To build on these successes, we encourage more 
integrated behavioral and biobehavioral work on child developmental 
trajectories, across infancy, childhood, and adolescence, in both 
normative and at-risk environments, across diverse contexts (school, 
home, and community) and including underrepresented and vulnerable 
groups. More research is also needed on integrated behavioral health in 
primary care settings and the impact of behavioral interventions on 
mental health, physical health, and quality of life. Child health would 
also benefit from additional work on the role of technology and social 
media to support optimal development in children, including those with 
disabilities, and increased access to and engagement with effective 
psychological and behavioral interventions for childhood conditions.
    Poverty and Child Health: Poverty can be especially detrimental in 
childhood and adolescence, leading to adverse impacts on physical 
health, mental health, social well-being, cognitive and emotional 
development, and the acquisition of motor and language skills. NICHD is 
in the unique position to examine the biological, psychological, 
social, cultural, and environmental factors that impact the developing 
child in high-poverty environments--including challenges due to chronic 
stress, neighborhood safety, school environments, family health status, 
education, job instability, unstable family structures, and substandard 
living conditions--and to evaluate interventions aimed at improving the 
developmental trajectories of these children.
    Reproductive Sciences: Research on the basic biological mechanisms 
of reproduction is a crucial foundation for all NICHD's work. 
Understanding reproductive biology and associated biological phenomena 
provides the foundation for innovative medical therapies and 
technologies and improves existing treatment options for gynecologic 
conditions. Often, this research focuses on serious conditions that are 
overlooked and underfunded, even though they impact many women. Future 
work could address infertility and the need for treatments for 
endometriosis, polycystic ovarian syndrome (PCOS) and uterine fibroids.
    Pelvic Floor Disorders Network (PFDN): Female pelvic floor 
disorders, which affect 25 percent of American women, represent a major 
public health burden with high prevalence, impaired quality of life, 
and substantial economic costs. The PFDN conducts research to improve 
treatment of these painful gynecological conditions. Current research 
aims to improve female urinary incontinence outcome measures and ensure 
high-quality outcomes.
    PregSource: NICHD's PregSource\TM\ Initiative enables pregnant 
women to track their health data from gestation to early infancy and 
access evidence-based information about healthy pregnancies. It will 
also allow researchers to utilize aggregated data and potentially 
recruit participants for clinical trials so that knowledge gaps can be 
eliminated and care for pregnant and post-partum women can be improved.
    Task Force Specific to Research in Pregnant Women and Lactating 
Women (PRGLAC): In 2018, the NICHD-led PRGLAC Task Force submitted 
recommendations to Congress on opportunities to achieve broader 
inclusion of pregnant and lactating women in research and expand the 
workforce of clinicians and researchers with expertise in obstetric and 
lactation pharmacology and therapeutics. In 2020, the Task Force 
released a second report with a detailed plan to implement those 
recommendations. We encourage NICHD to continue activities to advance 
PRGLAC recommendations in the coming year.
    NIH Pediatric Research Consortium (N-PeRC): N-PeRC is an NICHD-led, 
trans-NIH initiative that aims to harmonize pediatric research and 
training activities across the NIH. N-PeRC capitalizes on pediatric 
expertise at the NIH by enabling collaboration to explore gaps in the 
overall pediatric research portfolio and share best practices to 
advance science. N-PeRC has played a vital role throughout the COVID-19 
pandemic in identifying key child and adolescent research needs related 
to SARS-CoV-2.
    Human Development, Infancy Through Adulthood: NICHD supports 
research on infant-through-adult development, including how father-
child relationships and co-parenting positively impacts children's 
socio-emotional development and decreases behavior problems; children's 
adjustment after the birth of a sibling; pathways and outcomes 
associated with mothers' postseparation co-parenting relationships, 
with a particular focus on experiences of intimate partner violence and 
negative outcomes; and the health and well-being across three 
generations of lesbians, gay men, and bisexuals.
    Intellectual and Developmental Disabilities Research Centers 
(IDDRC): The IDDRCs are a critical national resource for basic research 
into the genetic and biological basis of human brain development, 
greatly improving our understanding of the causes of developmental 
disabilities and contributing to the development and implementation of 
evidence-based practices by evaluating the effectiveness of biological, 
biochemical, and behavioral interventions. These centers have 
contributed to new treatments for genetic disorders through the study 
of intellectual and developmental disabilities, such as Everolimus for 
epilepsy in TSC. We must build on progress in understanding and 
treating this class of disorders that affect so many. We urge resources 
and support for the IDDRCs for research infrastructure and expansion of 
cores to conduct basic and translational research to develop effective 
prevention, treatment and intervention strategies for children and 
adults with developmental disabilities.
    Preterm Birth: NICHD supports a comprehensive research program on 
the causes, prevention and treatment of preterm birth, the leading 
cause of infant mortality and intellectual and physical disabilities. 
Research shows the survival rate and neurological outcomes may be 
improving for very early preterm infants, but continued prioritization 
is needed through extramural preterm birth prevention research, the 
MFMU Network, the Neonatal Research Network, and intramural research 
program. Robust funding is needed for research to determine the complex 
interaction of behavioral, social, environmental, genetic, and 
biological influences on preterm birth with the goal of developing the 
interventions necessary to decrease prematurity.
    Population Dynamics: The NICHD Population Dynamics Branch supports 
research on how population change affects the health, development, and 
well-being of children and their families. Longitudinal surveys, such 
as the Fragile Families and Child Wellbeing Study, have demonstrated 
the role that family stability and parental involvement play in the 
long-term health and development of children, facilitating tremendous 
progress in the population sciences. NICHD also supports the Population 
Dynamics Centers Research Infrastructure Program, which supports 
research and research training in demographic or population research. 
These centers focus on research such as family demography and 
intergenerational relationships; education, work, and inequality; 
population health; and reproductive health. NICHD also supported a 
groundbreaking study showing that infants of mothers in low-income 
households that received monthly cash payments were more likely to show 
faster brain activity in a pattern associated with learning and 
development at later ages.
    Male Infertility: Male infertility is another relevant area of 
inquiry that would benefit from additional NICHD-sponsored research. 
For instance, the biological mechanisms associated with common causes 
of male infertility, such as varicoceles, remain poorly understood. 
These research domains represent important opportunities to develop 
better treatments for male infertility.

    [This statement was submitted by Matthew Mariani, 2022 Chair, 
Friends of NICHD and Policy Associate, Federal Advocacy, American 
Academy of Pediatrics.]
                                 ______
                                 
                 Prepared Statement of the FSHD Society
    Honorable Chairwoman Murray, Ranking Member Blunt, and 
distinguished members of the subcommittee, thank you. We are requesting 
the FY 2023 appropriation of an amount of $25 million for the agency 
U.S. DHHS National Institutes of Health (NIH) to sustain and continue 
its research program on facioscapulohumeral muscular dystrophy 
(hereafter called FSHD). We are requesting an additional $5 million for 
specifically targeted FSHD research through the NIH as requested 
herein.
    Madam Chairman, this is my sixty-third testimony before the U.S. 
Congress' Appropriations subcommittee on this matter. I have been 
professionally engaged in FSHD research since 1987, with a focus on 
funding research on the fundamental pathophysiology, molecular biology 
and genetics of the disease. I am co-founder, past- Chairman, -
President & CEO, and -CSO of FSHD Society, and have been involved in 
the evolution and design of FSHD research, gene mapping and genetics 
more or less from its inception to the present. My work and the FSHD 
Society's funding spans nearly every research lab working on FSHD, the 
tactical and strategic planning that have led to understanding how 
FSHD1\1\ and FSHD2,\2,3\ work, Muscular Dystrophy Community Assistance, 
Research and Education Amendments of 2001 (MD-CARE Act, Public Law 107-
84), advocacy and policy, and the relationship of the scientific 
community to the larger societal context in which FSHD is embedded.
    I am approaching near thirty years of testifying as a patient with 
FSHD for Appropriation of funding for FSHD. I have had this disease for 
twice that time. That is a long time to live with a disease of this 
burden. I have now seen, experienced the entire effects, and borne 
almost the full brunt of what FSHD can do to you. FSHD is a heritable 
disease and one of the most common neuromuscular disorders with a 
prevalence of 1:8,000.\4\ It affects 934,000 children and adults of 
both sexes worldwide. FSHD is characterized by progressive loss of 
skeletal muscle strength that is asymmetric in pattern and widely 
variable. Muscle weakness typically starts at the face, shoulder girdle 
and upper arms, often progressing to the legs, torso and other muscles. 
In addition to affecting any skeletal muscle, it can bring with it 
respiratory failure and breathing issues,\5\-\7\ mild-
profound hearing loss,\8\ eye problems and cardiac bundle blockage and 
arrhythmias.\9,10\ FSHD causes significant disability and death 
according the U.S. Centers for Disease Control and Prevention (CDC), 
National Center on Birth Defects and Developmental Disabilities, 
Atlanta, Georgia and others.\11,12\
    The NIH is currently the principal worldwide source of funding of 
biomedical research on FSHD. Currently annual funding specifically 
targeted for FSHD listed in NIH RCDC is $10 million. Given the 
remarkable advances and momentum in FSHD research in the past 8 years; 
it is appalling that FSHD funding has not grown according to NIH RCDC. 
This indicates a mismatch between NIH funding mechanisms and the 
external community working on FSHD.

                                  FSHD RESEARCH DOLLARS & FSHD AS A PERCENTAGE OF TOTAL NIH  MUSCULAR DYSTROPHY FUNDING
                                                                  [Dollars in millions]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                 Fiscal Year                    2010    2011    2012    2013    2014    2015    2016    2017    2018    2019     2020    2021e    2022e
--------------------------------------------------------------------------------------------------------------------------------------------------------
All MD ($ millions)..........................     $86     $75     $75     $76     $78     $77     $79     $81     $81     $83      $95      $97     $102
FSHD ($ millions)............................      $6      $6      $5      $5      $7      $8      $9     $11     $11     $10       $9       $9      $10
FSHD (% total MD)............................      7%      8%      7%      7%      9%     10%     11%     14%     14%     12%       9%       9%      10%
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sources: NIH/OD Budget Office & NIH OCPL & NIH RePORT RCDC (e=estimate, a=actual)

    Currently active projects listed in NIH RePORTer as having 
application to FSHD are $17.507 million FY 2022 (actual 04May2022), a 
17.2% portion of the estimated $102 million spent on all muscular 
dystrophies. A year ago at this time in fiscal year 2021 the NIH 
portfolio of active projects was $16.554 million (actual 23June2021), a 
17.1% portion of the estimated $97 million spent on all muscular 
dystrophies. (source: NIH Research Portfolio Online Reporting Tools 
(RePORT) keyword `FSHD or facioscapulohumeral or landouzy-dejerine').
    In my role, I provide initiator and seed funding to bring new ideas 
and researchers online and am asked to evaluate and compare the various 
research projects we have funded and understand their commonalities and 
differences. I have, if I had to estimate, made a fairly extensive 
study of five to six hundred FSHD projects and proposals. My effort to 
solve FSHD has been persistent in yielding refined advances, it is 
novel and original, and is clearly driven by an overall sense of goals 
and concepts that are meaningful to patients and their families. The 
research we've started is forward-looking, as illustrated by the number 
of industry and philanthropic partners/researchers that have picked up 
on this seminal work and contributed to it.
    FSHD is associated with epigenetic changes on the tip of human 
chromosome 4q35 in the D4Z4 DNA macrosatellite repeat array region 
leading to an inappropriate gain of expression (function) of the D4Z4-
embedded double homeobox 4 (DUX4) gene \13\-\16\. DUX4 is a 
transcription factor that kick starts the embryonic genome during the 
2- to 8-cell stage of development.\17\-\19\ Ectopic 
expression of DUX4 in skeletal muscle is associated with the disease 
and the disease's pathophysiology that leads to muscle death. DUX4 is 
never expressed in 'healthy' muscle. FSHD has had few clinical 
trials,\20\-\26,27,28\ and currently there is no cure or 
therapeutic option available to patients. DUX4 requires and needs to 
activate its direct transcriptional targets for DUX4-induced gene 
aberration and muscle toxicity.\29\-\42\ The genetics of 
FSHD are so remarkable, that NIH Director Dr. Francis Collins said on 
the front page of the New York Times, ``If we were thinking of a 
collection of the genome's greatest hits, this [FSHD] would go on the 
list.'' \43\ Add to this that FSHD was the sole disease mentioned in 
the recent tour de force Science publication 'The complete sequence of 
a human genome.' The paper is proof that scientists were able to 
sequence every base in the genome using at least one of six methods! 
FSHD was highlighted as having a bunch of newly assembled paralogs in 
the assembly; some of which showed evidence of being transcriptionally 
active. Great exposure for FSHD! This article will be read by the 
majority of genomics researchers worldwide--so should definitely 
increase awareness.\44\
    Blocking DUX4's DNA, DUX4's RNA or DUX4's protein ability to 
activate its targets has profound therapeutic 
relevance.\45\-\48\ The FSHD scientific community has in 
recent years pioneered inroads to treating FSHD using the enormous 
potential of genomic sequencing, genomic medicine, gene editing and 
next generation diagnostics. All with the central paradigm of the 
reduction of: DUX4, DUX4 expression, DUX4 protein activity, or the 
effects of DUX4-mediated toxicity. Strategies include modulating DUX4 
repressive pathways, targeting DUX4 mRNA, DUX4 protein, or cellular 
downstream effects of DUX4 expression.
    Our FY 2022 testimony on FSHD was quite comprehensive in scope, 
complete with 82 references, with a broad call to action in research 
areas from bench-side to clinic. Rather than restating--we ask the 
Committee to urge NIH to move forward on the many priorities listed.
    In FY 2023, we request NIH to additionally make an immediate and 
targeted push to answer the following three questions. Answers to these 
questions will help remove the obstacles to measuring disease 
progression, help measure if novel therapeutics are making a difference 
in stopping the disease and elucidate if muscle can grow again and be 
restored. At present, measuring disease progression and the 
effectiveness and safety of drugs remains ambiguous and the path 
forward deep and hard-going for industry, clinical partners and 
patients.
Three Key Research Questions
    How does DUX4 expression lead to pathophysiology? We know a lot of 
what can happen when DUX4 is expressed in a cell (mostly forced 
experimental expression), but not a lot about what happens when an FSHD 
muscle cell expresses DUX4 that leads to pathology.
    Can FSHD muscle pathology be reversed once DUX4 expression starts 
the pathogenic cascade in a particular muscle? This is a key question 
when looking to improve outcomes with either muscle building or DUX4 
halting therapies.
    Is there a systemic effect of local DUX4 expression that leads to 
amplification of muscle decline, either immune or some extracellular 
signaling? Answering this question will help delineate where along the 
travels of DUX4 from its birth and death in muscle we can intercept and 
control the disease process.
    New data/information generated on the basic mechanism of DUX4 and 
how it causes muscle disease has the potential to focus the design of 
future clinical trials on muscles and measurements that will increase 
the rigor of the design and decrease the number of individuals 
necessary for initial tests of drug activity. It is absolutely 
necessary to increase our resolution, clarity and understanding of what 
DUX4 is and what it does to muscle in FSHD. The gains in this area will 
effectively unpin or untether FSHD from the difficulty category of 
``slowly progressing neuromuscular diseases remaining recalcitrant'' to 
timely ascertainment that a clinical intervention can work.
    We request for fiscal year 2023, increasing NIH FSHD research 
funding/appropriation of the standard portfolio to $25 million. The 
growth has been slow, continuous and prone to year-to-year fluctuations 
downward and upward according to NIH funding data. Additionally, we 
request a one-time boost of $5 million to solicit applications to 
answer the three questions of key import. At this moment in time, FSHD 
needs an infusion of both longstanding and immediate discovery NIH 
grants both submitted and funded. NIH needs to increase funding by 
adding exploratory/developmental research grants (parent R21) and 
research project grants (parent R01). This is NIH's wheelhouse and 
forte without a doubt.
    Madam Chairman, thank you for this opportunity to update you on 
FSHD with this testimony.
                               references
---------------------------------------------------------------------------
    \1\ Gould T, Jones TI, Jones PL. Precise Epigenetic Analysis Using 
Targeted Bisulfite Genomic Sequencing Distinguishes FSHD1, FSHD2, and 
Healthy Subjects. Diagnostics (Basel). 2021 Aug 13;11(8):1469. doi: 
10.3390/diagnostics11081469. PMID: 34441403; PMCID: PMC8393475. (2021).
    \2\ Goossens R, Tihaya MS, van den Heuvel A, Tabot-Ndip K, 
Willemsen IM, Tapscott SJ, Gonzalez-Prieto R, Chang JG, Vertegaal ACO, 
Balog J, van der Maarel SM. A proteomics study identifying interactors 
of the FSHD2 gene product SMCHD1 reveals RUVBL1-dependent DUX4 
repression. Sci Rep. 2021 Dec 8;11(1):23642. doi: 10.1038/s41598-021-
03030-3. PMID: 34880314; PMCID: PMC8654949. (2021).
    \3\ Wang, L. H. & Tawil, R. Facioscapulohumeral Dystrophy. Curr. 
Neurol. Neurosci. Rep. 16, 66 (2016).
    \4\ Deenen, J. C. W. et al. Population-based incidence and 
prevalence of facioscapulohumeral dystrophy. Neurology 83, 1056-9 
(2014).
    \5\ Lu-Nguyen N, Malerba A, Antoni Pineda M, Dickson G, Popplewell 
L. Improving Molecular and Histopathology in Diaphragm Muscle of the 
Double Transgenic ACTA1-MCM/FLExDUX4 Mouse Model of FSHD with Systemic 
Antisense Therapy. Hum Gene Ther. 2022 Apr 28. doi: 5.1089/
hum.2021.251. Epub ahead of print. PMID: 35078334. (2022).
    \6\ Teeselink S, Vincenten SCC, Voermans NC, Groothuis JT, Doorduin 
J, Wijkstra PJ, Horlings CGC, van Engelen BGM, Mul K. Long-term follow-
up of respiratory function in facioscapulohumeral muscular dystrophy. J 
Neurol. 2022 Feb 11:1-8. doi: 10.1007/s00415-022-10990-7. Epub ahead of 
print. PMID: 35147730; PMCID: PMC8831680. (2022).
    \7\ Henke C, Spiesshoefer J, Kabitz HJ, Herkenrath S, Randerath W, 
Brix T, Gorlich D, Young P, Boentert M. Respiratory muscle weakness in 
facioscapulohumeral muscular dystrophy. Muscle Nerve. 2019 
Dec;60(6):679-686. doi: 10.1002/mus.26717. Epub 2019 Oct 23. PMID: 
31566774. (2019).
    \8\ Fuccillo E, Frezza E, Massa R, Di Girolamo S. Response To 
Letter To The Editor ``Auditory Dysfunction In Facioscapulohumeral 
Muscular Dystrophy Type 1: Beyond The Inner Ear Involvement'' By 
Gheller et al. Otol Neurotol. 2022 Mar 1;43(3):e392-e393. doi: 10.1097/
MAO.0000000000003423. PMID: 34772889. (2022).
    \9\ van Dijk GP, van der Kooi E, Behin A, Smeets J, Timmermans J, 
van der Maarel S, Padberg G, Voermans N, van Engelen B. High prevalence 
of incomplete right bundle branch block in facioscapulohumeral muscular 
dystrophy without cardiac symptoms. Funct Neurol. 2014 Jul-
Sep;29(3):159-65. PMID: 25473735; PMCID: PMC4264782. (2014).
    \10\ Ducharme-Smith A, Nicolau S, Chahal CAA, Ducharme-Smith K, 
Rehman S, Jaliparthy K, Khan N, Scott CG, St Louis EK, Liewluck T, 
Somers VK, Lin G, Brady PA, Milone M. Cardiac Involvement in 
Facioscapulohumeral Muscular Dystrophy (FSHD). Front Neurol. 2021 May 
24;12:668180. doi: 10.3389/fneur.2021.668180. (2021).
    \11\ Blokhuis AM, Deenen JCW, Voermans NC, van Engelen BGM, Kievit 
W, Groothuis JT. The socioeconomic burden of facioscapulohumeral 
muscular dystrophy. J Neurol. 2021 May 27. doi: 10.1007/s00415-021-
10591-w. (2021).
    \12\ Wallace B, Smith KT, Thomas S, Conway KM, Westfield C, Andrews 
JG, Weinert RO, Do TQN, Street N; Muscular Dystrophy Surveillance, 
Tracking, and Research Network (MD STARnet). Characterization of 
individuals with selected muscular dystrophies from the expanded pilot 
of the Muscular Dystrophy Surveillance, Tracking and Research Network 
(MD STARnet) in the United States. Birth Defects Res. 2021 Apr 
15;113(7):560-569. doi: 10.1002/bdr2.1764. (2020).
    \13\ Mocciaro E, Runfola V, Ghezzi P, Pannese M, Gabellini D. DUX4 
Role in Normal Physiology and in FSHD Muscular Dystrophy. Cells. 2021 
Nov 26;10(12):3322. doi: 10.3390/cells10123322. PMID: 34943834; PMCID: 
PMC8699294. (2021).
    \14\ Jagannathan S. The evolution of DUX4 gene regulation and its 
implication for facioscapulohumeral muscular dystrophy. Biochim Biophys 
Acta Mol Basis Dis. 2022 May 1;1868(5):166367. doi: 10.1016/
j.bbadis.2022.166367. Epub 2022 Feb 11. PMID: 35158020. (2022).
    \15\ Vuoristo S, Bhagat S, Hyden-Granskog C, Yoshihara M, Gawriyski 
L, Jouhilahti EM, Ranga V, Tamirat M, Huhtala M, Kirjanov I, Nykanen S, 
Krjutskov K, Damdimopoulos A, Weltner J, Hashimoto K, Recher G, Ezer S, 
Paluoja P, Paloviita P, Takegami Y, Kanemaru A, Lundin K, Airenne TT, 
Otonkoski T, Tapanainen JS, Kawaji H, Murakawa Y, Burglin TR, Varjosalo 
M, Johnson MS, Tuuri T, Katayama S, Kere J. DUX4 is a multifunctional 
factor priming human embryonic genome activation. iScience. 2022 Mar 
22;25(4):104137. doi: 10.1016/j.isci.2022.104137. PMID: 35402882; 
PMCID: PMC8990217.
    \16\ Wong CJ, Whiddon JL, Langford AT, Belleville AE, Tapscott SJ. 
Canine DUXC: Implications for DUX4 retrotransposition and preclinical 
models of FSHD. Hum Mol Genet. 2021 Dec 9:ddab352. doi: 10.1093/hmg/
ddab352. Epub ahead of print. PMID: 34888646.
    \17\ Hendrickson, P. G. et al. Conserved roles of mouse DUX and 
human DUX4 in activating cleavage-stage genes and MERVL/HERVL 
retrotransposons. Nat. Genet. 49, 925-934 (2017).
    \18\ Whiddon, J. L., Langford, A. T., Wong, C.-J., Zhong, J. W. & 
Tapscott, S. J. Conservation and innovation in the DUX4-family gene 
network. Nat. Genet. 49, 935-940 (2017).
    \19\ De Iaco, A. et al. DUX-family transcription factors regulate 
zygotic genome activation in placental mammals. Nat. Genet. 49, 941-945 
(2017).
    \20\ Tawil, R. et al. A pilot trial of prednisone in 
facioscapulohumeral muscular dystrophy. FSHDY Group. Neurology 48, 46-9 
(1997).
    \21\ Passerieux, E. et al. Effects of vitamin C, vitamin E, zinc 
gluconate, and selenomethionine supplementation on muscle function and 
oxidative stress biomarkers in patients with facioscapulohumeral 
dystrophy: a double-blind randomized controlled clinical trial. Free 
Radic. Biol. Med. 81, 158-69 (2015).
    \22\ Kissel, J. T. et al. Randomized, double-blind, placebo-
controlled trial of albuterol in facioscapulohumeral dystrophy. 
Neurology 57, 1434-40 (2001).
    \23\ Elsheikh, B. H. et al. Pilot trial of diltiazem in 
facioscapulohumeral muscular dystrophy. Neurology 68, 1428-9 (2007).
    \24\ Wagner, K. R. et al. A phase I/IItrial of MYO-029 in adult 
subjects with muscular dystrophy. Ann. Neurol. 63, 561-71 (2008).
    \25\ Statland JM, Campbell C, Desai U, Karam C, Diaz-Manera J, 
Guptill JT, Korngut L, Genge A, Tawil RN, Elman L, Joyce NC, Wagner KR, 
Manousakis G, Amato AA, Butterfield RJ, Shieh PB, Wicklund M, Gamez J, 
Bodkin C, Pestronk A, Weihl CC, Vilchez-Padilla JJ, Johnson NE, Mathews 
KD, Miller B, Leneus A, Fowler M, van de Rijn M, Attie KM. Randomized 
phase 2 study of ACE-083, a muscle-promoting agent, in 
facioscapulohumeral muscular dystrophy. Muscle Nerve. 2022 Apr 15. doi: 
10.1002/mus.27558. Epub ahead of print. PMID: 35428982. (2022).
    \26\ Mellion ML, Ronco L, Berends CL, Pagan L, Brooks S, van Esdonk 
MJ, van Brummelen EMJ, Odueyungbo A, Thompson LA, Hage M, Badrising UA, 
Raines S, Tracewell WG, van Engelen B, Cadavid D, Groeneveld GJ. Phase 
1 clinical trial of losmapimod in facioscapulohumeral dystrophy: 
Safety, tolerability, pharmacokinetics, and target engagement. Br J 
Clin Pharmacol. 2021 Dec;87(12):4658-4669. doi: 10.1111/bcp.14884. Epub 
2021 May 14. PMID: 33931884. (2021).
    \27\ Ghasemi M, Emerson CP Jr, Hayward LJ. Outcome Measures in 
Facioscapulohumeral Muscular Dystrophy Clinical Trials. Cells. 2022 Feb 
16;11(4):687. doi: 10.3390/cells11040687. PMID: 35203336; PMCID: 
PMC8870318. (2022).
    \28\ Gros M, Nunes AM, Daoudlarian D, Pini J, Martinuzzi E, Barbosa 
S, Ramirez M, Puma A, Villa L, Cavalli M, Grecu N, Garcia J, Siciliano 
G, Sole G, Juntas-Morales R, Jones PL, Jones T, Glaichenhaus N, Sacconi 
S. Identification of Serum Interleukin 6 Levels as a Disease Severity 
Biomarker in Facioscapulohumeral Muscular Dystrophy. J Neuromuscul Dis. 
2022;9(1):83-93. doi: 10.3233/JND-210711. PMID: 34459413; PMCID: 
PMC8842759. (2022).
    \29\ Rickard, A. M., Petek, L. M. & Miller, D. G. Endogenous DUX4 
expression in FSHD myotubes is sufficient to cause cell death and 
disrupts RNA splicing and cell migration pathways. Hum. Mol. Genet. 24, 
5901-14 (2015).
    \30\ Sandri, M. et al. Caspase 3 expression correlates with 
skeletal muscle apoptosis in Duchenne and facioscapulo human muscular 
dystrophy. A potential target for pharmacological treatment? J. 
Neuropathol. Exp. Neurol. 60, 302-12 (2001).
    \31\ Block, G. J. et al. Wnt/b-catenin signaling suppresses DUX4 
expression and prevents apoptosis of FSHD muscle cells. Hum. Mol. 
Genet. 22, 4661-72 (2013).
    \32\ Statland, J. M. et al. Immunohistochemical Characterization of 
Facioscapulohumeral Muscular Dystrophy Muscle Biopsies. J. Neuromuscul. 
Dis. 2, 291-299 (2015).
    \33\ Rickard, A. M., Petek, L. M. & Miller, D. G. Endogenous DUX4 
expression in FSHD myotubes is sufficient to cause cell death and 
disrupts RNA splicing and cell migration pathways. Hum. Mol. Genet. 24, 
5901-14 (2015).
    \34\ Kowaljow, V. et al. The DUX4 gene at the FSHD1A locus encodes 
a pro-apoptotic protein. Neuromuscul. Disord. 17, 611-23 (2007).
    \35\ Bosnakovski, D. et al. An isogenetic myoblast expression 
screen identifies DUX4-mediated FSHD-associated molecular pathologies. 
EMBO J. 27, 2766-79 (2008).
    \36\ Wallace, L. M. et al. DUX4, a candidate gene for 
facioscapulohumeral muscular dystrophy, causes p53-dependent myopathy 
in vivo. Ann. Neurol. 69, 540-52 (2011).
    \37\ Geng, L. N. et al. DUX4 activates germline genes, 
retroelements, and immune mediators: implications for 
facioscapulohumeral dystrophy. Dev. Cell 22, 38-51 (2012).
    \38\ Yao, Z. et al. DUX4-induced gene expression is the major 
molecular signature in FSHD skeletal muscle. Hum. Mol. Genet. 23, 5342-
52 (2014).
    \39\ Homma, S., Beermann, M. Lou, Boyce, F. M. & Miller, J. B. 
Expression of FSHD-related DUX4-FL alters proteostasis and induces TDP-
43 aggregation. Ann. Clin. Transl. Neurol. 2, 151-66 (2015).
    \40\ Jagannathan, S. et al. Model systems of DUX4 expression 
recapitulate the transcriptional profile of FSHD cells. Hum. Mol. 
Genet. 25, 4419-4431 (2016).
    \41\ Jones, T. I. et al. Facioscapulohumeral muscular dystrophy 
family studies of DUX4 expression: evidence for disease modifiers and a 
quantitative model of pathogenesis. Hum. Mol. Genet. 21, 4419-30 
(2012).
    \42\ Campbell AE, Shadle SC, Jagannathan S, Lim JW, Resnick R, 
Tawil R, van der Maarel SM, Tapscott SJ. NuRD and CAF-1-mediated 
silencing of the D4Z4 array is modulated by DUX4-induced MBD3L 
proteins. Elife. 2018 Mar 13;7. pii: e31023. doi: 10.7554/eLife.31023 
(2018).
    \43\ Kolata, G., Reanimated 'Junk' DNA Is Found to Cause Disease. 
New York Times, Science. Published online: August 19, 2010 http://
www.nytimes.com/2010/08/20/science/20gene.html (2010).
    \44\ Nurk S, Koren S, Rhie A, Rautiainen M, Bzikadze AV, Mikheenko 
A, Vollger MR, Altemose N, Uralsky L, Gershman A, Aganezov S, Hoyt SJ, 
Diekhans M, Logsdon GA, Alonge M, Antonarakis SE, Borchers M, Bouffard 
GG, Brooks SY, Caldas GV, Chen NC, Cheng H, Chin CS, Chow W, de Lima 
LG, Dishuck PC, Durbin R, Dvorkina T, Fiddes IT, Formenti G, Fulton RS, 
Fungtammasan A, Garrison E, Grady PGS, Graves-Lindsay TA, Hall IM, 
Hansen NF, Hartley GA, Haukness M, Howe K, Hunkapiller MW, Jain C, Jain 
M, Jarvis ED, Kerpedjiev P, Kirsche M, Kolmogorov M, Korlach J, 
Kremitzki M, Li H, Maduro VV, Marschall T, McCartney AM, McDaniel J, 
Miller DE, Mullikin JC, Myers EW, Olson ND, Paten B, Peluso P, Pevzner 
PA, Porubsky D, Potapova T, Rogaev EI, Rosenfeld JA, Salzberg SL, 
Schneider VA, Sedlazeck FJ, Shafin K, Shew CJ, Shumate A, Sims Y, Smit 
AFA, Soto DC, Sovic I, Storer JM, Streets A, Sullivan BA, Thibaud-
Nissen F, Torrance J, Wagner J, Walenz BP, Wenger A, Wood JMD, Xiao C, 
Yan SM, Young AC, Zarate S, Surti U, McCoy RC, Dennis MY, Alexandrov 
IA, Gerton JL, O'Neill RJ, Timp W, Zook JM, Schatz MC, Eichler EE, Miga 
KH, Phillippy AM. The complete sequence of a human genome. Science. 
2022 Apr;376(6588):44-53. doi: 10.1126/science.abj6987. Epub 2022 Mar 
31. PMID: 35357919 (2022).
    \45\ Jagannathan S1,2,3, Ogata Y4, Gafken PR4, Tapscott SJ3, 
Bradley RK1. Quantitative proteomics reveals key roles for post-
transcriptional gene regulation in the molecular pathology of 
facioscapulohumeral muscular dystrophy. Elife. 2019 Jan 15;8. pii: 
e41740. doi: 10.7554/eLife.41740 (2019).
    \46\ Bouwman LF, den Hamer B, van den Heuvel A, Franken M, Jackson 
M, Dwyer CA, Tapscott SJ, Rigo F, van der Maarel SM, de Greef JC. 
Systemic delivery of a DUX4-targeting antisense oligonucleotide to 
treat facioscapulohumeral muscular dystrophy. Mol Ther Nucleic Acids. 
2021 Sep 27;26:813-827. doi: 10.1016/j.omtn.2021.09.010. PMID: 
34729250; PMCID: PMC8526479. (2021).
    \47\ Soliman HAN, Toso EA, Darwish IE, Ali SM, Kyba M. 
Antiapoptotic Protein FAIM2 is targeted by miR-3202, and DUX4 via 
TRIM21, leading to cell death and defective myogenesis. Cell Death Dis. 
2022 Apr 25;13(4):405. doi: 10.1038/s41419-022-04804-x. PMID: 35468884; 
PMCID: PMC9038730. (2022).
    \48\ Guo D, Daman K, Chen JJ, Shi MJ, Yan J, Matijasevic Z, Rickard 
AM, Bennett MH, Kiselyov A, Zhou H, Bang AG, Wagner KR, Maehr R, King 
OD, Hayward LJ, Emerson CP Jr. iMyoblasts for ex vivo and in vivo 
investigations of human myogenesis and disease modeling. Elife. 2022 
Jan 25;11:e70341. doi: 10.7554/eLife.70341. PMID: 35076017; PMCID: 
PMC8789283. (2022).

    [This statement was submitted by Daniel Paul Perez, Co-Founder & 
Director Emeritus, FSHD Society.]
                                 ______
                                 
      Prepared Statement of the GBS|CIDP Foundation International
            summary of recommendations for fiscal year 2023
_______________________________________________________________________

  --Provide $49 billion for the National Institutes of Health (NIH) and 
        proportional increases across its Institutes and Centers
  --Continue expanding GBS research supported by NIH with proportional 
        funding increases for the National Institute of Neurological 
        Disorders and Stroke (NINDS), and the National Institute of 
        Allergy and Infectious Diseases (NIAID)
  --Provide $11 billion for the Centers for Disease Control and 
        Prevention (CDC) and $6 million for the Chronic Disease 
        Education and Awareness Program
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for your time and your consideration of 
the priorities of the community of individuals impacted by Guillain-
Barre Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy 
(CIDP), and related conditions as you work to craft the FY 2023 L-HHS 
Appropriations Bill.
           about gbs, cidp, variants, and related conditions
Guillain-Barre Syndrome
    GBS is an inflammatory disorder of the peripheral nerves outside 
the brain and spinal cord. GBS is characterized by the rapid onset of 
numbness, weakness, and often paralysis of the legs, arms, breathing 
muscles, and face. Paralysis is ascending, meaning that it travels up 
the limbs from fingers and toes towards the torso. Loss of reflexes, 
such as the knee jerk, are usually found. Usually, a new case of GBS is 
admitted to ICU (Intensive Care) to monitor breathing and other body 
functions until the disease is stabilized. Plasma exchange (a blood 
``cleansing'' procedure) and high dose intravenous immune globulins are 
often helpful to shorten the course of GBS. The acute phase of GBS 
typically varies in length from a few days to months. Patient care 
involves the coordinated efforts of a team such as a neurologist, 
physiatrist (rehabilitation physician), internist, family physician, 
physical therapist, occupational therapist, social worker, nurse, and 
psychologist or psychiatrist. Recovery may occur over 6 months to 2 
years or longer. A particularly frustrating consequence of GBS is long-
term recurrences of fatigue and/or exhaustion as well as abnormal 
sensations including pain and muscle aches.
Chronic Inflammatory Demyelinating Polyneuropathy
    CIDP is a rare disorder of the peripheral nerves characterized by 
gradually increasing weakness of the legs and, to a lesser extent, the 
arms. It is the gradual onset as well as the chronic nature of CIDP 
that differentiates it from GBS. Like GBS, CIDP is caused by damage to 
the covering of the nerves, called myelin. It can start at any age and 
in both genders. Weakness occurs over two or more months. Unlike GBS, 
CIDP is chronic, with symptoms constantly waxing and waning. Left 
untreated, 30 percent of CIDP patients will progress to wheelchair 
dependence. Early recognition and treatment can avoid a significant 
amount of disability. Post-treatment life depends on whether the 
disease was caught early enough to benefit from treatment options. The 
gradual onset of CIDP can delay diagnosis by several months or even 
years, resulting in significant nerve damage that may take several 
courses of treatment before benefits are seen. The chronic nature of 
CIDP differentiates long-term care from GBS patients. Adjustments 
inside the home may need to be made to facilitate a return to normal 
life.
Multifocal Motor Neuropathy
    MMN is a rare disorder in which focal areas of multiple motor 
nerves are attacked by one's own immune system. Typically, MMN is 
slowly progressive, resulting in asymmetrical weakness of a patient's 
limbs. Patients frequently develop weakness in their hand(s), resulting 
in dropping of objects or sometimes inability to turn a key in a lock. 
The weakness associated with MMN can be recognized as fitting a 
specific nerve territory. MMN has many features similar to CIDP in that 
its onset is progressive over time, causing increased disability that 
reflects the greater number of nerve sites involved. However, unlike 
CIDP, MMN is asymmetric and affects the right and left side of the body 
differently. The clinical course of MMN is chronically progressive 
without remission.
                          about the foundation
    The Foundation's vision is that every person afflicted with GBS, 
CIDP, or variants has convenient access to early and accurate 
diagnosis, appropriate and affordable treatments, and dependable 
support services.
    The Foundation's mission is to improve the quality of life for 
individuals and families across America affected by GBS, CIDP, and 
their variants by:
  --Providing a network for all patients, their caregivers and families 
        so that GBS or CIDP patients can depend on the Foundation for 
        support, and reliable up-to-date information.
  --Providing public and professional educational programs worldwide 
        designed to heighten awareness and improve the understanding 
        and treatment of GBS, CIDP and variants.
  --Expanding the Foundation's role in sponsoring research and engaging 
        in patient advocacy.
               centers for disease control and prevention
    CDC and the National Center for Chronic Disease Prevention and 
Health Promotion (NCCDPHP) have resources that could be brought to bear 
to improve public awareness and recognition of GBS, CIDP and related 
conditions. The Foundation supports a meaningful increase to the 
Centers for Disease Control and Prevention as well as continued support 
of the Chronic Disease Education and Awareness Program. This program 
seeks to provide collaborative opportunities for chronic disease 
communities such as ours that lack dedicated funding from ongoing CDC 
activities. Such a mechanism allows public health experts at the CDC to 
review project proposals on an annual basis and direct resources to 
high impact efforts in a flexible fashion.
                     national institutes of health
    NIH hosts a modest research portfolio focused on GBS, CIDP, 
variants, and related conditions. This research has led to important 
scientific breakthroughs and is well positioned to vastly improve our 
understanding of the mechanism behind these conditions. We ask that 
resources continue to be used to support the important collaboration 
between NIAID, NINDS and the GBS|CIDP community. During the pandemic, 
we participated in a conference with NINDS that discussed how 
intramural and extramural researchers can develop a roadmap that would 
lead research into these conditions into the next decade and encourage 
younger investigators to apply for grants that lead to sustained 
research activities. This however was not the size and scope of the 
original planned meeting. We are continuing to have conversations with 
the leadership of both institutes to facilitate follow up and plan for 
a more robust agenda and list of goals for a future in person 
conference. In our meetings with the leadership, we also spoke about 
the possibilities of cross-institute work between NINDS and NIAID to 
expand the research and understanding of the link between Zika and GBS. 
While such a conference would not require additional appropriations, 
the Foundation urges you to provide NIH with meaningful funding 
increases to facilitate growth in the GBS, CIDP, and related conditions 
research portfolio.
                             patient access
    As we have seen from communities that currently have access to home 
infusion, such as primary immunodeficiency diseases, the ability to 
choose the home as the preferred site of care has tremendous benefit in 
terms of health outcomes and overall convenience for patients. 
Individuals with CIDP and MMN often face mobility issues as limbs 
suffer nerve damage. Traveling to receive an infusion presents a 
tremendous hardship to many patients and their families. This hardship 
greatly affects rural patients who have to travel hundreds of miles to 
major cities in order to receive treatment, which can be both 
inconvenient and costly. The Foundation has seen that when there are 
obstacles to receiving regular infusions, patients tend to skip 
scheduled infusions, which leads to progressive disability. Many CIDP 
and MMN patients have access to IVIG home infusion through private 
insurance, which allows them to lead productive and active lives. When 
these individuals age on to Medicare, they can face disruption in their 
routine and suboptimal circumstances when managing their condition. 
Further, because the body's immune system is depressed at the end of an 
infusion cycle, CIDP and MMN patients face an elevated risk of 
contracting illness from visiting well-traveled sites of care for 
infusions. Most importantly, patients and physicians should have the 
authority to choose their preferred site of care. We hope that members 
of this subcommittee and Congress as a whole support legislation that 
will grant our patients this important access.
    The Foundation was founded over 40 years ago, and the four pillars 
that guide our mission are: support, education, advocacy, and research. 
Our patients rely on the premier research that is carried out at the 
NIH to improve the diagnosis and treatment process of these devastating 
illnesses. Without appropriate funding to the NIH and CDC, my fear as a 
parent of a GBS survivor and the Executive Director of the Foundation, 
is that many patients will needlessly suffer. There is so much to 
learn; there is no bio-marker and we do not know why the immune system 
reacts to trigger these conditions. I ask the Committee to provide $49 
billion to the NIH with proportional increases to NIAID and NINDS to 
continue the potentially lifesaving work being done for our community 
and ask for Congressional support of our initiative to improve access 
to life-saving treatments.

    [This statement was submitted by Lisa Butler, Executive Director, 
GBS|CIDP Foundation International.]
                                 ______
                                 
            Prepared Statement of Helen Keller International
    Madam Chairwoman, thank you for this opportunity to provide 
testimony to the subcommittee on behalf of Helen Keller Intl's U.S. 
Vision Programs. Helen Keller Intl respectfully requests this 
subcommittee recommend that the United States Department of Education 
and Department of Health and Human Services support programs that 
provide no-cost vision care for children from low-income families in 
fiscal year 2023.
    It is Helen Keller Intl's hope that, with the renewed support of 
the Department of Education, as well as continued support of our 
private donors, we will be able to deliver free vision screenings, eye 
exams, and prescriptions eyeglasses to thousands of economically 
disadvantaged and vulnerable children who may not otherwise have access 
to them. We also request that the Department of Health and Human 
Services consider funding school-based programs that identify vision 
issues and provide prescription eyeglasses to children from 
marginalized and low-income families whose educational performance and 
future vocational success may be hindered because of uncorrected vision 
problems.
                              our program
    Helen Keller Intl's U.S. Vision Programs exist to make clear vision 
accessible to all. Our model was first established in 1994 in the 
Washington Heights neighborhood of Manhattan. Since that time, we have 
reached more than 2 million individuals with vision screenings, eye 
exams, and free prescription eyeglasses. And yet, the need for 
accessible eye health services has not diminished. In fact, with low-
income communities continuing to deal with economic fallout of the 
COVID-19 pandemic, we believe that this need has only grown.
    Despite the fact that routine, comprehensive vision care is a 
standard part of preventive health, as many as 12 million adults and 4 
million children in the United States suffer from impaired vision due 
to uncorrected refractive error, which can easily be corrected with a 
pair of prescription eyeglasses. According to a recent study in 
Investigative Ophthalmology and Visual Sciences, Americans of color are 
significantly more likely to have uncorrected or under-corrected 
refractive error (otherwise known as nearsightedness, farsightedness, 
and astigmatism) than white Americans. These rates are even higher when 
the populations are low-income or uninsured. In this way, a lack of 
access to clear vision exacerbates racial and economic inequality in 
this country.
    In school, students who are not able to see clearly may have 
difficulty engaging with their schoolwork and their peers. Studies have 
found that children with vision issues are three times more likely to 
fail at least one grade. They may also be misdiagnosed with learning 
disabilities and are more likely to be socially isolated.
    Although refractive error is easily addressed with a pair of 
prescription eyeglasses, many individuals across this country cannot 
afford or easily access an eye exam or glasses. In an informal survey 
our organization conducted with low-income clients nationwide, nearly 2 
in 3 reported that they could not access an annual visit to the 
optometrist. The barriers to access for this essential care included 
cost, insurance, transportation, and long wait times at local clinics.
    Our U.S. Vision Programs are prepared to help meet this need by 
providing free eye health services directly on-site at low-income 
schools and other community-based locations around the United States. 
Our three-step model is simple, flexible, and cost-effective: we bring 
trained staff and optometrists directly into school buildings or 
community partner sites to provide vision screenings and eye exams at 
no cost to students or their families. If our team determines that a 
child requires eyeglasses, they can try on and select a frame from a 
large assortment of stylish, durable options. We return to fit each 
student with their glasses and provide literature regarding the 
importance of eye health and instructions on proper eyeglass care. In 
the instance that a child has symptoms of a more complex eye disorder 
(such as strabismus or amblyopia) we will provide a referral to one of 
our partnering ophthalmologic clinics for follow-up care.
    The services we offer are comprehensive and high quality, and this 
model is time-tested. We have refined our approach so that we can 
continue to provide this critical care during the COVID-19 pandemic, 
utilizing PPE, physical distancing, and the sanitization of surfaces 
and equipment to ensure that our clients and our staff stay healthy and 
safe.
                            positive results
    The impact of a pair of eyeglasses can be transformative. For many 
of the young people we serve, our program provides their first eye exam 
and their first pair of eyeglasses. Many students don't even realize 
that they are seeing the world differently from their peers until they 
first try on their glasses.
    Researchers at the University of Minnesota have determined that the 
provision of eyeglasses to school-aged children leads to increased 
reading scores and improved education outcomes. Our own surveys have 
reflected an increase in self-esteem among students who have received 
eyeglasses. Teachers we have surveyed also report that students who 
receive eyeglasses participate in class at a higher rate. Nearly 100-
percent of the school nurses we have surveyed state that Helen Keller 
Intl fills a glaring gap that exists between state-mandated vision 
screenings and the actual provision of exams and eyeglasses.
    This work has the capacity to change lives by removing the primary 
barriers that exist to clear vision: access and expense. Since 1994, we 
have provided more than 2 million vision screenings and delivered 
nearly 400,000 pairs of free prescription eyeglasses to children in 
need. With support from this subcommittee, we hope to see many more.
                       public/private undertaking
    Our U.S. Vision Programs are truly a public/private endeavor. In 
each of the five States in which we currently operate we bring together 
a wide range of community stakeholders, from parents and teachers to 
physicians and business people, all of whom are dedicated to restoring 
clear vision. This work is funded through a combination of public and 
private dollars--in addition to municipal contracts, we have more than 
a dozen corporate and foundation partners. They include the Lavelle 
Fund for the Blind, Alcon Laboratories, the Overdeck Family Foundation, 
the Wilf Family Foundation, Latter-day Saints Charities, the New York 
Community Trust, the Rose Hills Foundation, the Michael J. Connell 
Foundation, Healthcare Foundation of New Jersey, and Reader's Digest 
Partners for Sight Foundation, among others.
    Previously, the endorsement and support of the Department of 
Education played an integral role in our program, allowing us to reach 
larger numbers of students in more diverse locations, including rural 
communities in New Mexico, Texas, and Mississippi. With some of the 
restrictions surrounding the COVID-19 pandemic lifting, we endeavor to 
once again expand the scope of this work, and hope that we will have to 
subcommittee's support in doing so.
                               conclusion
    Helen Keller Intl's U.S. Vision Programs provide an invaluable--and 
often life-changing service to underserved youth in a manner that is 
both comprehensive and cost-effective. Our program reaches some of the 
most vulnerable children in the country, and provides them with free 
vision screenings, free eye exams, and free eyeglasses.
    We ask this subcommittee to recommend in its fiscal year 2023 
Committee report that the United States Department of Education and the 
Department of Health and Human Services support programs that provide 
vision care for children from low-income families. These funds will 
support ongoing programs, such as ours, and will provide the eye health 
services that these young people need to succeed in the classroom and 
beyond.
    As our founder, Helen Keller, once said: Alone we can do so little; 
Together we can do so much.

    [This statement was submitted by Kathy Spahn, President and Chief 
Executive Officer, Helen Keller International.]
                                 ______
                                 
            Prepared Statement of the Hepatitis B Foundation
        hbf recommendations for fiscal year 2023 appropriations
_______________________________________________________________________
National Institutes of Health
  --Along with the biomedical research community, the Hepatitis B 
        Foundation (HBF) supports the biomedical research community's 
        request for at least $49 billion for the National Institutes of 
        Health (NIH). This funding request is for the NIH's base level 
        programs, any funding for the new ARPA-H, or for other targeted 
        programs like pandemic preparedness, should supplement the $49 
        billion recommendation for NIH's base budget.
  --HBF commends NIAID, NIDDK, NCI for the call to update the Trans-NIH 
        Strategic Plan to Cure Hepatitis B and urges the Institutes to 
        issue targeted calls for research to implement and fund the 
        Strategic Plan.
Centers for Disease Control and Prevention
  --HBF supports $11 billion for the Centers for Disease Control and 
        Prevention programs in FY 2023, and within that $140 million 
        for the Division of Viral Hepatitis. HBF further urges the CDC 
        to allocate the necessary resources to address serious 
        surveillance shortcoming without adversely impacting other CDC 
        hepatitis B programs.
  --HBF urges the Division of Viral Hepatitis and the Immunization 
        Services Division (ISD) to take lead on the implementation of 
        the November 2021 Advisory Committee on Immunization Practices 
        (ACIP) recommendation that all adults between 19 and 59 be 
        vaccinated for hepatitis B.
HHS Office of the Secretary
  --HBF urges the Office of the Secretary and the Office of the 
        Assistant Secretary for Health fully support the CDC to ensure 
        the ACIP recommendation that all adults between 19 and 59 be 
        vaccinated for hepatitis B is implemented as early as possible 
        in FY 2023.
  --HBF urges the Public Health Service Corps to update their policies 
        to align with the CDC's guidelines and allow individuals with 
        chronic Hepatitis B to serve in the Public Health Service 
        Corps.
_______________________________________________________________________

    Ms. Chairwoman and Members of the subcommittee, thank you for the 
opportunity to provide testimony as you consider funding priorities for 
Fiscal Year (FY) 2023. I am Tim Block, President of the Hepatitis B 
Foundation (HBF). The Hepatitis B Foundation and its associated Baruch 
S. Blumberg Institute in Bucks County, Pennsylvania has grown to more 
than 100 researchers and public health professionals and has one of the 
largest, if not the largest, concentration of nonprofit scientists 
working on the problem of hepatitis B and liver cancer in the United 
States. The Foundation is a national disease advocacy organization that 
has become the world's leading portal for patient-focused information 
about hepatitis B. The Baruch S. Blumberg Institute is internationally 
recognized, and we believe, home to some of the most exciting and 
promising work in the field.
    Ms. Chairwoman, HBF strongly supports the biomedical research 
community's request for $49 billion for the NIH base budget. HBF 
further urges that NIH increase investments in hepatitis B research in 
order to find a cure for the 2.4 million Americans infected with the 
hepatitis B virus (HBV) and to eliminate the more than 10 deaths each 
day as a direct result of hepatitis B.
    In addition to the NIH, there are a number of programs within the 
jurisdiction of the subcommittee that are important to HBF, including 
the Centers for Disease Control and Prevention. We join the CDC 
Coalition, an advocacy coalition of more than 140 national 
organizations, in recommending $11 billion for the Centers for Disease 
Control and Prevention in the FY 2023 bill. Within that total, we join 
the Hepatitis Appropriations Partnership in urging $140 million for the 
CDC's Division of Viral Hepatitis.
    Finally, we would urge that the November 2021 ACIP recommendation 
that all adults between 19 and 59 be vaccinated for hepatitis B be 
fully implemented as early as possible in FY 2023. We urge the Office 
of the Secretary and the Office of the Assistant Secretary for Health 
to host an inter-agency Summit to discuss dissemination and 
implementation of the new recommendation.
             recognizing the leadership of the subcommittee
    Ms. Chairwoman, HBF appreciates your leadership and the leadership 
of this subcommittee in supporting public health service programs. Your 
support is greatly recognized and appreciated. We applaud the 
Committee's leadership in making progress in these important areas and 
to allocating increased funding to these programs during periods of 
fiscal austerity.
                     national institutes of health
    As previously noted, HBF supports the community's request for $49 
billion for the NIH. While we support the President's ARPA-H 
initiative, and recognize the importance of pandemic preparedness 
funding, it is imperative that the funding for these initiatives be 
additional funding, above the $49 billion basic request for NIH. It is 
crucial that new investments are not made at the expense of the 
important basic science that is critical to our scientific enterprise. 
In addition to overall funding for the NIH, HBF urges that NIH 
investments in hepatitis B research be increased to fund identified 
research opportunities that would help cure and eliminate the disease 
once and for all. The Hepatitis B Foundation appreciated the NIH's call 
for an update to the Strategic Plan for Trans-NIH Research to Cure 
Hepatitis B and we look forward to the final report. Report language is 
requested in the FY 2023 Report urging the NIAID and NIDDK to issue 
targeted calls for hepatitis B research proposals in FY 2023 focused on 
the many new research opportunities identified by the Strategic Plan.
    In the U.S., an estimated 2.4 million are chronically infected with 
hepatitis B virus (HBV). Worldwide, HBV is associated with 840,000 
deaths each year, making it the 10th leading cause of death in the 
world. Left undiagnosed and untreated, 1 in 4 of those with chronic HBV 
infection will die prematurely from cirrhosis, liver failure and/or 
liver cancer. Although HBV is preventable and treatable, there is still 
no cure for this disease. In view of the epidemic scope of hepatitis B 
and the fact that the virus was discovered 50 years ago, it is 
disappointing that funding for HBV research at the NIH is only expected 
to be funded at $70 million in FY 2023.
    There is the need, the know-how, and the tools to find a cure that 
will bring hope to almost 300 million people worldwide suffering from 
chronic hepatitis B. A cure was accomplished for hepatitis C with 
increased Federal attention and funding. It can be accomplished for 
hepatitis B as well. Each year, despite an effective vaccine, 1.5 
million people worldwide are newly infected, and the epidemic continues 
to grow. Moreover, despite the availability of seven approved 
medications to manage chronic HBV infection, none are curative, most 
require lifelong use, and only reduce the likelihood of developing 
liver cancer by 40-60 percent.
    In addition to the devastating toll on patients and their families, 
ignoring hepatitis B is costing the United States an estimated $4 
billion per year in medical costs. By increasing the NIH budget for 
hepatitis B we have a good chance of success in finding a cure in the 
next few years. There are exciting new research developments and 
opportunities in the field that make finding a cure very possible.
               centers for disease control and prevention
    Given the challenges and burdens of chronic disease and disability, 
public health emergencies, new and reemerging infectious diseases and 
other unmet public health needs, HBF joins 178 organizations in the CDC 
Coalition and urges a funding level of at least $11 billion for CDC's 
programs in FY 2023. This is $375 million more than the 
Administration's request. The CDC serves as the command center for the 
Nation's public health defense system against emerging and reemerging 
infectious diseases. States, communities, and the international 
community rely on CDC for accurate information and direction in a 
crisis or outbreak. While recent emergency funding has supported 
efforts to defeat COVID-19, we must provide stable, sufficient public 
health preparedness funding to allow our State and local health 
departments to maintain a standing set of core capabilities, so they 
are ready when needed, regardless of the next challenge or threat.
    The CDC's Division of Viral Hepatitis (DVH) is part of the National 
Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) 
at CDC. In collaboration with domestic and global partners, DVH 
provides the scientific and programmatic foundation and leadership for 
the prevention and control of hepatitis virus infections and their 
manifestations. HBF joins the Hepatitis Appropriations Partnership in 
recommending $140 million for the DVH in FY 2023.
    In November 2021, the CDC's Advisory Committee on Immunization 
Practices (ACIP) voted to recommend universal hepatitis B vaccination 
for all adults ages 19 to 59 in the U.S. This simplified, updated 
recommendation, as it is implemented, will significantly increase the 
vaccination rate of adults in the U.S. (currently only 30 percent of 
U.S. adults are vaccinated). Now, these recommendations need to be 
implemented. We urge the CDC, with support from the Office of the 
Secretary and the Office of the Assistant Secretary for Health, to 
ensure the ACIP recommendation is implemented as early as possible in 
FY 2023. As a first step, we urge the Office of the Secretary and the 
Office of the Assistant Secretary for Health to host an inter-agency 
Summit to discuss dissemination and implementation of the new 
recommendation. The CDC is further urged to promote awareness about the 
new vaccination guidelines among medical and health professionals, 
communities at high risk, and the public, and to improve collaboration 
and coordination across CDC to achieve this goal.
                        office of the secretary
    The Hepatitis B Foundation continues to be concerned that the 
Surgeon General's office maintains a hiring policy for Public Health 
Service employees that is inconsistent with the recommendation of the 
CDC by refusing to hire anyone with chronic hepatitis B. We urge the 
Surgeon General's office to change this policy to align with the 
``Updated CDC Recommendations for the Management of Hepatitis B Virus-
Infected Health-Care Providers and Students,'' which is based on 
science and recognizes that individuals living with chronic hepatitis B 
are not a risk to others. Compliance with the CDC policy is also 
necessary to meet the nondiscrimination obligations under the Americans 
with disabilities Act, Section 504 of the Rehabilitation Act and 
section 1557 of the Affordable care Act. The Public Health Service must 
update their guidelines.
                         summary and conclusion
    Mrs. Chairwoman, again we wish to thank the subcommittee for its 
past leadership. Significant progress has been made in meeting the many 
public health concerns facing this Nation, due to your efforts. HBF 
appreciates the opportunity to provide testimony to you on behalf of 
these paramount needs of the Nation.

    [This statement was submitted by Timothy Block, Ph.D., President, 
Hepatitis B Foundation.]
                                 ______
                                 
           Prepared Statement of the Hispanic Association of 
                       Colleges and Universities
    Chairwoman Murray, Ranking Member Blunt, and Members of the 
Committee, thank you for the opportunity to submit this testimony on 
behalf of the Hispanic Association of Colleges and Universities (HACU). 
Founded in 1986, HACU is the only national association that represents 
the 559 Hispanic-Serving Institutions (HSIs) in the country, including 
the District of Columbia and Puerto Rico. We appreciate the opportunity 
to provide our views regarding the Department of Education (DOE) Fiscal 
Year 2023 budget. Our requests for this fiscal year are:
  --$250,000,000 for Developing Hispanic-Serving Institutions (Title V, 
        Part A): $67,150,000 above fiscal year 2022; and
  --$100,000,000 for Promoting Postbaccalaureate Opportunities for 
        Hispanic Americans (Title V, Part B): $80,340,0000 above fiscal 
        year 2022.
    HACU commends the committee for increases to Title V Part A and 
Part B in recent years, including the $34.12 million increase for Part 
A and $5.81 million increase for Part B in fiscal year 2022. These 
funds are critical to HSIs as these are their main Federal funding 
vehicles. Unfortunately, funding levels have not kept up with the 
number of HSIs. Since their codification in 1992 as part of the 
amendments to the Higher Education Act of 1965, as amended, HSIs have 
continued to grow exponentially from 311 in 2010 to 569 in 2019, for 
example. However, the pandemic saw the number of HSIs decrease, for the 
first time in 20 years, to 559, partly due to the economic and social 
impacts that disproportionately impacted Hispanic students as the entry 
requirement for HSI status is to serve 25 percent or more such students 
in their total FTE enrollment.
    HSIs educate more than 5 million students, including two-thirds of 
the estimated 3.8 million Hispanic students in American higher 
education, most of whom are first-generation college students and come 
from low-income families. HSIs also enroll twice as many African 
American students as Historically Black Colleges and Universities 
(HBCUs), 41 percent of all Asian Americans, 21 percent of all Native 
Americans, and 16 percent non-Hispanic White students in U.S. higher 
education. Additionally, while only accounting for 16 percent of higher 
education institutions, HSIs enroll 31 percent of Pell recipients. 
Despite their great diversity and need, HSIs remain at the bottom of 
the Federal funding priorities, compared to other Minority-Serving 
Institutions (MSIs) and HBCUs.
    HSIs are consistently asked to do more with less. The first 
Congressional HSI appropriation in FY1995 was a meager $12 million for 
more than 125 HSIs. As the number of HSIs has climbed rapidly, Federal 
funding has been paltry over the years and amounted to a mere $315.7 
million in FY21, including $221.6 in discretionary funds.
    Coupled with persistent Federal underfunding, COVID-19 has 
exacerbated the financial needs of HSIs: delayed deferred maintenance, 
access to broadband, classroom facilities enhancements, and much needed 
wrap-around student services, particularly health and psychological 
services. As the pandemic lingers on, the funding needs of HSIs will 
become more critical. In a report released by HACU in September 
2021,\1\ HACU surveyed HSIs and received 111 responses on their 
infrastructure needs that require capital financing. More than nine in 
every 10 HSIs need funding for construction of new buildings, 
facilities, and classrooms; eight of every 10 for deferred maintenance; 
three of every four for IT infrastructure; and more than two-thirds for 
repairs.
---------------------------------------------------------------------------
    \1\ https://www.hacu.net/NewsBot.asp?MODE=VIEW&ID=3424.
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    Federal investments are essential to strengthen our workforce by 
enhancing educational attainment, especially in STEM and other fields 
of national priority. The U.S. Census Bureau reported that from 2010 to 
2020 Hispanics accounted for more than half the total growth of the 
National population and are now over 63 million, and it estimates that 
the Hispanic population will grow by 93.5 percent from 2016 to 2060.\2\
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    \2\ https://www.census.gov/content/dam/Census/library/publications/
2015/demo/p25-1143.pdf.
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    HSIs educate and train the most diverse and underserved communities 
and do so with fewer Federal resources per student than their peer 
institutions. As the Nation looks to rebuild the economy after the 
pandemic, it is critical that Federal investments strengthen our 
workforce by enhancing the educational infrastructure of HSIs to pave 
the path of success and opportunity for Hispanic Americans for the 
fiscal year 2023.
    As the Hispanic growth-rate in K-12 enrollment continues to 
accelerate, the number of Hispanic high-school graduates is expected to 
increase by 49 percent between 2012-13 and 2028-29, compared to 23 
percent for Asian/Pacific Islanders, and to a net drop of 3 percent and 
15 percent for Blacks and Whites, respectively. In fact, NCES projected 
in the same study an increase of 14 percent in Hispanic college 
enrollment between 2017 and 2028 from 3.5 million to over 4.0 million, 
but it may be under-projecting as in 2020 there were already 3.8 
million Hispanics college students, 67 percent of them at HSIs.\3\
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    \3\ https://nces.ed.gov/pubs2020/2020024abbrev.pdf.
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    Investing in HSIs is an investment in the success American 
workforce. Given the preceding demographic trends and projections, it 
is evident that the Nation's labor force is also becoming increasingly 
Hispanic. The U.S. Bureau of Labor Statistics (BLS) reports that 
Hispanics have the highest participation rate in the American labor 
force, which in 2019 was 66.8 percent, compared to 63.0 percent for 
Whites and 62.4 percent for Blacks.\4\
---------------------------------------------------------------------------
    \4\ https://www.bls.gov/emp/tables/civilian-labor-force-
participation-rate.htm.
---------------------------------------------------------------------------
    A U.S. BLS study projected that the Latino share of the workforce 
will increase dramatically from 1 in 10 in 2010 to 1 in 3 by 2050, 
while Whites will decrease from 81 percent to 75 percent, Blacks will 
remain at 12 percent, Asian Americans will increase from 5 percent to 8 
percent and all others from 2 percent to 5 percent during the same span 
of time.\5\ Currently, more than half of all the new workers joining 
the Nation's labor force is Hispanic. For America to remain competitive 
in the global economy, a much better educated and trained Hispanic 
labor force is required. As the backbone of Hispanic postsecondary 
education, HSIs must be placed at the top of Federal investment 
priorities without any further delay.
---------------------------------------------------------------------------
    \5\ https://www.bls.gov/opub/mlr/2012/10/art1full.pdf.
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    HACU and its supporters wholeheartedly commend the U.S. Congress 
and the Administration for investing significantly in HBCUs and other 
MSIs and urge them to continue doing so. Likewise, we exhort Congress 
and the President to invest with equal commitment in HSIs and their 
underserved students; they truly are the future of the Nation.
                               about hacu
    The Hispanic Association of Colleges and Universities, founded in 
1986, represents more than 500 colleges and universities in the United 
States, Latin America, Spain and school districts throughout the U.S. 
HACU is the only national association representing existing and 
emerging Hispanic-Serving Institutions (HSIs). The Association's 
headquarters in San Antonio, Texas, with regional offices in 
Washington, D.C and Sacramento, California.

    [This statement was submitted by Antonio Flores, PhD, President & 
CEO, 
Hispanic Association of Colleges and Universities.]
                                 ______
                                 
           Prepared Statement of the HIV Medicine Association
    Chairwoman Murray, Ranking Member Blunt and members of the 
subcommittee, my name is Marwan Haddad, MD, MPH, chair of the HIV 
Medicine Association (HIVMA), and I serve as the medical director of 
the Center for Key Populations at the Community Health Center Inc. 
(CHCI) in Middletown, Connecticut, one of the largest Federally 
Qualified Health Centers in the country. I am pleased to submit 
testimony on behalf of HIVMA. HIVMA represents nearly 5,000 physicians, 
scientists and other health care professionals around the country on 
the frontlines of the HIV epidemic. Our members provide care and 
treatment to people with HIV, lead HIV prevention programs and conduct 
research in communities across the country.
    For the FY 2023 appropriations process, we urge you to appropriate 
funding to support the Ending the HIV Epidemic (EHE) initiative, 
including: increased funding for the Ryan White HIV/AIDS Program 
(RWHAP) at the Health Resources and Services Administration (HRSA) 
across all parts, increased funding for the Centers for Disease Control 
and Prevention's (CDC's) HIV, hepatitis and sexually transmitted 
infections (STI) prevention programs, and increased investments in HIV 
research supported by National Institutes of Health (NIH).
    The funding requests in our testimony largely reflect the consensus 
of the Federal AIDS Policy Partnership (FAPP), a coalition of HIV 
organizations from across the country. For a chart of current and 
historical funding levels and coalition requests for each program, 
please see FAPP's FY 2023 Appropriations for Federal HIV/AIDS Programs.
ending the hiv epidemic initiative--u.s. department of health and human 
                                services
    We urge the Senate subcommittee to build on the inroads made by the 
EHE initiative, now in its fourth year and strengthened by the Federal 
National HIV/AIDS Strategy (2022-2025). We recommend funding the EHE 
initiative at least at the President's budget request for $850 million 
across CDC, HRSA and NIH for FY 2023, to be used for expanded access to 
antiretroviral treatment and pre-exposure prophylaxis (PrEP) to prevent 
HIV transmissions as well as improved access to routine and critical 
health services.
  national prep program--u.s. department of health and human services
    The President's budget calls for the creation of a national PrEP 
program to expand PrEP use and promote racial and ethnic equity in PrEP 
access. This much needed new program would provide access to PrEP at no 
cost for uninsured and underinsured individuals, as well as support and 
expand PrEP programs across a variety of agencies.
    A national PrEP program is needed to dramatically reduce new HIV 
cases and address significant PrEP access disparities among populations 
the HIV epidemic has heavily impacted. While 1.2 million individuals 
could benefit from this prevention drug, only 25 percent have been 
prescribed PrEP. The numbers drop even further for Black and Latinx 
individuals, to 8 percent and 14 percent. HIVMA supports a program to 
scale up access to PrEP medication.
     health resources and services administration--hiv/aids bureau
    HRSA's Ryan White HIV/AIDS Program is critical to ensuring that 
individuals with HIV are linked to care, are retained in care, have 
medical adherence and achieve viral suppression. RWHAP has been 
critical to our HIV response by supporting care and treatment for 
people with HIV without another source of coverage. In 2020, the viral 
suppression among RWHAP clients reached a record high of 89.4 percent 
as compared to 65.5 percent among all people diagnosed with HIV in the 
U.S. Sustaining an undetectable viral load in people with HIV is 
important to their health and to stop HIV transmissions. This is one of 
the many reasons RWHAP is a critical component of the EHE initiative in 
decreasing racial and ethnic, age-based and regional disparities. To 
sustain current services and to ensure more people with HIV benefit 
from HIV care and treatment, we urge Congress to fund the Ryan White 
HIV/AIDS Program at $2.942 billion in FY 2023, an increase of $447.5 
million over FY 2022. In addition, we strongly recommend providing at 
least $290 million in EHE funding for the Ryan White Program, a $165 
million increase over FY 2022.
    HIVMA urges an allocation of $231 million, a $25.5 million increase 
over FY 2022, for Ryan White Part C programs. It is critical to ensure 
that clinics in all jurisdictions nationwide receive additional funding 
to increase access to HIV care and treatment to help end the domestic 
HIV epidemic. Approximately half of Part C providers serve rural 
communities, making the clinics the primary source for delivering HIV 
care to rural jurisdictions.
    Part C of the Ryan White Program directly funds approximately 350 
community health centers and HIV clinics, providing medical care to 
more than 300,000 people each year. Ryan White clinics serve a 
significant number of individuals living with both substance use 
disorder and HIV, delivering a range of medical and support services to 
prevent, intervene and treat substance use disorders as well as related 
infectious diseases, including HIV, viral hepatitis and STIs.
    CHCI's Ryan White-Funded Clinic in Connecticut Is Leading on 
Expanding Access to HIV Prevention, Care & Treatment. The Center for 
Key Populations (CKP) at Community Health Center Inc. (CHCI) has 
received funding through the Ryan White Cares Act for more than 23 
years, making us a leading source of HIV primary care in the State of 
Connecticut. Each year CHCI has increased the number of HIV patients 
served, the number of services offered and the number of HIV tests 
conducted based on the needs of the communities we serve.
    The needs of both established and newly diagnosed patients with HIV 
are growing more complex, especially as the population ages. In 2021, 
even as HIV prevention methods became more available, CHCI experienced 
an increase in the number of patients living with HIV who accessed 
services at our sites. Of all new patients enrolled in care at CHCI in 
2021, 71 percent self-reported as racial and ethnic minorities and 56 
percent reported food and housing insecurity as major barriers to 
achieving optimal health care. Additionally, 4 percent of all Ryan 
White patients were uninsured, 87.9 percent had at least one clinical 
comorbidity and 62 percent reported unmet mental health needs at the 
time of intake. Among Ryan White Program patients at CHCI, 60 percent 
reported experiencing stigma or discrimination based on their gender 
identity, sexual orientation or HIV status in the last year. As the 
country resumed ``normal'' activities after the COVID-19 pandemic, 
individuals living with HIV reported significant symptoms of isolation 
that were difficult to overcome.
    CHCI's Ryan White Program eligible patients who are engaged in care 
are screened for substance use disorders routinely; in 2021, 59 percent 
screened positive, with 10 percent considering those needs urgent or 
severe. CHCI, like most Ryan White Part C programs, also receives 
funding from other parts of the Ryan White Program, and these help us 
provide support services that were particularly important in retaining 
patients in care and assisting in medication compliance. These services 
included home medical monitoring equipment, transportation, case 
management, patient navigation, home-delivered meals, grocery delivery, 
check-in phone calls and other key components of care unique to the 
Ryan White Program care model and contribute to optimal health care 
outcomes for all patients.
    The support services provided by Ryan White funding were pivotal in 
maintaining stability and transitioning care efficiently during the 
COVID-19 pandemic. The infrastructure developed over 23 years of 
funding gave Ryan White patients the additional support they needed to 
sustain healthy outcomes and return to care as soon as possible after 
the pandemic. These services are integral to the success of patients in 
maintaining viral load suppression to protect themselves and their 
communities.
health resources and services administration--bureau of primary health 
                                  care
    We recommend appropriating $172.3 million in new funding for HRSA's 
Community Health Center program for the EHE initiative, a $50 million 
increase over FY 2022. As part of the EHE initiative, HRSA's community 
health center program is focused on expanding HIV prevention services, 
including outreach, care coordination and access to PrEP services. In 
2020 and 2021, EHE resources were distributed to 213 health centers 
that received Health Center/Ryan White Program funding and/or were 
located close to a Ryan White Program where no jointly funded health 
center currently existed in targeted jurisdiction sites. These health 
centers reported more than 151,000 patients receiving PrEP services in 
the first year of the EHE initiative--a significant accomplishment in 
scaling up PrEP among the most affected populations, critical to 
reducing health disparities and ending HIV as an epidemic.
  centers for disease control and prevention--national center for hiv/
 aids, viral hepatitis, sexually transmitted diseases and tuberculosis 
                               prevention
    From CDC's leadership role in responding to the COVID-19 pandemic 
to its ongoing efforts to address persistent public health epidemics 
and threats, such as HIV, STIs and viral hepatitis, CDC is a critical 
national and global expert resource and response center. To 
meaningfully address these epidemics and the co-occurring crisis of 
substance use disorder--especially injection drug use--we request a 
$731.9 million overall increase above FY 2022 levels for a total of 
$2.077 billion.
    For the Division of HIV/AIDS Prevention (DHAP), we request a total 
of $1.233 billion, which is a $246 million increase over FY 2022 
levels. DHAP conducts our National HIV surveillance and funds State and 
local health departments and communities to conduct evidence-based HIV 
prevention activities. CDC's national surveillance system is critical 
to monitoring populations and regions impacted by the HIV epidemic and 
identifying outbreaks. We also strongly recommend appropriating at 
least the $310 million requested by the Administration for the EHE 
initiative, a $115 million increase above FY 2022, allowing CDC to 
scale up HIV testing to ensure early diagnosis and linkage to care, and 
PrEP programs to prevent new infections.
    Additionally, we urge the appropriation of $150 million for CDC to 
fund surveillance and programming, a $132 million increase above FY 
2022, to monitor and prevent injection-related infectious diseases as 
well as expand access to syringe services programs, harm reduction and 
overdose prevention. Funding for CDC's Infectious Diseases and Opioid 
Epidemic programming is critical to the National response to the opioid 
crisis, including expanding support for monitoring and data collection 
and strengthening national capacity to share information and expand 
access to effective prevention services, including syringe services 
programs.
    For the Division of Viral Hepatitis (DVH), we request a total of 
$140 million, which is a $99 million increase over FY 2022 levels. We 
have the tools to prevent this growing epidemic, but increased funding 
is urgently needed to expand testing and screening, prevention and 
surveillance to put the U.S. on the path to eliminating hepatitis as a 
public health threat.
    For the Division of STD Prevention (DSTDP), we request a total of 
$329.2 million, which is a $164.9 million increase over FY 2022 levels. 
CDC's 2020 STD Surveillance Report shows syphilis among newborns (i.e., 
congenital syphilis) increased, with reported cases up nearly 15 
percent from 2019 and 235 percent from 2016. Increases like these have 
created a public health emergency with devastating long-term health 
consequences, including infertility, cancer, HIV transmission and 
infant and newborn deaths.
         national institutes of health--office of aids research
    The historical response to the COVID-19 pandemic over the last 2 
years exemplifies the value of the Nation's longstanding commitment to 
NIH. Decades of medical research supported by NIH are the foundation 
for diagnostic, treatment and preventive interventions available today, 
and building on this research will be vital in finding a cure and 
vaccine for HIV. To advance these and other scientific discoveries, we 
ask that at least $3.875 billion be allocated for HIV research in FY 
2023, an increase of $681 million over FY 2022.
                               conclusion
    Thank you for considering this request to support lifesaving 
investments in domestic HIV and infectious diseases programs in the FY 
2023 (LHHS) appropriations bill. Fully funding these programs will 
ensure progress in ending the domestic HIV epidemic and help maintain 
the gains achieved in recent years. HIVMA looks forward to working with 
Congress to ensure that the resources necessary to make significant 
progress in preventing HIV and improving the health and well-being of 
people with HIV are provided. Please contact me or HIVMA's senior 
policy and advocacy manager, Jose A. Rodriguez, 4040 Wilson Boulevard, 
Suite 300, Arlington, VA, 22203, at [email protected] if you have 
any questions or need additional information.

    [This statement was submitted by Marwan Haddad, MD, MPH, Chair, HIV 

Medicine Association.]
                                 ______
                                 
        Prepared Statement of the HIV+Hepatitis Policy Institute
    On behalf of the HIV+Hepatitis Policy Institute, we respectfully 
submit this testimony in support of increased funding for domestic HIV 
and hepatitis programs in the FY 2023 Labor, HHS spending bill. The 
HIV+Hepatitis Policy Institute is a leading HIV and hepatitis policy 
organization promoting quality and affordable healthcare for people 
living with or at risk of HIV, hepatitis, and other serious and chronic 
health conditions.
    Our nation is on a path to eliminating two infectious diseases, HIV 
and viral hepatitis, in the U.S., but we need increased funding to 
accelerate our efforts particularly in communities and populations 
disproportionately impacted. The ongoing COVID-19 pandemic has 
demonstrated the interconnectedness of communities and health 
conditions and has allowed innovative service delivery. Increased 
investment in surveillance, education, prevention, and care and 
treatment will ensure we continue to address HIV and viral hepatitis, 
including taking a syndemic approach in order to achieve maximum 
impact.
    The programs and funding increases detailed below are pivotal to 
our Nation's ability to end both HIV and hepatitis.
                  ending the hiv epidemic in the u.s.
    Over the past 3 years, Congress has appropriated funding for the 
Ending the HIV Epidemic in the U.S. initiative, which sets the goal of 
reducing new HIV infections by 75 percent by 2025, and 90 percent by 
2030. Unfortunately, this funding has been far less than what estimates 
used in the creation of the EHE initiative deemed necessary and were 
proposed by both Presidents Trump and Biden. The initiative, which is 
currently focused on those jurisdictions that represent about 50 
percent of diagnoses, has already shown success with the money 
appropriated to date. The Health Resources and Services 
Administration's HIV/AIDS Bureau reports that in 2020, the Ryan White 
Program served 11,139 new clients and re-engaged an additional 8,282 
clients for a total of 19,421 clients during the first year of the 
COVID-19 pandemic when services often were disrupted. Additionally, 
community health centers funded by the EHE Initiative were able to 
increase PrEP (HIV prevention medication) to 389,000 people.
    In FY 2023, we urge Congress to fund EHE activities at the level 
requested in President Biden's FY23 Budget Request. For FY 2023, we ask 
that you fully fund the fourth year of the initiative to continue to 
scale up the EHE initiative by supporting the president's budget 
request of $850 million, an increase of $377 million from FY 2021.
  --$310 million for the CDC Division of HIV/AIDS Prevention for 
        testing, linkage to care, and prevention services, including 
        pre-exposure prophylaxis (PrEP) (+$115 million);
  --$290 million for the HRSA Ryan White HIV/AIDS Program to expand 
        comprehensive care and treatment for people living with HIV 
        (+$165 million);
  --$172 million for the HRSA Community Health Centers to increase 
        clinical access to prevention services, particularly PrEP (+$50 
        million);
  --$52 million for the Indian Health Service (IHS) to address the 
        combat the disparate impact of HIV and hepatitis C on American 
        Indian/Alaska Native populations (+$47 million); and
  --$26 million for NIH Centers for AIDS Research to expand research on 
        implementation science and best practices in HIV prevention and 
        treatment.
                                  prep
    It is estimated that only 23.4 percent of people who could benefit 
from PrEP have received a prescription. PrEP coverage is highest among 
white people, at 63.3 percent, yet only 8.2 percent of black people and 
14 percent of Hispanic/Latino people who could benefit from PrEP in the 
U.S. have a prescription. Additionally, PrEP coverage among women is 
only at 9.7 percent. Reducing these disparities must be a priority as 
we work to expand PrEP use.
    We are thankful that there has been an increased focus on PrEP both 
in Congress and from President Biden. In his FY 2023 budget request, 
President Biden called for a new mandatory funding program to expand 
PrEP across the United States through providing medication to uninsured 
and underinsured individuals, as well as supporting and expanding PrEP 
programs across a variety of agencies. As the HIV community, relevant 
stakeholders, and Congress consider this proposal along with others, we 
urge you to support funding for new and innovative grant programs to 
expand PrEP access, ensure that those who want PrEP can easily access 
the medication without any costs or barriers, and increase demand for 
PrEP among people who could benefit from this important medication. 
This can be accomplished with increased funding for PrEP services for 
community health centers, CDC's Division of HIV Prevention, and other 
programs.
                                  hiv
    Additionally, the success of the EHE initiative and PrEP delivery 
rests upon our underlying public health prevention, care, and treatment 
programs at the CDC, HRSA, and other agencies. Congress must ensure 
that these are also funded to provide services in all areas of the 
country.
    The Ryan White HIV/AIDS Program at the Health Resources and 
Services Administration provides medical care, medications, and 
essential coverage completion services to over 567,000 low-income, 
uninsured and/or underinsured individuals with HIV. Nearly 61 percent 
of clients live at or below 100 percent of the Federal poverty level 
and nearly three-quarters of the clients are from racial and ethnic 
minority populations. For over 30 years, the Ryan White program has 
pioneered innovative models of care which has resulted in over 89 
percent of Ryan White clients achieving viral suppression, a critical 
marker for decreasing new infections in the U.S. Currently, Ryan White 
Programs, and particularly the AIDS Drug Assistance Programs (ADAPs) 
are facing increased demand as people have lost health coverage and 
incomes due to the ongoing economic impact of COVID-19. Without 
increased funding some ADAPs may be forced to institute wait lists for 
medications or other cost containment measures.
    This program is especially important in many States where there are 
large healthcare coverage gaps because of States choosing not to expand 
Medicaid. There are approximately 400,000 people living with HIV who 
are not engaged in care and treatment. The Ryan White Program can play 
a large role in bringing these people into care and treatment and 
ensuring their virus is undetectable, which makes them untransmittable. 
The Ryan White Program also needs additional support to address the 
complex challenges of the overdose crisis, mental health crisis, and 
prevention and treatment of other infectious diseases, including COVID-
19, viral hepatitis, and STIs. We urge Congress to fund the Ryan White 
HIV/AIDS Program at a total of $2.942 billion in FY 2023, an increase 
of $447 million over FY 2022, of which $165 million is for the EHE 
initiative and $68 million is for ADAPs.
    There has been incredible progress in the fight against HIV over 
the last 40 years, but that progress has stalled with new infections 
plateauing since 2013. Increasing funding for high-impact, community-
focused HIV prevention services through the CDC's Division of HIV 
Prevention has proven to result in a strong return on investment. HIV 
continues to disproportionately impact Black gay and bisexual men, 
Latinx gay and bisexual men, Black heterosexual women, transgender and 
gender nonconforming women, people who inject drugs, and people who 
live in the South. HIV prevention tools that meet the special 
prevention needs of these populations must be expanded.
    Through partnerships with State and local public health departments 
and community-based organizations, the CDC has expanded targeted, high-
impact prevention programs that work to address racial and geographic 
health disparities. Additionally, the CDC's national surveillance 
system is a key tool in identifying people and regions most impacted by 
the epidemic and tailoring prevention efforts to meet the needs of 
those populations and prevent HIV transmission. There is no single way 
to prevent HIV, but jurisdictions use a combination of effective 
evidence-based approaches including testing, linkage to care, condoms, 
syringe service programs, and PrEP. We urge you to fund the CDC 
Division of HIV Prevention at $822.7 million in FY 2023, an increase of 
$67 million over FY 2022, in addition to the $310 million for EHE 
Initiative work at CDC.
    A holistic response to the HIV epidemic also depends on fully 
funding other priority programs at HHS, including the CDC's Division of 
School and Adolescent Health and STI prevention, the Minority HIV/AIDS 
Initiative, AIDS Research at the NIH, the Title X Family Planning 
Program, and the Teen Pregnancy Prevention Program (TPPP).
                            viral hepatitis
    Additionally, we respectfully request that you provide increased 
funding for viral hepatitis programs at the CDC. The CDC estimates that 
nearly 5 million people in the United States live with hepatitis B 
(HBV) or hepatitis C (HCV), and as many as 65 percent are unaware they 
are living with the disease. The opioid epidemic has significantly 
increased the number of viral hepatitis cases in the United States, 
with available data suggesting that more than 70 percent of the 57,800 
new HCV infections are among people who inject drugs. There are several 
curative treatments available for HCV, but individuals must have access 
to screening and linkage to care programs to be able to take advantage 
of these medications.
CDC Division of Viral Hepatitis
    The viral hepatitis programs at the CDC are severely underfunded, 
receiving only $41 million-far short of what is needed to build and 
strengthen our public health response to hepatitis. The Viral Hepatitis 
National Strategic Plan for the United States: A Roadmap to Elimination 
(2021-2025) lays out an ambitious plan to end the hepatitis epidemic; 
however, health departments and community partners are in desperate 
need of additional resources. Increased investment would allow the CDC 
to enhance testing and screening programs, conduct additional provider 
education, enhance clinical services specific to hepatitis at sites 
serving vulnerable populations, and increase services related to 
hepatitis outbreaks and injection drug use. With the treatment of 
hepatitis D expected to be approved this year, there will be increased 
needs for testing and linkage to care programs. While we are pleased 
that the Biden administration has prioritized viral hepatitis in its 
FY23 budget with an increase of $13.5 million, we urge you to provide 
the CDC Division of Viral Hepatitis with $140 million, an increase of 
$99 million over FY 2022 enacted levels.
      cdc's eliminating opioid-related infectious diseases program
    This CDC program focuses on addressing the infectious disease 
consequences of increased rates of injection drug use due to the opioid 
crisis. The U.S. is experiencing an ongoing public health emergency 
crisis with the U.S. surpassing 105,000 annual overdose deaths from 
opioid overdose in 2020, a more than 45 percent increase from January 
2020. Providing full support for this program is another key step in 
preventing new cases of viral hepatitis and HIV, addressing overdose 
prevention, and putting the country on the path towards elimination. We 
urge the committee to fund this program to eliminate opioid-related 
infectious diseases at $150 million, an increase of $133 million.
                    syringe service programs (ssps)
    We also ask that the committee support ending any prohibition on 
the use of Federal funds to purchase sterile needles or syringes for 
SSPs. A wealth of scientific evidence has shown that SSPs reduce the 
spread of infectious diseases, such as HIV and hepatitis. Full Federal 
funding for these programs will only serve to make the programs 
stronger and more effective.
                  federal hiv & hepatitis coordination
    Two important offices which coordinate the implementation of the 
NHAS and EHE activities need resources to bolster their ability to 
coordinate HIV and viral hepatitis activities across the Federal 
Government. The White House Office of National AIDS Policy and the HHS 
Office of Infectious Disease and HIV/AIDS Policy both play an important 
role in developing and implementing government-wide HIV strategies, as 
well as coordinating efforts among the wide range of Federal agencies 
working to end the HIV epidemic and the syndemics of STDs, hepatitis, 
TB, and overdoses. We urge you to provide a total of $20 million for 
the HHS Office of Infectious Disease and HIV/AIDS Policy and $3 million 
for the White House Office of National AIDS Policy in FY 2023.
    In conclusion, we urge the committee to continue its investment in 
our Nation's public health infrastructure specifically as it relates to 
addressing the ongoing HIV and hepatitis epidemics. Fortunately, we 
have the tools available to end both these epidemics; however, we must 
provide the necessary resources to accelerate our efforts to achieve 
these goals.

    [This statement was submitted by Carl Schmid, Executive Director, 
HIV+Hepatitis Policy Institute.]
                                 ______
                                 
                  Prepared Statement of Hope Charities
              summary of fiscal year 2023 recommendations
_______________________________________________________________________

  --Provide NIH with at least a $3.5 billion increase in discretionary 
        funding for FY 2023 to bring overall agency funding up to a 
        minimum of $49 billion annually.
    --Please provide proportional funding increases for NIH's various 
            Institutes and Centers, such as the National Institute of 
            Allergy and Infectious Diseases (NIAID) and the National 
            Heart, Lung, and Blood Institute (NHLBI).
    --Please provide separate, additional funding to further support 
            and advance implementation of the Advanced Research 
            Projects Agency for Health (ARPA-H) to ensure this 
            important initiative does not compete with (and ultimately 
            compliments) ongoing NIH research efforts.
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least a $2.55 billion increase in discretionary funding for 
        FY23 to bring overall agency funding up to a minimum of $11 
        billion annually.
    --Please provide established CDC Centers and Programs, such as the 
            National Center for Chronic Disease Prevention and Health 
            Promotion, with proportional funding increases.
    --Please provide the emerging CDC Chronic Disease Education and 
            Awareness (CDEA) program with $6 million for FY 2023, an 
            increase of $3 million over FY 2022.
  --Provide the Health Resources and Services Administration (HRSA) 
        with a funding level of at least $9.8 billion for FY 2023, an 
        increase of roughly $900 million over FY 2022.
  --Continue to support committee recommendations highlighting the 
        value and importance of charitable assistance programs and 
        encouraging proper access.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to present the views 
of Hope Charities and the patient communities that we serve. Primarily, 
we thank you for your continued support for medical research and public 
health programs that serve blood disorders and rare disease patients 
through the FY 2022 omnibus package. For FY 2023, Hope joins the 
broader medical research and public health community in asking that the 
investment in NIH, CDC, and HRSA be maintained and responsibly 
increased.
About Hope Charities
    Hope Charities is a national nonprofit organization, founded in 
2009, based in Louisiana. The mission of Hope Charities is to act as a 
conduit of hope, strength, and resources to families in a crisis caused 
by a chronic illness. We accomplish our mission through several 
programs including our Resource Connection Program; direct patient 
assistance, which helps families by subsidizing the cost of utilities, 
food, housing, transportation, and medical equipment; access to care 
through health insurance premium assistance as well as educational 
programs.
Complimenting Public Health Programs
    The Louisiana Department of Health classifies 63 percent (40 of 64) 
parishes as ``rural.'' The CDC reports that residents in rural areas 
have higher rates of poverty, less access to healthcare, and are less 
likely to have health insurance. Hope Charities works with Americans by 
increasing access to medical care for rural, underserved, and 
vulnerable populations. Our mission is to improve healthcare outcomes, 
which in turn decreases work absences, reduces the negative impact of 
chronic illness on mental health, and can lower the overall cost of 
healthcare.
    NIH conducts important research into many rare and chronic 
conditions, such as hemophilia, that incrementally improves care and 
options for affected individuals. This work is essential to advancing 
innovative research, improving outcomes, and lowering healthcare costs. 
The CDC and HRSA also support hemophilia treatment centers and have a 
variety of line-item programs that assist with public health and care 
delivery for patients affected by a variety of conditions. These 
programs, particularly at CDC's National Center for Chronic Disease 
Prevention and Health Promotion, have only seen modest increases in 
recent years, but much more can be done with an infusion of timely 
resources.
    Please note, as a safety net program, Hope Charities is pursuing a 
congressionally directed spending request to bolster efforts that 
support the work of hemophilia treatment centers and community health 
centers, in addition to requesting discretionary funding increases for 
Federal programs.
About the Patients that We Serve
    Hope recently received a request from Van, a 31 year old male who 
lives in Louisiana and has hemophilia. He was scheduled to have surgery 
at 5:30 a.m. on his right knee as a result of hemophilia-related 
injuries. He lives two hours away from his Hemophilia Treatment Center 
and the hospital where the surgery was to occur. He is on Medicaid and 
could not afford to travel to the hospital. Hope helped him with travel 
expenses and paid for a hotel room for him to stay the night before his 
surgery.
    Anna resides in Illinois and lives 8 hours from her nearest 
Hemophilia Treatment Center. Her minor son has hemophilia B. She 
requested funding from Hope for travel to an appointment. We paid for a 
hotel room for Anna and her son the night before their appointment. 
They attended their appointment early the next day, then traveled home.

    [This statement was submitted by Jonathan James, CEO, Hope 
Charities.]
                                 ______
                                 
     Prepared Statement of the Human Factors and Ergonomics Society
    On behalf of the Human Factors and Ergonomics Society (HFES), we 
are pleased to provide this written testimony to the Senate 
subcommittee on Labor, Health and Human Services, Education, and 
Related Agencies for the official record. HFES urges the subcommittee 
to provide no less than $500 million for the Agency for Healthcare 
Research and Quality (AHRQ) and a minimum of $375.3 million for the 
National Institute for Occupational Safety and Health (NIOSH), 
including $34 million for the Education and Research Centers (ERCs). 
HFES supports additional funding for the Advanced Research Projects 
Agency for Health (ARPA-H) through a supplement for the National 
Institute of Health (NIH) beyond the $49 billion recommended in fiscal 
year (FY) 2023.
    AHRQ supports research to improve health care quality, reduce 
costs, advance patient safety, decrease medical errors, and broaden 
access to essential services. As the lead Federal agency for funding 
health services research (HSR) and primary care research (PCR), AHRQ is 
the bridge between cures and care, and ensures that Americans get the 
best health care at the best value. The RAND Corporation released a 
report in 2021 as called for by the Consolidated Appropriations Act of 
2018, which identified AHRQ as ``the only agency that has statutory 
authorizations to generate HSR and be the home for Federal PCR, and the 
unique focus of its research portfolio on systems-based outcomes (e.g., 
making health care safer, higher quality, more accessible, equitable, 
and affordable) and approaches to implementing improvement across 
health care settings and populations in the United States.''
    HFES requests a minimum of $500 million for AHRQ, which is 
consistent with the FY 2010 level adjusted for inflation and reflects 
the demonstrated needs of pandemic response. This funding level will 
allow AHRQ to rebuild portfolios terminated after years of cuts. AHRQ 
is the Federal vehicle for studying and improving the United States 
healthcare system, and it needs the resources to meet its mission and 
this moment. Through this appropriation level, AHRQ will be better able 
to fund the ``last mile'' of research from cure to care.
    Additionally, HFES requests $375.3 million for NIOSH, including $34 
million for the Education and Research Centers (ERCs). NIOSH supports 
education and research in occupational health through academic degree 
programs and research opportunities. With an aging occupational safety 
and health workforce, ERCs are essential for training the next 
generation of professionals. The Centers establish academic, labor, and 
industry research partnerships to achieve these goals. Currently, ERCs 
are responsible for supplying many of the country's OSH graduates who 
will go on to fill professional roles.
    HFES supports the creation of Advanced Research Projects Agency for 
Health (ARPA-H) and advocates for additional funding to launch the 
agency in FY 2023. HFES advocates for $49 billion for NIH and 
additional supplemental funding to expand the ARPA-H effort ARPA-H will 
focus on high-risk, high-reward research that targets biomedical and 
health breakthroughs, while considering outcomes and the impact on 
healthcare and quality of life. These advancements will range from how 
to prevent, treat, and cure diseases that affect many Americans.
    HFES strongly believes that investment in scientific research 
serves as an important driver for innovation and the economy as well as 
for protecting and promoting the health, safety, and well-being of 
Americans. We thank the subcommittee for its longtime recognition of 
the value of scientific and engineering research and its contribution 
to innovation and public health in the U.S.
           the value of human factors and ergonomics science
    HFES is a multidisciplinary professional association with over 
3,000 individual members worldwide, including psychologists and other 
scientists, engineers, and designers, all with a common interest in 
designing safe and effective systems and equipment that maximize and 
adapt to human capabilities.
    For over 50 years, the U.S. Federal Government has funded 
scientists and engineers to explore and better understand the 
relationship between humans, technology, and the environment. 
Originally stemming from urgent needs to improve the performance of 
humans using complex systems such as aircraft during World War II, the 
field of human factors and ergonomics (HF/E) works to develop safe, 
effective, and practical human use of technology. HF/E does this by 
developing scientific approaches for understanding this complex 
interface, also known as ``human-systems integration.'' Today, HF/E is 
applied to fields as diverse as transportation, architecture, 
environmental design, consumer products, electronics and computers, 
energy systems, medical devices, manufacturing, office automation, 
organizational design and management, aging, farming, health, sports 
and recreation, oil field operations, mining, forensics, and education.
    With increasing reliance by Federal agencies and the private sector 
on technology-aided decision-making, HF/E is vital to effectively 
achieving our National objectives. While a large proportion of HF/E 
research exists at the intersection of science and practice-that is, 
HF/E is often viewed more at the ``applied'' end of the science 
continuum-the field also contributes to advancing ``fundamental'' 
scientific understanding of the interface between human decision-
making, engineering, design, technology, and the world around us. The 
reach of HF/E is profound, touching nearly all aspects of human life 
from the health care sector to the ways we travel and to the hand-held 
devices we use every day.
                               conclusion
    HFES urges the subcommittee to provide $500 million for AHRQ; 
$375.3 million for NIOSH, including $34 million for the Education and 
Research Centers (ERCs); and funding a supplement for ARPA-H through 
beyond a recommended $49 billion for NIH in FY 2023. These investments 
fund important research studies, enabling an evidence base, 
methodology, and measurements for improving healthcare, safety, and 
public health for Americans.
    On behalf of the HFES, we would like to thank you for the 
opportunity to provide this testimony. Please do not hesitate to 
contact us should you have any questions about HFES or HF/E research. 
HFES truly appreciates the subcommittee's long history of support for 
scientific research and innovation.

    [This statement was submitted by Christopher R. Reid, President, 
and Steven C. Kemp, CAE, Executive Director, Human Factors and 
Ergonomics Society.]
                                 ______
                                 
 Prepared Statement of the Infectious Diseases and the Opioid Epidemic 
                                Program
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee, my name is Brad Finegood and I work for King County (WA) 
as a Strategic Adviser addressing for Public Health-Seattle & King 
County in Seattle, WA. In this role it is my responsibility to lead the 
overdose prevention work for the community.
    I am pleased to submit testimony on behalf of King County, WA to 
urge Congress to appropriate $150 million for the Infectious Diseases 
and the Opioid Epidemic program at the Centers for Disease Control and 
Prevention (CDC) at the Department of Health and Human Services (HHS) 
to save lives and address the overdose crisis by supporting and 
expanding access to syringe services programs (SSPs).
    The United States is experiencing an urgent and unprecedented drug 
overdose crisis, with more than 100,000 overdose deaths from 2021-2022. 
Like the rest of the Nation, King County, WA continues to experience 
record overdose deaths each year. There have been significant increases 
in the county over the past decade, from 248 deaths in 2010 to 511 
deaths in 2020, to the biggest yearly increase yet in 2021 resulting in 
an estimated 719 deaths (some cases pending confirmation). The recent 
influx of fentanyl in the local drug supply has contributed 
significantly. Fentanyl is increasingly involved in overdose deaths, 
from 3 deaths in 2015 to 360 in 2021--a nearly 12,000 percent increase 
in just 6 years. Already marginalized demographic groups are 
disproportionately impacted. In King County, death rates (numbers per 
100,000) in 2020 were 77.2 for American Indians/Alaskan Natives, 32.7 
for Blacks, and 16.5 for Hispanics, compared to 16 for Whites.
    It is imperative that congress respond to this overdose crisis with 
the urgency it deserves and requires. We know that a public health 
approach is the most humane and effective approach to tackling this 
crisis. SSPs are an essential, evidence based public health 
intervention and a vital component of overdose prevention. The CDC has 
documented over 30 years of evidence that shows that SSPs reduce 
overdose deaths and infectious diseases transmission rates as well as 
increase the number of individuals entering substance use disorder 
treatment. These studies also confirm that SSPs do not increase illicit 
drug use or crime, but they do reduce the amount of improperly 
discarded syringes and save money.
    The King County Needle Exchange proudly serves clients by providing 
health education, naloxone training and distribution, safer sex 
supplies, and referrals for addiction treatment and other medical 
services, in addition to exchanging injection supplies. Our staff 
attempts to meet people where they are and help them address their 
needs in the safest and healthiest way possible, free of judgement and 
stigma. SSPs are among the only health care services trusted and used 
by people who use drugs, so SSP programs can effectively engage this 
highly stigmatized population.
    Unfortunately, the Nation has insufficient access to SSPs and the 
COVID-19 pandemic has decreased access to these life-saving services 
during a time when the need for services has increased dramatically. In 
January 2021, Drug Policy Alliance conducted a survey of SSPs that 
showed that 91 percent of respondents experienced an increase in 
clients in 2020. During this time of skyrocketing need, 42 percent of 
respondents experienced funding cuts and were forced to lay off staff 
and reduce services, limiting access to life saving interventions. 
Increased Federal funding in needed to expand access to these critical 
and effective programs. Tacoma, WA's NASEN's statistics show that there 
are only approximately 400 SSPs operating nationwide. Experts estimate 
that to sufficiently expand access to SSP programs, the U.S. would 
require at least 2,000 programs--5 times the number in existence now.
    Finally, expanding access to SSPs will reduce health care costs, 
including for infectious diseases treatment. Hepatitis C treatment can 
cost more than $30,000 per person, while HIV treatment can cost upwards 
of $560,000 per person. Averting even a small number of cases would 
save millions of dollars in treatment costs in a single year.
    With additional FY23 funding, CDC could expand SSPs at this 
critical time to help prevent overdose deaths, the spread of HIV and 
viral hepatitis and connect people to life-saving medical care.
    On a personal note--in addition to leading the overdose prevention 
work for King County, I am the brother of overdose victim. Every single 
person who counts as a fatal overdose is a family member to someone and 
an individual that could have been saved. We have the tools; we just 
need the funding to help implement.
    I want to thank the subcommittee for its past funding of the CDC 
Infectious Diseases and Opioid Epidemic program and urge Congress to 
provide $150 million for the program in FY23. Thank you also for your 
time and consideration of my testimony, and please do not hesitate to 
contact me at [email protected] if you have questions or 
need additional information.
    Sincerely.

    [This statement was submitted by Brad Finegood, MA, LMHC, Office of 
the 
Director, Strategic Advisor, Public Health--Seattle & King County.]
                                 ______
                                 
    Prepared Statement of the Infectious Diseases Society of America
    On behalf of the Infectious Diseases Society of America (IDSA), 
which represents more than 12,000 physicians, scientists, public health 
practitioners and other clinicians specializing in infectious diseases 
prevention, care, research and education, I urge the subcommittee to 
provide robust FY2023 funding for public health and biomedical research 
activities that save lives, contain health care costs and promote 
economic growth. IDSA asks the subcommittee to provide $397 million for 
the Antibiotic Resistance Solutions Initiative (ARSI) at the Centers 
for Disease Control and Prevention (CDC), $6.7 billion for the National 
Institute of Allergy and Infectious Diseases (NIAID), $300 million for 
the Biomedical Advanced Research and Development Authority (BARDA) 
Broad Spectrum Antimicrobials and CARB-X programs, and $200 million for 
the Strategic National Stockpile Special Reserve Fund program.
    While we must continue to direct substantial resources to tackle 
the COVID-19 pandemic, we must also address other domestic and global 
infectious diseases threats and epidemics, including those for which 
progress has stalled and/or worsened during the pandemic. For example, 
high levels of antibiotic use have exacerbated existing antimicrobial 
resistance (AMR), deepening the need for antimicrobial stewardship, 
surveillance and new antimicrobial drugs. From March-September 2020, 
there was a 24 percent increase in hospital-onset, multidrug-resistant 
infections associated with COVID-19 surges. The COVID-19 pandemic has 
shown us all too clearly the fundamental importance of expanding the 
infectious diseases workforce, public health infrastructure and 
biomedical research enterprise necessary to successfully confront the 
panoply of infectious threats facing our increasingly interconnected 
world.
               centers for disease control and prevention
Antibiotic Resistance Solutions Initiative (ARSI)
    We urge $397 million in funding for the Antibiotic Resistance 
Solutions Initiative in FY2023, the cornerstone of the Nation's efforts 
to detect, prevent, and respond to AMR. The President's budget proposal 
includes $197 million in discretionary funding and $200 million each 
year in mandatory funding from FY2023-2028 (as part of the larger 
pandemic preparedness request), for a total of $397 million in FY2023. 
IDSA members see the impact that AMR has on patients daily. 
Antimicrobial resistance is one of the greatest public health threats 
of our time. Drug-resistant infections sicken at least 2.8 million each 
year and kill at least 35,000 people annually in the United States. 
Antibiotic resistance accounts for direct healthcare costs of at least 
$20 billion. Infections are a primary or associated cause of death in 
50 percent of patients with cancer, as AMR can make these infections 
difficult or impossible to treat. Tragically some patients may be cured 
of their cancer but succumb to a resistant infection which can occur as 
a result of the effects of chemotherapy. AMR has a disproportionate 
impact on certain communities due to variance in risk of exposure, 
susceptibility to infection or treatment received. Rates of several 
serious antibiotic-resistant infections, including community-associated 
methicillin-resistant Staphylococcus aureus (MRSA) infections, are 
higher incidence in Black populations. Globally, resistant infections 
directly caused 1.27 million deaths in 2019 and played a role in 4.95 
million deaths. If we do not act now, antibiotic-resistant infections 
will be the leading cause of death by 2050 and could cost the world 
$100 trillion.
    Recommended funding is needed to expand antibiotic stewardship 
across the continuum of care; double State and local grant awards; 
expand the AR Laboratory Network globally and domestically to 
strengthen the identification; tracking and containment of deadly 
pathogens; support AMR research and epicenters; and increase public and 
health care professional education and awareness. The program is also a 
critical building block of CDC's public health infrastructure that 
directly supports broader agency activities, including COVID-19 first 
responders, foodborne illness pathogen detection, global AMR prevention 
and surveillance, and responses to sexually transmitted infections and 
health care-associated infections. Since FY2016, funding for the 
initiative has improved antibiotic use, increased state and regional 
laboratory capacity to rapidly detect resistant infections and enhanced 
tracking of health care-associated infections. However, many state 
laboratories still do not monitor and report resistance data on 
pathogens of importance, and the program will be unable to effectively 
address current and newly emerging threats and prepare for future 
challenges without a significant increase in funding in FY2023.
Advanced Molecular Detection (AMD)
    FY2023 funding of $175 million for the Advanced Molecular Detection 
program would ensure continued innovation in the detection and tracking 
of existing and emerging resistant pathogens. Funding would also enable 
federal, State, and local public health laboratories to expand the use 
of pathogen genomics, sustain important partnerships with academic 
research institutions, and bolster training to ensure integration of 
genomics into AMR surveillance and response. The pandemic has resulted 
in a substantial ramping up of CDC capacity for sequencing pathogens. 
CDC is in the process of establishing ``Centers of Excellence,'' 
linking together public health agencies and private sector partnerships 
focused on pathogen genomics and molecular epidemiology. The $175 
million would sustain the Centers of Excellence and support ongoing AMD 
activities.
National Healthcare Safety Network (NHSN)
    FY2023 funding of $100 million for the National Healthcare Safety 
Network (NHSN) will enable the program to meet its current and 
projected demands. Requested funding is needed to modernize and 
automate NHSN to alleviate the reporting burden and speed access to 
actionable data, which help measure and drive progress toward 
optimizing antibiotic use. Additionally, increased funding would 
provide access to technical support for more than 65,000 staff at 
health care facilities who use NHSN. In its FY2023 Inpatient 
Prospective Payment System (IPPS) rule, the Centers for Medicare and 
Medicaid Services (CMS) included a requirement that hospitals begin 
reporting antibiotic use and resistance data. IDSA has long advocated 
for this policy, which will strengthen our ability to detect and track 
emerging resistance threats and provide data to help evaluate 
stewardship interventions and inform best practices. Increased funding 
for NHSN will be essential to help hospitals that do not already report 
these data prepare to do so and to ensure the overall success of this 
initiative.
CDC Center for Global Health
    IDSA urges the subcommittee to provide $991 million in FY2023 
funding, including $456.4 million for CDC's Division of Global Health 
Protection. Public health experts address more than 400 diseases and 
health threats in 60 countries, including SARS-CoV-2. An emerging 
infection in any part of the world is just a plane ride away from the 
U.S. (or any other location). As highlighted by the COVID-19 pandemic, 
increased resources for this vital CDC program are needed to improve 
global capacity to prevent, detect and respond to health threats at 
their source before international spread. As a key implementor of the 
Global Health Security Agenda, the division works to improve health 
emergency preparedness and response, enhance infectious disease 
surveillance systems, strengthen laboratory capacity, train health care 
workers and disease detectives, and build and support emergency 
operations centers in countries with limited public health capacities. 
The program also works to address AMR by providing technical assistance 
to 30 countries, working to detect resistant threats; prevent and 
contain resistance pathogens; and improve antibiotic use. Other 
divisions in the CDC Center for Global Health are instrumental in 
providing technical assistance on HIV, tuberculosis (TB), malaria and 
other parasitic diseases, and also ensuring access to essential 
immunization services for children in low- and middle-income countries. 
U.S. leadership of global health security efforts is essential, and the 
resources allocated to those efforts have been inadequate. Until all 
countries have laboratory monitoring, surveillance capacities, and the 
trained staff and equipment necessary to detect and respond swiftly to 
emerging infectious threats, we all will remain vulnerable.
Elimination of Opioid-Related Infectious Diseases
    $120 billion in funding for the Opioid-Related Infectious Diseases 
program would allow CDC to address the significant and growing burden 
of the opioid epidemic by expanding surveillance for infectious 
diseases commonly associated with injection drug use, including HIV, 
viral hepatitis and infective endocarditis. CDC has found steep 
increases in multiple viral, bacterial and fungal infections due to 
injection drug use, and CDC estimates that individuals who inject drugs 
are 16 times more likely to develop an invasive MRSA infection. We are 
very concerned about how the opioid crisis is driving higher rates of 
infectious diseases including hepatitis C, endocarditis, HIV and 
pneumonia, as well as skin, soft tissue, bone and joint infections. 
Support systems for individuals with substance use disorders are 
suffering disruptions due to the COVID-19 pandemic, which may be 
worsening the opioid epidemic and associated infectious diseases.
        assistant secretary for preparedness and response (aspr)
Biomedical Advanced Research and Development Authority (BARDA), Broad 
        Spectrum Antimicrobials and Combating Antibiotic-Resistant 
        Bacteria Biopharmaceutical Accelerator (CARB-X )
    The BARDA broad spectrum antimicrobials program and CARB-X leverage 
public/private partnerships to develop products that directly support 
the government-wide National Action Plan for Combating Antibiotic-
Resistant Bacteria and have been successful in developing new FDA-
approved antibiotics. Despite this progress, the pipeline of new 
antibiotics in development is insufficient to meet patient needs, and 
$300 million in funding is needed to help achieve the goals of the 
2020-2025 Action Plan to accelerate basic and applied research for 
developing new antibiotics and other products. Additional funding will 
help prevent a post-antibiotic era in which we lose many modern medical 
advances that depend upon the availability of antibiotics, such as 
cancer chemotherapy, organ transplants and other surgeries.
Project BioShield Special Reserve Fund (SRF), Broad Spectrum 
        Antimicrobials
    The Project BioShield SRF is positioned to support the response to 
public health threats, including AMR. Efforts by BARDA and NIAID have 
been successful in helping companies bring new antibiotics to market, 
but those companies struggle to stay in business, and two filed for 
bankruptcy in 2019. In December 2019, SRF funds supported a contract 
for a company following approval of its antibiotic--a phase in which 
small biotechs that develop new antibiotics are particularly 
vulnerable. Funding is needed to expand this approach to better support 
the antibiotics market.
                     national institutes of health
National Institute of Allergy and Infectious Diseases (NIAID)
    $6.7 billion for NIAID, including $585 million for AMR research, 
would allow NIAID to address AMR while carrying out its broader role in 
supporting infectious diseases research, including emerging infectious 
diseases, HIV, TB and influenza. Increased FY2023 funding would 
strengthen investment in the biomedical research workforce, including 
training and efforts to support early-career physician-scientists and 
promote diversity, update the National clinical trials infrastructure 
to include community hospitals and enable access for underserved 
populations.
    With regard to AMR specifically, increased funding would support 
research on antimicrobial mechanisms of resistance, therapeutics, 
vaccines and diagnostics; development of a clinical trials network to 
reduce barriers to research on emerging and difficult-to-treat 
resistant infections; and support for training more physician 
scientists and clinical investigators to improve AMR research capacity, 
as outlined in the 2020-2025 National Action Plan to Combat Antibiotic-
Resistant Bacteria.
    The COVID-19 pandemic has demonstrated the need to better prepare 
our biomedical research infrastructure to respond to emerging 
infectious diseases and future emergencies, including the need to 
strengthen and diversify the ID research workforce. High educational 
debt, low research salaries, and competing work-life demands have 
driven many promising researchers from the field. In 2021, only 70 
percent of ID physician training programs filled their slots, leaving 
us with an inadequate pipeline of ID physician-scientists necessary to 
lead clinical trials and additional research to strengthen our 
prevention and responses to ID threats. Strong NIAID support for career 
development through increased FY2023 funding and other initiatives is 
critical to improving and diversifying the pipeline of physician-
scientists committed to a career in ID. NIAID should use increased 
resources to provide additional K, T, and F awards, and Early 
Investigator Awards, as well as new opportunities for community-based 
ID physicians to participate in clinical trials and other research to 
enhance recruitment, training and diversity of the physician-scientist 
workforce.
                               conclusion
    Thank you for the opportunity to submit this statement. The 
nation's infectious diseases physicians and scientists rely on strong 
Federal partnerships to keep Americans healthy and urge you to support 
these efforts. Please forward any questions to Lisa Cox at 
[email protected].

    [This statement was submitted by Daniel P. McQuillen, MD, FIDSA, 
President, Infectious Diseases Society of America.]
                                 ______
                                 
     Prepared Statement of the Integrative Health Policy Consortium
    Thank you, Chair Murray and Ranking Member Blunt, for this 
opportunity to testify in support of programs at the Department of 
Health and Human Services under your subcommittee's jurisdiction that 
are important to the members of the Integrative Health Policy 
Consortium (IHPC) (www.ihpc.org). Specifically, IHPC is writing to 
express its support for funding the National Center for Complementary 
and Integrative Health (NCCIH), a component of the National Institutes 
of Health (NIH), and the Federally Qualified Health Centers (FQHCs) 
program within the Health Resources and Services Administration (HRSA) 
in FY 2023.
    The Integrative Health Policy Consortium (IHPC) is a broad-based 
coalition of organizations whose mission is to eliminate barriers to 
health. IHPC includes 26 organizations representing more than 650,000 
state licensed, certified and/or nationally certified healthcare 
professionals, including medical doctors, registered nurses, doctors of 
chiropractic, naturopathic doctors, licensed acupuncturists, licensed 
massage therapists, and academic, research, clinical, and public 
education organizations. IHPC has championed the Congressional 
Integrative Health & Wellness Caucus and functions to support the 
Federal agencies overseeing America's health and health research needs. 
IHPC envisions a world with no barriers to health and is focused on 
promoting a healthier world that incentivizes health creation for all 
individuals, communities, and the planet.
        national center for complementary and integrative health
    IHPC appreciates the strong support that the Chair and Ranking 
Member have given the NIH. IHPC shares your enthusiasm for the agency's 
research and research training mission and encourages the subcommittee 
to continue prioritizing NIH funding. In addition, we urge the 
subcommittee to provide the National Center for Complementary and 
Integrative Health (NCCIH) with similar, commensurate increases. With 
additional support, NCCIH could support its ongoing mission as well as 
embark fully on a new, promising research initiative, the Whole Health 
Perspective. This initiative would promote research looking at the 
interactions between systems in the body, such as connections between 
the brain and the heart, that predispose people to disease and expand 
our understanding of integrative health and pathways to improving 
health and preventing disease.
    IHPC specially wants to draw attention to the importance of 
including all the regulated integrative health systems and professions 
in whole person research. One of the major lessons of the COVID-19 
pandemic and the importance of optimal health is the need for each of 
the major systems as well as integrative protocols to be studied in 
real world environments to determine the whole person effect of regular 
care through specific approaches such as acupuncture, naturopathic 
medicine, chiropractic, homeopathy, holistic nursing, massage therapy, 
lifestyle and functional medicine approaches, direct entry midwifery, 
and traditional healing approaches from Native American and indigenous 
communities.
    IHPC also supports the Center's proposed pain management research 
agenda as outlined in the President's FY 2023 budget. According to the 
President's budget, pain ``is a major public health problem and is the 
most common reason why Americans use complementary and integrative 
health practices.'' As a result, NCCIH supports a broad pain and pain 
management research portfolio that includes basic and clinical research 
and the development, evaluation, and implementation of complementary 
and integrative pain management techniques. NCCIH is a leader of the 
NIH-DoD-VA Pain Management Collaboratory, working with other Federal 
agencies to support research on nonpharmacologic approaches to pain 
management in innovative and integrative models of pain care delivery.
    IHPC joins other organizations that belong to the Ad Hoc Group for 
Medical Research in asking the subcommittee to prioritize NIH funding 
by endorsing an appropriation of at least $49 billion for the NIH, a 
$4.1 billion increase over the NIH's program level funding in FY 2022. 
In addition, we urge the Committee to ensure that any funding for the 
new Advanced Research Project Agency for Health (ARPA-H), supplements 
the $49 billion recommendation for NIH's base budget, rather than 
supplants the essential foundational investment in the NIH. Finally, we 
urge that NCCIH receive a commensurate funding increase (7.9 percent) 
in FY 2023.
                   federally qualified health centers
    Federally Qualified Health Centers (FQHCs) are community-based 
health care providers that receive funds from the HRSA Health Center 
Program to provide primary care services in underserved areas. In 
recent years, especially with the onset of the Nation's opioid crisis, 
FQHCs have emerged as a platform for Integrative Whole Health 
innovation and for the delivery of non-pharmacologic pain management 
services. During the COVID-19 pandemic, select FQHCs have expanded 
their services to deliver pain management services to an increased 
number of uninsured and underinsured individuals. To advance and expand 
the FQHC mission, IHPC endorses the recommendation issued by the 
National Association of Community Health Centers to provide community 
health centers with $1.8 billion in discretionary funding in FY 2023.
    Thank you for considering our views. The IHPC looks forward to 
working with you to enact the FY 2023 Labor, Health and Human Services 
and Education Appropriations bill and to help ensure our priorities are 
addressed in the final version of this important funding legislation.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    [This statement was submitted by Margaret Erickson, PhD, RN, CNS, 
APRN, APHN-BD, Co-Chair, Integrative Health Policy Consortium.]
                                 ______
                                 
      Prepared Statement of the Interstitial Cystitis Association
            summary of recommendations for fiscal year 2023
_______________________________________________________________________

  --Provide $1.5 million for the IC Education and Awareness Program and 
        the IC Epidemiology Study at the Centers for Disease Control 
        and Prevention (CDC)
  --Provide $49 billion for the National Institutes of Health (NIH) and 
        Proportional Increases Across all Institutes and Centers
  --Support NIH Research on IC, including the Multidisciplinary 
        approach to the Study of Chronic Pelvic Pain (MAPP) Research 
        Network and Chronic Pain
_______________________________________________________________________

    Thank you for the opportunity to present the views of the 
Interstitial Cystitis Association (ICA) regarding interstitial cystitis 
(IC) public awareness and research. ICA was founded in 1984 and is the 
only nonprofit organization dedicated to improving the lives of those 
affected by IC. The Association provides an important avenue for 
advocacy, research, and education. Since its founding, ICA has acted as 
a voice for those living with IC, enabling support groups and 
empowering patients. ICA advocates for the expansion of the IC 
knowledge-base and the development of new treatments. ICA also works to 
educate patients, healthcare providers, and the public at large about 
IC.
    IC is a condition that consists of recurring pelvic pain, pressure, 
or discomfort in the bladder and pelvic region. It is often associated 
with urinary frequency and urgency. This condition may also be referred 
to as painful bladder syndrome (PBS), bladder pain syndrome (BPS), and 
chronic pelvic pain (CPP). It is estimated that as many as 12 million 
Americans have IC symptoms. Approximately two-thirds of these patients 
are women, though this condition does severely impact the lives of as 
many as 4 million men. IC has been seen in children and many adults 
with IC report having experienced urinary problems during childhood. 
However, little is known about IC in children, and information on 
statistics, diagnostic tools and treatments specific to children with 
IC is limited.
    The exact cause of IC is unknown and there are few treatment 
options available. There is no diagnostic test for IC and diagnosis is 
made only after excluding other urinary/bladder conditions. It is not 
uncommon for patients to experience one or more years delay between the 
onset of symptoms and a diagnosis of IC. This is exacerbated when 
healthcare providers are not properly educated about IC.
    The effects of IC are pervasive and insidious, damaging work life, 
psychological well-being, personal relationships, and general health. 
The impact of IC on quality of life is equally as severe as rheumatoid 
arthritis and end-stage renal disease. Health-related quality of life 
in women with IC is worse than in women with endometriosis, vulvodynia, 
and overactive bladder. IC patients have significantly more sleep 
dysfunction, and higher rates of depression, anxiety, and sexual 
dysfunction.
    Some studies suggest that certain conditions occur more commonly in 
people with IC than in the general population. These conditions include 
allergies, irritable bowel syndrome, endometriosis, vulvodynia, 
fibromyalgia, and migraine headaches. Chronic fatigue syndrome, pelvic 
floor dysfunction, and Sjogren's syndrome have also been reported.
             ic public awareness and education through cdc
ICA recommends a specific appropriation of $1.5 million in fiscal year 
        2023 (FY 2023) for the CDC IC Program. This will allow CDC to 
        fund the Education and Awareness Program, per ongoing 
        congressional intent, as well as the IC Epidemiology Study.
    CDC had shifted the focus of the IC program to an epidemiology 
study and away from education and awareness, but thanks to the 
subcommittee the ICA and IC community have been able to open 
discussions with CDC to ensure a renewed focus on education and 
awareness activities. The IC community had been concerned that focusing 
solely on an epidemiology study instead of on education and awareness 
activities was detrimental to patients and their families. We have 
recently met with CDC thanks to the actions of this subcommittee where 
we openly and effectively communicated the need for CDC to include ICA 
in any collaboration along with the epidemiology study. We know that 
CDC has not received as generous increases as NIH over the past few 
fiscal years, but it is important the CDC continue supporting both 
critical components of the IC Program. The CDC IC Education and 
Awareness Program is the only Federal program dedicated to improving 
public and provider awareness of this devastating disease, reducing the 
time to diagnosis for patients, and disseminating information on pain 
management and IC treatment options. ICA urges Congress to provide 
funding for IC education and awareness in FY 2023.
    The IC Education and Awareness program has utilized opportunities 
with charitable organizations to leverage funds and maximize public 
outreach. Such outreach includes public service announcements in major 
markets and the internet, as well as a billboard campaign along major 
highways across the country. The IC program has also made information 
on IC available to patients and the public though videos, booklets, 
publications, presentations, educational kits, websites, self-
management tools, webinars, blogs, and social media communities such as 
Facebook, YouTube, and Instagram For healthcare providers, this program 
has included the development of a continuing medical education module, 
targeted mailings, and exhibits at national medical conferences.
    The CDC IC Education and Awareness Program also provided patient 
support that empowers patients to self-advocate for their care. Many 
physicians are hesitant to treat IC patients because of the time it 
takes to treat the condition and the lack of answers available. 
Further, IC patients may try numerous potential therapies, including 
alternative and complementary medicine, before finding an approach that 
works for them. For this reason, it is especially critical for the IC 
program to provide patients with information about what they can do to 
manage this painful condition and lead a normal life. With the recent 
developments in our conversations with the CDC we are confident that we 
will continue to provide key education and awareness that will continue 
to benefit the IC community.
         ic research through the national institutes of health
ICA recommends a funding level of $49 billion for NIH in FY 2023. ICA 
        also recommends continued support for IC research including the 
        MAPP Study administered by NIDDK.
    The National Institutes of Health (NIH) maintains a robust research 
portfolio on IC with the National Institute of Diabetes and Digestive 
and Kidney Diseases (NIDDK) serving as the primary Institute for IC 
research. The NIDDK Multidisciplinary Approach to the Study of Chronic 
Pelvic Pain (MAPP) Research Network has continued to include cross-
cutting researchers who are currently identifying different phenotypes 
of the disease. Phenotype information will allow physicians to 
prescribe treatments with more specificity. Research on chronic pain 
that is significant to the community is also supported by the National 
Institute of Neurological Disorders and Stroke (NINDS) as well as the 
National Center for Complementary and Integrative Health (NCCIH). The 
vast majority of IC patients often suffer major and multiple quality of 
life issues due to this condition. Many IC patients are unable to work 
full time because pain affects their mobility, sleep, cognition, and 
mood. These are people that simply want to lead productive lives, and 
need pain medication to do so. Due to the fact that IC is categorized 
as a non-cancer pain condition, IC patients already have a difficult 
time obtaining pain meds. IC doctors do not have time nor the 
inclination to effectively prescribe or monitor the distribution of the 
opioid class of medication. They often refer their patients to Pain 
Management Specialists, many who have never heard of IC, who often 
refuse to treat them. In addition, antidepressants and benzodiazepines 
are often used to treat both mood and sleeping disorders for IC 
patients. Additionally, the NIH investigator-initiated research 
portfolio continues to be an important mechanism for IC researchers to 
create new avenues for interdisciplinary research.
Patient Perspective
    IC is a tough disease to diagnose, and it is one of the most 
challenging things to deal with, finding a doctor that specializes in 
IC that can help diagnose and treat. I can't stress enough how 
important finding the right doctor is. IC patients need a doctor who 
understands and is willing to go along with them on this long, 
frustrating, painful and confusing road. I have found strength through 
having this that I never knew I had, strength to keep going when all 
treatments so far have failed me.
    There are a small number of treatments available for managing IC 
symptoms, but they only work on a small percentage of patients. I have 
tried those treatments and some drugs that ``might'' help. I manage my 
diet, take lots of supplements and have to see all kinds of doctors 
now. I have six! That includes holistic medicine doctors, physical 
therapists, and acupuncturist. That's along with my regular MD, 
urologist and two different gynecologists. This is what my life has 
become. The life of an IC patient. I deal with one or more symptoms of 
IC EVERY SINGLE DAY. Some days definitely better than others, but every 
single day. It affects my life in so many ways. Work, social, travel 
and my intimate relationships. I never know how I'm going to feel from 
one day to the next. Anxiety and fear included.
    Thank you for the opportunity to present the views of the 
interstitial cystitis community.

    [This statement was submitted by Lee Lowery, Executive Director, 
Interstitial Cystitis Association.]
                                 ______
                                 
          Prepared Statement of the Jamestown S'Klallam Tribe
    Chairwoman Patty Murray, Ranking Member Roy Blunt, and 
distinguished members of this subcommittee, on behalf of the Jamestown 
S'Klallam Tribe, I would like to thank you for this opportunity to 
submit written testimony on our funding priorities and recommendations 
for the FY 2023 appropriations process for the Department of Health and 
Human Services.
A. Tribal Specific Health Appropriation Priorities
    1. Support the President's FY 2023 Budget Request for Tribal Health 
Programs and Mandatory Funding for the Indian Health Service (IHS)
    2. 340(b) Drug Pricing Program
    3. Ensure that Medicare Reimburses Tribal Providers for Telehealth 
Services at the IHS All-Inclusive Rate or OMB rate
B. Tribal Priorities Administration for Children and Families & the 
        Administration for Community Living
    1. Child Welfare Programs Tribal Allocations Subpart 1, $350 
million; Subpart 2, $120 million $3.6 million Tribal Set Aside
    2. Promoting Safe and Stable Families $650 million for mandatory 
programs and $120 million for discretionary programs
    3. Fund Long Term Care
    4. Older American act Title VI, part A,B Native American Nutrition 
and Supportive Services- $55.5 million Title VI, $43 Million Nutrition 
and Support Services.
          a. tribal specific health appropriations priorities
    1. Support the President's FY 2023 Budget Request for Tribal Health 
Programs and Mandatory Funding for the Indian Health Service (IHS).--
The President requested $127.3 billion in discretionary funding and 
$1.7 trillion in mandatory funding for the Department of Health and 
Human Services in FY 2023 Appropriations. This is inclusive of $9.3 
billion for the Indian Health Service. The request also seeks to 
reclassify the entire IHS budget as mandatory for FY 2023. We fully 
support the President's historical request and commitment to 
implementing long term solutions to addressing the chronic underfunding 
of Tribal health programs and delivering on the Nation's promises to 
Indian Country. To include the proposal to reclassify IHS funding and 
exempt the IHS budget from sequestration. We urge Congress to follow 
suit and adopt the President's FY 2023 budget proposal.
    2. 340(b) Drug Pricing Program.--The 340(b) program serves as a 
critical safety net drug discount program that Tribal communities rely 
on to serve their citizens and community members who comprise the most 
vulnerable, underserved and isolated populations. The program has grown 
tremendously bringing down the cost of prescription drugs by 25-50 
percent. However, the actions of several drug manufacturers have 
undermined Congressional intent and the 340(b) program resulting in 
limitations on access to discounted prescription drugs. In 2021, HRSA 
issued violation letters to manufactueres who refused to comply with 
statutory obligations unless certain conditions were met. However, 
despite HRSA acting swiftly to address this issue, the manufacturers 
refused to come into compliance with the law. We urge Congress to take 
steps to ensure drug manufacturers are compliant with the law.
    3. Ensure that Medicare Reimburses Tribal Providers for Telehealth 
Services at the IHS All.--Inclusive Rate or OMB Rate--Tribal healthcare 
systems are under unprecedented strain in the aftermath of the public 
health crisis and resulting economic crisis. The financial toll has led 
to reductions in the availability of healthcare services. During the 
public health crisis, many hospitals and clincs turned to telemedicine 
as a necessary tool for the provision of healthcare. In early 2020, the 
Centers for Medicare and Medicaid Services (CMS) waived many of the 
telehealth restrictions on providers, technology, geographic areas and 
services. As a result, use of telehealth visits increased substantially 
in the Indian Healthcare System. The telehealth flexibilities that were 
authorized by CMS increased access to primary, speciality and 
behavioral healthcare services during the pandemic and should be made 
permanent. However, while IHS and Tribal sites receive the IHS All-
Inclusive Rate for telehealth services under Medicaid, Medicare is 
currently only reimbursing at the Part B rate which is only about $14 
dollars per unit of care. Medicare should reimburse at the full 
encounter rate to ensure providers can continue to utilize telehealth 
as a viable option for services.
   b. tribal priorities administration for children and families and 
                  administration for community living
    1. Child Welfare Programs Title IV B (subpart 1)--Tribal Allocation 
$350 Million & Promoting Safe and Stable Families Social Security Act 
Title IV B (subpart 2) $120 Million Tribal Allocation $3.6 Million.--
The pandemic amplified the existing disparities that Native children 
and families experience in child welfare systems. Limited access to 
supportive and rehabilitative services created an environment of 
enhanced risk for removal of Native children from their homes. Foster 
care is a reality that too many Native families face. Substance abuse, 
mental health challenges, economic instability, financial insecurity, 
and limited access to services continue to threaten the well-being of 
Native families, especially Native children. Tribes need the tools and 
resources to develop culturally based child centered trauma-informed 
care solutions including trained child therapists. Title IV B provides 
funding to Tribes to support community-based child welfare services. 
Tribal tradition and culture are an integral component of our child 
welfare programs because it has been proven that culturally tailored 
programs and services increase community participation and lead to 
better outcomes for American Indian and Alaska Native (AI/AN) children 
and families. Increased funding coupled with maximum flexibility to use 
these funds to provide ancillary child welfare services, including, 
parenting classes, conducting home visits, and addressing issues, such 
as, alcohol and substance abuse is essential so that AI/AN children can 
remain with their families and in their Tribal communities.
    2. Promoting Safe and Stable Families $650 million for mandatory 
programs and $120 million for discretionary programs.--Increase funding 
for the Promoting Safe and Stable Families program so that more Tribes 
are able to access this critical funding. Addressing trauma, promoting 
stronger families, and reducing the rates of foster care placements are 
all important components of this program. We appreciate the 
Administration's FY 2023 request for increased mandatory funding to 
support this program. We recommend that the programmatic increases 
include $650 million for mandatory programs and $120 million for 
discretionary programs.
    3. Fund Long Term Care.--Tribes are committed to ensuring that 
elders receive the respect, resources and care that they deserve; 
however, funding for elder programs is woefully inadequate to meet 
existing and future needs. Finding facilities to house our elders is a 
growing issue because many are cost prohibitive for both the elders and 
Tribal governments. Tribes want to keep elders on their homelands and 
in their homes so that they are close to their families and 
communities. Staying connected to their families, Tribal communities 
and cultures supports quality of life. In order to accomplish this we 
need resources to support assisted living, long term care, home and 
community based services and end of life hospice care. The Indian 
Healthcare Improvement Act (IHCIA) grants the Indian Health Service 
authorities for the provision of long term care but funding needs to be 
appropriated to provide these services.
    4. Older Americans Act Title VI, Part A, B Native American 
Nutrition and Supportive Services--$55.5 million Title VI, $43 Million 
Nutrition and Support Services.--Providing support services to our 
elders is deeply rooted in our beliefs and ensures the survival of our 
culture, traditions, and language. Title VI of the Older Americans Act 
is the primary funding source for the provision of nutrition, 
healthcare, and other holistic community-based cultural programs and 
supportive services. However, funding for elder programs is woefully 
inadequate to meet existing and growing needs. The Indian Healthcare 
Improvement Act (IHCIA) authorized the Secretary of HHS to fund these 
services but, to date, no funding has been appropriated for these 
services.
    The Jamestown S'Klallam Tribe continues to support the requests and 
recommendations of the Northwest Portland Area Indian Health Board, the 
National Indian Health Board, and the National Congress of American 
Indians. Thank you.

    [This statement was submitted by Hon. W. Ron Allen, Tribal 
Chairman/CEO, Jamestown S'Klallam Tribe.]
                                 ______
                                 
                Prepared Statement of Johnson & Johnson
    On behalf of Johnson & Johnson's 144,000 global employees, I am 
pleased to provide written testimony to the Senate Appropriations 
subcommittee on Labor, Health and Human Services, Education and Related 
Agencies in support of increased funding for the National Institutes of 
Health (NIH) Fiscal Year (FY) 2023 budget.
    Robust funding for NIH is necessary to ensure the agency continues 
to have the ability to fuel innovation in medical research, improving 
the trajectory of healthcare in the United States and around the world. 
NIH funding also encourages the pursuit of innovative solutions 
essential in addressing the increasingly complex health threats 
confronting the United States.
    As a physician and scientist, I have dedicated much of my life to 
translating basic scientific research into medical advances. In my role 
as Executive Vice President, Chief External Innovation, Medical Safety 
and Global Public Health Officer at Johnson & Johnson and as a board 
member of the American Association for Cancer Research, I am deeply 
aware of the value of our Nation's investment in research.
    In the United States, the majority of medical research into the 
root causes of disease is publicly funded by the NIH through research 
grants to more than 2,500 institutions across the country. The 
foundational research conducted by NIH-funded investigators plays an 
important complementary role to private sector research and development 
efforts. Specifically, healthcare companies build upon this 
foundational research, and make substantial investments in R&D to 
transform this foundational research into the breakthrough healthcare 
products of tomorrow.
    At Johnson & Johnson, we make a commitment to create life-enhancing 
innovations and to produce value through partnerships that will 
profoundly change the trajectory of health for humanity. To that end, 
in 2021, Johnson & Johnson invested nearly $14.7 billion in research 
and development across our pharmaceutical, consumer, and medical 
technology companies. Our teams of scientists work tirelessly to 
accelerate the translation of scientific discoveries into meaningful 
solutions for patients and consumers. Much of our work, and that of 
scientists across the industry, is facilitated by our understanding of 
underlying disease biology--precisely the type of research funded by 
the NIH.
    In addition, Johnson & Johnson recognizes the crucial importance of 
early-stage companies, and the critical role NIH plays in supporting 
these small businesses through Small Business Innovation Research 
(SBIR) and Small Business Technology Transfer (STTR) funding. Through 
Johnson & Johnson Innovation, entrepreneurs and startups can discuss 
the innovative ideas they're working on, seek to collaborate with 
Johnson & Johnson scientists, and access our global expertise and 
resources to accelerate their work. Through Johnson & Johnson 
Innovation--Johnson & Johnson Development Corporation, they may obtain 
venture capital funding to support their innovations. At Johnson & 
Johnson Innovation--JLABS incubator sites--including a new JLABS @ 
Washington DC site in collaboration with Children's National and 
BARDA--we support the life sciences ecosystem by helping entrepreneurs 
and scientists realize their dreams of creating healthcare solutions 
that improve lives. Their potentially disruptive, cutting-edge research 
may lead to novel platforms, products or technologies--advances that 
the scientific community could only imagine several years ago and that 
are becoming a reality today through the support of public-private 
partnerships like these.
    The work of the NIH is tied not only to innovation and the vitality 
of the life sciences, but also to the health of our National economy 
and to the health of our Nation. In FY 2021, NIH research funding 
directly and indirectly supported over 552,444 jobs and spurred nearly 
$94.18 billion in new economic activity. Moreover, diseases such as 
Alzheimer's, diabetes, cancer, and heart disease as well as current and 
future pandemics, threaten the lives of millions of our citizens and 
threaten to overwhelm our healthcare system in a matter of years, with 
enormous costs of care if we do not find ways to prevent, intercept, 
treat, and cure them. We must also continue to address public health 
crises and areas of pipeline need such as emerging infectious diseases 
and antimicrobial resistance. The pace of medical research must keep up 
with these challenges, and it is the NIH that must fuel that research.
    Investments in medical research over the last several decades by 
the Federal Government and private life sciences companies, combined 
with the work of industry and NIH-funded investigators across the 
country, have produced fundamental scientific advances and increasingly 
sophisticated areas of scientific inquiry. As the NIH is working on 
projects in areas like precision medicine, gene therapy, and vaccines 
to prevent infectious diseases, there has never been a more critical 
and promising time to work in medical research, nor a more critical 
time to fund the NIH.
    Johnson & Johnson believes that fully and consistently funding the 
NIH is critical to a commitment to fueling innovation in medical 
research. It is also a commitment to our communities by advancing 
science to match medical need, to our current and future generations of 
scientists by stimulating the life sciences ecosystem, and to the 
prosperity of our Nation as a worldwide leader in medical research. 
Sustainable, robust investment is needed to strengthen this research 
and to realize its benefits for improving people's lives and reducing 
the burden and associated costs of disease in the United States and 
around the world.

    [This statement was submitted by William N. Hait, MD, PhD, 
Executive Vice President, Chief External Innovation, Medical Safety and 
Global Public.]
                                 ______
                                 
                Prepared Statement of Knowledge Alliance
    Knowledge Alliance (KA), a non-partisan, non-profit organization, 
is comprised of leading education organizations committed since 1971 to 
the greater use of high-quality and relevant data, research, evaluation 
and innovation in education policy and practice at all levels. 
Collectively, we have spent the last 50 years supporting a set of 
education programs focused on building and disseminating evidence to 
improve teaching and learning in our Nation's classrooms.
    Knowledge Alliance believes that programs at the Institute of 
Education Sciences (IES)--such as the Regional Educational Laboratories 
(RELs) and the Research, Development, and Dissemination (RD&D) 
program--coupled with the Comprehensive Centers (CCs) and the Education 
Innovation and Research (EIR) program at the U.S. Department of 
Education (ED) are the foundation of the Nation's research, 
dissemination and technical assistance infrastructure. We deeply 
appreciate the increases in funding provided in Fiscal Year (FY) 22 for 
these critical programs to better tie evidence to practice in our 
schools and improve outcomes for students. Moreover, we know these 
funds will be critical in supporting schools as districts utilize 
evidence-based practices in their responses to COVID-19 learning loss 
and the other additional educational challenges posed by this 
transitional year, especially for student populations who have been 
historically underserved and were significantly impacted by the 
pandemic. We encourage Congress to continue to provide increases in 
each of these programs for FY23 to continue leveraging critical 
research, technical assistance, evaluation and innovation to help 
States, districts and schools.
    KA priority programs require additional Federal resources to 
address the continuously growing State and local needs for education 
research and technical assistance, as these programs provide critical 
support for States, districts and schools. In response to challenges 
from COVID-19, REL West and Comprehensive Center Regions 2, 13 and 15 
provided 8 workshops to approximately 570 state, regional, district and 
school staff on selecting and measuring evidence-based strategies using 
American Rescue Plan (ARP) funds. The primary focus of each event was 
to help State educational agencies (SEAs) develop strategies to support 
local educational agencies (LEAs) in using their ARP funds to address 
high-priority needs and select evidenced-based strategies. More 
recently, the National Comprehensive Center established three 
Communities of Practice (COP) to support SEAs and their partners in 
three areas: (1) Using ARP funds to implement evidence-based 
strategies; (2) Implementing school improvement strategies through an 
equity lens; and (3) Planning for summer/extended learning drawing from 
evidence-based practices where they exist. With recognition that States 
and districts can, and should, work together to solve common 
challenges, the National Comprehensive Center provides a unique space 
for SEAs and LEAs to learn from each other as they engage around 
specific problems of practice. In the COP around school improvement, 
SEA and LEA leaders have already reported how bringing together school 
leaders, teachers and districts in their community, through an equity 
lens, is inspiring new, innovative, approaches to help low-performing 
schools. Clearly, both RELs and CCs have been first in line to provide 
technical assistance and evidence-based resources to interested SEAs 
and LEAs. An increase in funding would allow these programs to expand 
their work and better meet the ever-growing need for support.
    Despite the evident need for education research, dissemination and 
technical assistance infrastructure, evidence shows that this work 
remains underfunded. Three recently released reports by the National 
Academies of Sciences, Engineering and Medicine (NASEM) noted that IES 
is currently overburdened and underfunded, preventing efficient grant 
review cycles, adequate staffing levels and innovation within the 
agency. In the NASEM report titled ``The Future of Education Research 
at IES,'' there was consensus that ``Congress should re-examine the IES 
budget, which does not appear to be on par with that of other 
scientific funding agencies.'' The report notes that education research 
programs at the National Science Foundation (NSF) and National 
Institutes of Health (NIH) receive substantially more funds than IES 
despite working with similar constituents on comparable issues. 
Moreover, as the hub of all Federal education research work, IES is 
best situated to effectively create and disseminate evidence-based 
resources to the field. It is evident that KA's priority programs 
require increases in FY23 to better meet the needs of States, 
districts, and schools nationwide.
    To support continued education research, evaluation and innovation 
outlined above, we urge you to provide increases over FY22 levels in 
FY23 for existing Federal research and development infrastructure. KA 
proposes a critical investment of $815.0 million for the Institute of 
Education Sciences (IES); $267.9 million for the Research Development 
and Dissemination (RD&D) program at IES; $65.0 million for the Regional 
Educational Laboratories (RELs) Program; $60.0 million for the 
Comprehensive Centers (CCs); and $514.0 million for the Education 
Innovation and Research (EIR) program
    This request translates to approximately a 10 percent increase for 
IES, RELs and CCs. We have requested an approximately 30 percent 
increase for RD&D to account for how, as the hub of general education 
research, it will be relied heavily upon to support research post-
COVID. Finally, KA's EIR request matches the President's FY23 budget, 
which recognizes the importance of education research innovation and 
proposes a significant investment in addressing the educator shortage, 
an issue KA members are actively working on.
    The below section provides greater detail on the request for each 
of the programs outlined above. Thank you for your consideration of 
these important recommendations. We believe that continued strong 
support for, and investment in, the education research and development 
infrastructure will help improve outcomes for students and effectively 
leverage scarce Federal resources. Furthermore, it will empower States 
and local school districts to develop and implement the innovative, 
evidence-based approaches that work best for the students in their 
communities.
                        fy23 appropriations asks
    The Institute of Education Sciences. IES is a major source of 
Federal funding for education research. Through its four research 
centers- the National Center for Education Research (NCER), National 
Center for Education Statistics (NCES), National Center for Education 
Evaluation and Regional Assistance (NCEE) and the National Center for 
Special Education Research (NCSER) -IES funds hundreds of grants and 
contracts annually that support a wide range of research projects. 
These centers support projects that provide vital information, often 
with an equity focus, on students with disabilities, teacher 
preparation and strategies for improving college and workforce 
readiness, among other topics. In the past year, IES has successfully 
pivoted its efforts to consider projects in the larger context of the 
COVID-19 pandemic and recovery.
    The What Works Clearinghouse produces reviews of research on 
education curriculum and practice guides with evidence-based 
recommendations to support teaching and learning. According to the 
Jefferson Education Exchange, nearly a third of educators surveyed used 
resources from the What Works Clearinghouse. In direct response to the 
COVID-19 pandemic, the What Works Clearinghouse released a Rapid 
Evidence Review of Distance Learning Programs that identifies and 
reports on what works in distance learning educational programming from 
Kindergarten onwards. Additionally, the WWC provides educational 
webinars to better disseminate research in the field, most recently 
they held a webinar on providing reading interventions for students in 
grades 4-9.
    Additional basic research could be done in areas of importance to 
educators and policymakers if more funding were available, particularly 
in the areas of postsecondary completion and workplace credentials. As 
basic research moves into the applied realm, the What Works 
Clearinghouse will continue to serve as a resource for educators 
looking for effective, research-based interventions.
    Regional Educational Laboratories. The 10 RELs nationwide, which 
operate under 5-year contracts with ED, conduct applied research, 
develop and disseminate research-based products and provide training to 
States and school district staff as well as resources for educators, 
families and caregivers. Since the RELs have a broad set of regional 
stakeholders that extend beyond the SEA, they are well-attuned to a 
wider range of student and teacher needs. In addition to forming 
research partnerships focused on problems of practice in the field that 
provide relevant and responsive research and findings that address 
local needs; RELs utilize the resources of the WWC, such as the 
practice guides, to break down the evidence into digestible chunks for 
educator use. They have also developed webinars and other resources 
based on the practice guides to aide in translating research for 
educators. RELs are continuously developing tools that districts and 
schools use to improve teaching and learning. In response to the 
pandemic, RELs have provided evidence-based resources to help address a 
host of critical challenges facing States, districts, educators and 
families as they continue to navigate the impacts of COVID-19.
    Education leaders in Michigan partnered with REL Midwest to develop 
the Midwest Alliance to Improve Teacher Preparation (MAITP). From 2017 
to 2021, MAITP conducted research with education leaders, 
practitioners, policymakers and researchers in Michigan, Illinois and 
Indiana to address teacher recruitment and retention.
    To increase the number of teachers available to Michigan public 
schools, MAITP members wanted to explore the validity of recruiting 
nonteaching certified teachers. In 2021, REL Midwest published a study 
that examined why some certified teachers no longer teach in Michigan 
public schools. The study found approximately 61,000 teachers certified 
in Michigan were not teaching in the State's public schools in 2017-18. 
The study also identified increased salary and simplification of 
certification requirements as desired incentives for teachers to 
consider returning to the classroom. REL Midwest created a companion 
infographic and documentary to communicate the study findings. The 
Michigan Department of Education drew on the findings and launched the 
``Welcome Back Proud Michigan Educator Campaign,'' an initiative that 
seeks to recruit individuals with expired teacher certificates into the 
teacher workforce by reducing-and in some cases, eliminating-
professional learning requirements for recertification.
    Education Innovation and Research. The EIR Program, authorized by 
Every Student Succeeds Act (ESSA), helps drive substantial and lasting 
improvements in student achievement by supporting the development and 
scale-up of successful innovations at the State and local levels. EIR 
uses a tiered evidence approach that has two important design 
principles: it provides more funds to programs with higher levels of 
evidence, and it requires rigorous and independent evaluations so that 
programs continue to improve, and future competitions can be geared 
towards more promising areas of investment.
    KA supports the Administration's FY23 EIR proposal which recommends 
a historic, and needed, increase in funding for the program. EIR would 
allow for the creation of more innovative evidence-based resources to 
address the myriad of educational challenges facing the Nation. Of this 
historic increase, $350 million would target projects that identify and 
scale up evidence-based strategies to elevate and strengthen a teacher 
workforce hit hard by COVID-19. Given the educator workforce shortage, 
KA supports the use of these funds to support efforts to stabilize the 
profession through improved support for educators and expanded 
professional growth opportunities, including access to leadership 
opportunities that can lead to increased pay and improved retention for 
fully certified, experienced, and effective teachers.
    Future Forward is a literacy intervention for students struggling 
with reading from kindergarten through third grade that combines 
intensive one-on-one tutoring during the school day with family 
engagement support embedded in all aspects of the program. Ongoing 
support from the U.S. Department of Education through the Education 
Innovation and Research (EIR) grant program has allowed Future Forward 
to rigorously evaluate their program with randomized controlled trials 
and multi-site regression discontinuity analysis. The external 
evaluation found the program yielded positive, statistically 
significant impacts on reading achievement, literacy, and regular 
school attendance. The EIR program has enabled Future Forward to 
subsequently sustain, replicate and scale those practices. In December 
of 2021, Future Forward was awarded an expansion-phase EIR grant and 
will work over the next 5 years to expand to several dozen new schools 
in rural communities across the country; prepare schools to take full 
ownership over long-term program implementation to ensure 
sustainability; and rebuild the online program management platform to 
become a first of its kind integrated reporting system for supplemental 
education programs. Future Forward was the recipient of a mid-phase EIR 
grant in 2017 (the program was known as ``SPARK'') as well as an 
Investing in Education (i3) grant in 2010.
    Comprehensive Centers. The Comprehensive Centers (CCs) provide 
technical assistance that builds the capacity of SEAs to help districts 
and schools improve educational outcomes for all students, close 
achievement gaps and increase the quality of instruction. The CCs 
include 19 Regional Centers that work closely with States in their 
regions on implementation of critical reforms in elementary and 
secondary education, as well as one national center providing technical 
assistance to the regional centers and SEAs. The CCs operate under a 
Memorandum of Understanding with each SEA in the region, and the SEA 
sets the scope of work to be conducted through the 5-year agreement.
    In 2021, the National Comprehensive Center and national partners 
launched the Summer Learning & Enrichment Collaborative (``the 
Collaborative'') to support States, school districts and community 
partners in using ARP funds to implement and expand evidence-based 
summer learning and enrichment experiences for students, especially 
those most impacted by the pandemic. Throughout the summer of 2021, the 
Collaborative invited States, school districts, community partners, and 
other stakeholders to participate in a series of eight virtual learning 
opportunities to discuss and share promising practices in planning and 
implementing summer experiences for all students and student groups.
    The Collaborative hosted over 50 topical sessions for over 1,300 
participants across 49 States. Sessions addressed a wide range of 
topics from staff recruitment to student attendance, STEM partnerships, 
developing community-school agreements and many more.
                                 ______
                                 
       Prepared Statement of the Learning and Education Academic 
                            Research Network
    We are writing on behalf of the LEARN Coalition to express our 
support for increased funding for several key education research 
programs that the LHHS subcommittee will debate as part of the Fiscal 
Year (FY) 2023 appropriations process. LEARN, a coalition of 41 leading 
research colleges of education across the country, supports critical 
investments in research aimed at advancing the scientific understanding 
of learning and development. We advocate for greater funding for these 
priorities across all Federal agencies, including the Institute of 
Education Sciences (IES), the National Institute of Child Health and 
Human Development (NICHD), and the National Institute of Mental Health 
(NIMH). Specifically, LEARN is requesting no less than $815 million for 
IES overall with $225 million dedicated to the Research, Development 
and Dissemination (RD&D) line item and $70 million for the National 
Center for Special Education Research (NCSER). Within the National 
Institutes of Health (NIH), LEARN requests that $2.02 billion go 
towards NICHD and $2.57 billion go towards NIMH. While advocating for 
these increased resources for fiscal year 2023, we want to express our 
appreciation for the increases for IES and NIH that were made in fiscal 
year 2022.
                    institute of education sciences
    As the primary Federal agency charged with supporting research for 
education practice and policy, IES is essential to developing a 
comprehensive, reliable, evidence base and ensuring that teaching and 
learning practices are grounded in this evidence base. While 12-15 
percent of NCER and NCSER's grant awards have been funded over the last 
several years, the number of grant competitions offered by IES are 
currently severely limited due to chronic understaffing within the 
agency. Furthermore, NCSER was unable to fund all the grant 
applications rated outstanding or excellent in fiscal year 2021 due to 
a lack of sufficient funds. Such evidence displays how IES is currently 
too understaffed and underfunded to support the Nation's education 
infrastructure to its best potential.
    Education research provides the bedrock of knowledge used by our 
principals, teachers, counselors and professors to help preK-12 
students and those seeking a postsecondary education succeed. The 
increases provided to IES will support the continued examination of 
what works and what does not work to further our education system's 
curricula, instructional techniques and assessments. This additional 
funding will bolster IES' work in relation to education research 
overall as well as provide support as the Nation works towards COVID-19 
recovery. Given the importance of developing reliable evidence during 
this critical time, LEARN is requesting $815 million for IES overall 
and $225 million for the RD&D line item within IES.
    In addition, we recommend that funding for research in special 
education, through NCSER, be increased to $70 million. NCSER is the 
only Federal agency specifically designated to develop and provide 
evaluations for programs for students with disabilities, but currently 
has a budget that has remained relatively flat since FY2014. Research 
funded by NCSER provides special educators and administrators evidence-
based resources that improve academic outcomes for children with or at 
risk of disabilities. Special education students were dramatically 
impacted by the change in schooling due to COVID-19; additional funding 
to NCSER is necessary to support data and evidence-based resources that 
will ensure a strong recovery for these students.
    Of note, prominent experts have expressed concern over the 
relatively small amount of funding being provided to IES compared to 
other Federal research agencies. In a 2022 National Academy of 
Sciences, Engineering and Medicine (NASEM) report titled ``The Future 
of Education Research at IES,'' a diverse panel of 17 experts in the 
field came to consensus that Congress should re-examine the IES budget 
as it is currently severely underfunded despite the continuously 
expanding work of IES. After hours of research and discussion, the 
panel recognized that IES funding ``does not appear to be on par with 
that of other scientific funding agencies,'' such as NIH or NSF, 
despite being charged to lead the Nation's education research agenda, 
collect and evaluate education research and disseminate evidence-based 
resources to classrooms nationwide. In alignment with this trusted 
outside evaluation, LEARN urges Congress to provide much needed fiscal 
support to IES by appropriating no less than $815 million to the agency 
overall, $225 million to the RD&D line time and $70 million to NCSER.
                     national institutes of health
    There are critical education research programs within the NIH that 
also need additional support. NICHD is essential to education research 
as it examines brain functions and the impact of different educational 
services on learning and development. LEARN supports an increase in 
NICHD funding to $2.02 billion. This increase will ensure that 
researchers can build on the knowledge already gained, evaluate what 
works best in treating developmental disorders and develop new 
research-based strategies to improve student's learning and 
development. Additionally, it will support NICHD's efforts to 
understand the long-term effects of COVID-19 on key at-risk 
populations, including the cognitive development of children and 
adolescents.
    LEARN also supports an increase in funding for NIMH to $2.57 
billion. This increase will help further understanding of the 
behavioral, biological and environmental mechanisms necessary for 
developing interventions to reduce the burden of mental and behavioral 
disorders and optimize learning and development. At a time when the 
mental health impact to children and adolescents remains dire following 
the COVID-19 pandemic, this research is needed more now than ever.
    The LEARN Coalition believes that collectively these key 
investments in education research will drive improvements in school, 
teacher and student performance in the coming years, strengthen the 
Nation's education infrastructure and ensure a strong, educated 
workforce in the long run. Thank you for considering these requests and 
please contact Alex Nock at [email protected] with any questions, 
comments or concerns.

    Sincerely,

    Camilla P. Benbow, Ed.D., Co-Chair, Learning and Education Academic 
Research Network (LEARN)
Patricia and Rodes Hart Dean of Education and Human Development of the 
Peabody College of Education and Human Development, Vanderbilt 
University

    Rick Ginsberg, Ph.D., Co-Chair, Learning and Education Academic 
Research 
Network (LEARN), Dean of the School of Education, University of Kansas

    Glenn E. Good, Ph.D., Co-Chair, Learning and Education Academic 
Research 
Network (LEARN), Dean of the College of Education, University of 
Florida
                                 ______
                                 
  Prepared Statement of the Low Income Home Energy Assistance Program
    The Low Income Home Energy Assistance Program authorized by 42 
U.S.C. Sec. Sec. 8621 et seq. (LIHEAP) is the cornerstone of government 
efforts to help needy seniors and families stay warm and avoid 
hypothermia in the winter, as well as stay cool and avoid heat stress 
(even death) in the summer. LIHEAP is an important safety net program 
for low-income unemployed and underemployed families struggling in this 
economy. LIHEAP helped approximately 6 million households afford their 
energy bills in FY 2019.\1\ This crucial safety net program protects 
the health and well-being of low-income seniors, consumers with 
disabilities, and families with very young children., We respectfully 
request that LIHEAP be funded at no less than $5.1 billion \2\ for FY 
2023 and an additional $500 million in emergency contingency 
funding.\3\
---------------------------------------------------------------------------
    \1\ Testimony of the National Energy Assistance Directors' 
Association, House subcommittee on Labor, Health and Human Services and 
Education and Related Agencies (April 8, 2019).
    \2\ 42 U.S.C. Sec. 8621(b).
    \3\ 42 U.S.C. Sec. 8621(e).
---------------------------------------------------------------------------
The Urgent Need for Adequate LIHEAP Appropriations
    Funding LIHEAP at no less than $5.1 billion for the regular program 
in FY 2023 and an additional $500 million in emergency contingency 
funding is imperative to address the record increases in energy prices 
\4\ coupled with the record increases in the cost of other essential 
necessities such as food and shelter \5\--price increases that hit the 
lower wealth households the hardest. The U.S. Bureau of Labor 
Statistics Consumer Price Index for April 2022 shows an 80.5 percent 
12-month increase in the cost of fuel oil, an 11 percent increase for 
electricity service and an 22.7 percent increase for natural gas. These 
12-month increases in energy costs have been amongst the highest 
increases in decades.\6\ Similarly the 12-month increase in the cost of 
food and shelter are also the highest increases in decades. Low-income 
households cannot escape these price increases. They are driving 
untenable choices between basic necessities.\7\
---------------------------------------------------------------------------
    \4\ See U.S. Bureau of Labor Statistics, News Release, Consumer 
Price Index--April 2022 (May 11. 2022), available at https://
www.bls.gov/news.release/cpi.nr0.htm (hereafter, ``May 11, 2002 CPI 
Release''); Ivan Penn, ``Get Ready for Another Energy Price Spike: High 
Electric Bills"(rates have jumped because of a surge in natural gas 
prices and could rise rapidly for years) (May 3, 2022), available at 
https://www.nytimes.com/2022/05/03/business/energy-environment/high-
electric-bills-summer.html.
    \5\ Fn. 5, May 11. 2022 CPI Release.
    \6\ Fn. 5, May 11, 2022 CPI Release; NEADA, ``Energy Inflation Hits 
Lowest Income Families Hardest'' (April 12, 2022), available at https:/
/neada.org/energyinflationpr/.
    \7\ See e.g., Christine Stephenson, ``Duke Energy, CenterPoint 
bills are spiking in Bloomington. ,'' The Herald Times (Feb.22, 2022), 
available at https://www.heraldtimesonline.com/story/news/local/2022/
02/22/duke-energy-bills-spiking-bloomington-monroe-county/6882306001/.
---------------------------------------------------------------------------
    Moreover, as moratoriums on disconnections of utility service 
during COVID have ended, utility disconnections are at record high 
levels in many parts of the country. The need for substantial LIHEAP 
funding is greater than ever. One market analysis conservatively 
estimates that while utility sector bad debt had declined to an average 
annual rate of 2.9 percent ($2.5 billion total) between 2000--2019, in 
2020 utility bad debt jumped to $5.2 billion.\8\ LIHEAP helps 
households at risk of energy disconnections due to non-payment remain 
connected to essential home energy and avoid choosing between energy 
bills and rent or food.\9\ For very poor, struggling households, LIHEAP 
helps bring the cost of these essential heating and cooling services 
within reach for an estimated 6 million low-income households and helps 
them stay connected.
---------------------------------------------------------------------------
    \8\ Kaulkin Ginsburg, ``The Kaulkin Report 2022 Ed.'' Kaulkin 
Ginsburg Co. at page 36; NEADA Press Release, ``Families are Drowning 
in Utility Debt: NEADA Calls for Additional Funding for Energy 
Assistance'' (April 26, 2022)(estimated utility arrearages increased to 
$23 billion at the end of 2019; 20.1 million households had utility 
debt), available at https://neada.org/wp-content/uploads/2022/04/
utilitydebtpr4-26.pdf.
    \9\ See e.g., Tami Luhby, ``Utility Shutoffs loom as energy prices 
soar and moratoriums end. But help is available'' (April 24, 2022), 
available at https://www.abc12.com/news/national/utility-shutoffs-loom-
as-energy-prices-soar-and-moratoriums-end-but-help-is-available/
article_85b1942f-1f6d-5799-8278-cbf8bf303f79.html; Mark Wolfe, 
``Opinion: Struggling US Families face a wave of power shutoffs if 
Congress doesn't act'' (updated April 28, 2022), available at https://
www.cnn.com/2022/04/28/perspectives/utility-bills-power-shutoffs/
index.html.
---------------------------------------------------------------------------
    Energy bills are not affordable for struggling, low-income 
households. The average LIHEAP household in 2015 devoted over 8 percent 
of total household income just for home energy services, compared to an 
average of under 4 percent for all U.S. households. Home energy is also 
more expensive during prolonged periods of extreme temperatures because 
households use more fuel to keep the home at safe temperatures. 
Prolonged colder than normal temperatures, such as the sharp cold wave 
that resulted in 22 deaths and affected a wide swath of the country 
January to March 2019,\10\ can result in an unexpected, increased use 
of heating fuels. Likewise, prolonged hot temperatures, which are 
becoming more common, can result in an increased need for air 
conditioning, particularly for consumers with certain medical 
conditions.\11\
---------------------------------------------------------------------------
    \10\ See e.g., ``Extreme cold in the Midwest led to high power 
demand and record natural gas demand,'' US Energy Information 
Administration, Today in Energy (Feb. 26, 2019) available at https://
www.eia.gov/todayinenergy/detail.php?id=38472.
    \11\ Lynne Page Snyder and Christopher Baker, Affordable Home 
Energy and Health: Making the Connections, AARP Public Policy Institute 
(June 2010) at pp.10-11, available at https://www.aarp.org/money/low-
income-assistance/info-06-2010/2010-05-consumer.html.
---------------------------------------------------------------------------
    Yet, struggling low-income households are at risk of disconnection 
from essential utilities because they do not have the savings or income 
on hand to afford their energy bills. The Federal Reserve finds that 4 
in 10 households report that they would have difficulty with an 
unexpected expense of $400 and that 3 in 10 households are either 
unable to pay their bills or are a modest financial setback from 
hardship.\12\ A growing body of research is documenting the rise in 
household income volatility (the dramatic fluctuation of income over 
time) and the impacts on household well-being.\13\ Approximately one-
third of households experience income volatility \14\ and irregular 
work schedules were the leading cause of volatility.\15\ When income is 
hard to predict, paying for necessities such as utility service can be 
difficult, if not impossible, without help from programs like LIHEAP. 
Households experiencing income volatility tend to turn to more 
expensive alternative financial services products such as payday 
loans.\16\ Low and moderate income consumers who experience income 
volatility have much higher rates of skipped bills, skipped medical 
care, skipped housing payments and food insecurity.\17\
---------------------------------------------------------------------------
    \12\ Board of Governors of the Federal Reserve, Report on the 
Economic Well-Being of U.S. Households in 2018 (May 2019) at p.21, 
available at https://www.federalreserve.gov/consumerscommunities/files/
2018-report-economic-well-being-us-households-201905.pdf.
    \13\ See e.g., Federal Reserve Survey of Household Economics and 
Decisionmaking reports available at https://www.federalreserve.gov/
consumerscommunities/shed.htm; The Aspen Institute Expanding Prosperity 
Impact Collaborative (EPIC) series on the issue of income volatility 
available at http://www.aspenepic.org/epic-issues/income-volatility/; 
Pew Charitable Trusts, How Income Volatility Interacts with American 
Families; Financial Security (March 9, 2017) available at https://
www.pewtrusts.org/en/research-and-analysis/issue-briefs/2017/03/how-
income-volatility-interacts-with-american-families-financial-security.
    \14\ Daniel Schneider and Kristen Harknett, Income Volatility in 
the Service Sector: Contours, Causes, and Consequences (July 2017) at 
p.3, available at http://www.aspenepic.org/epic-issues/income-
volatility/issue-briefs-what-we-know/issue-brief-income-volatility-
service-sector/; Board of Governors of the Federal Reserve, Report on 
the Economic Well-Being of U.S. Households in 2018 (May 2019) at p.2, 
available at https://www.federalreserve.gov/consumerscommunities/files/
2018-report-economic-well-being-us-households-201905.pdf.
    \15\ Income Volatility: A Primer (May 1, 2016) The Aspin Institute 
Financial Security Program and EPIC at p.5, available at https://
www.aspeninstitute.org/publications/income-volatility-a-primer/; Daniel 
Schneider and Kristen Harknett, Income Volatility in the Service 
Sector: Contours, Causes and Consequences (July 2017) at p.3, available 
at http://www.aspenepic.org/epic-issues/income-volatility/issue-briefs-
what-we-know/issue-brief-income-volatility-service-sector/.
    \16\ Daniel Schneider and Kristen Harknett, supra, fn. 15, at p. 9, 
available at http://www.aspenepic.org/epic-issues/income-volatility/
issue-briefs-what-we-know/issue-brief-income-volatility-service-sector/
(almost a quarter of consumers reporting week-to-week volatility report 
using payday lenders).
    \17\ Stephen Roll, David S. Mitchell, Krista Holub et al., 
Responses to and Repercussions from Income Volatility in Low- and 
Moderate-Income Households: Results from a National Survey, Aspen 
Institute EPIC, Center for Social Development, Intuit Tax & Financial 
Center (Dec. 2-17) at pp 6-7, available at https://
www.aspeninstitute.org/publications/responses-repercussions-income-
volatility-low-moderate-income-households-results-national-survey/.
---------------------------------------------------------------------------
    LIHEAP protects the health of the frail elderly, the very young and 
those with chronic health conditions, all of whom are highly 
susceptible to temperature extremes. LIHEAP also helps keep families 
together by keeping homes habitable during cold winters and sweltering 
summers.
LIHEAP Is a Critical Safety Net Program for the Elderly, the Disabled 
        and Households with Young Children
    Recent national studies have documented the dire choices low-income 
households face when energy bills are unaffordable. Because adequate 
heating and cooling are tied to the habitability of the home, low-
income families will go to great lengths to pay their energy bills. 
According to the US Energy Information Agency (EIA), one in three 
households face challenges meeting energy needs, with over 20 percent 
forgoing basic necessities to pay their energy bills, over 10 percent 
report keeping their home at unsafe temperatures and almost 15 percent 
received a disconnection notice.\18\ EIA's analysis is consistent with 
other studies showing that low-income households faced with 
unaffordable energy bills cut back on necessities such as food, 
medicine and medical care.\19\ The U.S. Department of Agriculture has 
documented the connection between low-income households, especially 
those with elderly persons, experiencing very low food security and 
heating and cooling seasons when energy bills are high.\20\ A pediatric 
study in Boston documented an increase in the number of extremely low 
weight children, age 6 to 24 months, in the 3 months following the 
coldest months, when compared to the rest of the year.\21\ It is 
shocking that in this wealthy nation, so many face heat-or-eat choices 
where families go without food during the winter to pay their heating 
bills, and their children fail to thrive and grow. A 2007 Colorado 
study found that the second leading cause of homelessness for families 
with children is the inability to pay for home energy.\22\
---------------------------------------------------------------------------
    \18\ ``One in three U.S. households faces a challenge in meeting 
energy needs,'' US Energy Information Administration, Today in Energy 
(Sept. 19, 2018) available at https://www.eia.gov/todayinenergy/
detail.php?id=37072.
    \19\ See e.g., National Energy Assistance Directors' Association, 
2018 National Energy Assistance Survey, Tables in section IV, F and G 
(Dec. 2018) (to pay their energy bills, 32 percent of LIHEAP recipients 
went without food, 41 percent went without medical or dental care, 31 
percent did not fill or took less than the full dose of a prescribed 
medicine, 13 percent got a payday loan). Available at http://neada.org/
wp-content/uploads/2015/03/liheapsurvey2018.pdf.
    \20\ Mark Nord and Linda S. Kantor, Seasonal Variation in Food 
Insecurity Is Associated with Heating and Cooling Costs Among Low-
Income Elderly Americans, The Journal of Nutrition, 136 (Nov. 2006) 
2939-2944.
    \21\ Deborah A. Frank, MD et al., Heat or Eat: The Low Income Home 
Energy Assistance Program and Nutritional and Health Risks Among 
Children Less Than 3 years of Age, AAP Pediatrics v.118, no. 5 (Nov. 
2006) e1293-e1302. See also, Child Health Impact Working Group, 
Unhealthy Consequences: Energy Costs and Child Health: A Child Health 
Impact Assessment of Energy Costs And The Low Income Home Energy 
Assistance Program (Boston: Nov. 20060.
    \22\ Colorado Interagency Council on Homelessness, Colorado 
Statewide Homeless Count Summer, 2006, research conducted by University 
of Colorado at Denver and Health Sciences Center (Feb. 2007).
---------------------------------------------------------------------------
    When people are unable to afford paying their home energy bills, 
dangerous and even fatal results occur. In the winter, families resort 
to using unsafe heating sources such as space heaters, ovens and 
burners, all of which are fire hazards. Space heaters pose 3 to 4 times 
more risk for fire and 18 to 25 times more risk for death than central 
heating. In 2007, space heaters accounted for 17 percent of home fires 
and 20 percent of home fire deaths.\23\ In the summer, the inability to 
keep the home cool can be lethal, especially to seniors. According to 
the CDC, older adults, young children and persons with chronic medical 
conditions are particularly susceptible to heat-related illness and are 
at a high risk of heat-related death. The CDC reports that 3,442 deaths 
resulted from exposure to extreme heat during 1999-2003.\24\ The CDC 
also notes that air-conditioning is the number one protective factor 
against heat-related illness and death.\25\ LIHEAP assistance helps 
these vulnerable seniors, young children and medically vulnerable 
persons keep their homes at safe temperatures during the winter and 
summer and also funds low-income weatherization work to make homes more 
energy efficient.
---------------------------------------------------------------------------
    \23\ John R. Hall, Jr., Home Fires Involving Heating Equipment 
(Jan. 2010) at ix and 33.
    \24\ CDC, ``Heat-Related Deaths--United States, 1999-2003'' MMWR 
Weekly, July 28, 2006.
    \25\ CDC, ``Extreme Heat: A Prevention Guide to Promote Your 
Personal Health and Safety'' available at http://emergency.cdc.gov/
disasters/extremeheat/heat_guide.asp.
---------------------------------------------------------------------------
    LIHEAP is an efficient and effective targeted health and safety 
program that works to bring fuel costs within a manageable range for 
vulnerable low-income seniors, the disabled and families with young 
children. We respectfully request that LIHEAP be funded at no less than 
$5.1 billion in FY 2023 and an additional $500 million in emergency 
contingency funding.

    [This statement was submitted by Olivia Wein, Staff Attorney, 
National 
Consumer Law Center.]
                                 ______
                                 
    Prepared Statement of the Lymphatic Education & Research Network
_______________________________________________________________________
Key Recommendations:
  --Establish a National Commission on Lymphatic Disease Research at 
        the NIH to identify emerging opportunities, challenges, gaps, 
        structural changes, and recommendations on lymphatic disease 
        research
  --Provide the National Institutes of Health (NIH) with $49 billion 
        for FY 2022 and advance lymphatic disease research by expanding 
        resources and encouraging better coordination among relevant 
        institutes and centers
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        $11 billion for FY 2022 and enable $6 million for the Chronic 
        Disease Education and Awareness Program.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to submit the 
priorities of the lymphatic diseases community you as you consider FY 
2023 appropriations for the National Institutes of Health (NIH) and the 
Centers for Disease Control and Prevention (CDC).
                              about le&rn
    The Lymphatic Education & Research Network (LE&RN) is an 
internationally recognized non-profit organization founded in 1998 to 
fight lymphatic diseases through education, research, and advocacy. 
These include lymphedema, lipedema, lymphatic anomalies, and the 
continuum of lymphatic diseases. With chapters throughout the world, 
LE&RN seeks to accelerate the prevention, treatment and cure of these 
diseases while bringing patients and medical professionals together to 
address the unmet needs surrounding lymphatic diseases, which include 
lymphedema and lipedema.
                about lymphedema and lymphatic diseases
    The lymphatic system is a circulatory system that is critical to 
immune function and good health. When it is compromised and lymph flow 
is restricted, the physical impact to patients can be devastating, life 
altering, and can lead to shortened lifespan. Lymphedema (LE) is one 
such lymphatic disease. LE is a chronic, debilitating, and incurable 
swelling that can be a result of cancer treatment, inherited or genetic 
causes, and damage to the lymphatic system from surgery or an accident, 
or from parasites as in lymphatic filariasis. Stanford University 
estimates that up to 10 million Americans have lymphedema. This 
represents more Americans than those living with AIDS, Multiple 
Sclerosis, Parkinson's disease, Muscular Dystrophy and ALS--combined. 
The World Health Organization puts the global number of people with 
this disease at 250 million. There is no cure. There is no approved 
drug therapy. And there are currently only three drug studies worldwide 
seeking a treatment. Psychosocially bruised by a disease that leaves us 
deformed, we do our best to hide our lymphedema. We are currently 
isolated and alone.
    Lymphedema is an equal opportunity disease, affecting women, men 
and children alike. Many are born with congenital or hereditary 
lymphedema. Others, like our veterans, get the disease as a result of 
physical trauma, bacterial infection, or as result of exposure to burn 
pits. Lymphedema is an ignored disease. A study concluded that 
physicians are currently getting an average of only 15-30 minutes of 
study on the lymphatic system in their entire medical training. This 
leaves them ill-prepared to diagnose the disease. Misdiagnosis leads to 
improper treatment. Those who are diagnosed find it difficult to find 
certified lymphedema therapists. Few medical centers exist that are 
prepared to address lymphatic diseases. Surgeons are experimenting with 
treatment that could alter the course of the disease. However, the 
necessary basic research is not being done to inform their procedures. 
And currently, Medicare and Medicaid do not cover some of the basic 
treatment needs of these patients--such as compression garments, which 
must be worn daily by patients.
            fiscal year 2023 appropriations recommendations
    We have been hopeful with recent advancements, but more needs to be 
done. We ask that within 20 years, we will make lymphedema and other 
lymphatic diseases truly treatable. To reach this goal will require a 
commitment to important medical research. LE&RN joins the broader 
medical research community in thanking Congress for continuing to 
provide the National Institutes of Health with proportional and 
sustainable funding increases over the past several fiscal years, and 
we ask you all to continue to prioritize these activities by providing 
at least a $49 billion for NIH in FY 2023.
    We continue to urge the subcommittee to work to expand and advance 
the lymphatic disease portfolio at the NIH. In late 2015, the NIH 
hosted a Lymphatic Symposium, where experts in the field identified a 
scientific roadmap that could build the research portfolio up to a 
level of at least $70 million annually over subsequent years by funding 
meritorious grants on critical topics. In an effort to further support 
and enhance emerging lymphedema and lymphatic disease research 
activities, we ask the subcommittee to encourage further collaboration 
among relevant institutes and centers conducting research in this area. 
We are grateful to the subcommittee for continuing to support the 
establishment of a National Commission on Lymphatic Disease Research, 
which can thoroughly examine the portfolio and make recommendations on 
how best to advance this emerging scientific area under NIH's current 
structure. We ask that you continue to impress on NIH the critical need 
for this Commission and how they can work with relevant stakeholders 
such as ourselves. Currently, the National Institutes of Health spends 
approximately $25 million annually on lymphatic research, and only $5 
million of this is dedicated to clinical lymphedema research. Experts 
state with confidence that there is no other disease affecting more 
Americans that receives so little attention. It must also be noted that 
study of the lymphatic system is poised to bring miracles for a host of 
diseases that are part of the lymphatic continuum: obesity, heart 
disease, diabetes, Rheumatoid arthritis, cancer metastasis, AIDS, 
Crohn's disease, lipedema, and a host of other diseases. Recent 
research discovered lymphatics surrounding the brain, which now has us 
studying its impact on Alzheimer's disease and multiple sclerosis. We 
appreciate the subcommittee's continued support for the establishment 
of a National Commission on Lymphatic Diseases and ask that NIH be held 
accountable for the lack of progress on its establishment. We 
appreciate some steps that NIH is taking to address the subcommittee's 
and our concerns about the National Commission, but we still are not at 
the point where the Commission is set to begin key work. While we 
remain hopeful that our continued work with NIH will continue to pay 
off, strong support from Congress remains essential for our success.
    LE&RN also joins the public health community in asking Congress to 
provide the Centers for Disease Control and Prevention (CDC) with $11 
billion through FY 2023 and to increase funding to increase awareness, 
education, and surveillance of lymphatic diseases. We encourage the 
subcommittee to support $6 million for the Chronic Disease Education 
and Awareness Program in FY 2023 which will allow CDC to work with 
stakeholder organizations to expand important initiatives on chronic 
diseases such as lymphedema and lymphatic diseases. Formal study of the 
lymphatic system and of lymphatic diseases is virtually nonexistent in 
the current curricula of U.S. medical schools, and misinformation 
routinely leads to misdiagnosis and under-treatment. This delay and 
misdirection of treatment results in irreparable physical and 
psychosocial harm to patients suffering from these already debilitating 
diseases. CDC can help to address this lack of public and provider 
awareness.
    Thank you for the opportunity to testify before you today. LE&RN 
looks forward to working with you all to advance medical research and 
public health activities that will improve patient outcomes for the 
members of our community suffering from these debilitating diseases.

    [This statement was submitted by William Repicci, President and 
CEO, 
Lymphatic Education & Research Network.]
                                 ______
                                 
                  Prepared Statement of March of Dimes

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    March of Dimes, the Nation's leading nonprofit organization 
fighting for the health of all moms and babies, appreciates this 
opportunity to submit testimony for the record on fiscal year (FY) 2023 
appropriations for the Department of Health and Human Services (HHS). 
March of Dimes leads the fight for the health of all mothers and 
infants through our research, community services, education, and 
advocacy.
    Our organization strongly supports President Biden's ongoing and 
demonstrated commitment to maternal health in his HHS budget proposal 
for FY 2023, which includes strong increases for critical programs 
supporting families, and we recommend the following funding levels for 
programs and initiatives that are essential investments in maternal and 
child health.
    Eunice Kennedy Shriver National Institute of Child Health and Human 
Development (NICHD): March of Dimes recommends that Congress provide no 
less than $1.816 billion for NICHD's groundbreaking biomedical research 
activities in FY 2023. Increased funding will allow NICHD to sustain 
vital research on preterm birth, maternal mortality, maternal substance 
use, prenatal substance exposure and related issues through extramural 
grants, Maternal-Fetal Medicine Units, the Neonatal Research Network 
and the intramural research program.
    Additionally, now that the Task Force on Research Specific to 
Pregnant and Lactating Women (PRGLAC) has laid the foundation for 
addressing research on safe and effective therapies for pregnant and 
lactating women in clinical trials by releasing recommendations in 
September 2018, as mandated by Congress in the 21st Century Cures Act 
(Public Law 114-255), and provided an additional implementation plan 
increased funding will allow for NICHD to more closely look at ways to 
include and integrate pregnant and lactating women in clinical trials. 
NICHD funding also supports research to address gaps in our 
understanding of the best way to treat mothers with opioid use disorder 
and the long-term impact of opioid exposure in utero. We support the 
inclusion of this dedicated funding to address the Nation's preterm 
birth crisis.
    Surveillance for Emerging Threats to Mothers and Babies Initiative: 
March of Dimes recommends funding the Surveillance for Emerging Threats 
to Mothers and Babies Initiative Program (known as SET-NET) within the 
National Center for Birth Defects and Developmental Disabilities at 
Centers for Disease Control and Prevention (CDC) at $100 million. SET-
NET was created during the Zika outbreak, which allowed CDC to create, 
a unique nationwide mother-baby linked surveillance network to monitor 
the virus' impact in real-time to inform clinical guidance, educate 
health care providers and the community, and connect families to care. 
Unfortunately, States were unable to sustain systems due to the program 
being chronically underfunded, and we were left without a national 
system to mobilize when COVID-19 struck.
    Consequently, we have an incomplete picture on how to best care for 
mothers and babies with confirmed or suspected virus infection as the 
CDC currently only supports 28 State, local, and territorial health 
departments. The increased funding will allow for CDC to address these 
knowledge gaps and expand the initiative to provide real-time clinical 
and survey data from all 50 States, territories and jurisdictions on 
the impact of COVID-19 and new public health threats.
    Perinatal Quality Collaboratives: PQCs are state or multistate 
networks working to improve the quality of obstetric care and improve 
outcomes. Currently, CDC funds 13 State-based PQCs that are 
implementing recommendations across health facility networks. However, 
many PQCs lack adequate resources to meet demands and reach their 
maximum potential. We request a specific funding level be set-aside 
under the $164 million Safe Motherhood Initiative request to fully 
scale these programs in all States.
    Maternal Mortality Review Committees: Under the Enhancing Reviews 
and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program, 
CDC provides funding, technical assistance, and guidance to state 
maternal mortality review committees. These multidisciplinary 
committees identify, review and characterize maternal deaths and 
prevention opportunities. Currently, CDC has made 24 awards and 
supports 25 State agencies and organizations that coordinate and manage 
MMRCs. However, more standardized data collection is needed to help 
examine all the factors contributing to severe maternal mortality, 
preventable deaths, and poor birth outcomes. To this end, we request a 
specific funding level be set-aside under the $164 million Safe 
Motherhood Initiative request to reach all 50 States, DC, and Puerto 
Rico and Tribes with enhanced technical assistance to maximize MMRCs.
    Newborn Screening: Newborn screening is one of our Nation's most 
successful public health programs. Each year, nearly every one of the 
approximately 4 million infants born in the United States is screened 
for certain genetic, metabolic, hormonal and/or functional conditions. 
The early detection afforded by newborn screening ensures that infants 
who test positive for a screened condition receive prompt treatment, 
saving or improving the lives of more than 12,000 infants each year.
    Both the Newborn Screening Quality Assurance Program at CDC and the 
Heritable Disorders program at Health Resources and Services 
Administration's (HRSA) have significantly improved the quality of 
newborn screening programs throughout the country. NSQAP works hand-in-
hand with state laboratories by performing quality testing for more 
than 500 laboratories to ensure the accuracy of newborn screening 
tests. Where the Heritable Disorders program provides assistance to 
States to improve and expand their newborn screening programs and 
supports the work of the Advisory Committee on Heritable Disorders in 
Newborns and Children (ACHDNC), which provides recommendations to the 
HHS Secretary for conditions to be included in the Recommended Uniform 
Screening Panel (RUSP). To continue sustaining, improving, and 
enhancing these programs, March of Dimes urges funding of $29 million 
for NSQAP and $29.883 million for the Heritable Disorders program for 
FY23.
    In addition, we request $15 million under the CDC to support full 
implementation of the Recommended Uniform Screening Panel (RUSP) in all 
50 States. These additional resources for timely implementation of 
newborn screening conditions with a goal of complete RUSP 
implementation nationwide by 2025.
    Lastly, we request $2 million under HRSA to support a newborn 
screening study. It would direct HHS to commission a study with the 
National Academy of Medicine (NAM) on uniform screening panel review 
and recommendation processes to identify factors that impact decisions 
to add new conditions to the uniform screening panel, to describe 
challenges posed by newly nominated conditions, including low-incidence 
diseases, late onset variants, and new treatments without long-term 
efficacy data.
    Grants for Maternal Depression Screening and Treatment: 1 in 5 
women are affected by anxiety, depression, and other maternal mental 
health (MMH) conditions during pregnancy or the year following 
pregnancy. These illnesses are the most common complication of 
pregnancy and childbirth, impacting 800,000 women in the United States 
each year. Sadly, MMH conditions often go undiagnosed and untreated, 
increasing the risk of multigenerational long-term negative impact on 
the mother's and child's physical, emotional, and developmental health, 
increasing the risk of poor health outcomes of both the mother and 
baby. Furthermore, women of color and women who live in poverty are 
disproportionately impacted by MMH conditions, experiencing them 2-3 
times the rate as White women.
    At the current funding level, only seven States have received 
grants to provide real-time psychiatric consultation, care 
coordination, and training for front-line providers to better screen, 
assess, refer and treat pregnant and postpartum women for depression 
and other behavioral health conditions. March of Dimes urges the 
Committee to provide $11.5 million in fiscal Year2023 to add five 
programs and provide technical assistance to non-grantee States.
    Maternal Mental Health Hotline: We thank the Committee for funding 
$4 million in FY22 to the new maternal mental health hotline launched 
by HRSA. This funding will allow qualified counselors to staff a 
hotline 24 hours a day and conduct outreach efforts on maternal mental 
health issues. COVID-19 has exacerbated maternal mental health 
conditions at 3-4 times the rate prior to the pandemic and leaving 
these conditions untreated can have a long-term effects. We urge the 
Committee to support President Biden's request of $7 million to allow 
for the hotline to provide text messaging services, culturally-
appropriate support, and continue public awareness efforts.
                               conclusion
    March of Dimes looks forward to working with you and all Members of 
Congress to secure the resources needed to improve our Nation's health. 
Federal public health programs are essential to preventing preterm 
birth, ending preventable maternal deaths, and addressing the maternal 
mental health that impacts mother, infants and families.
                                 ______
                                 
             Prepared Statement of Meals on Wheels America
    Dear Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee:
    Thank you for the opportunity to submit testimony concerning Fiscal 
Year 2023 (FY23) appropriations for the Older Americans Act (OAA) 
Nutrition Program, administered by the Department of Health and Human 
Services' (HHS) Administration for Community Living (ACL). On behalf of 
Meals on Wheels America, the Nationwide network of community-based 
senior nutrition providers and the individuals they serve, we are 
grateful for your longstanding leadership and support for the program. 
For 50 years, these programs have served as daily lifelines, providing 
hundreds of millions of meals and vital social connection to a growing 
number of older adults who rely on the OAA Nutrition Program to meet 
their basic needs. The critical role and significance of this 
bipartisan legislation have been made even more evident throughout the 
COVID-19 pandemic, in which local home-delivered and congregate 
programs continue to experience dramatic and sustained increases in the 
number of older adults who require nutrition and social support.
    To sustain these proven and effective nutrition programs that 
reduce senior hunger and loneliness, improve health and well-being, and 
enable independence, appropriations increases are urgently needed in FY 
2023. Accordingly, we are calling for a minimum of $1,933,506,000 for 
the OAA Nutrition Program to be included in the final FY 2023 Labor, 
Health and Human Services, Education and Related Agencies (Labor-HHS-
Ed) Appropriations bill. The specific line-item requests are:
  --Congregate Nutrition Services (Title III-C-1)--$965,342,000
  --Home-Delivered Nutrition Services (Title III-C-2)--$791,342,000
  --Nutrition Services Incentive Program (NSIP) (Title III)--
        $176,822,000
    This FY23 request reflects the amount necessary to maintain current 
levels of service, while enabling the network to expand and adapt to 
serve more seniors. As our country strives to respond, recover and 
rebuild from the COVID-19 health and economic crises, these nutrition 
programs are a lifeline for millions of older adults and the services 
they provide must flex to meet the need. We must not go backwards and 
instead invest more significantly in these cost-effective programs that 
allow individuals to age at home, with better health and independence, 
outside of costly healthcare facilities.
    Overseen by ACL's Administration on Aging and implemented at the 
local level through thousands of community-based providers, the OAA 
Nutrition Program delivers nutritious meals, social connection and 
safety checks to adults 60 and older--either in a group setting or 
directly in the home--and has been at the forefront of addressing 
senior hunger and isolation for five decades.
    Nutrition is a crucial part of overall health, development, and 
quality of life and is fundamental to healthy aging. Older adults who 
are food insecure and lack consistent access to nutritious meals 
experience worse health outcomes and are at increased risk for heart 
disease, depression, diabetes and declines in cognitive function and 
mobility than those who are food secure.\1\ Most older Americans 
possess at least one factor that puts them at greater risk of food 
insecurity, malnutrition, social isolation and/or loneliness, thereby 
increasing the likelihood of experiencing negative health effects. 
Despite the wide recognition of the relationship between healthy aging 
and access to nutritious food and regular socialization, millions of 
older adults were struggling to meet these basic needs even prior to 
the COVID-19 pandemic.
---------------------------------------------------------------------------
    \1\ Ziliak and Gunderson, 2021, The Health Consequences of Senior 
Hunger in the United States: Evidence from the 1999-2016 NHANES, report 
prepared for Feeding America, available at www.feedingamerica.org/
research/senior-hunger-research/senior.
---------------------------------------------------------------------------
    The reality of senior hunger today is sobering, and there are 
millions more older adults who need our help, but who we are not 
reaching today. We know in 2020, during the pandemic, over 9 million 
(12 percent) older adults 60+ were threatened by hunger--nearly 5.2 
million (7 percent) of whom experienced low food security or very low 
food security. Nationwide, that is one in eight older adults struggling 
with hunger--and the fraction of seniors experiencing very low food 
security has increased almost 90 percent since 2001.\2\ It has also 
been estimated that up to almost half of all older adults may be at 
risk of becoming or is already malnourished.\3\ Today, millions of 
seniors experience some degree of food insecurity and are forced to 
make choices about the foods they eat due to financial strain, and/or 
forgo eating properly to pay for utilities, rent and/or medication.
---------------------------------------------------------------------------
    \2\ U.S. Census Bureau, 2020, Current Population Survey (CPS) 
December Food Security Supplement, dataset available at https://
www.census.gov/data/datasets/time-series/demo/cps/cps-supp_cps-repwgt/
cps-food-security.html.
    \3\ Kaiser et al., 2010, ``Frequency of malnutrition in older 
adults: a multinational perspective using the mini nutritional 
assessment'', Journal of the American Geriatrics Society 58(9):1734-8, 
abstract available at https://pubmed.ncbi.nlm.nih.gov/20863332/.
---------------------------------------------------------------------------
    As greater awareness of food insecurity, social isolation and 
loneliness and their negative effects on physical and mental health 
have emerged since the COVID-19 pandemic, it is important to note that 
older adults in particular--especially those who were already homebound 
and/or living in rural areas--have long been at higher risk of these 
threats to healthy aging. Older adults have unique challenges 
maintaining community connections and accessing healthcare, which can 
be further compounded if one has physical limitations, lack of 
transportation, inadequate financial resources, and/or other obstacles 
to accessing resources.
    Certain segments of the population experience a range of different 
challenges at disproportionately higher rates. As examples, older 
adults who are racial or ethnic minorities; lesbian, gay, bisexual, 
transgender, and queer (LGBTQ+); living with disabilities or limited 
mobility; living in or near poverty; and in rural areas face systemic 
inequities that too often result in a lack of adequate resources and/or 
access to services they need to remain well in later life.
    The OAA Nutrition Program is designed to reduce hunger, food 
insecurity and malnutrition, and promote socialization and the overall 
health and well-being of older adults. OAA services, including 
congregate and home-delivered meals, are targeted toward seniors with 
the greatest social and economic need, including those who are low-
income; are a racial or ethnic minority; live in a rural community; 
have limited English proficiency; and/or are at risk of institutional 
care.
    The impact of these services on seniors' lives is powerful, and 
older adults who receive them have better health because of 
participating. Most seniors receiving OAA nutrition services 
consistently report that participating in the program helps them feel 
more secure, prevents falls or fear of falling, and allows them to stay 
in their own home.\4,5\ In turn, this helps avoid preventable emergency 
room visits, hospital admissions and readmissions, extended stays in 
rehab, and premature institutionalization--ultimately reducing our 
Nation's health care costs.
---------------------------------------------------------------------------
    \4\ Administration for Community Living (ACL), 2019, National 
Survey of OAA Participants, available on ACL's AGID Custom Tables, 
available at https://agid.acl.gov/.
    \5\ Meals on Wheels America, 2015, More Than a Meal Pilot Research 
Study, report prepared by Thomas & Dosa, available at 
www.mealsonwheelsamerica.org/learn-more/research/more-than-a-meal/
pilot-research-study.
---------------------------------------------------------------------------
    A rigorously designed study from 2015 found that older adults 
receiving home-delivered meals experienced statistically significant 
improvements in health than their counterparts who did not receive 
services. The group who received home-delivered meals and safety checks 
were more likely to have improved physical and mental health, including 
reduced feelings of anxiety and loneliness, and fewer hospital 
admissions and falls.\6\ On the ground, senior nutrition program staff 
and volunteers delivering meals can help identify and promptly notify 
caregivers and healthcare providers of a change in an older adult's 
condition so that necessary steps can be taken to address urgent and/or 
developing health conditions and medical needs, both physical and 
mental.
---------------------------------------------------------------------------
    \6\ See footnote 5.
---------------------------------------------------------------------------
    It is often through an older adult's need for nutrition services 
that they become aware of and connected to other services available in 
their communities. For many Meals on Wheels participants, staff and 
volunteers may be the only individual(s) she or he sees that day. 
Social connection is part of the Meals on Wheels model and can include 
intentional and additional face-to-face conversation during delivery or 
enhanced programming, like friendly visiting or telephone reassurance 
calls. Further, in-home safety services include a regular environmental 
safety check and established approach for addressing identified 
hazards, fall risks, and home modification needs. For example, Meals on 
Wheels programs helped refer and/or serve an estimated 18,000 older 
adults who needed home repairs in 2018, and 34 percent of programs 
report directly offering home repair and modification services.\7\
---------------------------------------------------------------------------
    \7\ Meals on Wheels America, 2021, Membership Perspectives and 
Practices Survey, research conducted by Trailblazer Research (report in 
publication).
---------------------------------------------------------------------------
    The power and importance of the OAA Nutrition Program was never 
more clear than during the COVID-19 pandemic. Practically overnight, 
the thousands of programs across the country faced an unprecedented 
surge in demand as the number of older adults sheltering in place 
increased and congregate centers shifted ways of operating. Programs 
quickly adapted traditionally their high-touch service model to 
continue safely offering senior clients critical, person-centered 
supports that go well beyond the meal itself.
    Programs like Meals on Wheels were and continue to be pivotal to 
our Nation's pandemic response and recovery, and senior nutrition 
programs have been highly sought out for the trusted nutrition and 
social connections they offer. Despite the incredible response from the 
senior nutrition network to quickly scale services, challenges remain 
in addressing the demand. A survey of Meals on Wheels America 
membership last year found 97 percent of programs believe that there 
continues to be substantial unmet need in their communities and about 
60 percent of programs reported that the major limitation to serving 
meals to all the seniors in their community who need them is funding to 
pay for the meals.\8\ The gap between those struggling with hunger and 
those receiving nutritious meals through the OAA will continue to widen 
across the country if not adequately addressed with the necessary 
support and investment from both public and private sources.
---------------------------------------------------------------------------
    \8\ Meals on Wheels America, July 2021, 2021 Mid-year COVID-19 
Pulse Survey, available at www.mealsonwheelsamerica.org/learn-more/
research/covid-19-research-portfolio.
---------------------------------------------------------------------------
    Even prior to the pandemic, Federal funding for aging services was 
not keeping pace with increasing demand, rising costs and inflation. 
Now, more than 2 years into this public health emergency, programs are 
continuing to deliver life-saving services at sustained high rates with 
ongoing and emerging challenges and uncertainties. Currently, 8 in 10 
Meals on Wheels programs are still serving more home-delivered meals 
and clients than they were before COVID-19, and many of them are taking 
drastic steps to sustain their programs due to funding challenges. Some 
of these measures include but are not limited to adding seniors to 
waiting lists, discontinuing, or cutting back services. As of April 
2022, 20 percent of Meals on Wheels programs reported adding clients to 
a waiting list. Most senior nutrition programs are currently facing at 
least one significant barrier, such as rising costs of inflation, food, 
and gas (necessities like beef and gas have been up 16 percent and 38 
percent, respectively) or sustaining funding, and a third have reported 
that increased operating costs are requiring them to tap into reserve 
funding.\9\
---------------------------------------------------------------------------
    \9\ Meals on Wheels America, April 2022, Spring Member Pulse 
Survey, available at www.mealsonwheelsamerica.org/learn-more/research/
covid-19-research-portfolio.
---------------------------------------------------------------------------
    Thanks to your leadership, ACL received emergency funding necessary 
to help address the significant needs presented by the pandemic. ACL 
and its programs have subsequently been able to reach new communities 
and people who have long needed services, such as meals, but were not 
receiving them. Senior nutrition programs nationwide have expanded 
capacity, innovated operations, and shown that their services can 
literally be a matter of life and death. Now we are at a crossroads. 
Pandemic-level funding for these programs must be sustained. We must 
not go backwards.
    We understand the difficult decisions you face with respect to 
annual appropriations bills and other budgetary challenges. However, 
the risks and benefits of healthy aging cannot be underestimated, both 
in social and economic costs. The requested appropriations increase 
will help provide the funding levels necessary for community-based 
nutrition programs to serve more older adults and sufficiently address 
the increased demand for services and help offset the higher operating 
costs they are experiencing.
    In closing, as the subcommittee develops its FY23 Labor-HHS-
Education appropriations bill, we urge you to fund programs that are 
critical to healthy aging, including $1.934 billion for the OAA 
Nutrition Program, so that local community-based senior nutrition 
programs can ensure the health, safety and social connectedness of our 
Nation's older adults, build the capacity of ACL's programs and 
services, and bridge the growing gaps and unmet need for services in 
communities nationwide. Thank you for your leadership, support and 
consideration. We look forward to working together to ensure that no 
older adult in America is left hungry and isolated.

    [This statement was submitted by Ellie Hollander, President and 
CEO, Meals on Wheels America.]
                                 ______
                                 
                    Prepared Statement of METAvivor
            fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Please provide the National Institutes of Health (NIH) with an 
        increase of at least a $3.5 billion for FY 2023 to bring total 
        agency funding up to a minimum of $49 billion annually.
    --Please provide separate and distinct funding for the emerging 
            Advanced Research Projects Agency for Health (ARPA-H) at 
            NIH, which would further support this promising effort 
            without disrupting ongoing NIH efforts.
  --Please continue to support additional investment for the cancer 
        ``moonshot'' as outlined by the 21st Century Cures Act and 
        otherwise ensure the National Cancer Institute (NCI) has 
        adequate resources.
  --Please continue to emphasize the importance of Federal research 
        activities focused on controlling and eliminating cancer that 
        has already disseminated (Metastatic Cancer) through committee 
        recommendations and timely oversight of ongoing activities.
  --Please support $5 million for a pilot program at CDC to modernize 
        the Surveillance, Epidemiology, and End Results Research 
        Program (SEER) Registry to better capture the experience of 
        metastatic cancer patients.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you once again for considering the views of 
METAvivor and the stage IV metastatic cancer community as you work on 
FY 2023 appropriations for medical research and public health. The 
community is deeply grateful for the sustained investment in NIH, and 
emerging calls for a robust and comprehensive effort to enhance cancer 
research. Please maintain this commitment for FY 2023 by supporting 
innovative medical research, including the reinvigoration of the 
``moonshot'' and by providing adequate resources for public health 
programs, including new funds to modernize the SEER registry (building 
on prior committee recommendations).
                            about metavivor
    My name is Jamil Rivers. I had a typical family before my diagnosis 
of ``de novo'' metastatic breast cancer. I was 39 years old, married, 
with three children and a full-time job. We were very active and always 
doing something. I have a big, tight-knit family and we love to travel. 
I had just changed jobs and we moved into a new house. I never missed a 
beat--and then my husband was diagnosed with stage-one colon cancer. I 
became his caregiver. It was in 2017, and everyone got sick in the 
wintertime like we always do. We had colds and were coughing, but my 
cold didn't go away. I also had this pain and this pinch, like I had 
pulled a muscle on my right side. When I went to the doctor about my 
cold and cough, they had prescribed me antibiotics. I also asked for an 
ultrasound because appendicitis runs in my family. The results showed 
that I had lesions in my liver. I had no other symptoms and no other 
pain, but further testing showed I had stage IV ``de novo'' metastatic 
breast cancer. It was the most shocking news ever.
    The breast cancer had spread to my liver, my spleen, lymph nodes, 
lungs, bones, my abdomen and my chest wall. I was devastated. I'm 
blessed with this beautiful family and my kids are really young. At the 
time they were only 5, 6 and 16 years old. Why would God bless me with 
this beautiful family and then strip me from them? I couldn't wrap my 
brain around the fact that my husband and I could both have a serious 
health issue. It just wasn't a possibility.
    ``Who is going to take care of our kids?'' That was the first thing 
I thought about in the midst of my devastation. But after that, I 
realized I had to survive for them; I have to be here for them. I 
wanted my kids to know that I did everything I could possibly do in my 
power to be here for them. I had to process my diagnosis so I could 
focus on my health. You never think this could happen to you but it 
did. It happened to me.
    I'm the type of person who, when a challenge is brought to me, I 
figure out how to execute it and get it done. I basically had to figure 
out. I empowered myself and armed myself with as much knowledge, 
information, resources and support as possible. My mission was 
survival.
    I'm my kids' mom and no one else can be. I'm the breadwinner in my 
family and everyone is also on my benefits. It was imperative that I 
keep my job and do well at my job so I could continue to take care of 
them. I started chemotherapy right away because, on paper, I was 
literally dying. The kids had to see me lose all of my hair and be 
really tired. That's when I started researching what else I could do in 
terms of integrative therapy to help me manage the side effects of the 
chemo in order to still work, be active and take care of my kids the 
same way I always had.
    Now, my husband is in recovery and after 1 year of chemotherapy, my 
tumors have shrunk to the point where they're a microscopic size so you 
can't see them on a scan... also known as ``no evidence of disease''. 
I'm still working, taking care of the kids and involved in their school 
activities. I want to soak in every waking second with my family.
    I'm not giving up anytime soon.
    Through my advocacy, I have tried to help bring more attention to 
metastatic breast cancer, the need for more research funding and 
investment towards metastatic breast cancer. I now serve as Board 
President of METAvivor and work alongside others to push this important 
work forward. I hope the lives of the more than 600,000 people with 
stage IV metastatic cancer is considered when making decisions about 
the future of cancer research and especially funding the stage IV 
metastatic cancer research. METAvivor has worked hard to fund research. 
Since 2009, we have funded over $18 million but we need more...stage IV 
metastatic cancer needs more research.
               the facts about metastatic stage iv cancer
    Roughly 600,000 Americans die annually from cancer. Ninety percent 
of these deaths are caused by a metastasis. If we wish to lower the 
death rate, we must tackle metastasis. For more than 20 years, the 
primary focus has been on preventing cancer altogether and if that 
fails, catching it early. But aside from convincing people to stop 
smoking, forbidding smoke in common areas and removing colon polyps 
prior to malignancy, little progress has been made. For most cancers, 
it is believed there are multiple causes, few if any of which are 
known, making prevention a formidable goal. Improved equipment has 
allowed some cancers to be diagnosed as early as stage 0; however, 
stage 0 patients are also metastasizing. And although we are slowly 
adding drugs to the treatment repertoire, a treatment's effectiveness 
often runs out in 2-3 months. Thus, we empty our toolbox of drugs far 
too quickly and we, metastatic patients, die. Saving lives is an 
achievable goal but tragically is not being realized because the focus 
continues to be prevent and early detect. Those goals have been 
maximized. Backs have been turned to the metastatic community long 
enough. It is high time to include metastasis as a major focus area.
                    about seer modernization funding
    As the saying goes, what gets measured, gets done. Currently, 
cancer registries do not capture data on metastatic recurrence or 
metastatic progression. There are many opportunities though to properly 
incorporate critical metastatic cancer information into cancer 
registries moving forward, including squeezing more out of current 
registry data, linking registries to data resources that can inform 
about recurrence or progression, and build the infrastructure necessary 
to systematically incorporate recurrence information into registries. 
For example, NCI is working to enhance reporting through pathology, 
radiology, and hospitals while several research teams are exploring 
algorithms that use administrative data to identify recurrence events. 
Currently these efforts are concentrated in areas in which information 
infrastructure exists to support them and are not yet nationally 
scalable. A key emerging conclusion is that there would be a tremendous 
value in ``A Big Count'' of breast cancer metastases on an ongoing 
basis. This would be achievable if States would develop scalable 
processes and invest the time and resources to do the counting and 
gather the data. This could incorporate the utilization of innovative 
tools developed by NCI or could be complementary to those efforts.
    The community asks Congress to establish a $5 million pilot program 
administered by CDC that can provide grants to a few meritorious States 
to develop and test local solutions to directly incorporate metastatic 
breast cancer recurrence and progression into current cancer 
surveillance activities. This would provide a handful of multi-year 
cooperative agreements to stakeholders at approximately $250,000 
annually. This modest investment would facilitate:
  --The development of local information infrastructures to routinely 
        count metastatic events at and after a cancer diagnosis;
  --The creation of possibly the best MBC database in existence that 
        researchers will want to access and will likely cite for 
        decades to come;
  --The ability to generate survival curves capturing the time to 
        recurrence or metastasis after diagnosis overall and within 
        different population subgroups;
  --Key collaborations with NIH and CDC, including recommendations and 
        best practices to advance systematic incorporation of this data 
        moving forward.

    [This statement was submitted by Jamil Rivers, Board Chair, 
METAvivor.]
                                 ______
                                 
        Prepared Statement of Michelson Center for Public Policy
    The Michelson Center for Public Policy (MCPP) thanks the 
subcommittee for its long-standing bipartisan leadership in support of 
the National Institutes of Health (NIH). Robust support for science and 
innovation is critical if we are to advance public health, sustain U.S. 
leadership in medical research, and remain competitive in today's 
innovation economy.
    In year two of the COVID-19 pandemic, not only do lives continue to 
be lost but the U.S. economy continues to suffer as well. It is 
estimated that the COVID-19 pandemic will cost the U.S. economy more 
than $16 trillion.\1\ The NIH's fiscal year (FY) 2022 budget was less 
than 0.3 percent of that. The NIH is the world's largest funder of 
medical research and the basic, clinical, and translational research 
that it funds is the very fuel that feeds the American engine of 
discovery and drives innovation in pharmaceuticals and biotechnology. 
More importantly, NIH research saves lives and improves wellbeing for 
millions worldwide. Now is the time to vaccinate the economy and 
bolster our ability to respond to the emerging public health threats of 
tomorrow by continuing to invest heavily in biomedical research with 
transformative potential. MCPP urges the subcommittee to provide NIH 
with $100 billion in base funding in FY 2023.
---------------------------------------------------------------------------
    \1\ https://news.harvard.edu/gazette/story/2020/11/what-might-
covid-cost-the-u-s-experts-eye-16-trillion/.
---------------------------------------------------------------------------
    The Michelson Center for Public Policy (MCPP) is a 501(c)(4) social 
welfare organization that propels legislative change through meaningful 
collaboration with elected officials, government agencies, and civic 
leaders to achieve positive outcomes in medical research, education, 
equity, and animal welfare. MCPP is an affiliated but separate 
organization from the Michelson Philanthropies network of foundations 
(Michelson 20MM Foundation, Michelson Found Animals Foundation, and 
Michelson Medical Research Foundation) and complements the Michelson 
Philanthropies' thought leadership and expertise with bold and 
effective advocacy. MCPP's founder and co-chair is physician, inventor, 
and philanthropist Gary Michelson, M.D. He is committed to using his 
platform to advocate for robust investment in biomedical research, 
disruptive innovation that can deliver more treatments and cures, and 
support for the next generation of researchers.
    Through the Michelson Medical Research Foundation, Dr. Michelson 
makes grants to support high-quality, cutting-edge medical research 
because a single breakthrough could benefit the lives and health of 
hundreds of millions. But philanthropy cannot do it alone. Truly 
transformative medical advances are seeded by robust investment in the 
NIH and these investments have exponential returns for the economy, 
jobs, tax revenues and--most importantly--humankind.
    MCPP is thankful for the strong bipartisan support that the 
subcommittee leaders, Chairwoman Patty Murray and Ranking Member Roy 
Blunt, have shown in providing the NIH with its seventh consecutive 
funding increase during this time of constrained budgets. These 
increases have helped the NIH regain ground from the years of largely 
flat funding in inflation-adjusted dollars. However, we must do more.
    The Biden Administration has proposed to fund the NIH at $49 
billion in FY 2023, which includes $4 billion for the Advanced Research 
Projects Agency for Health (ARPA-H). This is a good start, but it is 
not nearly enough. This is precisely the right time to be bold and go 
bigger. We cannot afford to be modest in our efforts. No one deserves 
to fall ill and die, or to helplessly watch as their child, parent or 
spouse suffers because we failed to do the work right now to save them. 
We must dramatically increase NIH's base funding, so that a lack of 
funding is not the reason why patients go untreated and diseases remain 
a threat to public health.
    The COVID-19 pandemic has shown that the NIH cannot only rely on 
incremental annual increases to its base budget to meet the next public 
health challenge. A fraction of the resources put into combating the 
pandemic should have been invested in the NIH years ago. With impacts 
like $16 trillion from one pandemic, we need more than inflationary 
increases to NIH each year to keep pace and inoculate the country 
against the next public health crisis.
    Not only is NIH research essential to advancing health and national 
security, it also plays a key economic role. Funds provided to NIH are 
not costs, but instead generate remarkable rates of economic return and 
even greater returns on our health and wellbeing. In FY 2021, NIH 
invested $35.73 billion, over 80 percent of its budget, in the 
biomedical research industry across the country. This investment 
supported more than 552,444 jobs nationwide and generated nearly $94.18 
billion in economic activity across the U.S.\2\ Just one NIH-funded 
medical research program, The Human Genome Project, directly generated 
more than a trillion dollars for the U.S. economy-a 178-fold return on 
investment--and has paid for itself many times over in industry tax 
revenues returned to the government.\3\
---------------------------------------------------------------------------
    \2\ NIH's Role in Sustaining the U.S. Economy--2022 Update, https:/
/unitedformedicalresearch.org/wp-content/uploads/2022/03/UMR_NIHs-Role-
in-Sustaining-the-U.S.-Economy-FY21.pdf.
    \3\ https://www.nih.gov/about-nih/what-we-do/impact-nih-research/
our-society.
---------------------------------------------------------------------------
    MCPP is enthusiastic about the newly established Advanced Research 
Projects Agency for Health (ARPA-H) and the potential it has to drive 
innovation and accelerate the development of innovative therapeutics, 
treatments, and cures for chronic conditions such as cancer, diabetes, 
and Alzheimer's Disease. Too often, research supported by the NIH 
results in incremental advancements and not the transformative 
scientific breakthroughs that only come from robust investment in high-
risk high-reward research. The research at ARPA-H must complement the 
work at the NIH, and not duplicate current research efforts at the 
NIH's Institutes and Centers. To have the largest impact on biomedical 
research, medicine, and healthcare, ARPA-H should focus on breakthrough 
technologies that are multi-disciplinary and operate across disease 
groups as well as focus on questions and topics that do not fit well 
within the confines of traditional biomedical research but may have 
clinical or commercial applications, something the NIH has historically 
been unable to do.
    In addition, funding for ARPA-H should supplement, not supplant 
NIH's base budget funding. For ARPA-H to yield successful results with 
the most promise for transformative advances, NIH must receive adequate 
base funding to ensure breakthroughs in the same basic research that 
makes these transformative advances possible.
    A crucial component of ensuring that the NIH is equipped to meet 
the health challenges of the future is supporting the next generation 
of scientists. Early career researchers in the biomedical sciences face 
many struggles as they move toward independence. Lack of independent 
funding opportunities and tenure-track faculty positions place many 
early career researchers in a cycle of training positions that may 
hinder growth, innovation, and scientific independence. In addition, 
the NIH funding ecosystem is harmfully ``hypercompetitive.'' In FY 
2021, only one out of every five applicants was ultimately awarded NIH 
funding,\4\ and the resulting grant was almost always less than the 
amount requested to effectively perform the research. This system 
especially disadvantages early career investigators, squandering the 
potential of scientists with groundbreaking and innovative ideas.\5\ 
Furthermore, among early career researchers, women, parents, and those 
from underrepresented backgrounds in STEM bear a disproportionate 
amount of this burden. MCPP urges the subcommittee to build NIH's 
ability to devote more of its annual budget to programs that support 
early career researchers, with the goal of attaining 10 percent of the 
agency's overall budget invested in the most promising young 
investigators conducting highly innovative research with truly 
transformative potential.
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    \4\ https://report.nih.gov/nihdatabook/report/20.
    \5\ https://nexus.od.nih.gov/all/2018/05/04/the-issue-that-keeps-
us-awake-at-night/.
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    MCPP thanks the subcommittee for its important work dedicated to 
ensuring the health and security of the Nation, and we appreciate this 
opportunity to urge the subcommittee to continue the success of NIH by 
providing $100 billion in FY 2023. This is the minimum amount needed to 
transform our Nation's investment in life-saving medical research, 
enhance NIH's ability to support highly innovative and groundbreaking 
research, and expand support for young investigators.
    We have a once-in-a-lifetime opportunity to pave the way for future 
medical advances to benefit humankind. Let's seize it.
                                 ______
                                 
         Prepared Statement of the Morehouse School of Medicine
              summary of fiscal year 2023 recommendations
_______________________________________________________________________
Health Resources and Services Administration:
  --$1.51 billion for the Health Resources and Services Administration 
        (HRSA) Title VII health professions and Title VIII nursing 
        workforce development programs.
    --$47.42 million for HRSA's Minority Centers of Excellence
    --$47.95 million for HRSA's Health Careers Opportunity Program.
    --$2 million for HRSA's Minority Faculty Loan Repayment Program.
    --$67 million for HRSA's Scholarships for Disadvantaged Students 
            (SDS)
    --$67 million for HRSA's Area Health Education Center (AHEC) 
            Program
Centers for Disease Control and Prevention
  --$74 million for the Racial and Ethnic Approaches to Community 
        Health (REACH) Program
National Institutes of Health
  --$49 billion for the National Institutes of Health
    --$1 billion for the National Institute on Minority Health and 
            Health Disparities (NIMHD).
      -- $300 million for the Research Centers at Minority Institutions 
            (RCMI)
    --$200 million in new, annual research funding dedicated 
            specifically targeted at enabling historically black health 
            professions schools to support research that reverses 
            health status disparities among minority Americans.
    --$100 million for NIH's Extramural Research Facilities program
    --$50 million to reinvigorate the NIMHD's Research Endowment 
            Program (REP)
Office of the Secretary
  --$72 million for the Office of Minority Health at the Department of 
        Health and Human Services.
  --$5 billion in new funding designated for Historically Black Health 
        Professions Institutions for the improvement and development of 
        health care infrastructure.
Department of Education
  --$100 million for the Strengthening Historically Black Graduate 
        Institutions (HBGI) Program.
Community Project Funding/Congressional Directed Spending Request 
        (HRSA)
  --$950,000 request to continue the development of a Research and 
        Academic Building on MSM's main campus ($10 million total cost)
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to submit testimony 
and thank you for your leadership in addressing challenges facing the 
health workforce, health disparities, and medically underserved 
communities. I am Dr. Valerie Montgomery Rice, President, and Dean of 
Morehouse School of Medicine (MSM).
    Morehouse School of Medicine was founded to address the disparities 
in health status and health care among vulnerable populations. Central 
to our mission is increasing the diversity and cultural competence of 
the health professional scientific workforce, addressing the primary 
health care, mental health and public health needs of underserved 
populations, as well as engaging in innovative research and developing 
patient-centered programs aimed at advancing health equity in Georgia 
and across the Nation. This is a mission that we, and our Historically 
Black Colleges and Universities (HBCU) medical school colleagues, take 
seriously.
    We are proud to be a one of the four institutions that comprise our 
Nation's HBCU medical schools. While each of our esteemed institutions 
brings something slightly different to the table, we all share one 
common goal: helping Americans achieve their optimal level of health. 
HBCU medical schools are distinguishable from our other institutional 
colleagues because health equity is at the core of everything we do. 
From the research opportunities that we engage in, to our 
prioritization of clinical continuity for underserved communities, to 
our commitment to providing access to trusted medical services for 
those who need it most, we have always existed to protect the most 
vulnerable amongst us.
    We have learned valuable lessons over the past 2 years, and 
continue to respond the best we can to the pandemic, but we know that 
there is more work to be done. The country has now seen what MSM and 
other Historically Black Graduate Institutions (HBGIs) and HBCUs know 
and work towards everyday: the pitfalls and shortcomings of minority 
health. Our funding recommendations are robust and necessary given the 
discussion concerning the devastating effect of the pandemic on people 
of color and the need to address this effect for any future pandemic. 
To be as clear we can be, there must be more robust investment on 
minority health and disparities. To achieve this we know that it will 
require the steadfast leadership of health equity champions. We stand 
ready to work with you and your colleagues to facilitate these efforts.
    Health disparities across racial and ethnic groups in the U. S. 
have been well documented over the last several decades and have 
remained remarkably persistent in spite of the changes in many facets 
of the society over that period. Moreover, the benefits of increasing 
diversity in the health professions to reduce such disparities have 
been studied at length, are based on empirical data, and are well 
understood by the medical community. Examples of these benefits 
include:
  --Minority physicians are more likely to practice in medically 
        underserved areas and care for patients regardless of their 
        ability to pay.
  --Minority physicians are more likely to choose primary care 
        practices.
  --Evidence suggests that improving cross-cultural communication 
        between doctors and patients and providing patients with access 
        to a diverse group of doctors improve adherence, satisfaction 
        and health outcomes.
  --There is evidence that the intellectual, cultural sensitivity, 
        competency, and civic development of students is enhanced by 
        learning in a diverse educational environment.
  --A diverse health workforce encourages a greater number of 
        minorities to enroll in clinical trials designed to alleviate 
        health disparities.
    There is little left to discover or dispute with respect to the 
benefits of achieving greater racial and ethnic diversity of the 
Nation's health professionals--the attention has once again shifted to 
identifying the most effective and sustainable methods to do so. While 
there are many national campaigns underway to increase diversity in all 
medical and health professions schools particularly during this period 
of enrollment growth, it is imperative that we further recognize and 
leverage the public value of Historically Black Health Professions 
Schools.
    The daunting news that Blacks Americans in the U.S. are 
disproportionately suffering and dying from COVID-19 unfortunately was 
not a tremendous surprise to those of us who regularly monitor and 
understand health status disparities in this nation. There are well-
known health status challenges faced daily by Black Americans and 
minority health care providers, it also represents a surrogate for the 
glaring lack of health infrastructure in medically under-served 
communities. At MSM and other HBGI institutions, we have long been and 
remain committed to addressing these very same disparities in whatever 
way that we can, with an eye first and foremost towards the communities 
with the greatest need across our country.
    Ironically, as a result of their mission focus the financial models 
of historically black health professions schools are uniquely 
disadvantaged compared to most of their peer institutions. Unlike 
subspecialty-oriented, research-intensive institutions--with higher 
margin clinical services, an integrated hospital system, substantial 
research enterprises, sizeable endowments, and a critical mass of 
wealthy donors--these institutions are faced with an unprecedented set 
of adverse factors that challenge their financial viability. 
Consequently, they are disproportionately dependent on the various 
Federal programs that support their core purpose.
    Specifically, these programs include: the Title VII Health 
Professions Training Programs administered by the Health Resources and 
Services Administration (HRSA) of the Department of Health and Human 
Services (HHS); the Research Centers at Minority Institutions (RCMI), 
the Extramural Research Facilities; the Research Endowment; and Centers 
of Excellence programs administered the National Institutes of Health's 
National Institute on Minority Health and Health Disparities; and the 
Historically Black Graduate Institution (HBGI) program administered by 
the Office of Postsecondary Education of the U.S. Department of 
Education (DOE).
    President Biden recently signed the John Lewis NIMHD Research 
Endowment Revitalization Act to revitalize this important initiative, 
and it is our expectation that NIMHD will act swiftly to reinvigorate 
the research endowment program so minority-serving institutions can 
participate in this competitive opportunity to build their research 
endowments in a manner consistent with the statutory goal of assisting 
them in achieving a research endowment that is comparable to the 
endowments of other schools in their health professions discipline. The 
NIMHD Research Endowment Program (REP) allows academic institutions to 
build research infrastructure and recruit, train, and maintain a 
diverse faculty and student body. Robust funding would allow active and 
former NIMHD Centers of Excellence to continue their historic focus on 
research to close the gap between the burden of illness and premature 
mortality experienced more commonly by communities of color, as well as 
other medically underserved populations. It would also help improve 
access to grants to fund research projects, as well as hire staff and 
provide scholarships for students who come from underserved 
communities. To ensure successful implementation, we are asking for the 
Committee to allocate robust funding to NIMHD for this program.
    In addition to the recommendations referenced above, MSM has 
submitted a community project funding/congressionally directed spending 
request for continuing to develop a new academic and research facility 
that will provide critical support in the Institution's mission to 
improve and diversify the healthcare workforce. The recent growth in 
the size and diversity of the student body has not only made it 
necessary to train more healthcare professionals committed to 
underserved communities, but it also requires expanded space and 
resources on campus. More classrooms, lecture spaces, learning 
communities, research laboratories, and common spaces for knowledge 
sharing are all needed to meet the needs of a growing student body.
    Madam Chair, unfortunately, over the past several years funding for 
diversity-focused programs has deteriorated in varying degrees. Absent 
a monumental overall investment the financial position and academic 
viability of historically black health professions schools will 
deteriorate rapidly. The front loaded investment in health professions 
training programs, graduate programs in biomedical sciences and public, 
and safety net providers is more cost effective than absorbing 
uncompensated care originating from minority and underserved 
communities. Now is the time for targeted investments in historically 
black health professions schools to ensure a steady pipeline of 
minority healthcare providers, biomedical scientists, and other health 
practitioners prepared to support and advance the delivery of high 
quality, culturally appropriate, evidence-based health care. Thank you 
all again for the opportunity to share the priorities of the Morehouse 
School of Medicine.

    [This statement was submitted by Valerie Montgomery Rice, M.D., 
President and Dean, Morehouse School of Medicine.]
                                 ______
                                 
                       Prepared Statement of NAF
    NAF is a national network of education, business, and community 
leaders who work together to ensure high school students are college, 
career, and future ready. NAF appreciates the opportunity to submit 
testimony to the Senate Labor, Health and Human Services, Education, 
and Related Agencies (LHHS) Appropriations subcommittee regarding our 
request for fiscal year 2023 report language for paid work-based 
learning funded at $5,000,000 at the Department of Labor's Employment 
and Training Administration.
    NAF's educational design promotes open enrollment in our career 
academies and allows students of all backgrounds and capabilities to 
participate. The design is replicable, sustainable, and cost-effective, 
and because it integrates within public schools, supports lasting 
systemic reform and equity nationwide. NAF transforms the learning 
environment to include STEM-infused, industry-specific curricula and 
work-based learning experiences. NAF serves more than 120,000 high 
school students in 35 States and territories. NAF is focused on helping 
to eliminate systemic, educational, and professional barriers, 
especially those faced by students of color.
    Public secondary education institutions play a critical role in 
preparing youth for future success through initiatives like career and 
technical education programs, access to local colleges, and work-based 
learning opportunities with employers. As a principal public 
institution that teens go through before becoming adults, the secondary 
education system plays a significant role in setting up the next 
generation for success in the workforce. Work-based learning programs 
ensure a connection between schools and the working world, whether it's 
preparing students to enter existing jobs, encouraging entrepreneurial 
endeavors, or serving as a foundation for career opportunities after 
post-secondary education.
    Research shows that participation in work-based learning during 
high school has a positive impact on students, including completing 
high school, securing higher-quality jobs, and boosting equity and 
economic opportunity.\1\ Work-based learning is the continuum of 
activities both in classroom learning and the workplace setting that 
leads students to gain real world experience. Work-based learning has 
proven impacts on earnings, job quality and stability and is a critical 
lever in addressing systemic racial and economic inequities.
---------------------------------------------------------------------------
    \1\ Sun, J., & Spinney, S. (2017). Transforming the American High 
School Experience: NAF's Cohort Graduation Rates from 2011-2015. ICF 
International.
---------------------------------------------------------------------------
    Students in NAF academies are more likely to graduate on-time than 
their peers who are not involved with career academies. NAF has an 
overall positive effect on all students but is particularly impactful 
for those at-risk of not graduating-with full, 4-year program 
participation in a high-quality career academy, these students were 10 
percentage points more likely to graduate on-time than their non-NAF 
counterparts. Black and Hispanic students attending NAF academies also 
are shown to have higher high school graduation rates.ii
    Students who graduated from a career academy amassed 11 percent 
more total earnings each year, over the 8 years following high school 
than those who did not attend a career academy. Youth who drop out of 
high school can expect to earn $10,000 less annually compared to high 
school graduates.\2,3\ In 2020, NAF academies reported 99 percent of 
the seniors graduated with 87 percent of graduates planning to go to 
college.
---------------------------------------------------------------------------
    \2\ Kemple, J. J., & Willner, C. J. (2008). Career Academies Long-
Term Impacts on Labor Market Outcomes,. mdrc.
    \3\ ICF. (2017). Transforming the American High School Experience: 
NAF's Cohort's Graduation Rates from 2011-2015, 2017.
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    Work-based learning helps students to build relationships, sharpen 
essential skills and expand their networks beyond their immediate 
communities. The relationships with adults nurtured through work-based 
learning opportunities are also shown to be long-lasting, positively 
benefiting students up to a decade later. Eighty percent of jobs are 
filled through personal and professional connections.\4\ Young people 
deserve an education that builds workforce essential skills, helps them 
create social capital, and connects them to opportunity.
---------------------------------------------------------------------------
    \4\ Fisher, J. F. (2020, February 14). How to get a job often comes 
down to one elite personal asset, and many people still don't realize 
it. Retrieved from CNBC: https://www.cnbc.com/2019/12/27/how-to-get-a-
job-often-comes-down-to-one-elite-personal-asset.html.
---------------------------------------------------------------------------
    The most effective work-based learning experiences provide 
sustained and meaningful interaction between a student and employer 
partner. This would include career preparation activities such as 
internships, apprenticeships, and mentorship programs. While less 
intensive activities--such as guest speakers, mock interviews, and 
worksite tours--are important to help students with career awareness 
and exploration and to introduce employers to the concept of work-based 
learning, the more time- and resource-intensive activities like 
internships are where students gain the most insight into the working 
world and able to hone their professional skills.
    When created with intentional student learning outcomes and 
ownership by all stakeholders, work-based learning can shape students' 
aspirational opportunities by helping them explore potential careers of 
interest; build student skills; and help level the playing field by 
exposing students to networking opportunities to build a diverse 
professional network, which research indicates is particularly 
transformative for students of color and those from low-income 
households.
    While funding to schools for career and technical education is 
provided through the Perkins Career and Technical Education Act, this 
funding cannot be used to pay students for their work. However, paid 
internships are vital to closing the equity gap. Moreover, 
opportunities to intern in the nonprofit and government sectors can 
foster interest in public service careers among financially 
disadvantaged students. This potential for increased awareness of civic 
affairs would represent an important step toward a more engaged and 
inclusive democracy.
    To build upon Congress' previous support for work-based learning 
coordinators at the secondary education level, NAF urges the 
subcommittee to support and advocate for the inclusion of the following 
report language in the fiscal year 2023 Appropriations bill, ``The 
Committee includes $5,000,000 to provide grants to no more than three 
national, non-profit education organizations, which work 
collaboratively with Title I public high schools to facilitate paid 
internships for enrolled high school students completing secondary 
career and technical education in information technology, finance, 
health sciences, hospitality, and engineering. Ninety percent of funds 
shall be used by grantees to support paid internships with local 
employers, which shall include, but not be limited to, non-profit and 
government agencies. Preference shall be given to organizations with 
existing internship preparation programming and internship assessment 
tools in order to provide an evaluation of outcomes to the 
Department.''
                               conclusion
    Work-based learning is advantageous for employers and communities. 
It is a proven way to grow the talent pipeline and help students be 
ready for the workforce.\5\ By partnering with high schools to provide 
work-based learning opportunities to students, employers help develop a 
talent pipeline aligned with their workforce needs. Employers also gain 
the opportunity to observe prospective employees in action before 
making the investment to hire them.\6\ The nation must invest in work-
based learning, so workers have the skills they need to succeed; and 
employers have the diverse talent they need to thrive. NAF appreciates 
the opportunity to share its expertise; and thanks you for your 
consideration of this important request.
---------------------------------------------------------------------------
    \5\ Ross, M., Moore, K. A., Murphy, K., Bateman, N., DeMand, A., & 
Sacks, V. (2018, October). Pathways to high-quality jobs for young 
adults. Retrieved from Brookings: https://www.brookings.edu/research/
pathways-to-high-quality-jobs-for-young-adults/.
    \6\ Benefits of Work-Based Learning. (n.d.). Retrieved from JFF: 
https://www.jff.org/what-we-do/impact-stories/center-for-
apprenticeship-and-work-based-learning/benefits-work-basedlearning/ 
#::text=Jobseekers%20also%20see%20work%2Dbased,of%20%20a%20skilled%regi
onal%20 workforce.
---------------------------------------------------------------------------
                                 ______
                                 
Prepared Statement of the National Alliance for Eye and Vision Research
    Serving as ``Friends of the National Eye Institute,'' the National 
Alliance for Eye and Vision Research (NAEVR) is a 501(c)4 non-profit 
advocacy coalition comprised of over 55 organizations, research 
institutions, and companies involved in and supportive of eye and 
vision research. NAEVR is grateful to Congress, especially the House 
and Senate Labor, Health, and Human Services (LHHS) Appropriations 
subcommittees, for the strong bipartisan support for NIH funding 
increases over the past 7 years. The $14.88 billion increase during 
that timeframe has helped the agency, and researchers, regain lost 
ground after a decade of effectively flat budgets.
            support nih base funding of at least $49 billion
    The past increased investments in NIH have continued to improve our 
understanding of fundamental life and health sciences, advance research 
across conditions, and prepare the Nation to combat existing and future 
health threats, including COVID-19. To maintain and build on this 
momentum, NAEVR strongly supports a funding level of at least $49 
billion for the NIH's base program level, a $4 billion increase over 
the comparable FY22 enacted level, with an emphasis that any additional 
funds for the Advanced Research Projects Agency for Health (ARPA-H) 
supplement, rather than supplant, this core investment in NIH. This 
increase would help keep NIH's base budget ahead of the biomedical 
research and development price index (BRDPI) and provide for inflation 
plus growth to support promising science across the Institutes and 
Centers.
    NAEVR continues to support ARPA-H funding and supports any funding 
above the $1 billion allocated in FY22 to be supplemental to the NIH 
base budget as referenced above. NAEVR is further interested in 
identifying and supporting ways that vision researchers can engage in 
advanced research projects through ARPA-H given how vital vision 
researchers have proven to be across advancements in multiple 
conditions.
    NAEVR is also supportive of the proposed use of mandatory funding 
to supplement NIH's base funding to improve pandemic response and 
readiness. COVID-19 has continued to impact research and our society 
and focusing research to address these issues is vital.
                  support nei funding of $950 million
    NAEVR also urges Congress to fund the National Eye Institute at 
$950 million, an $86.1 million increase over the comparable FY22 
enacted level. Vision researchers continue to perform extremely well in 
cross NIH initiatives because of how central the eye is to not only 
vision, but it provides one of the best windows into the brain and 
brain function. While funding for NEI has increased along with other 
NIH institutes, the FY22 funding level continues to remain below 2012 
inflation-adjusted dollars.
    NEI will play an even greater role in research that can stem the 
tide of the looming vision epidemic in the United States. The Centers 
for Disease Control (CDC) estimates that three-in-five Americans over 
40 have eye and vision problems (90 million Americans). By 2050, CDC 
estimates a 72 percent increase in diabetic retinopathy, an 87 percent 
increase in cataracts, a 100 percent increase in glaucoma, a 100 
percent increase in macular degeneration, and a 150 percent increase in 
vision impairment and blindness. Americans are facing an increasing 
burden of vision impairment and eye disease due to an aging population, 
the disproportionate impact risk and incidence of eye disease in fast-
growing minority populations, and comorbidities impacting vision from 
numerous chronic conditions such as diabetes. With an ever-increasing 
reliance on electronic communication and screen time for children and 
adults, increased rates of myopia, dry eye, and eye strain are all 
expected to impact future generations.
    Maintaining the momentum of vision research and increasing the 
investment in vision research is vital to not only vision health but 
also to Americans' independence and quality of life. In a 2014 
Research!America and Alliance for Vision Research (AEVR) survey of over 
2,000 adults, vision loss was rated as potentially having the greatest 
effect on their day-to-day life, greater than the loss of limb, memory, 
hearing, and speech. Maintaining the momentum of vision research is 
vital to vision health, as well as to overall health and quality of 
life. Since the United States is the world leader in vision research 
and training the next generation of vision scientists, the health of 
the global vision research community is also at stake.
          nei-funded research saves sight and restores vision
    The past Federal investment in vision research has led to major 
advances in the prevention of vision loss as well as the restoration of 
vision.
    Audacious Goals Initiative: The NEI has been at the forefront of 
regenerative medicine with its Audacious Goals Initiative (AGI), which 
launched in 2013 with the goal of restoring vision. Engaging a broad 
constituency of scientists from the vision community and numerous other 
disciplines, the AGI currently funds major research consortia that are 
developing innovative ways to image the visual system. Researchers can 
now look at individual nerve cells in the eyes of patients in an 
examination room and learn directly whether new treatments are 
successful. Another consortium is identifying biological factors that 
allow neurons to regenerate in the retina. And the AGI is gathering 
considerable momentum with current proposals to develop disease models 
that may result in clinical trials for therapies within the next 
decade.
    Retinal Diseases: The NEI has been at the forefront of research 
into retinal diseases. NEI-funded researchers helped show that a 
protein called Vascular Endothelial Growth Factor (VEGF) stimulates 
abnormal blood vessel growth that occurs in the advanced stages of the 
``wet'' form of Age-related Macular Degeneration (AMD) and Diabetic 
Retinopathy. Food and Drug Administration (FDA)-approved anti-VEGF drug 
therapies that slow the development of blood vessels in the eye delay 
vision loss and may improve vision for patients. The NEI has funded 
comparison trials of anti-VEGF drugs to provide eye care professionals 
and patients with the information they need to choose the best 
treatment options.
    With respect to the ``dry'' form of AMD, known as geographic 
atrophy and the leading cause of vision loss among individuals aged 65 
and older, in late 2019 NEI began a first-in-human clinical trial that 
tests a stem cell-based therapy from induced pluripotent stem cells 
(iPSC) to treat geographic atrophy. This trial converts a patient's own 
blood cells to iPS cells which are then programmed to become retinal 
pigment epithelial (RPE) cells, which nurture the photoreceptors 
necessary for vision and which die in geographic atrophy. Bolstering 
remaining photoreceptors, the therapy replaces dying RPE with iPSC-
derived RPE.
    Genetics/Genomics: The NEI has been at the forefront of genetics/
genomics and gene therapy approaches to various vision disorders-both 
common and rare. The causes of AMD and glaucoma remain elusive-although 
most cases are not inherited, genetics does play a role. While NEI-
funded researchers have identified many genetic risk factors for AMD 
and glaucoma, further study of these genes is helping to elucidate the 
biology of these disease and holds promise for improved therapies.
    NEI-funded research has also made discoveries of dozens of rare eye 
disease genes possible, including the discovery of RPE65, which causes 
congenital blindness called Leber congenital amaurosis (LCA). As of 
late 2017, NEI's initial efforts led to a commercialized, Food and Drug 
Administration (FDA)-approved gene therapy for this condition. These 
gene-based discoveries are forming the basis of new therapies that 
treat the disease and potentially prevent it entirely.
    Front-of-Eye Research: The NEI has launched an Anterior Segment 
Initiative (ASI) to capitalize on research opportunities at the front 
of the eye. The ASI is addressing clinically significant, quality-of-
life problems such as ocular pain and Dry Eye Disease (DED), especially 
in terms of pain and discomfort sensations, as well as disruptions in 
the tearing process. Using multi-disciplinary approaches, the ASI plans 
to elucidate relevant anterior segment innervation pathways that 
contribute to normal or abnormal functioning of the neural circuits 
related to the ocular surface.
              economic burden of eye and vision conditions
    Vision disorders represent the fifth-highest direct medical cost in 
the United States. In a 2014 Prevent Blindness study, it was reported 
that vision disorders will cost an estimated $182.5 billion in 2022--
only less than heart disease, cancers, emotional disorders, and 
pulmonary conditions. Left unaddressed, and with the looming vision 
epidemic, this is projected to grow to an inflation-adjusted $717 
billion by 2050. The U.S. is spending over $545 per American on the 
treatment of vision disorders every year while only spending $2.50 per 
American on research that can improve outcomes. [http://
costofvision.preventblindness.org/]
    NEI's breakthrough research is a cost-effective investment that has 
led to treatments and therapies that may delay, save, and prevent 
health expenditures. It can also increase productivity, help 
individuals maintain their independence, and improve their quality of 
life as vision loss is associated with increased depression and 
accelerated mortality.
                                summary
    NAEVR supports the efforts of Congress to provide an eighth 
consecutive year of increases in the base funding for NIH. This funding 
is vital to building on the momentum of existing research and NAEVR is 
confident a funding level of at least $49 billion will provide the 
necessary increase in FY23 to continue this growth. Inflation plus 
growth investment for the National Institutes of Health (NIH) and 
specifically the National Eye Institute (NEI), is vital to ensure we do 
not fall short of the Institute's ability to respond to the research 
needs of today to improve the outcomes of patients in the future.
    NAEVR supports the NEI and believes that a funding level of $950 
million would reflect the urgent need to address eye and vision 
research in the United States. This funding would allow NEI to support 
researchers to identify new treatments, therapies, and interventions 
and address the future crisis in vision care as Americans age and more 
Americans rely on increased screen time to remain productive.
    NAEVR thanks the LHHS Appropriations subcommittee for the 
opportunity to submit this written testimony, especially as it 
continues to grapple with the multitude of short and long-term 
challenges exacerbated by the COVID-19 pandemic.
    For more information, or if the subcommittee has additional 
questions, please contact Dan Ignaszewski, Executive Director of NAEVR 
at [email protected]. Additional information can also be found on 
NAEVR's website at www.eyeresearch.org. Thank you again for your time 
and consideration,
    Sincerely.

    [This statement was submitted by Dan Ignaszewski, Executive 
Director, National Alliance for Eye and Vision Research.]
                                 ______
                                 
   Prepared Statement of the National Alliance for PANS/PANDAS Action
    Madam Chairwoman,
    It is an honor to provide testimony to the subcommittee on behalf 
of thousands of children and young adults across the country who have 
had their lives turned upside down by Pediatric Acute-Onset 
Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune 
Neuropsychiatric Disorders Associated with Streptococcus (PANDAS), 
which are Childhood Post-Infectious Neuroimmune Disorders (CPINDs). We 
are requesting support of report language and $5,000,000 in program 
funding for PANS and PANDAS in the fiscal year 2023 Labor, Health And 
Human Services, Education and Related Agencies bill.
    First, I would like to thank the Committee for the strong language 
included in past Committee reports. It has been effective and has 
brought attention to PANS and PANDAS. However, it is now time to take 
decisive action to direct NIH and other Federal agencies to increase 
funding for investigations into these conditions.
    I am the parent of three children with PANDAS, a founding member of 
the National Alliance for PANS/PANDAS Action (NAPPA), and co-founder of 
the Mending Minds Foundation. I helped start these organizations to 
drive much-needed research and awareness.
    PANS and PANDAS are neuroimmune disorders caused by a misdirected 
immune response following an infection. In short, antibodies and immune 
cells that would normally fight infection ``go rogue'' and attack the 
brain. The resulting inflammatory process leads to debilitating 
neurological and behavioral changes in young people.
    PANS and PANDAS cause life-altering and horrific symptoms. The 
first sign is dramatic deterioration in one or more areas of 
functioning including cognitive, motor, sensory, executive, social, and 
emotional. These disorders have an alarming impact on mood and 
personality, rendering an adolescent who thrived in school suddenly 
unable to leave the house, or an exuberant healthy child intensely 
phobic and anorexic. Restrictive eating, severely impulsive, self-
harming behavior, and suicidal ideation may necessitate 
hospitalization. Children's lives are in danger.
    My family's story illustrates the devastating reality posed by 
these diagnoses. My two older children presented with primary mental 
health and neurological symptoms and, as a result, the underlying 
immune dysfunction was missed. Psychotropic medications did not 
alleviate these symptoms, and my children continued to deteriorate. We 
finally arrived at the true cause of their illness: undiagnosed, 
untreated strep infection, the same bacteria that causes a sore throat. 
When they received medication to address this underlying infection, 
they began to respond and improve in ways that had not been possible 
with mental health treatment alone.
    Like many children with PANS and PANDAS, their identification and 
treatment was delayed due to ?limited awareness and clinical 
understanding. Unfortunately, lack of medical care to address the 
underlying infectious, inflammatory, and/or immune process resulted in 
symptom escalation and prolonged illness. The risk of misdiagnosis is 
greater in communities already facing barriers due to income and racial 
disparities in health care.
    My children also exemplify the contrast between delayed and early 
identification. My oldest two have suffered more serious complications 
and required more extensive treatment. They have lost critical time 
between the onset of their symptoms and medical intervention that they 
cannot completely regain. My youngest was treated successfully when her 
symptoms began, and she recovered quickly. Catching this illness early 
is the best path to full and complete recovery. When left undiagnosed 
and untreated, the condition may worsen and lead to chronic illness in 
young adulthood and beyond.
    Caring for youth in a sustained crisis places a heavy financial 
burden on families, health care systems, and schools. Parents endure 
lost wages and out-of-pocket medical costs. Insurers incur immense 
costs due to repeated emergency room visits, inpatient medical and 
psychiatric stays, and years of pharmacological and behavioral 
therapies for symptom management.
    Educational systems face an enormous financial burden when 
providing special education services for children who need increased 
academic support, one-to-one aides, home tutoring, or out-of-district 
placements. Shortening the time to identification and appropriate 
medical treatment would significantly minimize these societal costs.
    In the past 2 years, COVID-19 has brought increased recognition of 
the irrefutable link between infections and delayed, but highly 
disruptive, immune and inflammatory reactions in the body and brain, 
including post-infectious psychosis, depression, and anxiety. Medical 
illness triggering psychiatric symptoms is not a new phenomenon and 
holds the key to understanding the connection between the body's 
response to infection and mental illness.
    The youth mental health crisis, which arose out of the global 
pandemic, is staggering. Suicide is a leading cause of death in young 
people beginning at age 10. Children and adolescents with PANS and 
PANDAS have a high degree of impulsivity and often have intrusive 
thoughts of self-harm and of killing themselves. Tragically, many young 
people have lost their lives from PANS and PANDAS as a result of 
impulsive acts causing self-injury or persistent thoughts of death, 
including Louisa, the 13-year-old daughter of one of NAPPA's founding 
members.
    Prior to the onset of PANDAS, Louisa flourished socially and 
academically-a straight A student with much promise who aspired to 
become a doctor. The day that Louisa became ill was her last day at 
school. She was never able to return and suffered terribly for two and 
a half years until her untimely death. Her parents donated Louisa's 
brain to Georgetown University's brain bank dedicated to PANS/PANDAS 
research. Growing this critical research and ensuring that all children 
are routinely screened for PANS and PANDAS will save lives.
    Researchers can develop better screening tools and biomarkers to 
identify youth with underlying medical illnesses. Larger and longer-
term studies can lead to more effective individualized treatment. 
Across the U.S., dedicated scientists and clinicians are doing 
groundbreaking work that cannot continue without funding.
    They cannot achieve the breakthroughs our children so desperately 
need alone. A $5 million commitment from Congress and NIH to dedicate 
funding to PANS and PANDAS will promote the development and application 
of diagnostic tools and effective interventions early in the course of 
illness, when affected youth can recover quickly and return to thriving 
in their homes, schools, and communities.
    The ability of children suffering from PANS and PANDAS to regain 
their quality of life with appropriate intervention is exemplified by 
the story of Tim:

      Tim was a happy, healthy 10-year-old, thriving in school and 
        engaged in many extracurricular activities. He was an avid 
        reader and a valued contributor on his chess, soccer, and 
        tennis teams. He was honored as an exemplary school community 
        member. Shortly after an infection, he became so riddled with 
        OCD that he was unable to leave his bedroom to attend school or 
        medical appointments, and some days he refused to eat.
      He lost his reading, writing, and math skills. He was in physical 
        pain and could not sleep at night. When Tim suddenly began 
        attempting to jump off the balconies of his house and running 
        into traffic, his parents had to provide round the clock 
        supervision. This continued despite repeated trips to numerous 
        doctors and therapists. His family said it was as if an alien 
        had invaded his brain and his body. The stress took an enormous 
        toll on their family, including their other children. Medical 
        providers were baffled, had a 10-year-old somehow become 
        bipolar overnight? Thanks to the family's persistence and a 
        dedicated medical team familiar with PANDAS, the root cause was 
        finally identified. All of this mayhem stemmed from a simple 
        strep infection. With treatment for his underlying infection 
        and immune dysfunction, Tim returned to school and resumed his 
        activities. The crippling OCD is gone, the dark thoughts are 
        gone, the arthritis is gone, and the headaches are gone. He has 
        his life back.

    We are living in complicated times when our vulnerability to 
infectious diseases has never been so glaring. We turn to medicine and 
science for the rapid development of tests, treatments, and vaccines to 
harness the immune system in the fight against COVID-19. We must now 
use those tools to improve the lives of children with PANS and PANDAS. 
Funding research will be a vital next step for the health of our 
country and the future of our children.
    I would like to conclude by emphasizing the following points:
  --Early intervention lowers the risk of chronic illness and 
        alleviates the heavy financial burden on families, school 
        systems, health care systems, and insurers.
  --When left untreated, PANS and PANDAS can result in unintentional 
        loss of life. Directing resources to screening young people 
        will save lives.
  --The association between neuropsychiatric illness and infections has 
        become even more evident because of SARS CoV-2 and provides 
        increasing opportunities for breakthroughs in research and 
        treatment.
  --25 years after NIH began researching PANDAS, program funding 
        remains insufficient to develop diagnostic tests and to 
        identify more effective treatments.
  --NIH research funding for PANS/PANDAS would bring much-needed 
        attention to these diagnoses in the medical community, thereby 
        aiding in early identification and treatment.
    Advancing our understanding of PANS and PANDAS through a $5 million 
commitment will contribute to a paradigm shift in research, medicine, 
and mental health care. Such a Federal investment in scientific 
research will dramatically change the lives of many young people 
affected by these neuroimmune disorders.
    America's youth deserve the best that our healthcare system has to 
offer-not a lifetime of pain and symptom management. Your support will 
help PANS and PANDAS families achieve their dream of solving this 
nationwide health crisis.

    [This statement was submitted by Amanda Peel Crowley, Founding 
Member, 
National Alliance for PANS/PANDAS Action.]
                                 ______
                                 
 Prepared Statement of the National Alliance of Public Charter Schools
    Madam Chair and Members of the subcommittee, I am pleased to 
present the views of the National Alliance for Public Charter Schools 
(the National Alliance) on the Fiscal Year (FY) 2023 appropriation for 
the Charter Schools Program (CSP) and other programs administered by 
the U.S. Department of Education. The National Alliance is the leading 
national nonprofit advocacy organization committed to advancing the 
public charter schools movement.
    I would like to thank the subcommittee for maintaining support for 
the CSP at a funding level of $440 million in FY 2022, as the program 
helps expand educational opportunities for children and families and 
drives improvements in educational outcomes nationwide. Indeed, the 
importance of charter schools (supported by the CSP) in offering 
choices to needy families has been demonstrated by the continued growth 
in charter school enrollments during the ongoing COVID-19 pandemic. As 
the subcommittee considers the budget for FY 2023, we ask that you 
increase the CSP appropriation to at least $500 million.
    The National Alliance also strongly supports the provision of 
additional resources for Federal K-12 education programs that fund 
schools more generally, including Title I Grants to Local Educational 
Agencies (LEAs) and the State Grants under the Individuals with 
Disabilities Education Act. We endorse the Administration's request for 
increased funding for these programs, which will help public schools, 
including charter schools, address the challenges they now face in 
enabling students to recover from learning losses attributable to the 
pandemic and to reach the outcomes we want all students to achieve.
The Operation of Charter Schools During the Pandemic
    In the wake of the pandemic, charter schools acted more quickly 
than district-managed schools to provide real- time virtual 
instruction, made more regular contact with students and families, and 
were more likely to track online attendance.\1\ Charter schools may 
have also been faster to deliver remote learning tools and technology 
to students, to a student population that was more likely to lack 
access to internet connectivity and devices than their traditional 
public school counterparts.\2\ When asked if they felt they had the 
resources and support they needed to teach effectively during the 
pandemic in spring 2020, 66 percent of charter school teachers said yes 
compared to 61 percent of district school teachers.
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    \1\ Linda Jacobson, ``Charters Were Quicker to Provide Instruction, 
Regular Contact During Closures, Reports Say.'' The 74 Million, April, 
2020, https://www.the74million.org/article/charters-were-quicker-to-
provide- instruction-regular-contact-during-closures-reports-say-but-
thats-also-how-they-keep-the-kids-one-expert- explains/; CREDO, 
``Charter Schools' Response to the Pandemic in California, New York and 
Washington State,'' Stanford University, February, 2022, https://
credo.stanford.edu/wp-content/uploads/2022/02/Charter-School-COVID-
Final.pdf (pg. 17-18).
    \2\ National Center for Education Statistics, ``Impact of the 
Coronavirus (COVID-19) Pandemic on Public and Private Elementary and 
Secondary Education in the United States (Preliminary Data)'', U.S. 
Department of Education, February, 2022, https://nces.ed.gov/pubs2022/
2022019.pdf.
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    A 2020 report that we produced in partnership with the organization 
Public Impact found that small charter school networks and single-site 
charter schools (which together account for 65 percent of all charter 
schools) were more likely than district schools to set expectations 
that teachers would engage in real-time synchronous instruction, check 
in regularly with students, and monitor attendance.
    And what was the impact of these efforts? Charter school 
enrollments grew by 7 percent in school year 2020-2021, the largest 
increase in half a decade. Preliminary data for 2021-22 show that 
charter enrollment continues to increase nationally. Moreover, charter 
schools continue to be the only sector within the public school 
universe that grew during this period. Parents clearly appreciated the 
options offered by charter schools and took advantage of those options 
by enrolling their children.
Charter School Enrollments, Operations, and Accomplishments
    In school year 2020-2021 more than 3.6 million students enrolled in 
some 7,700 charter schools, representing about 7.2 percent of total 
public school enrollment. As the charter school sector has grown, it 
has continued to serve students and families whose needs were not being 
met by district schools and who desired additional options. The most 
recent data indicate that some 60 percent of charter school students 
are eligible for free or reduced-price school meals and over two-thirds 
are students of color. Both of these percentages exceed those of 
district schools. To reiterate, charter school enrollments have grown 
in large measure because of what the schools offer to families of 
historically underserved students.
    Notwithstanding charter schools' growth and achievements, recent 
years have seen the proliferation of a number of misconceptions about 
these schools. One is that they are not public schools and represent an 
attempt to ``privatize'' public education. Let's be clear: charter 
schools are public schools, and open to all students. A second 
misconception is that charter schools are unaccountable. To the 
contrary, they are subject to public accountability requirements as set 
forth in State authorizing legislation and in their individual 
charters. Unlike schools in general, if they do not produce results 
they will close. Further, while charter schools typically have more 
flexibility than district schools (in such areas as determining 
curriculum and employing staff), they are held to the same testing and 
accountability requirements as other schools under the Elementary and 
Secondary Education Act (ESEA).
    And charter schools are delivering results. The 2015 Urban Charter 
School Study, from the Center for Research on Education Outcomes 
(CREDO) at Stanford University, found that students in urban charter 
schools gained an average of 40 additional days of learning per year in 
math and 18 days in reading, compared to their non-charter-school 
peers. Moreover, the study found that the longer a student attended an 
urban charter school, the greater the gains: four or more years of 
enrollment in such a school led to 108 additional learning days in math 
and 72 in reading.
    Most recently, a 2021 meta-analysis of research on charter school 
effects and competitive influence by the National Bureau of Economic 
Research (NBER) highlighted trends from three decades of research. It 
found that charter schools located in urban areas boost student test 
scores, particularly for Black, Latinx, and low-income students; that 
attending some urban charter schools increases college enrollment and 
voting; and that the competitive impact of charter schools on 
traditional public schools suggests a small beneficial influence on 
neighboring schools' student achievement.\3\
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    \3\ Cordes, Sarah A. 2018. ``In Pursuit of the Common Good: The 
Spillover Effects of Charter Schools on Public School Students in New 
York City.'' Education Finance and Policy 484-512. https://
www.mitpressjournals.org/doi/abs/10.1162/edfp_a_00240.
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    A 2020 study from the Program on Education Policy and Governance at 
Harvard University, using results from National Assessment of 
Educational Progress fourth- and eighth-grade reading and math 
assessments, found greater academic gains between 2015 and 2017 for 
students in charter schools than for students in traditional public 
schools The study found particularly significant gains for African 
American and low-income students attending charter schools, they were 
almost 6 months ahead of their peers in reading and math compared with 
students in traditional public schools over the 12-year span of the 
study. This was the first nationwide study to compare student 
achievement trends over time between sectors rather than effectiveness 
at a single point in time.
The Importance of the Federal Charter Schools Program
    Since its creation in 1994 during the Clinton Administration, the 
CSP has received bipartisan support. The program was originally 
authorized to provide start-up funding for new charter schools, but it 
has evolved to address additional objectives, including meeting the 
needs of charter schools for adequate facilities and supporting the 
expansion and replication of high-quality charter schools operated or 
managed by charter management organizations.
    Since the program's inception, the Congress has appropriated some 
$6.8 billion for the CSP. To put that number in context, it is 
equivalent to less than 2 percent of the appropriations for Title I LEA 
Grants over that time. This modest investment has enabled the number of 
charter schools to grow from only a handful in the early 1990s to the 
7,700 or so operating today. Because States have not typically financed 
the planning and initial start-up costs of their new charter schools, 
it is inconceivable that the charter sector would have grown as rapidly 
and successfully without this Federal investment. Nor have States and 
localities provided charter schools the same facilities and facilities 
funding that are available to district-operated schools; Federal 
funding for the two CSP facilities programs, while not adequate, has 
thus addressed a gaping unmet need.
    Charter school enrollment has grown rapidly, but it has not kept up 
with family demand. Surveys indicate that some 3.3 to 5 million 
additional students would attend a charter school if space were 
available to them. Many of those are students who currently attend 
schools identified as in need of support and improvement under Title I, 
that is, schools that are not meeting State performance targets. The 
increase we recommend would enable the creation of charter schools to 
serve more of the students and families who want them.
Regulation of the Charter Schools Program
    As you may know, on March 14 of this year the Administration 
published for public comment a Notice of Proposed Priorities, 
Requirements, Definitions, and Selection Criteria (NPP) for the CSP. 
This notice came out late in the fiscal year, jeopardizing the ability 
of the Department of Education to review and respond to comments, 
decide on final rules, conduct CSP competitions, and make awards before 
the end of the fiscal year. It also was issued in violation of Section 
4307of the ESEA, which requires stakeholder engagement prior to 
rulemaking that impacts charter schools and the CSP. Because of this 
poor timing and the fact that the NPP included provisions that raised 
grave concerns within the charter school community, the National 
Alliance has called on the Administration to put the proposed rules on 
hold, conduct the FY 2022 competitions under the current rules, and use 
the next year to engage with the community about what improvements are 
needed in the program and how those improvements can best be 
accomplished through regulation. The National Alliance is grateful that 
many thousands of individuals and organizations expressed the same 
concerns in their comments on the rule.
    To be clear: we are not opposed to greater transparency in the 
operation of the program, although we note that the transparency-
related provisions of the NPP were vague and would have led to 
confusion and inconsistent implementation. Nor do we dispute the 
Administration's contention that the statute requires that grantees and 
subgrantees retain administrative control over their grants and 
subgrants. However, the administration has put forward appropriations 
language on the charter school management issue that is unclear and was 
developed, like the NPP, without consultation or stakeholder input. We 
believe it should be possible to work out an acceptable regulatory 
solution on this issue without additional appropriations language, such 
as including current guidance on contracting with for-profit entities 
as in program regulations. Therefore, we do not support the proposed 
language.
    Further, in response to concerns about charter schools that receive 
start-up support but never open, we can endorse the proposed regulation 
prohibiting schools from receiving implementation funding until they 
have obtained a charter and a facility, so long as such a school may 
receive support for such planning and program design activities as 
curriculum development, hiring and training staff, carrying out 
community engagement activities, and purchasing books, other materials, 
supplies, and equipment.
    On the other hand, we will never support regulations that limit 
charter schools to operating in communities with overcrowded schools, 
give district school officials the ability to veto the opening of 
charter schools, or demand that charter schools have demographically 
diverse enrollments and staff even when the communities they serve are 
not diverse. Again, we thank the many commenters who expressed their 
opposition to these and other provisions of the NPP.
                            fy 2023 request
    Our request for fiscal Year2023 is $500 million, a $60 million 
increase. We also recommend that the appropriations act give the 
Department of Education sufficient flexibility to allocate funds across 
CSP programs in response to current needs of the field. $500 million 
would provide sufficient funding for new grants to States and CMOs and 
thus enable those entities to support the creation of new charter 
schools. This would enable the expansion of high-quality schools and 
reduce wait lists in order to provide high-quality educational options 
to more families, particularly those in communities that have been hit 
hard by the pandemic and where the learning needs are greatest. We also 
request report language that would ensure that State entity grantees 
have access, at the beginning of the grant period, to the full seven 
percent reservation for technical assistance as provided for in the 
statute.
    Finally, our request would help charter schools access appropriate 
facilities. Charter schools generally have not had the same access to 
funding sources that support the facilities needs of other public 
schools. This forces schools to scrape by in buildings not designed for 
learning, use funds that should have been available for instruction to 
cover facility needs, or simply not open at all. The two small 
facilities programs included in the CSP-Credit Enhancement for Charter 
School Facilities and the State Facilities Incentive Grants-help fill 
some of this unmet need.

    [This statement was submitted by Nina Rees, President and CEO, 
National 
Alliance of Public Charter Schools.]
                                 ______
                                 
     Prepared Statement of the National Alopecia Areata Foundation
 the foundation's fiscal year 2022 l-hhs appropriations recommendations
_______________________________________________________________________

  --At least $49 billion for the National Institutes of Health (NIH).
    --Proportional funding increases for National Institute of 
            Arthritis and Musculoskeletal and Skin Diseases (NIAMS), 
            National Institute of Allergy and Infectious Diseases 
            (NIAID) and the National Center for Advancing Translational 
            Science (NCATS)
  --Please provide $11 billion for the Centers for Disease Control and 
        Prevention (CDC).
    --Please provide $6 million for the Chronic Disease Education and 
            Awareness Program.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for your time and your consideration of 
the priorities of the alopecia areata community as you work to craft 
the FY 2023 L-HHS Appropriations Bill.
                         about alopecia areata
    Alopecia areata is a prevalent autoimmune skin disease resulting in 
the loss of hair on the scalp and elsewhere on the body. It usually 
starts with one or more small, round, smooth patches on the scalp and 
can progress to total scalp hair loss (alopecia totalis) or complete 
body hair loss (alopecia universalis).
    Alopecia areata affects approximately 2.1 percent of the 
population, including more than 6.9 million people in the United States 
alone. The disease disproportionately strikes children and onset often 
occurs at an early age. This common skin disease is highly 
unpredictable and cyclical. Hair can grow back in or fall out again at 
any time, and the disease course is different for each person. In 
recent years, scientific advancements have been made, but there remains 
no cure or indicated treatment options.
    The true impact of alopecia areata is more easily understood 
anecdotally than empirically. Affected individuals often experience 
significant psychological and social challenges in addition to the 
biological impact of the disease. Depression, anxiety, and suicidal 
ideation are health issues that can accompany alopecia areata. The 
knowledge that medical interventions are extremely limited and of minor 
effectiveness in this area further exacerbates the emotional stresses 
patients typically experience.
                          about the foundation
    NAAF, headquartered in San Rafael, California, supports research to 
find a cure or acceptable treatment for alopecia areata, supports those 
with the disease, and educates the public about alopecia areata. NAAF 
is governed by a volunteer Board of Directors and a prestigious 
Scientific Advisory Council. Founded in 1981, NAAF is widely regarded 
as the largest, most influential, and most representative foundation 
associated with alopecia areata. NAAF is connected to patients through 
local support groups and also holds an important, well-attended annual 
conference that reaches many children and families.
    NAAF initiated the Alopecia Areata Treatment Development Program 
(TDP) dedicated to advancing research and identifying innovative 
treatment options. TDP builds on advances in immunological and genetic 
research and is making use of the Alopecia Areata Clinical Trials 
Registry which was established in 2000 with funding support from the 
National Institute of Arthritis and Musculoskeletal and Skin Diseases; 
NAAF took over financial and administrative responsibility for the 
Registry in 2012. NAAF is engaging scientists in active review of both 
basic and applied science in a variety of ways, including the November 
2012 Alopecia Areata Research Summit featuring presentations from the 
Food and Drug Administration (FDA) and NIAMS.
    NAAF is also supporting legislation to provide coverage for cranial 
prosthetics under Medicare. This bill will grant increased access to 
cranial prosthetics and therapies for patients with alopecia areata and 
other forms of medical hair loss. Many patients living with medical 
hair loss suffer from a variety of diseases, including cancer. With no 
known cause or cure, alopecia areata is an autoimmune skin disease 
affecting approximately 6.9 million Americans, many of whom are 
children.
                     national institutes of health
    NIH hosts a modest alopecia areata research portfolio, and the 
Foundation works closely with NIH to advance critical activities. NIH 
projects, in coordination with the Foundation, have the potential to 
identify biomarkers and develop therapeutic targets. In fact, 
researchers at Columbia University Medical Center (CUMC) have 
identified the immune cells responsible for destroying hair follicles 
in people with alopecia areata and have tested an FDA-approved drug 
that eliminated these immune cells and restored hair growth in a small 
number of patients. This huge breakthrough has led to NIAMS providing a 
research grant to the researchers at Columbia to continue this work. In 
this regard, please provide NIH with meaningful funding increases to 
facilitate growth in the alopecia areata research portfolio.
                          patient perspective
    ``There is a chance you could lose all your hair.'' That was the 
last thing anyone ever wants to hear. I will never forget standing in 
the shower in November 2015 with my hands full of hair and in complete 
disbelief. Was this really happening to me? I felt as though my 
identity was being ripped away from me as every strand of hair fell out 
of my head. My hair was my identity. Who would I be without it? How was 
I going to live like this for the rest of my life?
    I lost all of my hair on my entire body including eyebrows and 
eyelashes within four weeks and I was diagnosed with the autoimmune 
disease called alopecia areata. For the next year, I did everything in 
my power to grow my hair back from every topical cream to medicines 
that compromised my immune system to weekly steroid injections into my 
scalp. This was the worst pain I had ever experienced in my life but I 
would do anything to grow my hair back.
    Nothing was working. I had to stop as my mind, body, and soul 
couldn't take it anymore.
    I don't know what was worse, the treatments or the stares I would 
receive out in public as everyone thought I was going through treatment 
for cancer. I wanted to blend in with society so badly, but wigs were 
so expensive. I refused to look at myself in the mirror because I hated 
the reflection. I wore a hat everywhere I went even to bed until the 
lights were turned off to take it off and I wouldn't take any pictures, 
especially during the holidays because I was ashamed of my appearance. 
I wanted my life back so I could be a good mom to my daughters and just 
enjoy life. Alopecia areata is not just cosmetic, it takes an emotional 
toll as it caused severe anxiety and depression that I continue to deal 
with years later. I was very fortunate to have the unconditional 
support of my parents who helped me to purchase wigs so I could feel 
somewhat normal again; however, there are too many people with alopecia 
areata who do not have the luxury of support that I was blessed with. 
Your support would impact people's lives immensely.''
    Thank you for the opportunity to testify before you today. NAAF 
looks forward to working with you all to advance medical research and 
public health activities that will improve patient outcomes for the 
members of our community suffering from alopecia.

    [This statement was submitted by Nicole Friedland, President & CEO, 
National Alopecia Areata Foundation.]
                                 ______
                                 
   Prepared Statement of the National Area Health Education Centers 
                              Organization
    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to submit testimony 
on behalf of the National AHEC Organization (NAO). I serve as the chief 
executive officer of NAO with over 14 years of experience as an AHEC 
Center Director from Kentucky. The NAO is the professional organization 
that represents Area Health Education Centers (AHECs) across the 
country. We support advances in the AHEC network to improve health by 
leading the Nation in recruiting, training, and retaining members of a 
diverse health workforce in rural and underserved communities. As a 
member of the Health Professions and Nursing Education Coalition 
(HPNEC), NAO is pleased to recommend $790 million for the health 
professions training programs under Title VII and VIII of the Public 
Health Service Act that are administered by the Health Resources and 
Services Administration (HRSA). Of this amount, the NAO recommends 
$67.00 million in fiscal year (FY) 2023 for the Area Health Education 
Center program.
    The national AHEC network consists of more than 300 AHEC program 
offices and centers, serving over 85 percent of the counties in the 
United States. With 50 years of operation, AHECs meet the current and 
emerging needs of the communities they serve through robust community-
academic partnerships, with a focus on exposure, education, and 
training of the current and future health care workforce.
                highlighted ahec programmatic activities
  --AHEC Scholars Program: This 2-year program initiative recruits, 
        trains, and supports interdisciplinary groups of health 
        professions students committed to increase health care quality 
        through community-based service and health care transformation. 
        Every AHEC Scholars program includes 40 hours of didactic and 
        40 hours of community-based or clinical activities each year. 
        Through these experiences, Scholars develop new skills and 
        knowledge designed to expand their understanding of the social 
        determinants of health and health equity (or lack of), for 
        populations living in rural and underserved communities. This 
        curriculum is a critical tool to prepare a diverse, equitable, 
        compassionate, qualified health care workforce.
  --Continuing Education: The NAO and member AHECs provide accredited 
        continuing education programs and professional support for 
        healthcare professionals who seek licensure and certification 
        credits with an emphasis on rural health and health care in 
        underserved areas.
  --Health Professions Pipeline: AHECs expose students in grades 9-12 
        to health careers through job shadowing, health career 
        presentations, and summer programming. Undergraduates 
        participate in AHEC networking/enrichment programs to enhance 
        their knowledge, experience, and forward the pathway to health 
        professions school admission.
  --Clinical Rotations: Clinical training rotations are available 
        throughout most of the AHEC network to enhance clinical 
        expertise for medical students, residents, pharmacy, PA, APRN 
        and other health professions students in rural and underserved 
        communities.
    The AHEC program is reauthorized through FY 2025. The AHEC 
authorization language recommends a funding level of $250,000 annually 
for each AHEC Center. A FY 2023 funding level of $67 million would 
facilitate that recommendation.
             justification for nao's funding recommendation
    Funding the AHEC program at $67 million provides critical 
opportunities to support AHECs as they:
  --Foster strategic community-based partnerships within the 
        communities they serve to address the health workforce needs 
        related to the emerging health issues such as COVID-19 
        pandemic;
  --Strengthen linkages between academic health science centers and 
        community health service delivery systems to provide additional 
        training opportunities for students, faculty, and 
        practitioners;
  --Increase the return on Federal investment by leveraging State and 
        local resources to meet the required 1:1 funding match in 
        support of health workforce development;
  --Expedite the transformation of the health care system by training 
        the current and future workforce for a value-based, patient-
        centered, team-based practice environment for innovative models 
        of care.
    The AHEC network is a part of a critical pipeline that fuels the 
recruitment, training, distribution, and retention of a national health 
workforce. At a time where the AAMC projects our Nation will have a 
shortage of nearly 120,000 physicians by 2030, AHEC stands as a central 
access point in meeting this demanding shortage area. Primary care 
practitioners are the front-line in prevention of disease and providing 
cost savings in the United States healthcare system. In recognizing 
this, the AHEC program engages in pre-pipeline, pipeline, and post-
pipeline activities that guide individuals through health careers 
pathways and beyond, with a special emphasis on primary care providers. 
In the 2020-2021 academic year, AHECs introduced more than 178,000 
students, ranging from high school to collegiate status, to careers in 
the health professions and health workforce. AHECs facilitated 24,766 
student clinical rotations, many of which were in rural and 
underserved. Additionally, AHECs were responsible for training 416,862 
professionals through continuing education, and more than 7,000 
students were enrolled in the AHEC Scholars program. Madam Chair, these 
facts make AHECs integral in the recruitment, interdisciplinary 
training, and retention of the healthcare workforce.
    AHECs have a continual focus on improving the health care system by 
working with 120 medical schools, 600 nursing and allied health 
schools, healthcare settings like CHCs, behavioral health practices, 
and community-based organizations across the Nation. Through these 
longstanding partnerships, the AHECs employ traditional and innovative 
approaches to develop and train a diverse health care workforce 
prepared to deliver culturally appropriate, high-quality, team-based 
care for rural and underserved communities. AHECs are embedded in the 
communities they serve, positioning them to respond rapidly to emergent 
training needs of health professionals, health professions students, 
and inter-professional teams on issues associated with natural 
disasters, disease outbreaks, and substance use disorders.
    Madam Chair, thank you and the committee for the opportunity to 
present the views of the National AHEC Organization. Allow me to re-
emphasize the funding request of $67.00 million for the Area Health 
Education Centers program. As you begin the FY 2023 process, we look 
forward to working with the subcommittee to continue prioritizing 
health workforce initiatives that improve training opportunities, the 
quality of our healthcare workforce, and alleviate patient care, 
research in health disparities, and health professionals going into the 
health workforce.

    [This statement was submitted by Dwain Harris, Chief Executive 
Officer, 
National Area Health Education Centers Organization.]
                                 ______
                                 
     Prepared Statement of the National Association of Councils on 
                       Developmental Disabilities
    The National Association of Councils on Developmental Disabilities 
(NACDD), a national membership organization for the State Councils on 
Developmental Disabilities (DD Councils), appreciates the opportunity 
to present this testimony. NACDD respectfully requests $88.48 million 
for the DD Councils within the Administration for Community Living 
(ACL) in the Fiscal Year (FY) 2023 Labor-HHS-Education Appropriations 
Bill, the same level included in the President's FY23 budget.
    We also respectfully request that the following report language be 
included in the Fiscal Year 2023 Labor, Health and Human Services, 
Education Appropriations bill:

      Technical Assistance.--The Committee instructs the Department to 
        provide not less than $700,000 for technical assistance and 
        training for the State Councils on Developmental Disabilities. 
        In addition, the Committee encourages ACL to consult with 
        Developmental Disabilities Act stakeholders prior to announcing 
        opportunities for new technical assistance projects and to 
        notify the Committee prior to releasing new funding opportunity 
        announcements, grants, or contract awards with technical 
        assistance funding.

    Authorized by the Developmental Disabilities Assistance and Bill of 
Rights Act (DD Act), DD Councils work collaboratively with the 
University Centers for Excellence in Developmental Disabilities and the 
Protection and Advocacy Program for Developmental Disabilities, to 
assure that individuals with developmental disabilities and their 
families participate in the design of and have access to needed 
community services, individualized supports, and other forms of 
assistance that promote self-determination, independence, productivity, 
and integration and inclusion in all facets of community life, through 
culturally competent programs. Appointed by Governors and consisting of 
at least 60 percent of people with DD and their families, DD Councils 
assess problems or gaps in the intellectual and developmental 
disabilities (I/DD) system and design innovative solutions that make 
real changes to social systems such as employment, transportation, 
education, healthcare, housing and more, to fully integrate people with 
I/DD into society.
    The request for an increase in funding for FY 2023 is supported by 
the steadily and rapidly increasing numbers of people with 
developmental disabilities who continue to lack comprehensive and 
coordinated support systems to meet specific needs for full community 
inclusion. During the COVID-19 pandemic many people with developmental 
disabilities lost the assistance provided by families and other 
informal supports and people with disabilities disproportionately 
experienced loss of employment. Demand for services even after the 
pandemic has remained significantly higher than before the pandemic.
    DD Councils direct resources through partnerships with local non-
profits, businesses, and State and local governments, to overcome 
obstacles to community living for people with I/DD. States and 
territories rely on DD Councils to turn fragmented approaches into 
innovative and cost-effective strategies to increase the percentage of 
individuals with I/DD who become independent, self-sufficient, and 
integrated into the community. Examples of DD Council projects include 
partnerships to increase competitive and integrated employment, 
campaigns promoting access to qualified direct support workers, 
programs for successfully transitioning to independent living, advocacy 
for access to affordable housing, training to build leadership and 
advocacy skills, and more. DD Council members also provide a critical 
and unique role in educating State and local policymakers by directly 
participating in the design of State and local government-funded 
supports and services affecting their lives.
    During the COVID-19 pandemic, DD Councils provided life-saving 
access to information, resources, and support to people with I/DD and 
their families. The past 2 years underscored the critical role of the 
DD Councils to meet the needs of people with I/DD so they can live 
safely in the community and free from discrimination. States have 
called on DD Councils to create life-saving solutions to problems faced 
by people with I/DD during the pandemic. Federal agencies and States 
have looked to DD Councils to bridge public health communication gaps 
with the I/DD community; advocate for non-discrimination in health 
care; promote immunization; distribute personal protective equipment; 
support access telehealth; and more. This funding request reflects the 
increased need for direct resources through partnerships with local 
non-profits, businesses and State and local governments, to provide 
innovative and cost-effective strategies so more people with I/DD can 
become independent, self-sufficient, and integrated into the community.
    Thank you for consideration of our request. For more information, 
please contact Erin Prangley at [email protected], National 
Association of Councils on Developmental Disabilities, 1825 K Street, 
N.W., Suite 600, Washington, D.C.
                                 ______
                                 
   Prepared Statement of the National Association of County and City 
                            Health Officials
    The National Association of County and City Health Officials 
(NACCHO) is the voice of the nearly 3,000 local health departments 
across the Nation. Local health departments continue to lead the 
Nationwide response to COVID-19, while also working to protect the 
health and safety of their communities from a myriad of public health 
challenges, many of which have worsened during the multi-year pandemic 
response.
    COVID-19 has brought to the fore the critical role of governmental 
public health, especially local health departments, in all aspects of 
daily life and exposed the consequences of years of underinvestment in 
our public health system. Congress has the opportunity now to rebuild 
the public health system to face current and future challenges. To 
enable local health departments to support Federal public health 
priorities and effectively lead in their communities, NACCHO requests 
Congress provide robust investments to the public health workforce and 
infrastructure, and exercise oversight to ensure Federal funds are 
efficiently and equitably allocated to the local level.
                      public health loan repayment
    The public health workforce is the backbone of our Nation's 
governmental public health system, but was understaffed and overworked 
even before the pandemic. Local health departments have lost over 20 
percent of workforce capacity since 2008,\1\ and over a third of the 
local public health workers were projected to leave the field in the 
next 5 years due to retirement or to pursue opportunities in the 
private sector.\2\ Furthermore, at least 500 local and State health 
officials have reportedly left their positions during the pandemic due 
to politicization, harassment, termination, and burnout.\3\ Combined, 
these forces create an urgency to addressing our public health 
workforce crisis.
---------------------------------------------------------------------------
    \1\ NACCHO, 2019 National Profile of Local Health Departments, 
https://www.naccho.org/uploads/downloadable-resources/Programs/Public-
Health-Infrastructure/NACCHO_2019_Profile_final.pdf.
    \2\ Leider JP, Coronado F, Beck AJ, Harper E. Reconciling Supply 
and Demand for State and Local Public Health Staff in an Era of 
Retiring Baby Boomers. Am J Prev Med. 2018;54(3):334-340.
    \3\ Baker M. and Ivory D. (2021, October 18). Why Public Health 
Faces a Crisis Across the U.S. The New York Times. https://
www.nytimes.com/2021/10/18/us/coronavirus-public-health.html.
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    A bipartisan group of Senators have recognized this need and 
introduced legislation, the Strengthening the Public Health Workforce 
Act (S. 3506), that would authorize a public health workforce loan 
repayment program and give local, State, and Tribal health departments 
a vital tool to recruit and retain top talent. Additionally, Senators 
Murray and Burr have incorporated the proposal into the PREVENT 
Pandemics Act recently approved by the Senate Health, Education, Labor, 
and Pensions Committee. In conjunction with this legislation, NACCHO 
urges Congress to provide $200 million for the establishment of a 
public health loan repayment program at the Health Resources and 
Services Administration so that health departments can immediately 
bolster their efforts to strengthen the public health workforce.
               public health infrastructure and capacity
    Local health departments operate on limited and unpredictable 
budgets that do not allow for long-term investments in needed 
infrastructure and cross-cutting needs. Federal public health funding 
has traditionally followed a boom-and-bust cycle in response to 
crises?. Additionally, funds are often limiting, for example tied to a 
specific disease state or programmatic function, which makes it 
difficult to invest in or sustain critical health department functions 
not tied to a specific disease state. Local health departments need 
sustainable, disease-agnostic, predictable funding to support local 
public health infrastructure, including data modernization and 
workforce development. Such funding would allow local health 
departments to focus on certain skillsets that are critically 
necessary--like communication, outreach, data analysis, and 
digitalization--but that they largely lack due to current funding 
constraints. The lack of this ability at the local level hinders 
efforts to support Federal public health objectives.
    NACCHO is grateful that Congress recognized this need and 
established a new Public Health Infrastructure and Capacity line within 
the CDC in fiscal year 2022, and NACCHO requests $1 billion for this 
crucial program in fiscal year 2023. Importantly, funding to support 
cross-cutting core public health functions should supplement, not 
supplant the disease-specific funding that currently supports many 
critical health department activities. Indeed, new capabilities 
supported by disease-agnostic funding will ultimately enhance the 
functionality of existing programs. NACCHO also requests Congress 
require CDC to ensure at least 35 percent of a State's allocation be 
directed toward local health departments with clear expectations 
regarding the timing of such suballocations.
               centers for disease control and prevention
    The CDC has unmatched expertise and experience in tackling a broad 
array of public health issues including the ongoing COVID-19 pandemic 
and other pre-existing challenges that have been exacerbated by the 
pandemic like mental health, substance use, sexually transmitted 
infections, and chronic disease. CDC serves as the command center for 
the Nation's public health defense system against emerging and 
reemerging infectious diseases, man-made and natural disasters, and 
other public health emergencies. Strong funding is critical to 
supporting all of CDC's activities and programs, which are essential to 
protect the health of our communities, and NACCHO requests $11 billion 
for CDC in FY 2023. Due to years of underfunding, many CDC programs 
have not received the resources that are needed to address the many 
health challenges we face as a nation, resulting in many of CDC's most 
effective prevention programs not reaching all communities.
    Additionally, Federal funding from the CDC intended for both State 
and local health departments continues to have variable reach to local 
public health agencies. Ensuring these resources reach the local health 
department level in a timely way is critical to enabling communities to 
address public health needs. NACCHO requests that Congress include 
report language similar to that included in the explanatory statement 
accompanying Division H (L-HHS) of the fiscal year 2022 Consolidated 
Appropriations Act (H.R. 2471) encouraging CDC to require States to 
fund local health departments when programmatically appropriate, and 
further urging CDC to publicly track and report to the Committee how 
funds provided to State health departments are passed through to local 
health departments, including amount, per grant award, by local 
jurisdiction, and date funds are made available to each local health 
department.
       public health emergency preparedness cooperative agreement
    The PHEP Cooperative Agreement provides funding to 50 States, 4 
large cities (Chicago, Los Angeles County, New York City, and 
Washington, D.C.), and eight territorial health departments to 
strengthen public health departments' capacity and capability to 
effectively plan for, respond to, and recover from public health 
emergencies.
    NACCHO urges $1 billion for PHEP in fiscal year 2023, the level at 
which the program was originally funded when it was created after the 
9/11 terrorist attacks. Public health emergencies have increased in 
number and scope since the establishment of the PHEP program, and PHEP 
funding has not kept pace. Restoring funding to $1 billion is necessary 
to allow the program to comprehensively support local communities and 
States in their ability to prepare to respond to terrorist threats, 
infectious disease outbreaks, natural disasters, and biological, 
chemical, nuclear, and radiological emergencies, and other threats.
    More than 55 percent of local health departments rely solely on 
Federal funding for emergency preparedness. However, funding from State 
health departments to local health departments can have a varied 
approach and have reduced over time as overall Federal appropriations 
fell. To ensure all communities have the resources they need to prepare 
for and respond to public health emergencies, NACCHO requests report 
language to provide increased transparency around suballocations of 
PHEP funding from States to local health departments, similar to 
language included in both the House (H. Rept. 117-96) and Senate 
Committee Reports for the FY22 Labor, Health and Human Services, and 
Education, and Related Agencies Appropriations Bill requesting a State 
distribution table in the fiscal year 2024 Congressional Budget 
Justification, showing how funding is being allocated to local health 
departments, how States are determining these allocations, and date 
funds are made available to each local health department.
                     data modernization initiative
    The local health department COVID-19 response was hampered by a 
historical lack of resources, outdated systems, and an overall 
underfunding of public health infrastructure. Public health needs a 
robust, modern, and secure public health information ecosystem capable 
of sustainment and surge that delivers real-time, accurate, and useful 
data to public health and policymakers at the local, State, and Federal 
levels. Across the country, local and State public health departments 
operate a mismatched network of siloed public health information 
systems, most of which do not talk to each other nor to the health care 
delivery sector, and all of which are in urgent need of upgrade to 
prepare for and respond to public health challenges. To meet these 
challenges, NACCHO requests $250 million for the CDC's Data 
Modernization Initiative and asks Congress to urge CDC to consider 
local health department access and needs at all stages of data 
development.
              epidemiology and laboratory capacity awards
    The ELC program provides annual funding, strategic direction, and 
technical assistance to domestic jurisdictions for core capacities in 
epidemiology, laboratory, and health information technology activities. 
In addition to strengthening core infectious disease capacities 
nationwide, this cooperative agreement also supports a myriad of 
specific infectious disease programs. Like other Federal streams, 
funding through ELC grants has variable reach to the local level. 
NACCHO requests Congress urge CDC to work with States to prioritize 
funding to local health departments based on factors such as population 
size, disease burden, and other public health metrics to promote 
equitable funding distribution, and to publicly track and report how 
funds are passed through to local entities.
                         medical reserve corps
    The Medical Reserve Corps (MRC) is a national network of local-
organized volunteers committed to improving the public health and 
resiliency of their communities. Two-thirds of the Nation's 800 MRC 
units are housed within local health departments. MRCs are deployed to 
address public health emergencies and have stepped up to serve their 
communities during the COVID-19 response--in FY2021, MRC units provided 
2.7 million hours of service, compared to about 300,000 hours in FY2019 
prior to the pandemic. Additionally, the number of volunteers across 
the MRC network has grown from roughly 175,000 at the beginning of 2020 
to over 300,000. The total economic value of MRC volunteer 
contributions is estimated at over $91 million.
    NACCHO advocates for $12 million for MRC so that capacity built 
during COVID-19 can be sustained and at the ready for future public 
health emergency responses. NACCHO also requests Congress urge ASPR to 
continue the historical funding approach that provides funds directly 
to local MRC units and ensures efficient release and delivery of funds.
    NACCHO appreciates the consideration of these requests and looks 
forward to working with Congress to strengthen and support local public 
health.

    [This statement was submitted by Lori Tremmel Freeman, MBA, Chief 
Executive Officer, National Association of County and City Health 
Officials.]
                                 ______
                                 
           Prepared Statement of the National Association of 
                       Federally Impacted Schools
    Dear Chairwoman Murray and Ranking Member Blunt:
    The National Association of Federally Impacted Schools (NAFIS) 
strongly urges the Senate Labor-Health and Human Services-Education 
Appropriations subcommittee to continue recognizing the Federal 
Government's obligation to federally impacted communities as you set 
funding priorities for the U.S. Department of Education.
    Based on our analysis, we urge you to provide at least a $2 million 
increase for Federal Property and a $55 million increase for Basic 
Support for FY 2023.
    NAFIS represents the 1,100-plus Impact Aid-recipient school 
districts that together educate 10 million students across the Nation. 
Impact Aid is the oldest elementary and secondary education program and 
is a partnership between local communities and the Federal Government 
where there is significant non-taxable property, such as military 
installations, Indian treaty or trust land, Alaska Native Claims 
Settlement Act land, Federal low-rent housing facilities, national 
parks and national laboratories. Congress recognized in 1950 that the 
Federal Government had an obligation to help meet the local 
responsibility of financing public education in areas impacted by a 
Federal presence. That same recognition holds true today.
    While the Administration has indicated it does not intend to 
support funding cuts to education programs, the President's FY 2023 
budget request includes many--including a $16 million cut to Impact 
Aid--because Congress finalized FY 2022 appropriations after the 
Administration finalized its FY 2023 request. It is particularly 
disappointing that the Impact Aid funding request is notably below the 
levels included in both the House and Senate FY 2022 appropriations 
bills, which were in conference at the time the FY 2023 budget was 
developed.
    NAFIS is grateful for the subcommittee's past support of the Impact 
Aid program, and we hope to see that support continue in FY 2023. 
Federally impacted school districts cannot afford stagnant 
appropriations or a loss of funding. FY 2023 will require additional 
funds to build on the important funding progress made in the last few 
years.
    Section 7003 Basic Support: Although appropriations have increased 
in recent years, Basic Support remains significantly underfunded. The 
Basic Support payment formula is based on several factors, including 
the actual cost of education. That cost is measured by the Local 
Contribution Rate (LCR), which is based on per pupil expenditures (PPE) 
from 3 years prior.
    Basic Support is currently funded at about 60 percent of the 
payment formula. Because the program is so underfunded, the Impact Aid 
law includes a proration factor called the Learning Opportunity 
Threshold (LOT), which measures the need a school district has for 
Impact Aid funds. The higher a school district's LOT, the more reliant 
it is on Impact Aid.
    In 2020, for the first time in more than a decade, LOT paid out at 
over 100 percent. That means the highest need Impact Aid districts got 
their full payment. However, hundreds of other school districts still 
received far less than they would have if the program were fully 
funded.
    For FY 2021, the LOT Payout is estimated to be 98 percent. Whenever 
the LOT Payout is below 100 percent, all federally impacted school 
districts--including those with the most need that rely most heavily on 
Impact Aid funds to operate--receive payments below those calculated by 
the formula in the Impact Aid law.

------------------------------------------------------------------------
            Fiscal Year                    LOT Payout         LCR Rates
------------------------------------------------------------------------
FY 2011...........................    97.066 percent of LOT    $5,215.00
FY 2012...........................    96.109 percent of LOT    $5,330.00
FY 2013...........................    87.061 percent of LOT    $5,404.50
FY 2014...........................    91.730 percent of LOT    $5,406.00
FY 2015...........................    93.074 percent of LOT    $5,386.00
FY 2016...........................    93.690 percent of LOT    $5,468.00
FY 2017...........................    92.332 percent of LOT    $5,635.50
FY 2018...........................    96.187 percent of LOT    $5,840.50
FY 2019...........................    98.138 percent of LOT    $6,036.00
FY 2020...........................    101.15 percent of LOT    $6,268.50
FY 2021...........................        98 percent of LOT    $6,495.00
FY 2022\*\........................      100+ percent of LOT    $6,794.00
------------------------------------------------------------------------
\*\Estimated final rates

    We expect that the LCR in the Impact Aid formula could increase by 
3.5-4 percent in FY 2023 based on projected increases in per pupil 
expenditures (NCES data will be available in September on which the FY 
2023 LCR will be based). Without a corresponding increase in 
appropriations, the LOT Payout could drop substantially.
    The increases in appropriations and LOT Payout have been critical 
for federally impacted school districts, especially given increased 
costs stemming from the COVID-19 pandemic. A $55 million increase for 
FY 2023 would build on these increases and help the program keep pace 
with the rising costs of education. With that increase, the 7003 Basic 
Support formula will still be approximately $850 million below fully 
funding its formula. We encourage Congress to make up this gap and set 
a glide path to fully fund the formula.
    Section 7003(d) Children with Disabilities: Another important 
element of Impact Aid is the Children with Disabilities (CWD) section, 
which provides funding for military-connected or Indian lands students 
with an active Individualized Education Program (IEP). It has been 
funded at $48 million since 2008, despite rising costs of providing 
special education services. This currently means a school district 
receives approximately $1,200 per eligible student living on Federal 
property (or $600 for military-connected students who do not live on a 
military installation). As the cost of special education rises, this 
$48 million appropriation is stretched too thin, especially given the 
chronic underfunding of IDEA. Payments per CWD dropped from $1,215.65 
in FY 2018 to $1,205.00 in FY20. School districts are continuing to 
educate their students with disabilities, spending significant general 
funds to do so.
    Section 7002 Federal Property: We thank you for the $4 million 
increase in 7002 payments in FYs 2019 through 2022. For FY 2023, we 
request an additional $2 million to build on these increases. These 
funds will partially offset new costs as the Federal Government 
continues to take property off local tax rolls and as the value of 
taxable land on which the funding formula is based increases.
    Section 7007 Construction: Finally, the Construction section of 
Impact Aid receives very little support, languishing at a $17 million 
level for the past several years. For comparison purposes, in FY 2005 
Section 7007 received just over $45 million. We recommend that FY 2023 
Impact Aid Section 7007 funds be distributed under Section 7007(b) 
competitive grants, since FY 2022 funds will be dispersed through 
Section 7007(a) formula grants.
School superintendents are saying...
    Impact Aid provides the necessary funding to ensure that all 
        students in our district have access to a Free Appropriate 
        Public Education and high levels of learning every day for 
        every student to ensure that all students are prepared to 
        graduate Life, College, and Career ready!--Washington

    We would not be able to operate without Impact Aid; our Impact Aid 
        funds pay for all support staff, consultants, utilities, daily 
        operations, professional development, curriculum, materials, 
        and technology needs.--Montana

    Impact Aid money has helped improve our relations with the Southern 
        Ute Tribe. Over the last 10 years, we have developed a 
        meaningful MOU, included a representative from the Tribe on our 
        administrative team, added a Ute Language Class, and had 
        regular and meaningful community meetings with Tribal leaders 
        to get important feedback.--Colorado

    Because of Impact Aid, we have truly leveled the playing field and 
        dramatically improved the working relationship with the Seneca 
        Nation. Instead of the conversation being framed ``you are not 
        doing enough'' the conversation is now ``how can we partner to 
        do more for all children''. Because we have been able to use IA 
        funding to improve program, graduation rates, drop out rates, 
        Advanced Placement rates our enrollment has dramatically 
        increased in the past 5 years (+300 students). Simply put IA 
        has made our ``product'' better, much better.--New York

    Additional investments in Impact Aid are critical to help school 
districts close achievement gaps, update technology, expand access to 
early childhood and afterschool programs, integrate culturally relevant 
curriculum, replace failing infrastructure, offer competitive salaries 
to recruit and retain school leaders, and more. These investments help 
school districts provide supportive and nourishing learning 
environments for all students. Through increased funding, we ask you to 
continue to view the program as a critical Federal investment and a tax 
replacement program for federally impacted communities.
    Sincerely.

    [This statement was submitted by Nicole Russell, Executive 
Director, National 
Association of Federally Impacted Schools.]
                                 ______
                                 
     Prepared Statement of the National Association of Drug Court 
                             Professionals
    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, I am honored to have the opportunity to submit my 
testimony on behalf of 1.5 million graduates of treatment court 
programs and the 150,000 people treatment court programs will connect 
to lifesaving substance use and mental health treatment this year 
alone. Given the ongoing substance use crisis, I am requesting that 
Congress provide funding of $105 million for the Drug Treatment Court 
Program at the Department of Health and Human Services, Substance Abuse 
and Mental Health Services Administration for fiscal year 2023.
    I am writing to you today as a husband, employee, taxpayer, and 
grateful drug court graduate. Before coming to the Lewis County Drug 
Court program, I spent much of my life cycling in and out of the 
justice system for crimes fueled by addiction. I went to jail seven 
times--and that doesn't encompass the many times I wasn't caught 
breaking and entering, stealing, and causing general harm to my 
community doing anything to support my addiction. I had also been to 
treatment multiple times, but without accountability, I'd never truly 
had the chance to heal from the trauma of my past, and I was never able 
to sustain my recovery. I often wonder what might have happened if 
there were no drug court available to me.
    The multidisciplinary treatment court team, which includes case 
managers, treatment providers, and counselors, not only looked at the 
facts of my case, but they also looked at my entire criminal history, 
my addiction history, and my life experiences up to that point. They 
created a plan to ensure I received the treatment and social services I 
needed, while still holding me accountable for my actions and the 
requirements of the program. Receiving treatment for my addiction was 
only part of the process. Because sustained, long-term recovery is the 
goal, drug court helped me work on myself from the inside out, 
addressing issues that had been impacting my behavior since I was a 
child.
    I completed the program in 2016, and I have dedicated myself to 
repairing the damage I caused by giving to others what was given to me. 
I first worked for an organization that conducts outreach to vulnerable 
populations with substance use disorders and helps them get their lives 
back on track. I also became the president of the nonprofit 
organization that helps support the Lewis County Drug Court, ensuring 
the lifesaving work of our program continues well into the future.
    In February of this year, I had to step down as president of that 
organization, but for good reason--I became the community outreach 
worker at the very same drug court that changed my life. The treatment 
court team is like a family, and I work every day alongside my fellow 
team members to ensure our participants are connected to the services 
and treatment they need to turn their lives around the way I did. And 
while I'm no longer president, I'm still a proud and active member of 
the nonprofit organization full of graduates like me. And taking 
``family'' one step further, I recently married my wife.
    I am proof that treatment courts, such as adult drug courts, 
veterans treatment courts, family treatment courts, and others, offer a 
public health and public safety response to these crises by expanding 
and enhancing substance use treatment capacity to serve more 
individuals in their communities.
    But don't just take my word for it; there is overwhelming empirical 
evidence showing the effectiveness of these programs. The Government 
Accountability Office has concluded the drug court model reduces crime 
by up to 58 percent. Further, the Multi-Site Adult Drug Court 
Evaluation conducted by the Department of Justice confirmed drug 
treatment courts significantly reduce both drug use and crime, as well 
as finding a cost savings averaging $6,000 for every individual served. 
Additional benefits include improved employment, housing, and financial 
stability, as well as reduced foster care placements.
    I am not alone in my success. This year, treatment courts will 
connect 150,000 people who have mental health and substance use 
disorders with treatment options best suited to them. Together, the 
court team offers the tools to overcome substance use disorder and past 
trauma to create meaningful, healthy relationships. Support from the 
Drug Treatment Court Program at the Department of Health and Human 
Services ensures the nearly 4,000 treatment courts in the United States 
today provide critical treatment services to save lives and reunite 
families.
    But as our country continues to battle the ongoing opioid crisis, 
we know there are many more people who still need this opportunity. I 
strongly urge this committee to recommend funding of $105 million to 
the Drug Treatment Court Program in fiscal year 2023, so treatment 
courts in Washington and beyond can continue providing substance use 
treatment that allows people to heal from the inside out.

    [This statement was submitted by Brant Byrd, graduate of Lewis 
County, 
Washington, Drug Court Chehalis, Washington.]
                                 ______
                                 
 Prepared Statement of the National Association of Free and Charitable 
                                Clinics
    On behalf of the National Association of Free and Charitable 
Clinics (NAFC) Board of Directors, our patients, and the 1,400 Free and 
Charitable Clinics in the United States, thank you for the opportunity 
to submit this written testimony to the Labor, Health, and Human 
Services, Education, and Related Agencies subcommittee. The National 
Association of Free and Charitable Clinics is respectfully asking for 
funding for the following HHS programs, the Federal Tort Claims Act 
(FTCA) for Free Clinics, the Nurse Loan Repayment Program, the National 
Health Service Corps, The Breast and Cervical Cancer Screening Program 
under Title X, and the Corporation for National and Community Service.
                               background
    Annually, 2 million patients through 6.9 patient visits receive 
health care at America's Free and Charitable Clinics. This care is 
provided by a volunteer and staff workforce of over 200,000 individuals 
from medical and non-medical fields. Unfortunately, 96% of our patients 
are uninsured and living at 100 to 300% of the poverty level. In 
addition, 4% of our patient population is eligible for Medicaid in 
their States; however, they do not have access to dental care or 
affordable medications through their state Medicare Medicaid programs. 
In addition, 58% of our patients are women, 37% of patients are 
Hispanic (Hispanic individuals make up 18% of the US population), 36% 
of patients are Caucasian (Caucasian individuals make up 60% of the US 
population, and 17% of patients are Black (Black individuals make up 
13% of the US population).
    Racial, societal, and economic factors directly impact people's 
health and ability to access health care and other resources needed to 
have a healthy life. Free and Charitable Clinics and Pharmacies are on 
the frontlines of natural disasters and the coronavirus pandemic, but 
they are on the frontlines of injustice in health care. We are 
committed to working toward health equity and addressing the racial, 
societal, and economic factors that influence people's health.
    Free and Charitable Clinics and Charitable Pharmacies are safety-
net health care organizations that utilize a volunteer/staff model to 
provide a range of medical, dental, pharmacy, vision, and behavioral 
health services to economically disadvantaged individuals. Such 
clinics/pharmacies are 501(c)(3) tax-exempt organizations or operate as 
a program component or affiliate of a 501(c)(3) organization. Entities 
that otherwise meet the above definition, but charge a nominal/sliding 
fee to patients, may still be considered Free or Charitable Clinics or 
Pharmacies provide essential services are delivered regardless of the 
patient's ability to pay. Free or Charitable Clinics and Charitable 
Pharmacies restrict eligibility for their services to individuals who 
are uninsured, underinsured, and have limited or no access to primary, 
specialty, or prescription health care.
                         appropriations request
    Our clinics receive little to no State or Federal funding, we do 
not receive HRSA 330 funds, and we are not Federally Qualified Health 
Centers or Rural Health Centers. Therefore, our clinics rely heavily on 
the generosity of individual donors, foundations, and grants as funding 
sources.
    Free and Charitable Clinics are a supreme example of private-public 
partnerships. We are excellent partners to the Federal Government 
because we provide access to health care to individuals who typically 
utilize the emergency department for routine care. Therefore, it is 
imperative to our operations that the Free Clinic Medical Malpractice 
(FTCA), the National Health Service Corps, the Nurse Corps Loan 
Repayment Program, The Breast and Cervical Cancer Screening Program 
under Title X, and the Corporation for National and Community Service 
programs continue to be adequately funded.
FTCA
    The Federal Torts Claims Act Program allows volunteer medical 
providers to provide health care to our patient populations and receive 
malpractice protection from the Federal Government. In addition to 
saving the clinics money, this program allows providers to understand 
that their expertise is valued and essential to the health of our 
patients. Therefore, we request that this program be funded in FY23 at 
the FY22 level of $1 million.
Nurse Corps Loan Repayment Program
    The Nurse Corps Loan Repayment Program allows registered nurses 
(including advanced practice registered nurses and nursing faculty) to 
help to create healthy communities in poor urban and rural areas as 
they build their careers by paying off 60% of their unpaid nursing 
student loans in just 2 years- plus an additional 25% of the original 
balance for an optional third year. In return, NURSE Corps members 
fulfill a service obligation at one of the eligible entities located in 
designated mental health or primary medical care Health Professional 
Shortage Areas across the United States. This program allows free and 
charitable clinics to recruit talented nurses by assisting them with 
their nursing school loans. Therefore, we request that this program be 
fully funded in FY23 at the FY22 levels.
National Health Service Corps
    The National Health Service Corps allows the next generation of 
medical providers to receive loan repayment for providing their time 
and expertise in a clinic that is in a health professional shortage 
area. Over 52% of clinics are in a health professional shortage area. 
The loan repayment program also allows for more medical students or 
nursing students to understand that the need for primary care doctors 
is at an all-time high in this country. Therefore, we ask that this 
program be funded at the FY23 budget request level of $210 million.
Breast and Cervical Screenings
    The Breast and Cervical Cancer Screening Program funded under Title 
X is how they receive routine cancer screenings for many uninsured 
women. According to a study conducted by the American Cancer Society, 
Emory University, and Dana Farber Institute: Differences in health 
insurance explained about 35% of the excess risk of death in black 
women compared with white women. Almost three times as many black women 
were uninsured or had Medicaid insurance (22.7%) compared to white 
women (8.4%). The study authors wrote, ``Lack of insurance is a barrier 
to receiving timely and high-quality treatment and screening 
services.'' Free and Charitable Clinics utilize this program to ensure 
that our patients have access to screening, testing, and life-saving 
treatment. Therefore, we request that this program be fully funded in 
FY23 at the FY22 levels.
Corporation for National and Community Service
    In addition to private donations, Free and Charitable Clinics need 
volunteers to increase our capacity at our locations across the 
country. The AmeriCorps Vista program allows clinics to enhance their 
operations, procedures, policies, and educational materials. The 
AmeriCorps Vista program is essential for expanding care and allowing 
volunteers to receive work experience in a non-profit setting. 
Therefore, we ask that this program be fully funded in FY23 at the FY22 
levels.
                                closing
    Our patients face various complex challenges and barriers to health 
care access. Therefore, Free & Charitable Clinics have been deeply 
committed to providing whole-person health care and addressing social 
determinants of health and health disparities.
    Please ensure that these programs continue to be fully funded, so 
we can continue to partner to ensure that every person has access to 
affordable quality health care. We thank you for the opportunity to 
share this written testimony.

    [This statement was submitted by Nicole Lamoureux, CEO and 
President, 
National Association of Free and Charitable Clinics.]
                                 ______
                                 
    Prepared Statement of National Association of State Head Injury 
                             Administrators
    On behalf of the National Association of State Head Injury 
Administrators (NASHIA), thank you for the opportunity to submit 
testimony regarding FY 2023 appropriations for Federal programs that 
impact approximately 2.87 million Americans who are treated annually in 
emergency departments and hospitals for a traumatic brain injury (CDC, 
2014). We appreciate your support for additional funding for FY 2022 to 
the U.S. Department of Health and Human Services' (HHS) Administration 
for Community Living (ACL) TBI State Partnership Program that helps 
States expand services to address the cognitive, behavioral and 
physical rehabilitative and long-term needs of Americans living with 
brain injury in accordance with the Traumatic Brain Injury (TBI) 
Program Reauthorization Act of 2018.
    However, as not all States or territories are currently 
participating in the grant program, NASHIA is requesting increased 
funding for the ACL TBI State Partnership Program (TBI SPP) so that 
individuals living with brain injury and their families have resources 
and assistance to return to home and community, school and employment 
regardless of where they live in this country. In addition, we support 
full funding for the National Concussion Surveillance System 
administered by the CDC's National Center for Injury Prevention and 
Control (NCIPC). And, we also support additional funding for the ACL's 
National Institute on Disability, Independent Living, and 
Rehabilitation Research (NIDILRR) program authorized by the Workforce 
Innovation and Opportunity Act (WIOA) of 2014, which authorizes 
research, including research conducted by the TBI Model Systems. 
Specifically, NASHIA is requesting:
  --$19 million additional funding for the ACL TBI State Partnership 
        Program to provide funding to all States, territories and 
        District of Columbia;
  --$5 million additional funding for the CDC's NCIPC to establish and 
        oversee a National Concussion Surveillance System as authorized 
        by the TBI Program Reauthorization Act of 2018.
    NASHIA is also requesting a funding increase of $6.6 million to 
expand the NIDILRR TBI research capacity through the TBI Model Systems 
(TBIMS):
  --To increase the number of TBIMS from 16 to 18 ($2.5 million each; 
        and
  --$1 million to expand TBIMIS collaborative research projects for 
        additional research on TBI as a chronic condition.
    Each year, a substantial number of Americans are injured due to 
motor vehicle crashes, falls, military-related injuries, violence, 
industrial injuries, sports-related injuries and other injuries that 
cause cognitive, emotional, physical, sensory and health-related 
problems resulting in unemployment and loss income; homelessness; 
incarceration; and institutional and nursing home placement due to lack 
of community alternatives. While recent trends have noted the 
increasing number of Americans with TBI-related disabilities among 
older adults due to falls, the COVID-19 pandemic is raising alarms 
regarding those who are infected who may experience hypoxia due to the 
deprivation of oxygen, resulting in brain damage that may necessitate 
the need for rehabilitation to regain functioning and ongoing supports 
should functioning not be restored. In addition, the increased risk of 
domestic and intimate partner violence during the time of the ``stay at 
home'' orders put people at risk for sustaining a brain injury from the 
abuser hitting the head, slamming the head against the wall or from 
near strangulation. As we emerge from the pandemic, the impact on both 
those at risk for a brain injury and for those with a brain injury will 
certainly become more apparent.
    This past year has been especially challenging for individuals with 
brain injury and their families. States have reported that brain injury 
program participants have cancelled services due to the fear and 
anxiety that COVID-19 has caused them. At the same time, providers have 
experienced loss of income as the result of not being able to perform 
contractual duties due to the restrictions related to the pandemic. 
Thus, the Federal funding requested is critical to assist States with 
issues that emanated from the pandemic as programs and services are 
brought back to pre-pandemic status.
         administration for community living--tbi act programs
    The ACL TBI State Partnership Grant Program is the only program 
that assists States in building and expanding service capacity to 
address the complex needs associated with brain injury that generally 
require the coordination of multiple systems (e.g., medical, 
rehabilitation, education, vocational, behavioral health, and Medicaid/
Medicare) and payers (e.g., insurance, Workers' Comp, State and Federal 
programs). Twenty-eight States are currently funded by the ACL TBI SPP 
for 5 years. We are requesting additional funding so that all States, 
territories and District of Columbia may receive funding to address 
gaps in services within their States.
    These grants also help to carry out the ACL priorities to increase 
direct services, including home and community-based services; 
accelerating COVID-19 recovery; supporting caregivers; and advancing 
equity.
 centers for disease control and prevention--national center on injury 
                         prevention and control
    CDC's National Injury Center initiated a pilot study as a first 
step in implementing a national surveillance system to determine the 
extent of mild brain injury or concussions in this country. Most 
individuals with a concussion are treated in an emergency department or 
physician's office and may not be reported in other data systems that 
capture the number of Americans who are hospitalized with moderate to 
severe TBI. Subsequently, Congress included $5 million authorization to 
implement the National Concussion Surveillance System within the TBI 
Program Reauthorization Act of 2018.
    Last year, the Government Accountability Office (GAO) issued a 
Report to Congress that found that data on the overall prevalence of 
brain injuries resulting from intimate partner violence are limited and 
that such data is needed to better understand the problem to ensure 
that resources are targeted appropriately to address these issues. In 
2013, the Institute of Medicine (IOM) and the National Research Council 
released an extensive report on sports-related concussions in children 
and teens and also examined sports-related concussions among military 
dependents, as well as concussions in military personnel ages 18 to 21 
that result from sports and physical training at military service 
academies or during recruit training. The report noted that limited 
data is available and recommended that CDC oversee a national 
surveillance system to accurately determine the incidence of sports-
related concussions.
    We strongly support funding to implement a national surveillance 
system to help States, Federal and national partners with needed data 
to address prevention, identification, and treatment for concussions. 
We are joined in this support by:
    AANS/CNS Joint Section on Neurotrauma & Critical Care; Advancing 
States; Alzheimer's Association; American Academy of Physical Medicine 
and Rehabilitation (AAPMR); American Association of Neurological 
Surgeons; American Physical Therapy Association; Brain Injury 
Association of America; Concussion Legacy Foundation; Congress of 
Neurological Surgeons; Friends of TBI Model Systems; Injury Prevention 
Research Center at Emory; Matthew Gfeller Center, University of North 
Carolina at Chapel Hill; National Association of State Directors of 
Developmental Disabilities Services; National Association of State 
Mental Health Program Directors; National Athletic Trainers' 
Association; National Disability Rights Network; North American Brain 
Injury Society; Safe Kids Worldwide; SCORE Program, Children's National 
Hospital; The Center on Brain Injury Research & Training at the 
University of Oregon; The National Concussion Management Center; United 
States Brain Injury Alliance (USBIA); USA Field Hockey; USA Lacrosse; 
and USA Football.
    acl's national institute on disability, independent living, and 
                   rehabilitation research (nidilrr)
    NIDILRR supports innovative projects and research in the delivery, 
demonstration, and evaluation of medical, rehabilitation, vocational, 
and other services designed to meet the needs of individuals with TBI 
through TBI Model Systems grants. Each TBI Model System contributes to 
the TBI Model Systems National Data and Statistical Center (TBINDSC), 
participates in independent and collaborative research, and provides 
valuable information and resources. This research is critical to help 
TBI providers to better deliver services that result in good outcomes.
    In closing, NASHIA is a nonprofit organization that works on behalf 
of States to promote partnerships and build systems to meet the needs 
of individuals with TBI with the goal of all States having resources to 
assist individuals with TBI to return to home, community, work and 
school after sustaining a brain injury. Federal funding is critical to 
help States in that endeavor, including data and research to support an 
effective delivery system. We urge you to consider increasing funding 
to the ACL TBI State Partnership Program; the ACL NIDILRR program to 
expand TBI research; and to CDC to establish a National Concussion 
Surveillance System.
    Thank you for your continued support. Should you wish additional 
information, please do not hesitate to contact: Susan L. Vaughn, 
Director of Public Policy, [email protected] or Zaida Ricker, NASHIA 
Government Relations, [email protected].
                                 ______
                                 
   Prepared Statement of the National Coalition for Homeless Veterans
    Dear Chair Murray and Ranking Member Blunt, Chairman Heinrich and 
Ranking Member Boozman, and Chairman Schatz and Ranking Member Collins:
    As you begin work on the fiscal year 2023 Appropriations bills, the 
National Coalition for Homeless Veterans (NCHV) submits this letter as 
testimony, requesting your respective subcommittees to fully fund the 
programs that directly impact homeless veterans to perpetuate the 
successes in reduction of homeless veterans. Multiple Federal 
departments and agencies play vital roles in combatting, preventing, 
and ending veteran homelessness in America including the Department of 
Labor (DOL), the Department of Veterans' Affairs (VA) and the 
Department of Housing and Urban Development (HUD).
    COVID-19 has continually impacted the economy in unprecedented 
ways, and as the VA's own Secretary testified, we have yet to reach 
peak requests for care. The Committee's diligence in providing 
emergency appropriations for these programs shows great foresight, yet 
now we must work toward permanent housing for those veterans housed 
with those funds, in regular program appropriations so we do not return 
veterans to pre-emergency levels of veteran homelessness. Every veteran 
deserves safe and permanent housing, whether they are currently 
experiencing homelessness or are facing housing-cost burdens that put 
them at risk of homelessness. We therefore ask that you fully fund the 
listed programs at the following levels:
                          department of labor
    The Homeless Veterans' Reintegration Program (HVRP) provides 
services to assist in reintegrating homeless veterans into meaningful 
employment within the labor force and to stimulate the development of 
service delivery systems that will address the employment challenges 
facing homeless veterans. ($107.5 Million)
                     department of veterans affairs
    1. The Healthcare for Homeless Veterans Program (HCHV) performs 
outreach to identify veterans experiencing homelessness who are 
eligible for VA services and assist these veterans in accessing 
appropriate health care and benefits. ($275 Million)
    The Homeless Providers Grant and Per Diem (GPD) promotes the 
development and provision of transitional housing and services with the 
goal of helping homeless veterans achieve residential stability, 
increase their skill levels and/or income, and obtain greater self-
determination. Includes $180 million for post-covid per diem 
adjustments and $50 million for the next round of Capital Grants. ($500 
Million)
    The Healthcare for Reentry Veterans and Veteran's Justice Outreach 
program helps justice-involved veterans avoid the unnecessary 
criminalization of mental illness and extended incarceration by 
ensuring that eligible veterans have timely access to Veterans Health 
Administration. ($75 Million)
    The Supportive Services for Veteran Families (SSVF) program 
provides funding for very low-income veteran families in or 
transitioning to permanent housing. The Secretary has expressed a 
departmental goal of permanently housing an additional 38,000 homeless 
veterans by the end of the year and the funding should reflect that 
aim. NCHV is requesting continued report or bill language to ensure 
sufficient rapid rehousing and homelessness prevention capacity 
monitoring the expansion of the shallow subsidy initiative of the SSVF 
program until outcomes are tangible. ($795 Million)
    Case Managers working Case Management for the HUD-VASH Program work 
with homeless veterans can use this resource to address the 
multifaceted needs they have. Veterans must agree to participate in 
case management in order to receive a HUD-VASH voucher. The President's 
Fiscal Year 2023 Budget and the VA secretary have requested larger base 
increases to continue to hire full-time equivalent (FTE) case managers. 
($594 Million)
    The Medical Support and Compliance (0152) accounts under VA Medical 
Services for homeless veteran programs requires additional funding to 
support the use of administrative fees for the hiring and retention of 
staff. (Highest Funding Possible)
              department of housing and urban development
    Additional funding for new HUD-VASH Vouchers provides a much-needed 
yearly increase in program funding to allow for continued referrals. 
Many factors contribute to underutilization like housing stock, case 
manager hiring and retention, and VA has been working to alleviate what 
it can and has made some progress on hiring FTEs. Additional vouchers 
will allow developers to operationalize additional supportive housing 
for veterans. Includes $40 million for project-based vouchers. ($90 
Million)
    Tribal HUD-VASH--Tribes have been working to actively increase 
capacity within HUD-VASH to meet community needs. ($5 Million)
                               reporting
    We request that each Secretary produce continuing reports on racial 
equity and access to programs providing services to homeless veterans. 
The reports track departmental expenditures within Homeless Veteran 
Programs specifically with regard for minority, female and LGBTQ 
populations. This report would be provided annually to the 
Appropriations and Veterans' Affairs subcommittees of jurisdiction. The 
information should be disaggregated by ethnicity, age, gender identity, 
and discharge status. The data collected to produce the report will be 
crucial in determining how to continue future homeless veteran 
population reductions and should be accessible to the general public.
    We request report language in the VA appropriations bill to 
continue the implementation of a housing first oriented approach to 
addressing veteran homelessness. Given the research on its outcomes and 
cost effectiveness NCHV requests Congress direct the Department to 
continue implementation of housing-first oriented systems and efforts 
to meaningfully incorporate appropriate levels of transitional housing 
capacity into systems across the country to meet the needs of veterans 
who choose recovery services or transitional housing programs.
    We request the VA Secretary produce a report regarding increased 
effectiveness and efficiency of VA's Grant and Per Diem. The report 
would include historical rate data (3-5 years) disaggregated by 
location & zip code and not solely by grantee name, in addition to 
ethnicity, age, gender identity, and discharge status. The report would 
include the number of beds indicated by geographic location and 
disaggregated by type of bed and their level of congregate setting. The 
report would also include a proposal and ramifications for decoupling 
GPD rates from the state home domiciliary rate in favor of more 
regional calculation based on area fair market rents. When the National 
Health Emergency sunsets the GPD rate will revert to 115 percent of the 
state home rate. NCHV has testified repeatedly that this rate is 
nowhere near sufficient to shelter veterans in major urban areas like 
California where the cost is over 400 percent of the state home rates.
    We thank you for your past and continued support of veteran 
homelessness programs and your consideration of these important 
requests.

    Sincerely.

    [This statement was submitted by Kathryn Monet, Chief Executive 
Officer, 
National Coalition for Homeless Veterans.]
                                 ______
                                 
     Prepared Statement of the National College Attainment Network
    On behalf of the National College Attainment Network (NCAN), we 
write to respectfully request that investments in education programs, 
such as funding for Federal student aid, remain a high priority for the 
Labor-HHS-Education subcommittee in Fiscal Year 2023. NCAN hopes that 
discretionary funding will rise in FY23 for programs that are critical 
to our Nation's students and future workforce. Thank you for your 
continued leadership on investing in the Federal programs that support 
students in their pursuit of postsecondary education,
    For FY23, NCAN requests these funding levels for the U.S. 
Department of Education programs:
  --NCAN recommends the requisite funding in FY23 so that the maximum 
        Pell Grant award can be increased to $12,990, double the 
        maximum Pell Grant award (award year 2021-22).
  --Supplementary Educational Opportunity Grant funding of $1.09 
        billion.
  --Federal Work-Study funding of $1.52 billion.
  --TRIO program funding of $1.307 billion.
  --GEAR UP funding of $435 million.
  --$620 million increase in administrative funding for Federal student 
        aid management.
    Additionally, we request that the Corporation for National and 
Community Service receive $1.34 billion in funding for FY23--and that 
the AmeriCorps program, that allows some college access programs to 
provide near-peer mentors for their students, receive $557 million in 
funding.
    Founded in 1995, NCAN represents more than 500 members across the 
country that all work toward a shared mission to build, strengthen, and 
empower communities and stakeholders to close equity gaps in 
postsecondary attainment for all students. Collectively, we are 
committed to college access and success so that all students, 
especially those underrepresented in postsecondary education, can 
achieve their educational dreams. NCAN's members span a broad range of 
the education, nonprofit, government, and civic sectors, including 
national and community-based nonprofit organizations, federally funded 
TRIO and GEAR UP programs, school districts, colleges and universities, 
foundations, and corporations.
    Drawing on the expertise of our hundreds of organizational members 
in every U.S. state, NCAN is dedicated to improving the quality and 
quantity of support that underrepresented students receive to apply to, 
enter, and succeed in postsecondary education. Students of color, 
students from low-income backgrounds, and those who are the first in 
their family to attend college experience disproportionately lower 
rates of postsecondary success. For example, a low-income student is 29 
percent less likely to enroll in postsecondary education directly after 
high school than a high-income student. Ultimately, only 35 percent of 
low-income high school students obtain a postsecondary credential by 
age 26, compared to 72 percent of high-income students.
    To help close equity gaps in attainment, NCAN requests the 
following in Federal investments:
Pell Grant Investments
    NCAN recommends that the maximum Pell Grant award be increased to 
$12,990, double the maximum award (award year 2021-22).
    The Pell Grant has served as the cornerstone of financial aid for 
students from low-income backgrounds pursuing higher education since 
its creation in 1972. This need-based grant provides crucial support 
for around 7 million students each year, or about one-third of 
undergraduates. Without this need-based grant funding, far less 
students from low-income backgrounds would be able to access higher 
education. NCAN appreciates investments Congress has made to raise the 
maximum Pell Grant award in recent years.
    Given that the previously required automatic inflationary increases 
have expired, annual investments by Congress are essential for our 
Nation's students who are least likely to have the means to pay for 
education after high school. Even with recent investments, the maximum 
Pell Grant award's purchasing power at a 4-year public institution only 
covers 30 percent of the cost of attendance. At its high in the 1970s, 
the maximum Pell Grant award could have covered more than three-fourths 
of the average cost of attendance--tuition, fees, and living expenses--
at a 4-year public institution.
    To address its long-term purchasing power, and so that the maximum 
award cover at least half of the cost of attendance at a 4-year public 
institution, the maximum Pell Grant award should be doubled. In the 
president's FY23 budget request, the administration requests Congress 
consider a Pell Grant increase of $1,775, through discretionary and 
mandatory funding, to bring the maximum award to $8,670 for the 2023-24 
award year. If Congress adopted this increase, the maximum award's 
purchasing power would increase to 36 percent. Further, this historic 
investment is necessary to reach the goal outlined in the president's 
budget of doubling the Pell grant by 2029.
FAFSA Simplification
    In the president's FY23 budget request, the administration requests 
a $620 million increase in administrative funding for the management of 
Federal student aid. This funding is necessary to help with the 
implementation of the FAFSA Simplification Act and FUTURE Act--two laws 
that will achieve the goal of simplifying the Free Application for 
Federal Student Aid (FAFSA) process, a top priority for NCAN. With the 
Office of Federal Student Aid announcing a phased implementation plan 
for FAFSA simplification, to take full effect 1 year later than 
originally anticipated, NCAN supports this funding request to ensure 
that the timeline is not further delayed. The urgency for students to 
access need-based aid has only grown since passage of the legislation.
Campus-Based Aid
    As low-income students piece together resources from a variety of 
sources to support their postsecondary education pursuits, every dollar 
and type of aid is significant. For most low-income students, the 
Supplemental Educational Opportunity Grant (SEOG) and Federal Work-
Study help to fill unmet need in their financial aid packages.
    The SEOG program should be increased for FY23 so that institutions 
of higher education to support a greater percentage of our Nation's 
lowest-income students. For FY22, NCAN respectfully requests that 
Congress fund the SEOG program at a total of $1.09 billion.
    Sixty-four percent of today's students work while enrolled in 
school. The Federal Work-Study (FWS) program allows students to work in 
a flexible environment, learn important skills, and minimize the amount 
of time they spend commuting between work and campus. For FY23, NCAN 
respectfully requests that Congress increase the FWS program budget for 
a total of $1.52 billion.
Federally Funded College Access Programs--TRIO and GEAR UP
    High school seniors, and especially students from low-income 
backgrounds, require a variety of programs to help assist as they 
strive to pursue education beyond high school. NCAN's members serve 
roughly two million students annually in their path towards attainment. 
To reach the students who need crucial assistance services, our members 
build important partnerships with TRIO and GEAR UP programs. NCAN 
respectfully requests that Congress continue its investment in 
federally funded college access programs at the amounts requested by 
their communities: $1.307 billion for TRIO and $435 million for GEAR 
UP.
Corporation for National and Community Service (CNCS)
    For every dollar spent on national service, our Nation sees a major 
return on investment. Service plays an important role in the college 
access movement. Many of NCAN's largest members can maximize their 
impact for underrepresented students by participating in the AmeriCorps 
public-private partnership. Continuing support for CNCS, and 
specifically the AmeriCorps program, will enable additional volunteers 
to work with low-income students, students of color, and students who 
are first in their family to attend college. NCAN respectfully requests 
of that the Corporation for National and Community Service and the 
AmeriCorps program receive $1.34 billion and $557 million, 
respectively, for FY23.
    Thank you for this opportunity to provide our funding priorities 
for fiscal year 2023. Through continued supports--both financial and 
programmatic--our country can work together to close gaps in 
attainment, where a low-income student is about half as likely to 
complete a postsecondary degree or credential as a high-income student. 
NCAN appreciates your leadership in Congress to support these important 
Federal programs.
    Sincerely.

    [This statement was submitted by Kim Cook, Chief Executive Officer, 
National College Attainment Network .]
                                 ______
                                 
    Prepared Statement of the National Congress of American Indians
    On behalf of the National Congress of American Indians (NCAI), 
thank you for this opportunity to provide testimony on fiscal year 2023 
funding for the Department of Labor (DOL), Department of Health and 
Human Services (HHS), Department of Education (Ed.), and the 
Corporation for Public Broadcasting (CPB).
    Indian Country is socially, economically, and geographically 
diverse. Most Tribal lands are held in trust by the United States or 
have been completely taken from our Nations through the long history of 
Federal Indian policies of removal, assimilation, reorganization, and 
termination. As a result, we do not have the same asset base or tax 
base as other governments and our government revenue structure is 
different; Tribal Nations rely on Federal Government funding and on 
economic development. Policies failing to consider that we do not have 
the same capital equity as other American governments cause Federal 
programs and initiatives to be less successful than intended. Federal 
spending policy for programs that benefit Native Americans must be 
considered holistically across appropriations subcommittee 
jurisdictions and recognize the unique historical and political 
position forced upon Tribal Nations. The United States must be bold and 
look at new and unrealized solutions to Federal taxing and spending 
related to its trust and treaty obligations to Tribal Nations.
    After the COVID-19 pandemic struck, the Federal Government listened 
to Tribal Nations' collective voice and provided the largest single 
infusion of Federal funding for Native Americans in U.S. history.\1\ 
Funding from the American Rescue Plan Act embodied a simple and 
effective strategy to maximize the investment: empowering Tribal 
Nations to design their own solutions. This funding was not a panacea, 
particularly given that Tribal Nations began the pandemic on unequal 
footing compared to State and local governments, but it was historic, 
necessary, and essential. This historic inclusion in Federal spending 
for Indian Country must be the norm, and not the exception.
---------------------------------------------------------------------------
    \1\ Eric C. Henso et. al, ``Assessing the U.S. Treasury 
Department's Allocations of Funding for Tribal Governments under the 
American Rescue Plan act of 2021'', Harvard Project on American Indian 
Economic Development & Native Nations Institute, Policy Brief No. 7 
(November 3, 2021), available at: https://ash.harvard.edu/files/ash/
files/assessing_the_u.s.--treasury_
departments_allocations_of_funding_for_tribal_governments.pdf?m=16359725
21.
---------------------------------------------------------------------------
                          department of labor
    Beginning in February 2022, the Bureau of Labor Statistics 
published monthly data on American Indian and Alaska Native (AI/AN) 
employment, using data that was previously available through the Census 
Bureau's Current Population Survey. The newly published data reveals a 
labor market that would be considered catastrophic if it were 
representative of the full U.S. economy, with an unemployment rate more 
than double that of the Nation's topline unemployment rate.\2\ Indian 
Country is still recovering from the effects of the pandemic on the 
labor market, with unemployment rates reaching 28.6 percent during the 
peak of the pandemic fallout-an amount comparable to the National 
unemployment rate during the Great Depression.\3\ As of January 2022, 
the unemployment rate for Native Americans was still greater than the 
peak unemployment rate for white workers during the pandemic.\4\
---------------------------------------------------------------------------
    \2\ Robert Maxim, Randall Akee, and Gabriel R. Sanchez, For the 
first time, the government published monthly unemployment data on 
Native Americans, and the picture is stark, available at: https://
www.brookings.edu/blog/the-avenue/2022/02/09/despite-an-optimistic-
jobs-report-new-data-shows-native-american-unemployment-remains-
staggeringly-high/#:\:text=Prior%20to%20
the%20pandemic%2C%20Native,unemployment%20during%20the%20Great%20Depress
ion, Accessed: May 4, 2022.
    \3\ Id.
    \4\ Id.
---------------------------------------------------------------------------
    Even when controlling for a host of factors, the Brookings 
Institute posits that structural racism in the U.S. economy affects AI/
AN access to education and attainment as well as employment 
opportunities.\5\ As traditionally place-based peoples with strong 
cultural and historical ties to the land, AI/ANs tend to not move away 
even when the economy goes bad. This means that the structural 
impediments to economic growth are focused and exacerbated on Tribal 
lands, underscoring the importance of DOL employment and training 
programs for AI/ANs. Unfortunately, spending for Native American 
programs within DOL represents 0.5 percent of total regular DOL budget 
authority in the fiscal year 2022 Omnibus, with an increase of less 
than 4.8 percent over 5 years-an amount that drastically fails to keep 
pace with inflation for that same period according to the Bureau of 
Labor Statistics' own inflation calculator. With Federal investment 
metrics such as these, it is no surprise that the labor market in 
Indian Country remains in a State of catastrophe by national standards, 
which dampens local, regional, and national U.S. economic productivity.
---------------------------------------------------------------------------
    \5\ Id.
---------------------------------------------------------------------------
    This subcommittee can correct this investment deficiency by 
providing at least $61.5 million for DOL Native American Programs, 
$15.5 million for Tribal grants within YouthBuild Activities, and not 
less than $250 thousand to DOL Department Management for the 
Secretary's Native American Employment and Training Council, holding 
Native American Program resources harmless. Additionally, DOL has 
failed to make meaningful headway on the American Indian Population and 
Labor Force Report, required by Congress to be submitted every 2 years, 
despite several Tribal consultations on the need for it and meaningful/
useful data. Instead, in February 2022, the DOL Employment and Training 
Administration issued a 96-page report on the difficulty of compiling 
the report and opted to further pass the buck on to the Bureau of Labor 
Statistics--wasting time and taxpayer resources while simultaneously 
failing to meet Congress' mandate. DOL must be directed to execute this 
long overdue and meaningful report in consultation and collaboration 
with Tribal Nations, and DOL resources must be conditioned on the 
completion of this unfulfilled obligation. Executive Branch agencies 
should be held accountable to fulfill Congressional and U.S. Code 
requirements--not waste Federal resources meant to support Indian 
Country to issue reports on why projects are difficult. DOL must work 
with Tribal Nations and across Federal agencies to develop the report 
Indian Country needs and deserves to support Tribal solutions.
                department of health and human services
    As Congress declared in the Indian Health Care Improvement Act (25 
U.S.C. Sec. 1602), in order to fulfill its trust responsibility and 
treaty obligations, the U.S. must achieve the highest health care 
levels for AI/ANs and provide the requisite resources. While the Indian 
Health Service (IHS) is the primary source of Federal funds for 
healthcare for AI/ANs, annual appropriations for the IHS have never 
exceeded 50 percent of the demonstrated patient need. By cross-
referencing Office of Management and Budget data with Appropriations 
Committee reports, regular appropriations for HHS in fiscal year 2022 
for the benefit of Native Americans represents 0.68 percent of the 
total budget authority provided by Appropriations Committees. When this 
amount is controlled to remove IHS (funded within the jurisdiction of 
the Interior, Environment, and Related Agencies subcommittee), this 
subcommittee's investment in Indian Country is an appalling 0.15 
percent of its regular budget authority appropriated for fiscal year 
2022.
    This (lack of) investment tells a vivid story of health and 
wellbeing in Indian Country and of Congress' priorities for health and 
wellbeing when controlling for all competing interests within this 
subcommittee's jurisdiction. It tells a story of how Congress values 
(or fails to value) its treaty and trust obligations and the human 
lives that it obligated itself to protect in exchange for the wealth 
and bounty that created the most economically prosperous and powerful 
country in world history. The ongoing Coronavirus pandemic uniquely 
impacted and exacerbated the health conditions of Indian Country, but 
AI/ANs began this pandemic already in a health crisis caused by the 
United States' chronic underinvestment in its own obligations; by the 
promises to its citizens that it broke-that remain broken. Even as we 
recover globally from the pandemic, additional emerging issues are 
disproportionately impacting Tribal communities. The loss of our loved 
ones, our economies, and the devastating effects of isolation with 
inadequate infrastructure are causing a mental health crisis across 
Indian Country. The rising costs of goods and lingering labor fallout 
are affecting early childhood development outcomes. The lack of 
adequate communications infrastructure is affecting our educational 
attainment. This crisis is not over for our people, even as we face new 
crises on practically every front.
    The United States' trust and treaty obligations to Tribal Nations 
and their citizens cannot be singularly siloed into one bureau or 
agency. IHS services are largely limited to direct patient care, 
leaving little, if any, funding available for public health initiatives 
such as disease research and prevention, early childhood development 
and welling education, injury prevention, and promotion of healthy 
lifestyles. HHS administers a wide array of health and wellbeing 
programs for Indian Country, including child and family welfare, mental 
health services, education, and cultural preservation. This 
subcommittee can address these compounded crises by providing not less 
than $505.98 million for Tribal grants within Children and Families 
Services Programs-including $349.98 million for Programs for Children, 
Youth and Families and not less than $156 million for Native American 
Programs (Administration for Native Americans); $203.52 million for 
Tribal grants within the Substance Abuse and Mental Health Services 
Administration; $111.23 million for Tribal grants within the 
Administration for Community Living; $17.41 million for Tribal grants 
within Promoting Safe and Stable Families; and $14.01 million for the 
Tribal Home Visiting Program.
                        department of education
    The U.S. Department of Education funds promote the success of 
Native students in public schools, as well as Bureau of Indian 
Education-funded and tribally controlled schools and Tribal Colleges 
and Universities. An educated citizenry serves as a catalyst to boost 
prosperity and growth through a more competitive workforce, which can 
attract new businesses, stimulate Tribal economies, and foster 
entrepreneurial endeavors in the community. Tribal education is 
uniquely reliant on the Federal appropriations process because 
disparities in tax jurisdictions limit Tribal governments' ability to 
raise revenue in ways other governments take for granted. A growing 
body of research finds important positive connections between the 
linguistic and cultural environments in which Native American children 
grow and their outcomes. Congress must provide the resources to fulfill 
its trust and treaty obligations to Native Americans through culturally 
appropriate education.
    In order to fulfill these obligations and improve on AI/AN 
education and attainment, this subcommittee should provide not less 
than $2.095 billion for Indian Education programs--including $2 billion 
for Tribal Local Education Agencies (LEAs); $2 billion for Impact Aid 
for the benefit of Native students; $20 million for Bureau of Indian 
Education school assessment maintenance; $94.2 for Higher Education 
Tribal programs--including $45 million for Tribal Colleges and 
Universities and $15 million for Tribally Controlled Postsecondary 
Vocational/Tech Institutions; and $76 million for the American Indian 
Vocational Rehabilitation Services Program.
                  corporation for public broadcasting
    Native radio stations are critical to the communities they serve 
because they are often the first source of emergency reporting and 
information for Tribal citizens. Public broadcasters use datacast 
technology for public alert and warning systems, homeland security, and 
other public safety purposes. In addition to providing emergency 
information, Native radio stations provide vital access to healthcare 
information and other services specific to the Tribal communities they 
serve. Often, the only forum where Native stories and issues are 
broadly heard are on Native radio stations.
    Since 1976, the Corporation for Public Broadcasting's (CPB) 2-year 
advance appropriations have served as a Congressional strategy to 
protect public media from any immediate political pressure. Community 
Service Grants (CSGs) account for approximately 70 percent of CPB's 
appropriation, which directly funds 1,300 local public television and 
radio stations--including 36 Native radio stations. CPB also funds the 
essential system-wide station support services provided by Native 
Public Media, Inc., and the content production and satellite 
programming distribution by Koahnic Broadcast Corporation. This funding 
ensures that Native radio stations stay on-air and provide broadcast 
services to some of the most rural and remote locations in the United 
States.
    Congress should provide at least $7 million (advance appropriation 
for fiscal year 2025) to fund American Indian and Alaska Native radio 
stations, at least $500,000 (advance appropriation for fiscal year 
2025) for Native Public Media, and at least $500,000 (advance 
appropriation for fiscal year 2025) for the Koahnic Broadcast 
Corporation.
                               conclusion
    Tribal Nations are uniquely reliant on the Federal Government to 
fulfill its promises made in exchange for the land that created the 
foundation of the bounty and wealth of the United States. Our people 
have paid for every penny obligated to Indian Country hundreds of times 
over by providing this Nation with our land. In order to uphold this 
Nation's promises to its people, it must first uphold its promises to 
this land's First Peoples. We expect to continue to be treated as 
sovereign nations with governmental parity. We must continue down that 
path of Nation-to-Nation growth, and only then will all of our people 
be able to fully flourish.

    [This statement was submitted by Dante Desiderio, CEO, National 
Congress of American Indians.]
                                 ______
                                 
Prepared Statement of the National Council for Community and Education 
                              Partnerships
    Distinguished members of the Senate Labor-Health and Human 
Services-Education Appropriations subcommittee, thank you for the 
giving me the opportunity to provide testimony on the profound impact 
that the Gaining Early Awareness and Readiness for Undergraduate 
Programs (GEAR UP) initiative has had on my life. My name is Mark 
Figueroa, and it is my honor and pleasure to be writing this 
testimonial on behalf of GEAR UP alumni and over half a million GEAR UP 
students across the country. Given the program's return on investment, 
I urge the committee to appropriate $435,000,000 for GEAR UP in fiscal 
year 2023 to support an additional 80,000 students across our country 
so that they, too, can have the support I received in GEAR UP.
    As you know, GEAR UP provides 6- or 7-year grants to States and 
partnerships comprised of K-12, higher education, and community-based 
organizations that strengthen pathways to college and careers in low-
income communities. GEAR UP exposes students, and their families, 
starting in the 7th grade to comprehensive interventions that follow 
them through high school graduation and optionally, through the first 
year of postsecondary education. GEAR UP uses early and sustained 
interventions to ensure that students are successful in rigorous 
courses, are knowledgeable about the steps necessary to prepare for 
life beyond high school, and ultimately enroll in a high-quality 
certificate, associates', or bachelors' degree program that suits their 
goals. In the most recent year in which we had a large class of 
graduating seniors, the postsecondary enrollment rates of GEAR UP 
students were over 31 percent higher than low-income students 
nationally.\1\ Considering that GEAR UP achieves this critical goal at 
a cost of approximately $645 per student, per year, I strongly believe 
that the investment in GEAR UP pays significant dividends. GEAR UP is a 
powerful catalyst for sustained community improvement.
---------------------------------------------------------------------------
    \1\ U.S. Department of Education (2016). fiscal Year2017 Department 
of Education Justifications of Appropriation Estimates to the Congress: 
Higher Education (Volume II). Retrieved from: https://www2.ed.gov/
about/overview/budget/budget17/justifications/index.html.
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    I grew up in a place in Eastern Washington State in a region known 
as the Tri-Cities. This part of the country is fueled by passionate 
Latinx immigrant migrant families working in produce fields across the 
State of Washington. With long days and hard work, preparing for a 
higher education can be challenging for many. As a first-generation 
migrant student and the eldest of six in my family, post-secondary 
education seemed like a very distant, unknown land with no clear path 
toward it.
    However, participating in the GEAR UP program helped me actualize 
my dreams of a post-secondary education through mentors, college & 
career fairs, FAFSA nights, and college admissions workshops. Being the 
first in my family to pursue a higher education, my parents and I had 
many questions. It is a daunting process, especially if done alone. 
Nevertheless, GEAR UP was there to support us, and walk with us all the 
way. Because of GEAR UP, I was admitted and graduated from Washington 
State University. With these experiences, and the confidence that GEAR 
UP gave me, I was able to develop strong leadership skills, community 
connections, and discovered all the ways to give back to my community. 
During my time at Washington State University, I connected with other 
first-generation migrant students and encouraged them to follow their 
dreams. I joined the only Aztec-based brotherhood in the Pacific 
Northwest, I served in student government, and helped lead a student 
ministry at the intersection of faith and culture. Having led the way, 
with the support of GEAR UP, I am now there for my parents and my five 
sisters as they navigate the college-going process.
    Additionally, I was inspired by my experiences and the experiences 
of others with stories similar to mine, and I was able to bring 
awareness to various issues affecting college students from all walks 
of life. I currently volunteer with local civic engagement 
organizations to encourage members of my community to elevate their 
voices. I am a secondary education teacher, I coach soccer at the same 
high school where GEAR UP supported me, and I am working towards a 
master's degree in theology. I can attest to the truth that GEAR UP 
does work.
    For me, none of this would have been possible without the guidance 
of the GEAR UP program. Through my own achievements in attending 
postsecondary education, I can see that generational barriers in my 
family have been removed for future generations and they may find the 
same successes that I have through education. While the support that 
GEAR UP provided me was truly priceless, the only way that other 
students will be able to access the educational experiences I had 
because of GEAR UP, will be to continue to increase funding. 
Acknowledging that I am just one of the thousands of families GEAR UP 
has positively impacted highlights the impact of the GEAR UP program.
    As you take on the work of preparing for the fiscal year 2023 
appropriations, I urge you to consider increasing the investment in the 
GEAR UP program to $435,000,000 so that 80,000 more students just like 
me can benefit from the program as I did. Thank you to the committee 
for taking the time to read my testimony.
                                 ______
                                 
  Prepared Statement of the National Council for Diversity in Health 
                              Professions
    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to submit this 
statement for the record on behalf of the National Council for 
Diversity in the Health Professions (NCDHP). I am Dr. Wanda Lipscomb 
and I serve as President of the NCDHP and Director of the Center of 
Excellence for Diversity in Medical Education at Michigan State 
University. NCDHP was established in 2006 and is composed of 
institutions that are either currently or formerly distinguished as a 
``Center of Excellence'' through the Health Resources and Services 
Administration's (HRSA)'s Centers of Excellence (COE) program or are a 
current or former recipient of the Health Careers Opportunities Program 
(HCOP) grant, now known as the National HCOP Academies program. Every 
member institution within the council is committed to advancing 
pipeline programs and programmatic activity that leads to diversity in 
the health professions.
    The National Council for Diversity in Health Professions (NCDHP) is 
comprised of institutions with Centers of Excellence (COE) and Health 
Careers Opportunity Program (HCOP) grants funded by the Health 
Resources and Services Administration under the Title VII Health 
Professions Training Programs. COE/HCOP grantees are in health 
professions education and other institutions which excel in the 
development of educational pipeline programs for individuals from 
minority and disadvantaged backgrounds, and in the improvement of the 
quality of health care delivery to medically underserved communities. I 
am proud to put forth the following recommendations for the fiscal year 
(FY) 2023 appropriations process:
    Minority health professional development is a cost-effective and 
long-term mechanism of improving health care and decreasing health 
disparities in minority and underserved communities. 50-80% of Under-
Represented Minority (URM) physicians and other health professionals 
practice in shortage areas serving minority patients. Minority health 
professionals possess the cultural, experiential and linguistic skills 
needed to provide cost-effective health care to minority communities. 
Minority students identified, recruited, supported, admitted, and 
trained in the health professions in this decade will provide services 
into the 2060s and 2070s.
            hrsa centers of excellence (coe) recommendation
    COE award recipients serve as innovative resource and education 
centers to recruit, train, retain and graduate URM students and faculty 
at health professions schools. Programs improve information resources, 
clinical education, curricula, and cultural competence as they relate 
to minority health issues and social determinants of health. These 
award recipients also focus on facilitating faculty and student 
research on health issues particularly affecting URM groups. The goal 
of the program is to effectively deliver health care to underserved 
communities.
NCDHP recommends $47.42 million for the COE program in Fiscal Year 
        2023.
     hrsa health career opportunities program (hcop) recommendation
    HCOP provides opportunities for colleges and community-based health 
professions training and promotes the recruitment of qualified students 
and non-traditional students like veterans from disadvantaged 
backgrounds into health and allied health professions programs. As a 
major Federal pipeline program into the health professions, HCOP 
improves the acceptance, retention and matriculation rates of 
participating students by implementing tailored enrichment programs 
designed to address their academic and social needs.
NCDHP recommends $47.95 million for the HCOP program in Fiscal Year 
        2023.
 funding justification and appropriations history for hrsa's hcop and 
                              coe programs
    --The Association of American Medical Colleges projects that in the 
            U.S. there will be a shortage of nearly 120,000 primary 
            care physicians by the year 2030. Looming workforce 
            shortages exist not only in medicine, but also in 
            dentistry, public health, physician assistants and other 
            health professions. If not adequately addressed, our Nation 
            will continue to fall short in addressing the needs of 
            medically underserved communities as most recently exposed 
            by the COVID-19 pandemic.
    --We are seeking to restore COE and HCOP funding to FY 2005 levels. 
            For FY 2006 the COE appropriation was cut by 65% from $33M 
            to only $12M. Similarly HCOP was cut by 89% to only $4M. 
            Adjusting for inflation COEs $33M in 2005 dollars would be 
            $45M in 2021 dollars. HCOPs $35M in 2005 would now be $47M.
    --The number of COE grantees dropped from 34 (in 2005) to 19 (in 
            2020), and the number of HCOP grantees dropped from 74 (in 
            2005) to 22 (in 2020). These programs have not fully 
            recovered. Presently there is not enough funding in either 
            program to support a new competition-only to maintain 
            existing programs. A significant increase is needed in COE 
            and HCOP to increase the number of Latino, Black, American 
            Indian and disadvantaged students recruited, admitted and 
            graduated as culturally competent physicians and other 
            health professionals who have a high likelihood of 
            practicing in underserved minority communities. For 
            example, with increased funding, COE could launch an 
            initiative to increase the number of post-baccalaureate 
            slots and programs that enroll previously rejected 
            applicants in 1-year programs, with 90% being accepted to 
            medical school, of which >95% will graduate as physicians.
    As you begin the FY 2023 process, NCDHP asks that you further 
prioritize Title VII health professions training programs. Chairwoman 
Murray and Ranking Member Blunt, please allow me to express my 
appreciation to you and the members of this subcommittee. With your 
continued help and support, NCDHP member institutions are keeping 
course to overcome health workforce and health disparities. Thank you 
for your time and consideration of these requests. We look forward to 
working with the subcommittee to prioritize the health professions 
programs in FY 2023 and the future.

    [This statement was submitted by Wanda Lipscomb, Ph.D., President, 
National Council for Diversity in the Health Professions.]
                                 ______
                                 
   Prepared Statement of the National Council of Urban Indian Health
    My name is Francys Crevier, I am Algonquin and the Chief Executive 
Officer of the National Council of Urban Indian Health (NCUIH). On 
behalf of NCUIH, the National advocate for health care for the over 70 
percent of American Indians and Alaska Natives (AI/ANs) living off-
reservation and the 41 Urban Indian Organizations (UIOs) that serve 
these populations, I would like to thank Chairwoman Murray, Ranking 
Member Blunt, and Members of the subcommittee for the opportunity to 
submit public witness testimony regarding Fiscal Year (FY) 2023 
appropriations. We respectfully request the following:
  --Fully fund the Indian Health Service (IHS) at $49.8 billion and 
        Urban Indian Health at $949.9 million for FY23 (as requested by 
        the Tribal Budget Formulation Workgroup)
  --Advance appropriations for IHS until mandatory funding is enacted
  --Increase funding for Electronic Health Record Modernization
  --Increase funding to $30 million for Good Health and Wellness in 
        Indian Country (GHWIC)
  --Permanently reauthorize Native Connections (Tribal Behavioral 
        Health Grant)
  --Include urban Indians in language for all health programs
  --Include UIOs in critical opioid grants
Fully fund the Indian Health Service at $49.8 billion and Urban Indian 
        Health at $949.9 million for FY23 (as requested by the Tribal 
        Budget Formulation Workgroup)
    While your leadership was instrumental in providing the greatest 
investments ever for Indian health and urban Indian health, it is 
important that we continue in this direction to build on our successes. 
The average health care spending is around $12,000 per person, however, 
Tribal and IHS facilities receive only around $4,000 per patient. UIOs 
receive just $672 per IHS patient--that is only 6 percent of the per 
capita amount of the National average. That's what our organizations 
must work with to provide health care for urban Indian patients.
    The Federal trust obligation to provide health care to Natives is 
not optional, and we thus request Congress honor the Tribal Budget 
Formulation Workgroup (TBFWG) FY23 recommendations of $49.8 billion for 
IHS and $949.9 million for urban Indian health. That number is much 
greater than the FY21 enacted amount of $63.7 million, which truly 
demonstrates how far we have to go to reach the level of need for urban 
Indian health. At an IHS Area Report meeting where Tribal leaders 
presented their budget requests, one Oklahoma Tribal leader stated that 
``There are inadequate levels of funding to address the rising urban 
Indian population.'' Congress must do more to fully fund the IHS in 
order to improve health outcomes for all Native populations at the 
amount requested.
    In 2018 the Government Accountability Office (GAO-19-74R) reported 
that from 2013 to 2017, IHS annual spending increased by roughly 18 
percent overall, and roughly 12 percent per capita. In comparison, 
annual spending at the Veterans Health Administration (VHA), which has 
a similar charge to IHS, increased by 32 percent overall, with a 25 
percent per capita increase during the same period. Similarly, spending 
under Medicare and Medicaid increased by 22 percent and 31 percent 
respectively. In fact, even though the VHA service population is only 
three times that of IHS, their annual appropriations are roughly 13 
times higher.
    Currently, the entire Eastern seaboard is without any full-
ambulatory UIOs due to lack of funding. The IHS has deemed the two 
remaining UIOs on the East Coast to be outreach and referral only, with 
a combined less than two-million-dollar budget. Unfortunately, the 
pandemic has shown that two outreach and referral UIOs to serve all 
urban Indians on the entire East Coast of the country is a failure to 
uphold the Federal trust obligation. It is evident the UIO line item is 
insufficient to allow IHS to authorize our East Coast UIOs to open 
fully operational clinics. Native American Lifelines is actually two 
programs run in both Boston and Baltimore with an annual budget for 
both cities of $1.6 million. During the height of the pandemic, that 
meant Native people living in urban areas on the East Coast had to go 
back to reservations to get their vaccine to take advantage of the IHS 
authority that would give them the vaccine early and hopefully not 
become a mortality statistic.
    The Federal Government owes a trust responsibility to Tribes and 
AI/ANs that is not restricted to the borders of reservations. Funding 
for Indian health must be significantly increased if the Federal 
Government is, to finally, and faithfully, fulfill its trust 
responsibility.
Advance Appropriations for IHS Until Mandatory Funding is Enacted
    The Indian health system, including IHS, Tribal facilities and 
UIOs, is the only major Federal provider of health care that is funded 
through annual appropriations. If IHS were to receive mandatory funding 
or, at the least, advance appropriations, it would not be subject to 
the harmful effects of government shutdowns, automatic sequestration 
cuts, and continuing resolutions (CRs). When IHS is funded through a 
CR, the IHS can only expend funds for the duration of a CR, which 
prohibits longer term purchases, disrupts the contracts that allow UIOs 
to provide health care, and quite literally puts lives at risk. Because 
UIOs must rely on every dollar of limited Federal funding they receive 
to provide critical patient services, any disruption has significant 
and immediate consequences.
    NCUIH supports the President's proposal in the FY 2023 Budget to 
fund the IHS through mandatory appropriations and to exempt IHS from 
proposed law sequestration. The 10 years of appropriated mandatory 
funding in the FY 2023 Budget will ensure predictability that will 
allow the I/T/U system to engage in long-term and strategic planning. 
The lack of consistent and clear funding creates significant barriers 
on the already underfunded IHS system. Until authorizers act to move 
IHS to mandatory funding, we request that Congress provide advance 
appropriations to the Indian health system to improve certainty and 
stability.
Increase funding for Electronic Health Record Modernization
    We request your support for the Indian Health Service's (IHS) 
transition to a new electronic health record (EHR) system for IHS and 
UIOs. As EHR modernization moves from planning to fruition, it is 
vitally important that appropriations continue to increase as 
appropriate to provide for its success. NCUIH Requests the committee to 
support this transition with $355.8 million in FY23 appropriations. 
NCUIH is also supportive of the inclusion of report language suggested 
by members of Congress in a letter to the House appropriations 
committee.\1\
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    \1\ https://files.constantcontact.com/a3c45cb9201/562eb81b-dee4-
48b8-8519-69bcbebb0ff2.pdf?rdr
=true.
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CDC: Good Health and Wellness in Indian Country--$30 Million Good 
        Health and Wellness in Indian Country (GHWIC)
    The GHWIC program is CDC's single largest investment in Indian 
Country. The program funds a total of 27 Tribes, Tribal organizations, 
and UIOs to improve chronic disease prevention efforts, expand physical 
activity, and reduce commercial tobacco use. The FY 2023 President's 
Budget proposes maintaining at current levels of $22 million. NCUIH 
requests the Committee support the GHWIC program by increasing funding 
to $30 million for FY 2023.
SAMHSA: Tribal Behavioral Health Grant (Native Connections)--$23.2 
        Million
    The Tribal Behavioral Health Grant (known as Native Connections) is 
a 5-year grant program that helps American Indian and Alaska Native 
communities identify and address the behavioral health needs of Native 
youth. The program supports grantees in reducing suicidal behavior and 
substance use among Native youth up to age 24, easing the impacts of 
substance use, mental illness, and trauma in Tribal communities, and 
supporting youth as they transition into adulthood.
    As of June 2021, SAMHSA had awarded 242 5-year grants to eligible 
AI/AN entities including UIOs. The program is up for reauthorization in 
2022 and the FY23 President's budget has a request of $23.2 million for 
the program, an increase of $2.5 million from the FY 2022 Annualized 
Continuing Resolution. NCUIH requests the committee support addressing 
the behavioral health needs of our Native communities by reauthorizing 
this critical program.
Include Urban Indians in Language for All Health Programs
    The Declaration of National Indian Health Policy in the Indian 
Health Care Improvement Act States that: ``Congress declares that it is 
the policy of this Nation, in fulfillment of its special trust 
responsibilities and legal obligations to Indians to ensure the highest 
possible health status for Indians and urban Indians and to provide all 
resources necessary to effect that policy.'' In fulfillment of the 
National Indian Health Policy, the Indian Health Service funds three 
health programs to provide health care to AI/ANs: IHS sites, tribally 
operated health programs, and Urban Indian Organizations (referred to 
as the I/T/U). Unfortunately, this system has been hampered by decades 
of chronic underfunding. Additionally, while the majority of the Native 
population resides in urban areas, only 1 percent of the entire Indian 
health budget is provided for urban Indian health.
    When urban Indians are not specifically mentioned in programmatic 
language they are most often excluded from participating in such 
programs. Many programs in the Health and Human Services appropriations 
bills include language for Indian Tribes and Tribal organizations, but 
not for urban Indian organizations. Urban Indian Organizations are not 
considered Tribal organizations, which is a common misconception. 
Therefore, UIOs must be explicitly included to receive funding. UIOs 
also do not have access to other IHS line items like IHS and Tribal 
facilities and do not receive hospitals and health clinics money, 
purchase and referred care dollars, or IHS dental services dollars, and 
are not eligible for the IHS facilities fund.
    As one advocate stated, ``The language everywhere has to include 
the word 'urban'--urban Indian or urban Native. They have to say it, 
they have to write it and then it'll reach a critical mass, eventually. 
Because they don't get it, you know. We're just invisible.'' \2\
---------------------------------------------------------------------------
    \2\ https://www.usatoday.com/story/news/politics/2022/03/07/
opioids-native-americans-funding/9380063002/?gnt-cfr=1.
---------------------------------------------------------------------------
Include UIOs in Critical Opioid Grants
    UIOs have repeatedly been left out of funding designed to help AI/
AN communities address the opioid crisis. To address the opioid 
overdose epidemic in Indian Country by increasing access to culturally 
appropriate and evidence-based treatment, Congress provided funding for 
Tribal Opioid Response grants. NCUIH has long advocated for UIOs to be 
added to the Substance Abuse and Mental Health Services 
Administration's (SAMHSA) State Opioid Response (SOR) grants given the 
extent of the impact of the opioid epidemic on all AI/ANs regardless of 
residence. Since FY 2018, Congress has enacted set asides in opioid 
response grants to help Native communities address this crisis. 
However, it was only available for Tribes and Tribal organizations, 
meaning UIOs working against the same problem are left without the 
resources necessary to reach the highest health status for all AI/ANs 
as required of the Federal Government. This is a failure of equity. 
Without the necessary funding to address health crises in Indian 
Country, urban AI/AN people will again be left out of the equation.
    Last Spring, Congress introduced the State Opioid Response Grant 
Authorization Act of 2021 (H.R. 2379), which included a 5 percent set-
aside of the funds made available for each fiscal year for Indian 
Tribes, Tribal organizations, and UIOs to address substance abuse 
disorders through public health-related activities such as implementing 
prevention activities, establishing or improving prescription drug 
monitoring programs, training for health care practitioners, supporting 
access to health care services, recovery support services, and other 
activities related to addressing substance use disorders. NCUIH worked 
closely with Congressional leaders to ensure the inclusion of urban 
Indians in the funding set-aside outlined in this bill, which 
eventually passed the House on October 20, 2021. Despite this effort, 
UIOs were removed from the SOR Grant reauthorization, which saw a $5 
million increase (9 percent increase from FY 2021), included in the 
recently passed FY 2022 Omnibus (H.R. 2471). The final language in the 
Omnibus only listed ``Indian Tribes or Tribal organizations'' as 
eligible and did not use the language from H.R. 2379. When UIOs are not 
explicitly stated as eligible entities, we are excluded from critical 
resources and grants, which is a violation of the trust obligation.
    We were disappointed to yet again be left out of this key resource 
as our communities are plagued by the opioid crisis. Inclusion in this 
program could have enabled UIOs to expand services or workforce or to 
help address the catastrophic impacts of the opioid epidemic in Indian 
Country. We urge you to work to ensure funding designated to help AI/AN 
communities have the proper language to prevent UIOs from lacking 
access to these critical funds.
Conclusion
    These requests are essential to ensure that urban Indians are 
properly cared for, both during this crisis and in the critical times 
following. It is the obligation of the United States government to 
provide these resources for AI/AN people residing in urban areas. This 
obligation does not disappear in the midst of a pandemic, instead it 
should be strengthened, as the need in Indian Country is greater than 
ever. We urge Congress to take this obligation seriously and provide 
UIOs with all the resources necessary to protect the lives of the 
entirety of the AI/AN population, regardless of where they live.
                                 ______
                                 
         Prepared Statement of the National Eczema Association
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Provide the National Institutes of Health (NIH) with at least $49 
        billion in funding, a $3.5 billion increase over FY 2022.
    --Provide proportional funding increases for the individual NIH 
            institutes and centers that manage the eczema portfolio, 
            most notably the National Institute of Allergy and 
            Infectious Diseases (NIAID) and the National Institute of 
            Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
    --Provide additional, distinct funding for the emerging Advanced 
            Research Projects Agency for Health (ARPA-H) at NIH, which 
            would facilitate implementation of this important program 
            without supplanting ongoing NIH research activities.
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        $11 billion in funding, an increase of $2.55 billion over FY 
        2022.
    --Provide $6 million in funding for the Chronic Disease Education 
            and Awareness Program at CDC, an increase of $3 million 
            over FY 2022.
_______________________________________________________________________

    Thank you for the opportunity to present testimony on behalf of the 
National Eczema Association (NEA) and to share the experiences of the 
eczema community. Chairwoman Murray, Ranking Member Blunt, and 
distinguished members of the subcommittee, thank you for continuing to 
invest in medical research and public health programs through the FY 
2022 omnibus appropriations package. Recent years of funding increases 
have led to notable advances in eczema research and new opportunities 
for meaningful public health collaborations. As you work with your 
colleagues on FY 2023 appropriations, please maintain the commitment to 
increase funding for medical research and public health programs that 
serve eczema patients and raise awareness of the wide-ranging impacts 
on affected individuals and their families.
                 about the national eczema association
    The National Eczema Association is the largest patient advocacy 
organization dedicated solely to all forms of eczema, including atopic 
dermatitis (AD), the most common and chronic form of eczema. NEA 
represents the voice of over 31 million affected American adults, 
children, and their families, and is the driving force for an eczema 
community fueled by knowledge, strengthened through collective action 
and propelled by the promise for a better future.
                   about eczema and atopic dermatitis
    Eczema is the name for a group of conditions that cause the skin to 
become itchy, inflamed, and have a rash-like appearance. Atopic 
dermatitis (AD) is the most common type of eczema, affecting more than 
9.6 million children \1\ and about 16.5 million adults \2\ of all races 
and ethnicities \3\ in the United States. We are entering a new era of 
care for eczema patients with several n FDA-approved groundbreaking 
therapies for AD that have the potential to be transformative in their 
ability to ease the numerous physical, psychological, and quality of 
life burdens of eczema.\4,5,6\
---------------------------------------------------------------------------
    \1\ Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence 
in the United States: data from the 2003 National Survey of Children's 
Health. J Invest Dermatol. 2011;131(1):67-73.
    \2\ Chiesa Fuxench ZC, Block JK, Boguniewicz M, et al. Atopic 
Dermatitis in America Study: A Cross-Sectional Study Examining the 
Prevalence and Disease Burden of Atopic Dermatitis in the US Adult 
Population. J Invest Dermatol. 2019;139(3):583-590.
    \3\ Hanifin JM, Reed ML, Eczema Prevalence and Impact Working 
Group. A population-based survey of eczema prevalence in the United 
States. Dermatitis. 2007;18(2):82-91.
    \4\ Drucker AM, Wang AR, Li WQ et al. The burden of Atopic 
Dermatitis: Summary of a report for the National Eczema Association. J 
Invest Dermatol. 2017;137(1):26-30.
    \5\ Chiesa Fuxench ZC, Block, JK, Boguniewicz M, et al. Atopic 
dermatitis in America study: A cross-sectional study examining the 
prevalence and disease burden of atopic dermatitis in the US adult 
population. J Invest Dermatol.2019;139(3):583-590.
    \6\ Silverberg J, Gelfand J, Margolis D et al. Patient burden and 
quality of life in atopic dermatitis in US adults. Ann Allergy Asthma 
Immunol. 2018;121(3):340-347.
---------------------------------------------------------------------------
    Research in this area is largely led by the National Institutes of 
Health (NIH) through the National Institute on Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS) and the National Institute of 
Allergy and Infectious Diseases (NIAID). Much more basic, 
translational, and clinical research is needed to further the 
scientific understanding of all forms of eczema, as recent 
breakthroughs have led to the advent of potential drug and biologic 
therapies for atopic dermatitis. However, despite life-changing 
therapeutic advances, these novel treatment options are presenting 
emerging coverage, access, and out-of-pocket cost barriers for the 
diverse community. Public health activities are also relatively modest 
with meaningful opportunities for enhanced surveillance, public 
awareness, and healthcare provider education.
                              quick facts
  --31 million people in America are living with eczema.\7,8\
---------------------------------------------------------------------------
    \7\ Hanifin JM, Reed ML, Eczema Prevalence and Impact Working 
Group. A population-based survey of eczema prevalence in the United 
States. Dermatitis. 2007;18(2):82-91.
    \8\ Silverberg JI, Hanifin JM. Adult eczema prevalence and 
associations with asthma and other health and demographic factors: a US 
population-based study. J Allergy Clin Immunol. 203;132(5)1132-1138.
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  --The annual economic burden of AD (AD) is estimated to be over $5 
        billion.\9\
---------------------------------------------------------------------------
    \9\ Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. 
The Burden of Atopic Dermatitis: Summary of a Report for the National 
Eczema Association. J Invest Dermatol. 2017;137(1)26-30.
---------------------------------------------------------------------------
  --55 percent of affected adults with AD currently report inadequate 
        disease control.\10,11\
---------------------------------------------------------------------------
    \10\ Simpson EL, Guttman-Yassky E, Margolis DJ, et al. Association 
of Inadequately Controlled Disease and Disease Severity With Patient-
Reported Disease Burden in Adults with Atopic Dermatitis. JAMA 
Dermatol. 2018;154(8):903-912..
    \11\ Wei W, Anderson P, Gadkari A, et al. Extent and consequences 
of inadequate disease control among adults with a history of moderate 
to severe atopic dermatitis. J Dermatol. 2018;45(2):150-157.
---------------------------------------------------------------------------
                              nih research
    Ongoing congressional support for NIH has allowed for growth of the 
NIH annual budget to $42.9 billion in FY 2021 from $34.1 billion in 
FY2017. As a result of additional resources and high-quality 
investigator-initiated research proposals, the eczema research 
portfolio has grown from $32 million in FY 2017 to $46 million in FY 
2021. While the eczema portfolio is increasing, so are research costs, 
and this current funding translates to approximately $1.42 in annual 
research funding per American affected by eczema. More can be done as 
gaps in our basic understanding of eczema remain and patients continue 
to have limited treatment options. With additional NIH support, more 
ambitious projects can be initiated, including timely translational 
research and larger clinical studies.
                       cdc public health efforts
    The CDC budget's growth has been modest in recent years and as such 
the National Center for Chronic Disease Prevention and Health Promotion 
has been working in several priority areas with limited resources. 
Presently, and despite a significant U.S. disease prevalence, there are 
few public health efforts taking place in eczema. Additional public 
awareness, professional education, and related efforts would be of 
tremendous benefit to the eczema patient, caregiver and health care 
provider communities. The Chronic Disease Education and Awareness 
(CDEA) program provides an opportunity to infuse identified disease 
areas with additional needed resources and is currently supporting four 
novel projects through its first round of funding. Increasing CDEA 
funding to $6 million for FY 2023 will facilitate growth in the program 
while providing another opportunity to submit for projects in disease 
areas, such as eczema, not yet supported by the CDEA program or broader 
CDC efforts.
                            patient stories
Akilah from Pennsylvania: NEA Ambassador and parent of a teenager 
        living with eczema
    Akilah is one of NEA's Ambassadors and she is the parent of a 
teenager living with eczema. Her son has severe eczema and was 
diagnosed at a young age. As a parent, Akilah worked closely with her 
son's doctor to try and find a treatment that would work for him. This 
resulted in trying and failing a variety of treatments. Finally, they 
learned that a biologic was available but due to step therapy Akilah's 
son would have to try and fail methotrexate, which has a plethora of 
severe side effects and could damage internal organs. Akilah made the 
tough decision to say no to this treatment option and had a frank 
conversation with the doctor. Would you put your own child on this drug 
when there is a safer treatment available? She feels strongly that 
parents shouldn't have to have this conversation and they shouldn't 
have to battle with insurance companies to get the right treatment at 
the right time for their child. Her doctor helped her find a clinical 
trial for her son--and he has since been prescribed the biologic. She 
is a strong believer in research and that more treatment options need 
to be approved in the eczema space, especially in patients of color.
Christy from Utah: NEA Ambassador and a patient with atopic dermatitis
    Christy is one of NEA's Ambassadors and she has atopic dermatitis. 
She feels lucky to have had a great relationship with her dermatologist 
for the past 10 years. During this time, she has tried and failed a 
variety of treatments--until she finally found a treatment that worked 
for her. Unfortunately, when she switched jobs, she had a new insurance 
company that mandated step therapy. She was then forced to fail on 
medications that she's tried before. This made zero sense, both to her 
health and to her pocketbook, to have to try medications that were 
already documented as failure. Ultimately, she was able to get back on 
the right medication, but it took perseverance from her dermatologist 
as well as being her own advocate.

    [This statement was submitted by Julie Block, President & CEO, 
National 
Eczema Association.]
                                 ______
                                 
   Prepared Statement of the National Family Planning & Reproductive 
                           Health Association
    Dear Chairwoman Murray and Ranking Member Blunt:
    As President & CEO of the National Family Planning & Reproductive 
Health Association (NFPRHA), I thank you for this opportunity to 
provide testimony in support of a fiscal year (FY) 2023 appropriation 
of $737 million for the Title X family planning program (Office of 
Population Affairs, funded within the Health Resources and Services 
Administration account). We are grateful for Chairwoman Murray's 
longtime leadership in advocating for family planning, including 
proposing a historic $500 million for Title X in the FY 2022 bill, and 
urge you to take at least this substantial step forward in this year's 
bill.
    NFPRHA is a non-partisan, non-profit membership association that 
supports the work of family planning providers and administrators, 
especially in the safety net. NFPRHA membership includes more than 
1,000 entities that operate or fund more than 3,500 health centers that 
deliver high-quality family planning education and preventive care to 
millions of people every year in the United States. As a leading expert 
in publicly funded family planning, NFPRHA conducts and participates in 
research; provides subject matter expertise to policymakers, health 
care providers, and the public; and offers its members capacity-
building support aimed at maximizing their effectiveness and financial 
sustainability as providers of essential health care. Currently, more 
than 80 percent of all Title X grantees are NFPRHA members.
    Title X is the only Federal program dedicated to providing family 
planning services for people with low incomes. Title X-funded health 
centers are lifelines in their communities, providing high-quality 
reproductive and sexual health care, including cancer screenings, 
testing and treatment for sexually transmitted infections, 
contraceptive services and supplies, pregnancy testing, and other 
essential health care services. These centers offer care to people who 
often face severe structural barriers to accessing quality health care, 
such as people with low incomes, people who are un- or under-insured, 
people of color, people who live and work in rural areas, and LGBTQ 
people. Prior to the implementation of the Trump administration's 
devastating program rules in 2019, nearly 4,000 health centers in the 
Title X network served close to 4 million patients annually.\1\ In 
addition, six in 10 women who used Title X-funded health centers in 
2016 said that provider was their only source of health care for the 
entire year.\2\
---------------------------------------------------------------------------
    \1\ Christina Fowler et al, ``Family Planning Annual Report: 2018 
National Summary,'' RTI International (August 2019). https://
opa.hhs.gov/sites/default/files/2020-07/title-x-fpar-2018-national-
summary.pdf.
    \2\ Meghan Kavanaugh, ``Use of Health Insurance Among Clients 
Seeking Contraceptive Services at Title X-Funded Facilities in 2016,'' 
Guttmacher Institute (June 2018).
---------------------------------------------------------------------------
    For FY 2022, Title X is funded at $286.5 million, well below the 
$500 million proposed in the Senate bill and the $737 million that 
researchers from the Centers for Disease Control and Prevention, the 
Office of Population Affairs (OPA), and the George Washington 
University determined in 2016 would be needed annually just to provide 
family planning care to low-income women without insurance.\3\ We 
respectfully request that the Senate match that federally recommended 
level of funding, $737 million, for the Title X program in FY23. That 
funding level would allow the program to rebuild from crises 
experienced in recent years and expand to reach millions more 
Americans. We also note that this recommendation, based on the number 
of women in need, is a significant under-estimate of the true need, as 
the program now serves more than 100,000 men and nonbinary individuals 
each year.
---------------------------------------------------------------------------
    \3\ Euna August, et al, ``Projecting the Unmet Need and Costs for 
Contraception Services After the Affordable Care Act,'' American 
Journal of Public Health (February 2016): 334-341.
---------------------------------------------------------------------------
    An influx of funds is particularly important given the continued 
impacts that recovery from the Trump administration's 2019 program rule 
and the COVID-19 pandemic are having on the program, the providers 
funded by it, and most importantly the patients for whom Title X sites 
serve as critical, and sometimes their only, points of access to care. 
On July 15, 2019, the Trump administration's new regulations for Title 
X went into effect, and the impact was felt almost immediately: by fall 
2019, approximately 1,000 health centers across 33 States had withdrawn 
from the program, including all of the health centers in six States. 
Then, in March 2020, family planning providers, like all frontline 
health care workers, needed to adapt overnight to the realities of 
serving under-resourced communities during a global pandemic.
    In September 2021, OPA released the first Federal data showing the 
impact of the rule and COVID-19, and the results were devastating: 
relative to 2018, Title X-funded health centers provided family 
planning services to 2.4 million fewer patients in 2020, a staggering 
61 percent decrease over just 2 years. This drastic decrease translated 
to millions of fewer contraceptive services provided, more than 4.3 
million fewer STI and HIV tests administered, and more than 800,000 
fewer lifesaving breast and cervical cancer screenings performed with 
Title X funds. OPA attributed 63 percent of the decrease in patients 
served to the 2019 rule and 37 percent to the pandemic.\4\ Compounding 
these challenges in accessing Title X-funded services, a 2020 study 
showed the COVID-19 pandemic has led many women to want to delay or 
prevent pregnancy while it has simultaneously made it more difficult 
for people to access family planning and sexual health care, including 
contraception.\5\ Women of color and women with low incomes were more 
likely to report both findings.
---------------------------------------------------------------------------
    \4\ Christina Fowler, Julia Gable, and Beth Lasater, ``Family 
Planning Annual Report: 2020 National Summary,'' RTI International 
(September 2021). https://opa.hhs.gov/sites/default/files/2021-09/
title-x-fpar-2020-national-summary-sep-2021.pdf.
    \5\ Lindberg LD et al, ``Early Impacts of the COVID-19 Pandemic: 
Findings from the 2020 Guttmacher Survey of Reproductive Health 
Experiences,'' Guttmacher Institute (June 2020). https://
www.guttmacher.org/report/earlyimpacts-covid-19-pandemic-findings-2020-
guttmacher-survey-reproductive-health.
---------------------------------------------------------------------------
    The Biden-Harris administration has made significant progress 
toward restoring the Title X program, including finalizing a new rule 
in October 2021,\6\ distributing $6.6 million in Title X funds to 
communities with a dire need for family planning services in January 
2022,\7\ and distributing $256.6 million for Title X projects across 
the country just last month.\8\ However, the administration was unable 
to fund many qualified applicants, and under-funded dozens more, due to 
insufficient funds. While a small number of past grantees received 
additional funds in May 2022, it is clear that current funding of 
$286.5 million annually is simply insufficient to meet the needs of 
providers and patients across the country. Without additional funds, 
grantees and subrecipients are at significant risk of reducing service 
availability, laying off frontline health care workers, and even 
closing health centers.
---------------------------------------------------------------------------
    \6\ HHS Press Office, ``HHS Issues Final Regulation Aimed at 
Ensuring Access to Equitable, Affordable, Client-Centered, Quality 
Family Planning Services,'' US Department of Health and Human Services 
(October 4, 2021). https://www.hhs.gov/about/news/2021/10/04/hhs-
issues-final-regulation-aimed-at-ensuring-access-to-equitable-
affordable-client-centered-quality-family-planning-services.html.
    \7\ ASH Media, ``HHS Awards $6.6 Million to Address Increased Need 
for Title X Family Planning Services,'' US Department of Health and 
Human Services (January 21, 2022). https://www.hhs.gov/about/news/2022/
01/21/hhs-awards-6.6-million-address-increased-need-for-title-x-family-
planning-services.html.
    \8\ ASH Media, ``HHS Awards $256.6 Million to Expand and Restore 
Access to Equitable and Affordable Title X Family Planning Services 
Nationwide,'' US Department of Health and Human Services (March 30, 
2022). https://www.hhs.gov/about/news/2022/03/30/hhs-awards-256-
million-to-expand-restore-access-to-equitable-affordable-title-x-
family-planning-services-nationwide.html.
---------------------------------------------------------------------------
    With a significant increase in funds in FY23, OPA can make real 
progress toward rebuilding the Title X program and serving more people 
in need of these critical services. We thank you for your consideration 
of this request and look forward to working with you throughout the 
FY23 appropriations process. If you have questions about this request, 
please contact Lauren Weiss, Director, Policy & Communications, at 
[email protected].
    Sincerely,
    Clare Coleman
                                 ______
                                 
Prepared Statement of the National Institute of Diabetes and Digestive 
                          and Kidney Diseases
    On behalf of more than 37 million children, adolescents, and adults 
living with chronic kidney diseases (CKD) in the United States, the 
American Society of Nephrology, the American Society of Pediatric 
Nephrology, and the National Kidney Foundation request $49 billion for 
the National Institutes of Health base budget in Fiscal Year (FY) 2023, 
an increase of 7.9% that will provide real growth above biomedical 
research inflation, and request an increase for the National Institute 
of Diabetes and Digestive and Kidney Diseases (NIDDK) that is at least 
proportional to the increase for NIH. As Congress considers authorizing 
and providing additional appropriations for the Advanced Research 
Projects Agency for Health (ARPA-H), our request will ensure that 
funding for the new entity will supplement, not supplant, those funds 
provided to NIH to support much needed basic research and training 
programs in kidney disease.
    In addition, our organizations request that the committee include 
report language in the Labor, Health and Human Services, and Related 
Agencies (LHHS) appropriations bill to support achieving kidney health 
equity and a strong kidney health workforce. We request that Congress 
address kidney health equity by allocating resources at NIDDK to study 
improved methods for diagnosing kidney diseases that do not rely on 
race-based variables. Further, we request that Congress ensure there is 
a physician-scientist workforce ready to meet the current and future 
needs of people with kidney diseases by making certain new training 
programs, such as the Division of Kidney, Urologic, and Hematologic 
Diseases (KUH) U2C grant mechanism, increase the number of training 
slots for adult and pediatric physician-scientists. Greater investment 
in kidney research is needed to advance the understanding of the under-
recognized public health epidemic of kidney diseases and address the 
disproportionate impact of COVID-19 and racial disparities experienced 
by Americans living with these conditions.
    For nearly 800,000 Americans, kidney diseases progress to kidney 
failure, a life-threatening condition for which there is no cure. 
Kidney failure is most commonly managed by in-center hemodialysis, a 
therapy that has changed little in the 50 years since its development 
and has a survival rate worse than most cancers (and comparable with 
brain cancers). While a kidney transplant is the optimal therapy for 
most patients, it is often inaccessible due to a shortage of organs and 
inequities in our Nation's transplant health system. Both dialysis and 
transplant patients are immune compromised, which puts them at 
increased risk of communicable diseases--especially COVID-19. 
Devastatingly, COVID-19 has caused a 20% increase in mortality among 
people receiving dialysis, the first-ever decrease of people enrolled 
in the Medicare ESRD program. While the long-term effects of COVID-19 
on kidney health and function are under investigation, it is likely 
that COVID-19 will lead to an influx of new patients with kidney 
diseases, and that some of these patients will require ongoing care.
    Almost 50 years ago, Congress made a commitment to treat all 
Americans with irreversible kidney failure, regardless of age, through 
the Medicare End-Stage Renal Disease (ESRD) Program. Medicare annually 
spends approximately $125 billion on the care of people with kidney 
diseases, or 24% of all Medicare fee-for-service spending. Of this 
amount, $37 billion, or 7% of Medicare fee-for-service spending, is 
spent managing kidney failure. These costs do not include expenditures 
from Medicare Advantage or non-Medicare plans, which together cover 62% 
of people with kidney failure. Despite this enormous societal cost, 
kidney disease research supported by NIH is equivalent to one-half of 
one percent of Medicare fee for service expenditures for beneficiaries 
with kidney diseases and kidney failure.
    Even as Congress has provided steady increases for the NIH over the 
past decade, NIH funding for kidney disease research has lagged far 
behind that of NIH overall; between fiscal years 2015 and 2020, funding 
for NIH rose 37%, compared to just 19% for kidney research. 
Additionally, no dedicated funding has been provided to NIDDK to study 
the impact of COVID-19 on kidney health despite the severe impact of 
COVID-19 on people with kidney diseases. As a result, research of this 
critical topic has come at the expense of existing, and underfunded, 
research opportunities. Increased investment in kidney health research 
will improve outcomes for people living with kidney diseases and reduce 
costs to the US health care system. As Congress considers establishing 
new programs to fund science and innovation such as ARPA-H, our 
organizations request that the committee maintain and increase 
investment in kidney disease research by providing a $49 billion 
increase for NIH in FY 2023 with an at least proportional increase for 
NIDDK.
          improving equity in the diagnosis of kidney diseases
    People with kidney diseases face stark racial and socioeconomic 
disparities in disease burden and access to care. For instance, Black 
Americans and Hispanic Americans are more than four and two times as 
likely than White Americans respectively to have kidney failure. 
Disparities in prevalence and outcomes are due to multiple factors 
including lack of access to care, social determinates of health, and 
systemic racism. Greater investment in research is needed to increase 
understanding about the underlying causes of disparities and generate 
interventions to address them.
    One factor contributing to disparities in access to care--
especially transplantation--is the inclusion of race as a variable in 
the diagnosis of kidney diseases. Kidney function is commonly assessed 
using an equation to estimate glomerular filtration rate (GFR). In 
2021, ASN and NKF finalized a recommendation to remove a patient's race 
as a variable in equations to estimate GFR. Our organizations request 
the committee consider including report language in the FY 2023 LHHS 
appropriations bill directing NIDDK to prioritize research on new 
approaches for estimating GFR that do not include race as a modifier, 
such as the below:

      ``Improving the Diagnosis of Kidney Diseases.--The Committee 
        understands that current equations for assessing glomerular 
        filtration rate (GFR), a key measure of kidney function, 
        include the patient's race, and that this practice may lead to 
        disparities for African Americans in terms of access to care 
        and kidney transplantation. NIDDK should prioritize research on 
        new approaches for estimating GFR that do not include race as a 
        modifier.''
               enabling a strong kidney health workforce
    Most people with kidney diseases experience comorbidities such as 
cardiovascular disease (including heart attack and stroke), anemia, 
bone disease, hypertension, and diabetes, and face increased risk from 
communicable diseases, including COVID-19 which has increased 
hospitalization and mortality among this vulnerable population. 
Pediatric kidney disease patients are often more complex than adult 
patients, many are living with rare medical conditions with unique 
needs which must be better understood. A strong, demographically 
representative, and culturally competent workforce of physician-
scientists is needed to meet the needs of adults and children living 
with kidney diseases, especially while they face deadly consequences of 
the COVID-19 pandemic in their daily lives. Our organizations request 
that the committee ensure NIDDK is providing adequate support for 
training the next generation of kidney health scientists by requesting 
NIDDK to report the number of adult and pediatric training positions 
funded by the newly established U2C grant mechanism compared to prior 
mechanisms. Draft report language to support this request is provided 
below:

      Kidney, Urologic, and Hematologic Research Training Awards.--The 
        Committee understands that NIDDK's Division of Kidney, 
        Urologic, and Hematologic Diseases replaced its T32 training 
        grant mechanism, which provided grant support to institutions 
        whose programs promote diversity and offer doctoral degrees in 
        the health professions or health-related sciences in these 
        three disciplines, with a new U2C grant mechanism, which 
        requires institutions to submit a single application to receive 
        training slots in all three research areas. The T32 program 
        maintained a strong record of success in training new members 
        of the biomedical research workforce in nephrology, urology, 
        and hematology, including future pediatric researchers. With 
        this in mind, the Committee is concerned that the new U2C 
        mechanism may lead to a reduction in training slots for adult 
        and pediatric researchers in these three disciplines. The 
        Committee requests the Institute provide a comparison of 
        training positions, adult and pediatric, funded by discipline 
        under the T32 mechanism in 2018-19 to the number of slots 
        currently funded and projected to be funded in the next 3 years 
        under the U2C mechanism within 120 days of enactment.
    Greater investment in kidney research should be an urgent priority 
to slow disease progression, improve treatment, reduce morbidities, and 
improve patients' quality of life. NIDDK-funded scientists have 
produced several major breakthroughs in the past several years that 
require further investment to stimulate therapeutic advancements. For 
example, NIDDK launched the Kidney Precision Medicine Project that will 
pinpoint targets for novel therapies--setting the stage for 
personalized medicine in kidney care. However, additional funding is 
needed to accelerate these and other novel opportunities to improve the 
care of patients with kidney disease. Better understanding of kidney 
diseases and its progression in adults and children, combined with 
improved methods for detecting kidney diseases and a highly skilled 
workforce of physician-scientists, may even prevent irreversible kidney 
failure in the future.
    Thank you again for your leadership, and for your consideration of 
our request. Should you have any questions or wish to discuss kidney 
disease research in more detail, please contact Erika Miller with the 
American Society of Pediatric Nephrology at [email protected]; Zach 
Kribs with the American Society of Nephrology at [email protected]; 
or Lauren Drew with the National Kidney Foundation (NKF) at 
[email protected].
                about the american society of nephrology
    Since 1966, ASN has been leading the fight to prevent, treat, and 
cure kidney diseases throughout the world by educating health 
professionals and scientists, advancing research and innovation, 
communicating new knowledge, and advocating for the highest quality 
care for patients. ASN has more than 20,000 members representing 132 
countries. For more information, visit www.asn-online.org and follow us 
on Facebook, Twitter, LinkedIn, and Instagram.
           about the american society of pediatric nephrology
    Founded in 1969, the American Society of Pediatric Nephrology is a 
professional society composed of pediatric nephrologists whose goal is 
to promote optimal care for children with kidney disease and to 
disseminate advances in the clinical practice and basic science of 
pediatric nephrology. ASPN currently has over 600 members, making it 
the primary representative of the Pediatric Nephrology community in 
North America.
                  about the national kidney foundation
    The National Kidney Foundation is the largest, most comprehensive, 
and longstanding patient-centric organization dedicated to the 
awareness, prevention, and treatment of kidney disease in the U.S. In 
addition, NKF has provided evidence-based clinical practice guidelines 
for all stages of chronic kidney disease (CKD), including 
transplantation since 1997 through the National Kidney Foundation 
Kidney Disease Outcomes Quality Initiative (KDOQI). For more 
information about NKF, visit www.kidney.org.

    [This statement was submitted by Zach Kribs, Senior Government 
Affairs 
Specialist, American Society of Nephrology.]
                                 ______
                                 
 Prepared Statement of the National Institute of Environmental Health 
                                Sciences
    The Friends of the NIEHS are pleased to submit the following 
testimony regarding Fiscal Year (FY) 2023 Federal appropriations for 
the Labor, Health and Human Services, Education, and Related Agencies 
in support of the vital work being carried out by the NIH/NIEHS as a 
result of the annual appropriation provided for this work in the 
subcommittee's bill. We ask you to provide at least $909 million for 
NIEHS in FY 2023 as part of an overall appropriation for NIH of $49.048 
billion not inclusive of other funds for the Advanced Research Projects 
Agency for Health (ARPA-H) or pandemic preparedness. We further request 
additional funding of at least $100 million for NIEHS to lead research 
efforts on climate change and health, in partnership with other 
Institutes and Centers at NIH, to a total funding level of at least 
$1.01 billion.
    Our coalition of organizations represents a variety of interests, 
including medical and scientific professional societies, environment 
and public health focused organizations, children's health advocates, 
women's health advocates, and many others. Collectively, our community 
supports and calls attention to the vital work being done by the 
National Institute of Environmental Health Sciences. NIEHS, one of the 
component institutes and centers of the National Institutes of Health 
(NIH), focuses on the prevention of health problems and diseases with 
special emphasis on the intimate interactions between our bodies and 
the environments where we live, work, and play over our lifetimes.
    niehs plays a unique role in advancing public health priorities
    The NIEHS plays a unique role within the NIH; it is the leading 
institute conducting research to prevent human illness and disability 
by understanding how the environment influences the development and 
progression of human diseases and illnesses such as cancer, autism, 
asthma, Parkinson's disease, autoimmune diseases, chemical intolerance 
or toxicant-induced loss of tolerance, and chemical sensitivities. 
Expert research funded by NIEHS addresses diseases across all the NIH 
Institutes and Centers and identifies environmental contributors to 
health disparities. Specific research areas with projects that address 
national priorities include:
    Climate Change and Health: NIEHS-funded scientists are poised to 
make major discoveries that will help us appreciate and address the 
ongoing impacts of climate change on public health. However, additional 
funds are needed for NIEHS to maximize the potential for biomedical 
research to meet the public health needs driven by climate change. 
Additional research is necessary to design and tailor interventions 
that will reduce the impact of climate change on the incidence and 
severity of disease, in particular for disadvantaged communities that 
may not have resources to mitigate the effects of climate change. We 
strongly support additional appropriated funds for NIEHS so that NIEHS 
can work with all the Institutes and Centers at NIH to develop 
solutions that build on existing knowledge and promote 
transdisciplinary collaborations to meet the needs of communities 
affected by climate change.
    Breast Cancer and Health Disparities: NIEHS-funded studies have 
been instrumental in advancing our new knowledge about the causes of 
cancer, including the discovery of the first breast cancer 
susceptibility gene. In 2019, the NIEHS Sister Study, a national cohort 
of over 50,000 women, found that women who use chemical hair dye and 
chemical hair straighteners have an increased risk of breast cancer, 
particularly black women. The study results suggest that chemicals in 
hair products may play a role in breast carcinogensis.
    Maternal and Children's Health and Environmental Exposures: NIEHS-
funded research also helps us understand how and why pregnant women and 
children are uniquely vulnerable to harmful substances in their 
environment. Today's pediatric health challenges include chronic 
conditions such as obesity, asthma and neurodevelopmental disorders 
including learning disabilities and the impacts of COVID-19. 
Increasingly, in utero and early childhood exposures are correlated 
with life-long consequences including whether such exposures increase 
child and adolescent susceptibility to future illness and learning 
challenges. NIEHS research is critical, since children have unique 
susceptibility to toxicants due to their ongoing development and face 
higher rates of exposure to contaminants than adults by virtue of their 
size and developmentally-appropriate behaviors. Importantly, NIEHS 
helps us identify and act on risks to children's health. A recent 
NIEHS-funded study found fewer new asthma cases and an up to 20 percent 
lower rate of asthma after air quality improvements, including 
reductions in nitrogen dioxide and PM2.5, were made.
    Pandemic and Disaster Preparedness: Researchers funded by NIEHS 
have highly relevant expertise that has enhanced our response to COVID-
19 and prepared us for future pandemics, for example by identifying 
interventions to protect health care workers facing occupational 
exposure to SARS-CoV-2 and how environmental exposures such as air 
pollution impact individual susceptibility to infection and severity of 
disease. NIEHS can also positively impact our response to and recovery 
from natural disasters and climate change. For example, the Disaster 
Research Response Resources Portal (DR2) and Climate Change and Human 
Health Literature Portal provide researchers and the public with 
resources and tools to design studies in partnership with communities 
and rapidly translate research results into actionable interventions.
    Endocrine Disrupting Chemicals: NIEHS-funded research teams have 
led the way in advancing our understanding of how chemicals that 
interfere with the normal function of hormones and endocrine systems, 
also known as endocrine-disrupting chemicals (EDCs) can cause adverse 
health effects. New scientific knowledge on EDCs has established that 
these chemicals may have nontraditional dose response curves, 
developmental effects with long-term consequences, and unique effects 
at low doses due to the sensitive nature of the endocrine system. The 
decades of scientific contributions of NIEHS to this field resulted in 
a 2019 paper identifying key characteristics of EDCs.
      increased funding for nih and niehs is necessary in fy 2023
    In conclusion, to ensure that NIEHS-funded researchers are able to 
continue to advance research in support of the Nation's public health 
priorities, the Friends of NIEHS recommend that the subcommittee 
provide at least $909 million for NIEHS in FY 2023 as part of an 
overall appropriation for NIH of $49.048 billion in the FY 2023 Labor, 
Health and Human Services, Education, and Related Agencies 
appropriations bill. Further, the subcommittee should provide an 
additional $100 million for NIEHS to support necessary research on 
climate change and public health to a total level of $1.01 billion. 
Finally, we request that any funding for the new Advanced Research 
Projects Agency for Health (ARPA-H) agency complement this funding 
recommendation for NIH's base budget, rather than supplant the 
essential investment in the NIH, to ensure that NIH can continue to 
support and grow the investigator-initiated research programs that have 
provided the foundation for our collective successes in biomedical 
research.

    [This statement was submitted by Joseph Laakso, Director of Science 
Policy, 
Endocrine Society.]
                                 ______
                                 
       Prepared Statement of the National Institute on Drug Abuse
    Thank you for the opportunity to submit testimony in support of the 
National Institute on Drug Abuse (NIDA). The College on Problems of 
Drug Dependence (CPDD), a membership organization with over 1000 
members, has been in existence since 1929. It is the longest standing 
group of scholars in the U.S. addressing problems related to substance 
use disorders (SUDs). CPDD serves as an interface among government, 
industry, and academic communities maintaining liaisons with regulatory 
and research agencies as well as education, treatment, and prevention 
facilities in the SUD field.
    In the Fiscal Year 2023 Labor, Health and Human Services 
Appropriations bill, CPDD joins with the Ad Hoc Group for Medical 
Research in recommending a program level of at least $49.048 billion 
for the base budget of the National Institutes of Health (NIH), which 
would represent an increase of $4.1 billion over the comparable Fiscal 
2022 funding level. For the National Institute on Drug Abuse (NIDA), 
CPDD encourages the Committee to provide at least the President's 
recommended funding level of $1.843 billion for NIDA, which would 
represent an increase of $248 million over the comparable Fiscal 2022 
funding level for the Institute.
    CPDD also supports the proposal included in the President's Fiscal 
Year 2023 budget to change the name of the National Institute on Drug 
Abuse to the National Institute on Drugs and Addiction.
    We also respectfully request the inclusion of the following NIDA 
specific report language.

    Opioid Initiative. The Committee continues to be concerned about 
        the high mortality rate due to the opioid epidemic and 
        appreciates the important role that research plays in the 
        various Federal initiatives aimed at this crisis. The Committee 
        is also aware of the most recent provisional data from the 
        Centers for Disease Control and Prevention that shows opioid 
        overdose fatalities were predicted to exceed 100,000 in the 12-
        month period ending in June 2021, with the primary driver being 
        the increased overdose deaths involving synthetic opioids, 
        primarily illicitly manufactured fentanyls. More research is 
        needed to find new and better agents to prevent or reverse the 
        effects caused by this class of chemicals and to provide 
        improved access to treatments for those addicted to these 
        drugs. To combat this crisis the Committee has provided within 
        NIDA's budget no less than $405,400,000 for the Institute's 
        share of the HEAL Initiative and in response to rising rates of 
        stimulant use and overdose, the Committee has included language 
        expanding the allowable use of these funds to include research 
        related to stimulant use and addiction.

    Methamphetamine and Other Stimulants. The Committee is concerned 
        that, according to provisional data released by the Centers for 
        Disease Control and Prevention, over 45,000 overdose deaths 
        involved drugs in the categories that include methamphetamine 
        and cocaine in the 12-month period ending in June 2021, an 
        increase of 25 percent in a single year. The sharp increase has 
        led some to refer to stimulant overdoses as the ``fourth wave'' 
        of the current drug addiction crisis in America following the 
        rise of opioid-related deaths involving prescription opioids, 
        heroin, and fentanyl-related substances. No FDA-approved 
        medications are available for treating methamphetamine and 
        other stimulant use disorders. The Committee continues to 
        support NIDA's efforts to address the opioid crisis, has 
        provided continued funding for the HEAL Initiative, and 
        supports NIDA's efforts to combat the growing problem of 
        methamphetamine and other stimulant use and related deaths.

    Barriers to Research. The Committee is concerned that restrictions 
        associated with Schedule I of the Controlled Substance Act 
        effectively limits the amount and type of research that can be 
        conducted on certain Schedule I drugs, especially opioids, 
        marijuana or its component chemicals, and new synthetic drugs 
        and analogs. At a time when we need as much information as 
        possible about these drugs and antidotes for their harmful 
        effects, we should be lowering regulatory and other barriers to 
        conducting this research. The Committee appreciates NIDA's 
        completion of a report on the barriers to research that result 
        from the classification of drugs and compounds as Schedule I 
        substances including the challenges researchers face as a 
        result of limited access to sources of marijuana including 
        dispensary products.

    COVID Pandemic and Impact on Substance Use Disorders. The Committee 
        is acutely aware of the risks that the ongoing COVID-19 
        pandemic poses to individuals with substance use disorders. 
        According to the Centers for Disease Control and Prevention, 
        drug overdose deaths accelerated during the pandemic, and were 
        predicted to exceed 100,000 in the 12-month period ending in 
        June 2021, the highest number of overdose deaths ever recorded 
        in a 12-month period. Moreover, research supported by the 
        National Institute on Drug Abuse found that individuals with 
        substance use disorders are at increased risk for COVID-19 and 
        its more adverse outcomes. The Committee commends NIDA for 
        conducting research on the adverse impact of the pandemic on 
        SUDs and encourages the Institute to continue to support 
        research on these issues.

    Raising Awareness and Engaging the Medical Community in Drug Abuse 
        and Addiction Prevention and Treatment. Education is a critical 
        component of any effort to curb drug use and addiction, and it 
        must target every segment of society, including healthcare 
        providers (doctors, nurses, dentists, and pharmacists), 
        patients, and families. Medical professionals must be in the 
        forefront of efforts to curb the opioid crisis. The Committee 
        continues to be pleased with the NIDAMED initiative, targeting 
        physicians-in-training, including medical students and resident 
        physicians in primary care specialties (e.g., internal 
        medicine, family practice, and pediatrics). NIDA should 
        continue its efforts in this area, providing physicians and 
        other medical professionals with the tools and skills needed to 
        incorporate substance use and misuse screening and treatment 
        into their clinical practices. The Committee recommends that 
        NIDA increase its support for the education of scientists and 
        practitioners to find improved prevention and treatments for 
        substance use disorders.

    Electronic Cigarettes. The Committee understands that electronic 
        cigarettes (e-cigarettes) and other vaporizing equipment are 
        increasingly popular among adolescents, and requests that NIDA 
        continue to fund research on the use and consequences of these 
        devices.

    In addition, we request the following report language within the 
Office of the Director account:

    The HEALthy Brain and Child Development (HBCD) Study. The Committee 
        recognizes and supports the NIH HEALthy Brain and Child 
        Development Study, which will establish a large cohort of 
        pregnant women and follow them and their children up to age 10 
        to characterize the influence of a variety of factors on 
        neurodevelopment and long-term outcomes. The study aims to 
        enroll approximately 7,500 women from 25 sites across the US, 
        including regions of the country significantly affected by the 
        opioid crisis. Participants will include women from the general 
        population of pregnant women to assess normative development; 
        those who have or are using opioids and/or other substances 
        during their pregnancy; and women from comparable environments 
        to the latter, but who have not used substances during their 
        pregnancy. This knowledge will be critical to help predict and 
        prevent some of the known impacts of pre- and postnatal 
        exposure to drugs or adverse environments, including risk for 
        future illicit substance use, mental disorders, and other 
        behavioral and developmental problems. The Committee recognizes 
        that the HBCD Study is supported in part by the NIH HEAL 
        Initiative, and NIH Institutes, Centers, and Offices (ICOs), 
        including OBSSR, ORWH, NIMHD, NIBIB, NIMHD, NIEHS, NICHD, 
        NINDS, NIAAA, NIMH, and NIDA, and encourages additional NIH 
        support for this important study.

    Marijuana Research. The Committee is concerned that marijuana 
        policies on the Federal level and in the States (medical 
        marijuana, recreational use, etc.) are being changed without 
        the benefit of scientific research to help guide those 
        decisions. NIH is encouraged to continue supporting a full 
        range of research on the health effects of marijuana and its 
        components, including research, to understand how marijuana 
        policies affect public health.

    Substance use disorders are costly to Americans; it ruins lives, 
while tearing at the fabric of our society and taking a financial toll 
on our resources. Over the past three decades, NIDA-supported research 
has revolutionized our understanding of SUD as a chronic, often-
relapsing disorder -this new knowledge has helped to correctly 
emphasize the fact that SUD is a serious public health issue that 
demands strategic solutions.
    NIDA supports a comprehensive research portfolio that spans the 
continuum of basic neuroscience, behavior and genetics research through 
medications development and applied health services research and 
epidemiology. While supporting research on the positive effects of 
evidence-based prevention and treatment approaches, NIDA also 
recognizes the need to keep pace with emerging problems. We have seen 
encouraging trends in strategies to address these problems, but areas 
of continuing significant concern include the recent increase in 
fatalities due to synthetic fentanyl, as well as continued illicit use 
of prescription opioids. Our knowledge of how drugs work in the brain, 
their health consequences, how to treat people with SUDs, and what 
constitutes effective prevention strategies has increased dramatically 
due to research. However, because the number of individuals who are 
affected is still rising, we need to continue the work until this 
disease is both prevented and treated effectively and compassionately.
    We understand that the FY 2023 budget cycle will involve setting 
priorities and accepting compromise, however, in the current climate we 
believe a focus on SUDs deserves to be prioritized accordingly. Thank 
you for your support for the National Institute on Drug Abuse.
                                 ______
                                 
          Prepared Statement of the National Kidney Foundation
    The National Kidney Foundation (NKF) is pleased to submit testimony 
to highlight the significant burden that chronic kidney disease (CKD), 
including irreversible kidney failure, places on patients, families, 
society, and our Nation's health care system. We urge the subcommittee 
to increase funding for programs and activities as a bold step to help 
transform CKD awareness, prevention, detection, and management. 
Specifically, NKF requests $15 million for CKD activities at the 
Centers for Disease Control and Prevention and an increase for kidney 
research activities under the National Institute of Diabetes and 
Digestive and Kidney Diseases (NIDDK) that is at least proportional to 
the funding increase for NIH overall. We also request that 
appropriations for the Advanced Research Projects Agency for Health 
(ARPA-H) be in addition to a robust increase for NIH. Lastly, we urge 
greater collaboration between NIDDK and other Institutes studying 
related comorbidities and conditions that occur in kidney patients, 
such as hypertension, cardiovascular disease, immunology, disparities, 
and genomics.
                               about ckd
    Chronic kidney disease impacts an estimated 37 million American 
adults and is the Nation's 10th leading cause of death, and 1 in 3 
Americans are at risk of developing it. Although it is detectable 
through simple blood and urine tests, an estimated 90 percent of 
patients are undiagnosed, often until advanced stages when it is too 
late for interventions to slow disease progression (up to 40 percent of 
people with advanced kidney disease have not seen a nephrologist prior 
to progressing to kidney failure). Alarmingly, some patients are not 
diagnosed until they have progressed to irreversible kidney failure 
(end stage kidney failure, or ESKD) and must undergo urgent start 
dialysis. Nearly 800,000 Americans have ESKD, requiring kidney dialysis 
at least 3 times per week at a dialysis center, daily home dialysis, or 
a kidney transplant to survive. The 5-year survival rate for a dialysis 
patient is only 35 percent. The mortality rate for dialysis patients 
aged 66-74 is twice that of heart failure and 2.5 times that of cancer.
    Medicare spends an estimated $153 billion annually (fee-for-service 
and Medicare Advantage combined), nearly 25 percent of Medicare 
expenditures, on the care of people with a kidney disease diagnosis. 
Individuals with ESKD represent 1 percent of Medicare beneficiaries but 
comprise 7 percent of Medicare fee-for-service expenditures. The need 
for an increased Federal commitment to address the societal and 
economic burdens of CKD is undeniable.
    CKD is a disease multiplier, with patients often experiencing 
cardiovascular disease, bone disease, anemia and fatigue, and increased 
hospitalization. Quality of life is impacted by cognitive challenges, 
depression, infection, dietary restrictions, and other factors. CKD 
also is an independent risk predictor for heart attack and stroke. 
Early-stage intervention can improve outcomes and lower costs, yet 
fewer than half of patients with high blood pressure or diabetes (which 
together are responsible for three-fourths of all cases of ESKD) 
receive CKD testing. To improve awareness, early identification, and 
early-stage intervention, NKF calls on Congress to invest in kidney 
health programs throughout HHS.
                              disparities
    CKD is characterized by stark racial, ethnic, and socioeconomic 
disparities. Blacks/African Americans, Hispanics/Latinos, Asian 
Americans and Pacific Islanders, and Native Americans and Alaska 
Natives are at higher risk for CKD and ESKD. Blacks/African Americans 
make up 13 percent of the U.S. population, but account for 35 percent 
of Americans with kidney failure. Kidney failure among Blacks/African 
Americans and Hispanics/Latinos are 4 times and 1.3 times more likely 
compared to Whites, respectively. Blacks/African Americans and 
Hispanics/Latinos experience more rapid decline of kidney function than 
Whites and are less likely to have had a visit with a nephrologist 
prior to starting dialysis. Blacks/African Americans and Hispanic/
Latinos have less access to the kidney wait list, experience a longer 
wait once listed, and are less likely to receive a transplant from a 
living donor compared to Whites. The prevalent kidney transplant 
population with a functioning graft is 52 percent White, 20 percent 
Blacks/African Americans, and 16 percent Hispanics/Latinos. Among 
patients waitlisted in 2014, the median wait time for a transplant was 
37 months for Whites, 64 months for Blacks/African Americans, and 57 
months for Hispanics/Latinos.
                                covid-19
    COVID-19 has amplified the CKD and ESKD disparities discussed 
above, as kidney patients (including transplant recipients) are at risk 
for severe COVID-19 infection. This increased vulnerability is due to a 
series of factors, including compromised immune systems, multiple 
comorbidities, and exposure through the in-center dialysis care 
environment that necessitates close contact with others. COVID-19 
hospitalizations in April 2021 were 8,617 per 100,000 Medicare ESKD 
beneficiaries, compared to 1,932 per 100,000 Medicare beneficiaries 
overall. Transplant recipients in particular face higher COVID-19 
mortality risk. In addition, patients with severe COVID-19 are at an 
increased risk of developing acute kidney injury (AKI), often requiring 
the need for acute dialysis and sometimes resulting in CKD or 
irreversible kidney failure.
                 cdc chronic kidney disease initiative
    The CDC Chronic Kidney Disease Initiative comprehensive public 
health strategy was created at the urging of Congress and NKF more than 
15 years ago. Annual funding fluctuated between $1.6 million and $2.6 
million until Congress provided $3.5 million for FY 2022, for which we 
are most appreciative. The CKD Initiative supports a web site, 
surveillance and epidemiology activities, and assistance to the 
National Center for Health Statistics for CKD data collection. However, 
in order to address the roughly 90 percent of patients who are unaware 
they have CKD, and the 40 percent who receive no kidney-specific care 
before crashing into dialysis in full kidney failure, we must improve 
awareness of CKD among the public and health care practitioners to 
improve early detection, provide early intervention and improve 
outcomes. Early intervention can slow CKD progression and, in some 
instances, prevent kidney failure, reduce the impact of comorbidities, 
and reduce hospitalizations and readmissions. A sustained public 
awareness initiative under the guidance of CDC will educate at-risk 
individuals to enhance awareness of the causes, consequences, and 
comorbidities of kidney disease, and educate clinical professionals on 
early detection and opportunities for intervention. Especially in light 
of the connection between surviving COVID-19 and increased risk of 
developing kidney disease, the time is right for a major nationwide 
program to improve awareness and early detection of kidney disease.
    To expedite activities to improve early detection and intervention 
measures, NKF requests $15 million for the CKD Initiative to increase 
public awareness, educate clinical professionals and expand health 
system capacity to diagnose and manage CKD, implement systemic changes 
to reduce disparities, and spur innovation by entities that serve the 
kidney disease community. Additional funding also would expand capacity 
for national CKD prevalence surveillance to allow for repeated 
laboratory measures in the National Health and Nutrition Examination 
Survey (NHANES). Current national estimates of CKD prevalence using 
NHANES rely on single measurements of both serum creatinine and urinary 
albumin, preventing researchers from estimating CKD persistence.
                                 niddk
    Despite CKD's impact on patients and Medicare, NIH funding for 
kidney disease research is only about $700 million annually, or about 
$19 per CKD patient, a fraction of what is provided on other major 
diseases. Fiscal Year 2021 funding for NIDDK increased by less than 1 
percent, the smallest percentage increase of any disease Institute, and 
the FY 2022 increase was 3.4 percent. From FY 2015-2020, NIH monetary 
support for kidney research increased at half the rate of NIH funding 
increases overall. As a result, innovation in kidney research and 
treatment has lagged that of other diseases. Scientists however are at 
the cusp of potential breakthroughs in improving our understanding of 
CKD. Further advances can lead to new therapies to delay and treat 
kidney diseases, which has the potential to provide cost savings to the 
government like that of no other chronic disease given its unique 
Medicare coverage.
    In October 2021, NKF released a Research Roadmap containing 
recommendations for opportunities in pre-clinical and clinical research 
in which additional funding could help bridge existing deficits in 
kidney disease detection and management, reduce incidence and 
disparities, improve outcomes, and lower healthcare costs. Key 
recommendations include increasing the number of and access to clinical 
trials related to kidney disease (including increased participation by 
under-represented populations) and identifying and implementing 
strategies to improve the delivery of evidenced-base care in under-
represented populations. Our roadmap was the culmination of input from 
nephrology leaders and from kidney patients, family members and care 
givers, and living kidney donors. NKF leadership and staff presented 
the final recommendations to NIDDK staff and to representatives from 
other Institutes and participated in a briefing that was available to 
congressional staff and the public.
    As the first step towards expanding kidney research opportunities, 
NKF requests a substantial funding increase for NIDDK that is 
commensurate with the percentage increase to NIH as a whole. Within 
that increase, we respectfully request a percentage increase for kidney 
research proportional to if not greater than that of NIH overall. NKF 
applauds recent clinical practice changes in the diagnosis of kidney 
disease and requests priority consideration of new markers to estimate 
kidney function. NIDDK should prioritize research into the adoption of 
new equations for estimating the Glomerular Filtration Rate (eGFR) that 
do not include race as a modifier. We also request NIDDK give priority 
consideration to additional investments in CKD clinical trials, 
including diversity of participants, and initiatives to improve 
evidence-based care in under-represented populations.
    Lastly, we request Congress encourage related Institutes to 
consider additional funding of kidney activities. Opportunities include 
NHLBI support for cardiorenal syndromes in CKD patients; NIAID 
initiatives to study CKD effects on the immune system; and NCI 
activities to study decreased kidney function in cancer patients.
    Thank you for your consideration of the National Kidney 
Foundation's requests for Fiscal Year 2023.

    [This statement was submitted by Sharon Pearce, Senior Vice 
President, Government Relations.]
                                 ______
                                 
  Prepared Statement of the National Marrow Donor Program/Be The Match
    Chairwoman Murray, Ranking Member Blunt, and members of the 
subcommittee, my name is Kristin Akin from Chesterfield, Missouri. On 
behalf of the patients, family members, donors, couriers, volunteers, 
and staff of the National Marrow Donor Program (NMDP)/Be The Match, I 
want to express my most sincere gratitude to the members of the 
Committee for your work last year, continuing the full funding of the 
C.W. Bill Young Cell Transplantation Program (Program) within the 
Health Resources and Services Administration (HRSA), Health Care 
Systems account. In Fiscal Year 2023, we respectfully request that the 
subcommittee increase funding for the Program to the amount of 
$38,000,000 to eliminate financial and socioeconomic barriers that 
reduce access to cellular therapies for thousands of primarily 
traditionally underserved patients.
    With our Program being founded under the direction and guidance of 
our initial Congressional champion, the late Congressman C.W. Bill 
Young, NMDP/Be The Match has facilitated over 111,000 bone marrow, 
blood stem cell, and cord blood transplants. Each of these transplants 
represents a person and a family hoping above all else that cellular 
therapy would be the cure to save themselves or a loved one. As the 
home of the Nation's Registry, we are forever grateful to Mr. Young for 
his legacy of caring for blood cancer and blood disease patients. And, 
we are equally honored that Senator Roy Blunt has taken up the charge 
with his steadfast determination to ensure that NMDP/Be The Match has 
the support of Congress to continue and expand upon how we deliver 
cures to patients every single day. Through his commitment to seeing 
our patients as people he can help, Senator Blunt's longstanding 
promise of expanding the reach and resources of the Nation's Registry 
has saved thousands of lives. We know our patients are thankful beyond 
measure for his support and we feel that Congressman Young would be 
quite proud of Senator Blunt's wholehearted dedication to furthering 
the mission of saving lives through cellular therapy.
    By establishing a national bone marrow donor registry in the mid-
1980s, Congress promised patients with blood cancers, like leukemia and 
lymphoma and other life-threatening diseases, that they would have a 
way to find a life-saving donor match. While bone marrow transplant 
started as a cure for a single disease, we now provide cures for over 
75 diseases, everything from cancers, blood disorders, immune 
deficiencies and Sickle Cell. In 2019, the Program completed its 
milestone 100,000th transplant between a matched, unrelated donor and a 
patient. This has been a true public/private partnership for more than 
30 years and it is obvious that the funding is saving lives.
    My son, Andrew Preston Akin, was born on June 5, 2007. At 10 weeks 
old, what initially started as severe jaundice quickly landed us in the 
Pediatric Intensive Care Unit (PICU) at our local hospital. After 
months of tests, on September 7, 2007, our world was officially turned 
upside down when we were informed that Andrew had a rare immune 
deficiency called Hemophagocytic Lymphohistiocytosis (HLH), and the 
only cure was a bone marrow transplant.
    Our then six-month-old son underwent his first bone marrow 
transplant in an effort to save his life. He was started on the 
standard protocol for HLH (HLH 2004) and initially responded very 
positively. But, suddenly, his HLH came roaring back and not only did 
we have to move up his transplant, we used umbilical cord cells, as 
there was not a suitable bone marrow match on the registry at the time. 
Grateful and optimistic that this was the end of HLH and the beginning 
of a new and healthy Andrew, we were devastated to learn that 2 months 
after his transplant, it did not work, and he would need another one.
    In the meantime, we continued with steroids, chemotherapy and a 
host of other drugs, all the while keeping him in a bubble away from 
any germs. The search began again to find Andrew the best possible 
unrelated, matched bone marrow donor. Excited that marrow was going to 
be the answer to our prayer, Andrew underwent his second bone marrow 
transplant right before his first birthday. Sadly, almost a year to the 
day of his diagnosis, we learned that again, for various reasons, his 
transplant was not a success.
    Through this process, we learned several things about Andrew's 
disease: the cause of his HLH was among the newest genetic mutations--
X-Linked Lymphoproliferative Disorder #2 (XLP-2). Because it is X-
linked, the doctors immediately tested me and our other son Matthew. On 
my 34th birthday, I received among the worst news in my life: not only 
was I the carrier, but my healthy 4-year old son also carried the 
mutation, meaning it was only a matter of time before he, too, would 
get HLH.
    After countless discussions with the team of experts, we weighed 
the pros and cons of taking Matthew into transplant while he was 
healthy or waiting until the disease struck.
    We did another preliminary search on the bone marrow registry and 
found one perfect match. Not knowing if that match would be there down 
the road, we made the extremely difficult decision to transplant 
Matthew prophylactically.
    At the same time, we prepared Andrew for his third bone marrow 
transplant in less than 2 years.
    We were fighting for the lives of our two sons.
    Andrew, only 27 months old, developed severe pulmonary 
complications that ultimately took his life on September 5, 2009, in 
the PICU.
    Matthew was just two weeks post-transplant, we thought life could 
not get any worse, but somehow, eight short months later, it did. Our 
first-born son, Matthew Austin Akin passed away in the same PICU on May 
1, 2010. He was only 5 and a half years old.
    My husband and I have experienced every parent's worst nightmare, 
twice, but we both agreed we would not allow our son's deaths to be the 
last thing people remembered about them. It's why my husband and I 
started the Matthew and Andrew Akin Foundation in their memory: to 
raise awareness and critical funds for HLH, NMDP, and the American Red 
Cross, and to advocate for other parents and children.
    However, I would be remiss if I did not share that a very large 
part of what drives us to continue to help others is the fact that we 
were blessed with the opportunity to be parents again, twice, through 
adoption. William and Christopher are the reason we have love in our 
hearts and can fight for the memory of their brothers Matthew and 
Andrew.
    While Matthew and Andrew ultimately lost their lives due to disease 
complications, NMDP was our line of hope that we held onto from day one 
when learned that a successful bone marrow transplant was the only 
cure. With each transplant my boys received, we were reminded of the 
kindness of strangers, the feeling of indebtedness to NMDP and Congress 
for establishing the registry and the power of a worldwide network. It 
has been and will continue to be my honor to volunteer my time with 
NMDP.
    The C.W. Bill Young Cell Transplantation Program, authorized by 
Congress, has been funded by the Committee and fulfills three important 
missions. The first is the Nation's registry, which includes more than 
39 million selfless volunteers worldwide, like my sons' donors, who 
stand ready to be a life-saving bone marrow donor. It also includes 
more than 806,000 cord blood units through Be The Match and 
international partnerships, 115,000 of which are in the National Cord 
Blood Inventory, which is also funded by your Committee. When we 
couldn't find a matching donor for Andrew right away, a cord blood 
transplant was our only hope for his first transplant.
    While Matthew and Andrew were able to proceed to transplant thanks 
to their selfless matching donors, there are still many patients who 
cannot find a match on the registry. This is why the funding we are 
seeking in Fiscal Year 2023, is so critically important. From the 
moment doctors search the registry for a donor, to the safe delivery of 
the life-saving cells to the bedsides of patients for transplant--NMDP 
is there every step of the way. NMDP ensures that the global network, 
technology, and logistical support are in place to facilitate a 
transplant.
    The Program's second mission is to support patients and families 
through its Office of Patient Advocacy. NMDP works tirelessly to 
improve the lives of patients and provide one-on-one support to these 
individuals and their families. They offer the resources and guidance 
patients need throughout the transplant process--from deciding if 
transplant is right for them to adjust to life after transplant.
    Finally, the Stem Cell Therapeutic Outcomes Database is a third 
program component that helps doctors significantly impact/improve 
survival for blood cancer and other diseases while also improving the 
quality of life for thousands of transplant patients. NMDP is 
relentless in its search to find answers that will lead to better donor 
matching, more timely transplants, and treatment of even more blood 
diseases through transplant.
    Thank you for the opportunity to share my story and most 
importantly thank you for learning a little bit about my beautiful sons 
Matthew and Andrew. Your longstanding support for this Program is the 
hope that people hold onto after receiving their life-threatening 
diagnosis. On behalf of those who are alive today, those who are 
currently searching the National registry for their potentially life-
saving donor, and for those who will need to look to the Program for 
help in the future, I urge you to fund the C.W. Bill Young Cell 
Transplantation Program at $38,000,000 to immediately provide access to 
therapy at the point of diagnosis for all patients.
    Our request this year builds upon past funding to clear a pathway 
for more patients, especially those from minority and rural 
communities, to be able to access transplant services. It would enable 
targeted donor recruitment efforts, expand early intervention with 
community referring physicians upon patient diagnosis to accelerate the 
path to transplant, and propel innovation to improve outcomes and 
establish new treatment options to ensure a matched donor for all 
searching patients, regardless of their racial/ethnic background or the 
complexity of their DNA, ensuring access to transplant and equal and 
successful outcomes for all.
    More than any other Committee in Congress, the programs you support 
save lives every day. The increase we are asking for this year will 
immediately increase the number of patients who enter the pipeline to 
receive a bone marrow transplant for a lifesaving cure.

    [This statement was submitted by Kristin Akin on behalf of National 
Marrow Donor Program/Be The Match.]
                                 ______
                                 
         Prepared Statement of the National Pancreas Foundation
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --The Foundation joins the broader research community in requesting 
        that the National Institutes of Health (NIH) receive a funding 
        increase of at least $3.5 billion for FY 2023 to bring total 
        agency funding up to a minimum of $49 billion annually.
    --Please provide proportional increases for the various NIH 
            Institutes and Centers, including the National Institute of 
            Diabetes and Digestive and Kidney Diseases (NIDDK) and the 
            National Cancer Institute (NCI).
    --Please provide separate and distinct funding to further support 
            the emerging Advanced Research Projects Agency for Health 
            (ARPA-H) initiatives, which would ensure this important new 
            effort does not supplant any ongoing NIH activities.
  --The Foundation joins the broader public health community in 
        requesting that the Centers for Disease Control and Prevention 
        (CDC) receive a funding increase of at least $2.55 billion in 
        discretionary resources to bring total agency funding up to a 
        minimum of $11 billion annually.
    --Please provide $6 million in dedicated, line-item funding for the 
            Chronic Disease Education and Awareness (CDEA) Program 
            within the National Center for Chronic Disease Prevention 
            and Health Promotion to facilitate support for meritorious 
            and timely public health campaigns.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to submit testimony 
on behalf of the National Pancreas Foundation (NPF) and the patient 
community that we serve. We deeply appreciate the investments in the 
National Institutes of Health (NIH) that have occurred over the past 
five fiscal years and the research advancements that additional 
resources have facilitated, most notably in treatment progress for 
pancreatitis. We also thank you for the ongoing support for the CDEA 
program at CDC. The Foundation has developed a strong proposal and 
additional resources will allow us (along with many other patient 
groups) to apply and compete for a CDC cooperative agreement. For FY 
2023, we urge you to maintain this commitment to medical research and 
to similarly increase support public health programs. Thank you again.
                          about the foundation
    The National Pancreas Foundation is a patient-driven, non-profit 
organization that provides hope for those suffering from pancreatitis 
and pancreatic cancer by funding cutting edge research, advocating for 
new and better therapies, and providing support and education for 
patients, caregivers, and health care professionals.
                       conditions of the pancreas
    Pancreatitis can be acute or chronic. It is characterized by 
inflammation of the pancreas, and chronic pancreatitis does not heal or 
improve--it gets worse over time and leads to permanent damage. Chronic 
pancreatitis eventually impairs a patient's ability to digest food and 
make pancreatic hormones like insulin. Chronic pancreatitis can strike 
at any age, but often develops in patients between the ages of 30 and 
40, and is more common in men than women. The annual incidence rate is 
5-12 per 100,000 and the prevalence is 50 per 100,000. Pancreatitis can 
be managed with proper information and healthy practices.
    Pancreatic cancer is currently the third leading cause of cancer 
deaths in the United States. One of the major challenges associated 
with pancreatic cancer is that the condition often goes undetected for 
a long period of time because signs and symptoms seldom occur until 
advanced stages. By the time symptoms occur, cancer cells are likely to 
have spread (metastasized) to other parts of the body, often preventing 
surgical removal of tumors. Research indicates an emerging link between 
pancreatitis and the onset of pancreatic cancer.
                nih research: progress and opportunities
    NIDDK has been a leader on pancreatitis research while NCI has 
facilitated key breakthroughs for pancreatic cancer. More work needs to 
be done though as translation and clinical research are necessary to 
ensure innovative treatment options and diagnostic tools can be 
deployed to the benefit of affected patients.
    In this regard, NIDDK recently hosted an effort with the community 
to capitalize on progress for pancreatitis and ensure promising ideas 
move into the FDA pipeline for review. The need remains great as 
pancreatitis patients currently have extremely limited treatment 
options despite the severity of the illness.
    Moreover, the Cancer Moonshot has been extremely meaningful for 
scientific efforts focused on pancreatic cancer. Similar to 
pancreatitis though, treatment options remain extremely limited despite 
the severity of the disease. In fact, due to improvements in other 
areas and an overall lack of progress in outcomes, pancreatic cancer is 
now the third leading cause of cancer deaths in America.
    Over recent years, key Committee Recommendations have been included 
that have moved key pancreas research projects forward and it is our 
hope that the subcommittee will continue to demonstrate an interest in 
this area during the FY 2021 process as treatment development 
activities reach a critical phase.
                    cdc public health opportunities
    The National Center for Chronic Disease Prevention and Health 
Promotion coordinates line-item public health programs on a variety of 
conditions. Recently, CDC has limited their public health activities 
almost exclusively to these named efforts. While these programs have 
been highly successful for the conditions they represent, there is a 
tremendous public health need to launch a similar program for 
pancreatitis.
    A lack of adequate professional and public information about 
pancreatitis leads to a suboptimal situation where patients are not 
effectively managing the condition and as it progresses inappropriate 
interventions occur, most notably unnecessary surgery to remove the 
pancreas. The CDC can fill key knowledge gaps with a pancreatitis 
program to disseminate best practices to the professional community and 
make sure public health messages reach at-risk individuals. 
Pancreatitis can often be managed if the proper information is 
available, which can prevent the progression of disease, including the 
onset of pancreatic cancer.
    Increasing funding for the CDEA program to $6 million will provide 
CDC with the resources and flexibility it needs to hold another 
competition and award a third cohort of 3-year cooperative agreements 
through this mechanism. The collaborative public health efforts already 
underway with CDC have been meaningful for their communities and we 
look forward to pursuing a similar program and impact for pancreatitis.
                      african american initiative
    The incidence of pancreatitis is higher in African Americans than 
any other racial group in the U.S. Many studies suggest that 
environmental and socioeconomic factors have contributed to the 
increased risk of pancreatitis among African Americans. Other 
preventable risk factors that are more common among African Americans 
that increase the risk of pancreatitis include type 2 diabetes, and 
obesity. Although smoking is not a cause of pancreatitis, it can 
accelerate the progression of the disease.
    To promote health equity and address health disparities within the 
community, the Foundation worked with a diverse team of leading medical 
experts to develop and advance a pancreatitis and pancreatic cancer 
awareness campaign with the African American community. We welcome 
Federal collaborations to support further awareness and bolster 
critical public health activities.
Diane Tonelli's Story
    I am a resident of Massachusetts and I have chronic pancreatitis. I 
was first diagnosed in 2002 w acute pancreatitis-idiopathic just shy of 
2 years after my dad had died from pancreatic cancer. I was 
hospitalized 2 times, managed for pain and treated with TPN.
    I struggled intensely the first few years. I lost 28 pounds, down 
to 92 pounds by mid-summer of 2002.
    During the first few years I had genetic testing which was positive 
for genetic mutation CFTR R117H-cystic fibrosis and negative for BRCA1 
and 2, SPINK1 and PRSS1.
    Over the years since initial diagnosis I have had yearly screening. 
The disease had progressed to chronic pancreatitis with imaging 
revealing moderate to severe disease. I've had a sweat test which 
revealed probable Cystic fibrosis and bone density testing has revealed 
osteoporosis (density of an 80-year-old) due to decreased nutrition 
related to pancreas insufficiency.
    Currently I take pancreatic enzymes and continue to follow with GI 
for pancreas severity and have screening for pancreatic cancer.
Lee Zeidman's Story
    My name is Lee Zeidman. I am a Strategic Communications Consultant 
and pancreatic cancer survivor. I'm a native Washingtonian. I was part 
of the team that launched CNN in 1980. I also was a local sportscaster 
early in my career in Washington, D.C. and New York City.
    I came down with an acute case of pancreatitis while on a business 
trip on the west coast. It was the worst pain I've ever felt--and I've 
broken bones playing sports. I went to the emergency room. I flew home 
to New York City the next day and was admitted into Weill-Cornell 
Medical Center where I spent 10 days in the hospital.
    The doctors at Weill-Cornell diagnosed acute pancreatitis and told 
me it was manageable. My wife was concerned that it was cancer. She 
insisted they do a biopsy to rule out cancer. The doctor insisted there 
was no relationship between pancreatitis and pancreatic cancer (this 
was back in 2013, now doctors routinely look for cancer when treating 
pancreatitis). Grudgingly, the doctor agreed to do a biopsy after my 
wife repeatedly insisted. I was put on a liquid diet and sent home. Two 
days later the doctor called and told us to come back to the hospital, 
they needed to have an urgent conversation about my health. At that 
moment I knew the doctors had been wrong--I knew it was pancreatic 
cancer. The doctor refused to acknowledge the diagnosis and the news 
had to be delivered face-to-face. I quickly realized that had my wife 
not insisted on the biopsy, I might have died from pancreatic cancer 
within months.
    My surgery was 9 years ago. It gave me a new lease on life. I still 
go to Sloan Kettering for annual check-ups, but I remain cancer-free. I 
am diabetic and wear an insulin pump, but that's a small price to pay 
for surviving pancreatic cancer.

    [This statement was submitted by David Bakelman, Chief Executive 
Officer, 
National Pancreas Foundation.]
                                 ______
                                 
       Prepared Statement of the National Scleroderma Foundation
 the foundation's fiscal year 2023 l-hhs appropriations recommendations
_______________________________________________________________________

  --$11 billion in program level funding for the Centers for Disease 
        Control and Prevention (CDC), which includes budget authority, 
        the Prevention and Public Health Fund, Public Health and Social 
        Services Emergency Fund, and PHS Evaluation transfers.
    --A proportional funding increase for CDC's National Center for 
            Chronic Disease Prevention and Health Promotion (NCCDPHP).
    --$6 million for the Chronic Disease Education and Awareness 
            Program which seeks to improve public health and lower 
            healthcare costs through targeted awareness, physician 
            education, and public health campaigns conducted in 
            collaboration with stakeholder organizations and 
            communities.
  --At least $49 billion in program funding for the National Institutes 
        of Health (NIH).
    --Proportional funding increases for NIH's National Heart, Lung, 
            and Blood Institute (NHLBI); National Institute of 
            Arthritis and Musculoskeletal and Skin Diseases (NIAMS); 
            National Center for Advancing Translational Sciences 
            (NCATS).
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for your time and your consideration of 
the scleroderma community's priorities while working to craft the FY 
2023 L-HHS Appropriations Bill.
                           about scleroderma
    Scleroderma is a chronic connective tissue disease affecting 
approximately 300,000 Americans. The word scleroderma means hardening 
of the skin, which is one of the most visible manifestations of the 
condition. The cause of this progressive and potentially fatal disease 
remains unknown. There is no cure, and treatment options are limited.
    Symptoms vary greatly and are dependent on which organ systems are 
impacted. Prompt diagnosis and treatment by a qualified physician may 
improve health outcomes and lessen the chance for irreversible damage. 
Serious complications of the disease can include pain, skin ulcers, 
anemia and pulmonary hypertension.
                          about the foundation
    The National Scleroderma Foundation is a 501(c)(3) charitable 
organization founded in 1998 to advance medical research, promote 
disease awareness, and provide support and education to people with 
scleroderma. Supported by a network of thousands of individuals across 
the United States, the Foundation is a leader in funding peer-reviewed, 
innovative research to discover the cause, understand the mechanism, 
and overcome scleroderma forever.
    One of the most challenging things about scleroderma is that it 
shows up differently in each person. Scleroderma is complicated to 
manage, since it does not follow one clear path. At the National 
Scleroderma Foundation, we know that no two scleroderma journeys are 
the same. We help people find the resources that are right for them so 
they can live better with scleroderma.
               centers for disease control and prevention
    Early recognition and accurate diagnosis of scleroderma can improve 
health outcomes and save lives. CDC in general and the NCCDPHP 
specifically have programs to improve public awareness of scleroderma 
and other rare, life-threatening conditions. Please increase funding 
for CDC and NCCDPHP so that the agency can invest in additional, 
critical education and awareness activities that have the potential to 
improve health and save lives. The Foundation supports the continued 
support of the Chronic Disease Education and Awareness Program; this 
program seeks to provide collaborative opportunities for chronic 
disease communities that lack dedicated funding from ongoing CDC 
activities. Such a mechanism allows public health experts at the CDC to 
review project proposals on an annual basis and direct resources to 
high impact efforts in a flexible fashion.
                     national institutes of health
    NIH continues to work with the Foundation to lead the effort to 
enhance our scientific understanding of the mechanisms of scleroderma 
with the shared goal of improving diagnosis and treatment and 
ultimately finding a cure. Since scleroderma is a systemic fibrotic 
disease, it is linked to other manifestations of fibrosis such as 
cirrhosis, pulmonary fibrosis, and the fibrotic damage resulting from 
heart attack. Scleroderma is a prototypical manifestation of fibrosis, 
as it impacts multiple organ systems. Because of this, it is important 
to promote cross-cutting research across such Institutes as NIAMS and 
NHLBI.
    Please provide NIH with a significant funding increase so the 
scleroderma research portfolio can continue to expand and facilitate 
key breakthroughs. Continued support in the following areas is critical 
to improving the health of people with scleroderma:
  --The Trans-NIH Working Group on Fibrosis, which is working to 
        promote cross-cutting research across Institutes.
  --The Scleroderma Lung Study II, being led by NNHLBI, which is 
        comparing the effectiveness of two drugs in treating pulmonary 
        fibrosis in scleroderma.
  --Leading efforts to discover whether three gene expression 
        signatures in skin can serve as accurate biomarkers predicting 
        scleroderma as well as investigations into progression and 
        response to treatment to clarify the complex interactions of T 
        cells and interleukin-31 (IL-31) in producing inflammation and 
        fibrosis or scarring in scleroderma being led by NIAMS.
    Every story we hear from someone living with scleroderma reminds us 
how disruptive and life-altering this disease is. Now more than ever, 
it is important it is for us to understand scleroderma and find a cure.
Patient Perspective
    ``My constantly aching hands begged for mercy of just one day 
without pain. My joints started to feel like they were being torn away 
from my body. Anytime I touched something cold, my hands would tingle 
and burn. Painful sores started appearing on my knuckles. You stole my 
skin color and with that went my confidence. It was like I was turning 
into a mummy as my skin tightened with collagen, day by day. I was 
beginning to need help performing small tasks. Opening a water bottle 
or turning a key in the door started to become difficult. Standing for 
long periods of time made my hips radiate with pain. In 2012 I had to 
stop working at 24 years old. The definition of normal as I knew it was 
being torn down and built into something completely new. And so was my 
soul.
    I now need help with everything! Getting dressed, washing my hair, 
cleaning, doing laundry; pretty much anything I must use my hands for. 
You stole my independence. I had to learn to swallow my pride and ask 
for help. It's a tough thing to do, especially when you're at an age 
that's supposed to be your prime. Friends and family around me have 
blossomed into caregivers and helping me has become second nature to 
them. It's a beautiful thing when those surrounding you automatically 
adapt to your disability. Support is the lifeboat that keeps me 
afloat.''

    [This statement was submitted by Mary J. Wheatley, IOM, CAE, Chief 
Executive Officer, National Scleroderma Foundation.]
                                 ______
                                 
  Prepared Statement of the National Technical Institute for the Deaf
    Chairwoman Murray, Ranking Member Blunt and Members of the 
Committee:
    I respectfully submit the FY 2023 budget request for NTID, one of 
nine colleges of RIT, in Rochester, New York. Created by Congress by 
Public Law 89-36 in 1965, NTID provides a university-level technical 
and professional education for students who are deaf and hard of 
hearing, leading to successful careers in high-demand fields for a sub-
population of individuals historically facing high rates of 
unemployment and under-employment. NTID also prepares professionals to 
work in fields related to deafness. NTID students study at the 
associate, baccalaureate, master's and doctoral levels as part of a 
university (RIT) that includes more than 17,000 hearing students.
                             budget request
    On behalf of NTID, for FY 2023 I would like to request $95,200,000 
for Operations. NTID has worked hard to manage its resources carefully 
and responsibly. NTID actively seeks alternative sources of public and 
private support, with approximately 25 percent of NTID's Operations 
budget coming from non-federal funds, up from 9 percent in 1970. Since 
FY 2013, NTID raised more than $11 million in support from individuals 
and organizations.
    Like all college campuses, NTID is seeing a greater demand for 
mental health and counseling services, a phenomenon that has been 
exacerbated by the COVID-19 pandemic. With 45 percent of NTID students 
being eligible for Pell Grants, many of these students do not have 
access to external resources and rely on what they receive at RIT/NTID. 
This FY 23 request includes funding to hire three additional counselors 
to provide students with and connect students to the mental health and 
case management services they need. It also includes funding to hire 13 
additional captionists, a crucial service for deaf and hard-of-hearing 
students to access content inside and outside of class and another area 
where NTID has seen a dramatic increase in student requests.
    NTID's FY 23 request also includes funding to establish a new 
Bachelor's of Science in Applied Internet of Things (IoT). This 
interdisciplinary field involves the application of interconnected 
devices embedded with electronics that communicate and share 
information across the Internet. The new degree will address the four 
major areas of IoT--hardware, software, communication and 
cybersecurity--and will be applied across the many employment sectors 
of IoT, including agriculture, manufacturing, healthcare, and 
government.
    NTID's secondary mission includes preparing professionals to work 
in fields related to deafness, such as sign language interpreting, 
teaching deaf students, and audiology. NTID's FY 23 request would 
provide significant scholarships to support students in NTID's American 
Sign Language and Interpreting Education program and Master of Science 
in Secondary Education of Students who are Deaf or Hard of Hearing 
program, as well as provide externships to audiologists. The 
scholarships would aim to address the shortage of students going into 
these fields, as well as increase underrepresented students in these 
occupations.
    For FY 23, NTID hopes to increase outreach funding for the NTID 
Regional STEM Center (NRSC) partnership by $1,000,000 to expand NRSC 
programs. The NRSC partnership serves deaf and hard-of-hearing students 
primarily in 12 southeastern States by promoting training and 
postsecondary participation in STEM fields, providing professional 
development for teachers, and developing partnerships with business and 
industry to promote employment opportunities.
                               enrollment
    Truly a national program, NTID has enrolled students from all 50 
States. In Fall 2021 (FY 2022), NTID's enrollment was 1,166 students. 
NTID also serves students nationwide through Project Fast Forward, a 
project that builds a pathway for deaf and hard-of-hearing students to 
transition from high school to college in selected STEM disciplines by 
allowing deaf and hard-of-hearing high school students to take dual-
credit courses, earning RIT/NTID college credit while they are still in 
high school. In FY 2022, 245 deaf and hard-of-hearing high school 
students enrolled in dual-credit courses at partner high schools.
                         ntid academic programs
    NTID offers 21 high quality, career-focused associate degree 
programs preparing students for specific well-paying technical careers. 
NTID also provides transfer associate degree programs to better serve 
our student population seeking bachelor's, master's, and doctoral 
degrees. These transfer programs provide seamless transition to 
baccalaureate and graduate studies in the other colleges of RIT. NTID 
also offers two bachelor's degree programs (ASL-English Interpretation 
and Community Development & Inclusive Leadership) as well as an MS in 
Secondary Education of Students who are Deaf and Hard of Hearing.
    A cooperative education (co-op) component is an integral part of 
academic programming at NTID and prepares students for success in the 
job market. A co-op assignment gives students the opportunity to 
experience a real-life job situation and focus their career choice. 
Students develop technical skills and enhance vital personal skills 
such as teamwork and communication, which will make them better 
candidates for full-time employment after graduation. Last year, 219 
students participated in 10-week co-op experiences that augment their 
academic studies, refine their social skills, and prepare them for the 
competitive working world.
                        student accomplishments
    NTID deaf and hard-of-hearing students persist and graduate at 
rates higher than or on par with national persistence and graduation 
rates for all students at 2-year and 4-year colleges. For NTID deaf and 
hard-of-hearing graduates, over the past 5 years, an average of 95 
percent have found jobs commensurate with their education level. Of our
    FY 2020 graduates (the most recent class for which numbers are 
available), 95 percent were employed 1 year later, with 72 percent 
employed in business and industry, 21 percent in education and non-
profits, and 7 percent in government.
    Graduation from NTID has a demonstrably positive effect on 
students' earnings over a lifetime, and results in a notable reduction 
in dependence on Supplemental Security Income (SSI) and Social Security 
Disability Insurance (SSDI). In FY 2012, NTID, the Social Security 
Administration (SSA), and Cornell University examined earnings and 
Federal program participation data for more than 16,000 deaf and hard-
of-hearing individuals who applied to NTID over our entire history. The 
study showed that NTID graduates, over their lifetimes, are employed at 
a higher rate and earn more (therefore paying more in taxes) than 
students who withdraw from NTID or attend other universities. NTID 
graduates also participate at a lower rate in SSI programs than 
students who withdrew from NTID.
    Using SSA data, at age 50, 78 percent of NTID deaf and hard-of-
hearing graduates with bachelor degrees and 73 percent with associate 
degrees report earnings, compared to 58 percent of NTID deaf and hard-
of-hearing students who withdrew from NTID and 69 percent of deaf and 
hard-of-hearing graduates from other universities. Equally important is 
the demonstrated impact of an NTID education on graduates' earnings. At 
age 50, $58,000 is the median salary for NTID deaf and hard-of-hearing 
graduates with bachelor degrees and $41,000 for those with associate 
degrees, compared to $34,000 for deaf and hard-of-hearing students who 
withdrew from NTID and $21,000 for deaf and hard-of-hearing graduates 
from other universities.
    An NTID education also translates into reduced dependency on 
Federal transfer programs, such as SSI and SSDI. At age 40, less than 2 
percent of NTID deaf and hard-of-hearing associate and bachelor degree 
graduates participated in the SSI program compared to 8 percent of deaf 
and hard-of-hearing students who withdrew from NTID. Similarly, at age 
50, only 18 percent of NTID deaf and hard-of-hearing bachelor degree 
graduates and 28 percent of associate degree graduates participated in 
the SSDI program, compared to 35 percent of deaf and hard-of-hearing 
students who withdrew from NTID.
                            access services
    Access services include sign language interpreting, real-time 
captioning, classroom notetaking services, captioned classroom video 
materials, and assistive listening services. NTID provides an access 
services system to meet the needs of a large number of deaf and hard-
of-hearing students enrolled in baccalaureate and graduate degree 
programs in RIT's other colleges as well as students enrolled in NTID 
programs who take courses in the other colleges of RIT. Access services 
also are provided for events and activities throughout the RIT 
community. Historically, NTID has followed a direct instruction model 
for its associate-level classes, with limited need for sign language 
interpreters, captionists, or other access services. However, the 
demand for access services has grown recently as associate-level 
students request communication based on their preferences.
    During FY 2021, 117,831 hours of interpreting and 27,744 hours of 
real-time captioning were provided to students.
                                summary
    NTID's FY 2023 funding request ensures that we continue our mission 
to prepare deaf and hard-of-hearing people to excel in the workplace 
and expand our outreach to better prepare deaf and hard-of-hearing 
students to excel in college. NTID students persist and graduate at 
rates higher than or on par with national rates for all students. NTID 
graduates have higher salaries, pay more taxes, and are less reliant on 
Federal SSI programs. NTID's employment rate is 95 percent over the 
past 5 years. Therefore, I ask that you please consider funding our 
FY2023 request of $95,200,000 for Operations.
    We are hopeful that the members of the Committee will agree that 
NTID, with its long history of successful stewardship of Federal funds 
and an outstanding educational record of service to people who are deaf 
and hard of hearing, remains deserving of your support and confidence. 
Likewise, we will continue to demonstrate to Congress and the American 
people that NTID is a proven economic investment in the future of young 
deaf and hard-of-hearing citizens. Quite simply, NTID is a Federal 
program that works.

    [This statement was submitted by Dr. Gerard J. Buckley, President, 
National Technical Institute for the Deaf, Vice President and Dean, 
Rochester Institute of Technology.]
                                 ______
                                 
              Prepared Statement of The Nature Conservancy
    Chair Murray, Ranking Member Blunt and members of the subcommittee, 
thank you for the opportunity to submit recommendations for fiscal year 
2023 (FY23) appropriations for programs under the Department of Labor 
(DOL). The Nature Conservancy (TNC) is a nonprofit conservation 
organization working around the world to protect ecologically important 
lands and waters for people and nature. Our mission is to conserve the 
lands and waters upon which all life depends.
    TNC appreciates Congress's work last year to pass the bipartisan 
Infrastructure Investment and Jobs Act (IIJA), which included 
significant investments in developing employee training and an 
equitable workforce. This will help strengthen our communities, create 
jobs and build a more prosperous future for all. These investments 
complement but do not supplant the need for ongoing program funding 
through the appropriations process. We ask the subcommittee to advance 
a robust appropriations package that will serve as the foundation for 
implementing the IIJA and ensuring long-term success for critical 
programs under the panel's jurisdiction.
    The pandemic made evident the economic disparities that exist due 
to low-wage jobs. We appreciate concerns about the country's current 
economic scenario where the Congress must balance job growth while also 
addressing inflation. We see investments in employment training and on-
the-job training experiences as a tremendous opportunity to contribute 
to the Nation's economy. By supporting workforce development programs 
like the Job Corps and AmeriCorps, we can provide career development 
opportunities for youth and the unemployed through conservation and 
restoration projects on lands across the country.
    An example of the significant impacts investments in corps programs 
have on communities, their economies, and the environment is the work 
being done by the GulfCorps program. Over the last 5 years, TNC has 
worked extensively to develop, design and implement a region-wide, 
GulfCorps program, a five-state (Alabama, Florida, Mississippi, 
Louisiana and Texas) conservation corps program in the Gulf of Mexico 
region. This program was carried out under a contract with National 
Oceanic and Atmospheric Administration (NOAA) with funding from the 
Deepwater Horizon oil spill settlement. TNC has operated GulfCorps in 
partnership with NOAA, the RESTORE Council, the Student Conservation 
Association, The Corps Network and local conservation corps and 
community development organizations.
    In 2021, the RESTORE council voted to renew the program for 
additional 4 years and awarded $11.9 million to GulfCorps. The program 
will use the additional funding to create more than 400 conservation 
jobs over 4 years in the Gulf of Mexico. As of July 2021, this program 
has restored, conserved, and monitored 10,000 acres of TNC and partner 
lands. Additionally, 60 percent of the National AmeriCorps program 
alumni have taken their experience and skills and applied them to full-
time positions in the conservation field (both within TNC and with 
partners).
    The DOL budget levels detailed below represent a significant 
investment in our Nation's future. TNC asks your support for the 
following requests:
                          department of labor
    AmeriCorps: TNC supports no less than $1,340,000,000, which is 
consistent with the president's FY23 budget request. This amount 
represents a $140 million increase from FY22 funding. The AmeriCorps 
program (officially known as the Corporation for National and Community 
Service) supports approximately 77,500 members providing service to 
communities across the country through local organizations and 
Governors' State Service Commissions. The AmeriCorps' state and 
national programs accomplish critical projects like disaster response 
and recovery, infrastructure, wildfire remediation, public lands 
access, and disconnected youth and veteran engagement. AmeriCorps and 
the country's network of conservation corps aim to develop a service 
ethic in young people; build and support diverse, inclusive and 
equitable American communities; provide education and vocational 
training; complete significant amounts of high-quality work in 
communities and on our public lands and waters; and prepare 
participants to advance to a career in conservation.
    Conservation and restoration work that AmeriCorps supports has been 
shown to yield a high return on investment. For example, when 
performing coastal restoration work, on average 15 jobs are created per 
million dollars invested and this increases to up to 30 jobs per 
million dollars invested for the more complex, labor-intensive 
restoration projects, according to data collected by National Oceanic 
and Atmospheric Administration. Similarly, every $1 invested by the 
U.S. Forest Service (USFS) in resource management generates $1.43 in 
GDP and, on average, 19 jobs are created per million dollars invested. 
Additionally, projects completed by AmeriCorps and the network of 
conservation corps will help improve and support the local economies of 
the communities they are located in. We appreciate the increased 
funding provided in FY22 for AmeriCorps and TNC urges the subcommittee 
to continue strong funding for this program in FY23.
    Job Corps: TNC supports funding no less than $1,778,964,000, which 
is consistent with the president's FY23 budget request. This amount 
represents a $30 million increase from FY22 funding. DOL co-leads Job 
Corps with USFS. For almost 100 years, USFS has combined land 
stewardship with education and training, beginning with the development 
of the Civilian Conservation Corps in the 1930s. The agency manages 20 
percent of the DOL Job Corps through their Civilian Conservation 
Centers. We would like to see USFS participation continue to be 
supported by DOL at least at this level. The mission of the Forest 
Service Job Corps Civilian Conservation Centers is to train eligible 
youth ages 16 to 24 with educational, social and vocational skills, 
while offering an integrated approach to address the Nation's 
conservation challenges. As first responders during local, State and 
national disasters, USFS Job Corps students also are trained by local 
agency units to assist during national emergencies, including those 
caused by wildfires, floods, hurricanes and tornados. Each year, 
Civilian Conservation Centers serve about 3,800 students and about 85 
percent of the graduates start new careers, enroll in higher education 
programs or join the military, according to USFS. As mentioned in the 
previous section, projects supported by corps programs produce a high 
return on investment and aid in the economic recovery of local 
communities. TNC supports continued robust funding for the Job Corps 
program and its Civilian Conservation Centers.
    Thank you for the opportunity to submit TNC's recommendations for 
the FY23 subcommittee on Labor, Health and Human Services, Education 
and Related Agencies Appropriations Bill. Please contact me if you have 
any additional questions or would like additional information.

    [This statement was submitted by Sarah Murdock, Director, U.S. 
Climate 
Resilience and Water Policy, The Nature Conservancy.]
                                 ______
                                 
          Prepared Statement of NephCure Kidney International
            summary of recommendations for fiscal year 2023
_______________________________________________________________________

  --Provide $49 billion for the National Institutes of Health (NIH)
  --Provide a proportional increase for the National Institute of 
        Diabetes and Digestive and Kidney Diseases (NIDDK) and the 
        National Institute on Minority Health and Health Disparities 
        (NIMHD) and support the expansion of the FSGS/NS research 
        portfolio at NIDDK and NIMHD by funding more research into 
        primary glomerular disease.
  --Provide $11 billion for the Centers for Disease Control and 
        Prevention (CDC) and $6 million for the Chronic Disease 
        Education and Awareness Program.
_______________________________________________________________________

    Chairwoman Murray and Ranking Member Blunt, thank you for the 
opportunity to present the views of NephCure Kidney International 
regarding research on focal segmental glomerulosclerosis (FSGS) and 
nephrotic syndrome (NS). NephCure is the only non-profit organization 
exclusively devoted to finding a cure and supporting patients with FSGS 
and the NS disease group. Driven by a panel of respected medical 
experts and a dedicated band of patients and families, NephCure works 
tirelessly to support kidney disease research and awareness.
    NS is a collection of signs and symptoms caused by diseases that 
attack the kidney's filtering system. These diseases include FSGS, 
Minimal Change Disease, and Membranous Nephropathy, and others. When 
affected, the kidney filters leak protein from the blood into the urine 
and often cause kidney failure, which requires dialysis or kidney 
transplantation. According to a Harvard University report, 73,000 
people in the United States have lost their kidneys because of FSGS. 
Unfortunately, the causes of FSGS and other 'filter related' diseases 
are poorly understood.
    FSGS is the second leading cause of NS and is especially difficult 
to treat. There is no known cure for FSGS and current treatments are 
difficult for patients to endure. These treatments include the use of 
steroids and other dangerous substances that lower the immune system 
and contribute to severe bacterial infections, high blood pressure, and 
other problems in patients, particularly child patients. In addition, 
children with NS often experience growth retardation and heart disease. 
Finally, NS that is caused by FSGS, MCD, or MN is idiopathic and can 
often reoccur, even after a kidney transplant.
    FSGS disproportionately affects minority populations and is five 
times more prevalent in the African American community. In a 
groundbreaking study funded by NIH, researchers found that FSGS is 
associated with two aggressive APOL1 gene variants. 75 percent of Black 
Americans with FSGS possess this gene. These variants developed as an 
evolutionary response to African sleeping sickness and are common in 
the African American patient population with FSGS/NS. Researchers 
continue to study the pathogenesis of these variants.
    FSGS has a large social impact in the United States. FSGS leads to 
end-stage renal disease (ESRD) which is one of the most costly chronic 
diseases to manage. In 2008, the Medicare program alone spent $26.8 
billion, 7.9 percent of its entire budget, on ESRD. In 2005, FSGS 
accounted for 12 percent of ESRD cases in the U.S., at an annual cost 
of $3 billion. It is estimated that there are currently approximately 
20,000 Americans living with ESRD due to FSGS.
    Research on FSGS and other forms of NS could achieve tremendous 
savings in Federal health care costs and reduce health status 
disparities.
                   encourage fsgs/ns research at nih
    There is no known cause or cure for FSGS and scientists tell us 
that much more research needs to be done on the basic science behind 
FSGS/NS. More research could lead to fewer patients undergoing ESRD and 
tremendous savings in health care costs in the United States. NephCure 
works closely with NIH and has partnered with NIH on two large studies 
that will advance the pace of clinical research and support precision 
medicine. These studies are the Nephrotic Syndrome Study Network 
(NEPTUNE) and the Cure Glomerulonephropathy Network (CureGN).
    With collaboration from other Institutes and Centers, established 
the Rare Disease Clinical Research Network. This network provided an 
opportunity for NephCure Kidney International, the University of 
Michigan, and other university research health centers to come together 
to form the NEPTUNE. Now in its second 5-year funding cycle, NEPTUNE 
has recruited over 450 NS research participants and has supported pilot 
and ancillary studies utilizing the NEPTUNE data resources. NephCure 
urges the subcommittee to continue its support for RDCRN and NEPTUNE, 
which has tremendous potential to facilitate advancements in NS and 
FSGS research.
    NIDDK houses the Cure GN, a multicenter 5-year cohort study of 
glomerular disease patients. Participants will be followed 
longitudinally to better understand the causes of disease, response to 
therapy, and disease progression, with the ultimate objective to cure 
glomerulonephropathy. NephCure recommends that the subcommittee 
continues to support the work that the CureGN initiative has 
accomplished towards further understanding rare forms of kidney 
diseases. It is estimated that annually there are 20 new cases of ESRD 
per million African Americans due to FSGS, and 5 new cases per million 
Caucasians. This disparity is largely due to variants of the APOL1 
gene. Unfortunately, the incidence of FSGS is rising and there are no 
known strategies to prevent or treat kidney disease in individuals with 
the APOL1 genotype. NIMHD began supporting research on the APOL1 gene 
in FY13. Due to the disproportionate burden of FSGS on minority 
populations, it remains appropriate for NIMHD to continue to advance 
this research. NephCure asks the subcommittee to recognize the work 
that NIMHD and NIDDK are doing to address the connection between the 
APOL1 gene and the onset of FSGS and encourage NIMHD to work with 
community stakeholders to identify areas of collaboration.
    As a result of the important research done through NIH, we have 
been able to work with FDA to establish new endpoints for clinical 
trials leading to more trials than ever before. This has led to the 
creation of the Kidney Health Gateway Clinical which will connect 
patients with breakthrough clinical trials and access to top Nephrotic 
Syndrome doctors all in one place. These crucial trials will hopefully 
lead to more treatment options for our patients.
                chronic disease education and awareness
    We thank the subcommittee for the creation of the Chronic Disease 
Education and Awareness Program in FY 2022 and encourage continued 
support by providing $6 million for this critical program in FY 2023.
Patient Perspective
    Meet 16-year-old Macy! She was diagnosed with Nephrotic Syndrome 
and later FSGS when she was three. Her 13-year journey with kidney 
disease has been long and hard. Macy did not respond to treatments for 
her kidney disease and within 2 years of diagnosis, her native kidneys 
were damaged beyond repair and she was in kidney failure and on 
dialysis. At the age of five, she received a living donor kidney 
transplant, but her disease, FSGS came back and attacked her new to her 
kidney. It took a full year of aggressive treatments to get Macy's FSGS 
into remission post-transplant. For the past 10 years, Macy has taken 
18 to 26 medications a day. Those medications and her kidney disease 
have led to multiple co-morbidities. She is currently followed by 7 
specialties, has endured 30+ surgeries & been hospitalized over 100 
times. Macy participates in the Beads of Courage program in which she 
earns different beads for each procedure, appointment, etc. The strand 
of beads you see in this photo areis just the beads she earned in 2018! 
Those black beads are for pokes (lab draws, IVs, Shots) and Macy earned 
over 400 last year. As you can see kidney disease is tough! Although 
Macy continues to struggle with kidney disease and will need another 
transplant sooner than later, she doesn't let that stop her from living 
life! Macy loves dancing and musical theater, art, and hanging out with 
her dog Bentley!
    Thank you for the opportunity to present the views of the FSGS/NS 
community.

    [This statement was submitted by Josh M. Tarnoff, CEO, NephCure 
Kidney 
International.]
                                 ______
                                 
          Prepared Statement of the Neurofibromatosis Network
    Thank you for the opportunity to submit testimony to the 
subcommittee on the importance of funding for the National Institutes 
of Health (NIH), and specifically for continued research on 
Neurofibromatosis (NF), a genetic disorder closely linked to many 
common diseases widespread among the American population. My name is 
Kim Bischoff and I am the Executive Director of the Neurofibromatosis 
(NF) Network, a national organization of NF advocacy groups. We 
respectfully request that you include the following report language on 
NF research at the National Institutes of Health within the Office of 
the Director account in the Fiscal Year 2023 Labor, Health and Human 
Services, Education Appropriations bill.
    Neurofibromatosis [NF].--The Committee supports efforts to increase 
funding and resources for NF research and treatment at multiple 
Institutes, including NCI, NINDS, NIDCD, NHLBI, NICHD, NIMH, NCATS, and 
NEI. Children and adults with NF are at elevated risk for the 
development of many forms of cancer, deafness, blindness, developmental 
delays and autism. The Committee encourages NCI to increase its NF 
research portfolio in fundamental laboratory science, patient-directed 
research, and clinical trials focused on NF-associated benign and 
malignant cancers. The Committee also encourages NCI to support 
clinical and preclinical trials consortia. Because NF can cause 
blindness, pain, and hearing loss, the Committee urges NINDS to 
continue to aggressively fund fundamental basic science research on NF 
relevant to restoring normal nerve function. Based on emerging findings 
from numerous researchers worldwide demonstrating that children with NF 
have a higher chance of developing autism, learning disabilities, motor 
delays, and attention deficits, the Committee encourages NINDS, NIMH, 
and NICHD to increase their investments in laboratory-based and 
patient-directed research investigations in these areas. Since NF2 
accounts for approximately 5 percent of genetic forms of deafness, the 
Committee encourages NIDCD to expand its investment in NF2-related 
research. NF1 can cause vision loss due to optic gliomas. The Committee 
encourages NEI to expand its investment in NF1-focused research on 
optic gliomas and vision restoration.
    On behalf of the Neurofibromatosis (NF) Network, I speak on behalf 
of the over 100,000 Americans who suffer from NF as well as the 
millions of Americans who suffer from diseases and conditions linked to 
NF such as cancer, brain tumors, heart disease, memory loss, and 
learning disabilities. Thanks in large part to this subcommittee's 
strong support, scientists have made enormous progress since the 
discovery of the NF1 gene in 1990 resulting in clinical trials now 
being undertaken at NIH with broad implications for the general 
population.
    NF is a genetic disorder involving the uncontrolled growth of 
tumors along the nervous system which can result in terrible 
disfigurement, deformity, deafness, pain, blindness, brain tumors, 
cancer, and even death. In addition, approximately one-half of children 
with NF suffer from learning disabilities. NF is the most common 
neurological disorder caused by a single gene and is more common than 
Cystic Fibrosis, hereditary Muscular Dystrophy, Huntington's disease 
and Tay Sachs combined. There are three types of NF: NF1, which is more 
common, NF2, which initially involves tumors causing deafness and 
balance problems, and Schwannomatosis, the hallmark of which is severe 
pain. While not all NF patients suffer from the most severe symptoms, 
all NF patients and their families live with the uncertainty of not 
knowing whether they will be seriously affected because NF is a highly 
variable and progressive disease.
    Researchers have determined that NF is closely linked to heart 
disease, learning disabilities, memory loss, cancer, brain tumors, and 
other disorders including deafness, blindness and orthopedic disorders, 
primarily because NF regulates important pathways common to these 
disorders such as the RAS, cAMP and PAK pathways. Research on NF 
therefore stands to benefit millions of Americans.
Learning Disabilities/Behavioral and Brain Function
    Learning disabilities affect one-half of people with NF1. They 
range from mild to severe and can impact the quality of life for those 
with NF1. In recent years, research has revealed common threads between 
NF1 learning disabilities, autism, and other related disabilities. New 
drug interventions for learning disabilities are being developed and 
will be beneficial to the general population. Research being done in 
this area includes working to identify drugs that target Cyclic AMP, so 
they can be paired with existing drugs targeting RAS. Identification of 
new drug combinations may benefit people with multiple types of 
learning disabilities.
Bone Repair
    At least a quarter of children with NF1 have abnormal bone growth 
in any part of the skeleton. In the legs, the long bones are weak, 
prone to fracture and unable to heal properly; this can require 
amputation at a young age. Adults with NF1 also have low bone mineral 
density, placing them at risk of skeletal weakness and injury. Research 
currently being done to understand bone biology and repair will pave 
the way for new strategies to enhancing bone health and facilitating 
repair.
Pain Management
    Severe pain is a central feature of Schwannomatosis, and 
significantly impacts quality of life. Understanding what causes pain, 
and how it could be treated, has been a fast-moving area of NF research 
over the past few years. Pain management is a challenging area of 
research and new approaches are highly sought after.
Nerve Regeneration
    NF often requires surgical removal of nerve tumors, which can lead 
to nerve paralysis and loss of function. Understanding the changes that 
occur in a nerve after surgery, and how it might be regenerated and 
functionally restored, will have significant quality of life value for 
affected individuals. Light-based therapy is being tested to dissect 
nerves in surgery of tumor removal. If successful it could have 
applications for treating nerve damage and scarring after injury, 
thereby aiding repair and functional restoration.
Cancer
    NF can cause a variety of tumors to grow, which includes tumors in 
the brain, spinal cord and nerves. NF affects the RAS pathway which is 
implicated in 70 percent of all human cancers. Some of these tumor 
types are benign and some are malignant, hard to treat and often fatal. 
Previous studies have found a high incidence of intracranial 
glioblastomas and malignant peripheral nerve sheath tumors (MPNSTs), as 
well as a six-fold incidents of breast cancer compared to the general 
population. One of these tumor types, malignant peripheral nerve sheath 
tumor (MPNST), is a very aggressive, hard to treat and often fatal 
cancer. MPNSTs are fast growing, and because the cells change as the 
tumor grows, they often become resistant to individual drugs. Clinical 
trials are underway to identify a drug treatment that can be widely 
used in MPNSTs and other hard-to-treat tumors.
    The enormous promise of NF research, and its potential to benefit 
millions of Americans who suffer from diseases and conditions linked to 
NF, has gained increased recognition from Congress and the NIH. This is 
evidenced by the fact that numerous institutes are currently supporting 
NF research, and NIH's total NF research portfolio has increased from 
$3 million in FY1990 to an estimated $28 million in FY 2022. Given the 
potential offered by NF research for progress against a range of 
diseases, we are hopeful that the NIH will continue to build on the 
successes of this program by funding this promising research and 
thereby continuing the enormous return on the taxpayers' investment.
    We appreciate the subcommittee's strong support for the National 
Institutes of Health and will continue to work with you to ensure that 
opportunities for major advances in NF research at the NIH are 
aggressively pursued. Thank you.
                                 ______
                                 
                   Prepared Statement of New Leaders
    Thank you for the opportunity to provide testimony regarding the 
fiscal year 2023 Labor, Health and Human Services, Education, and 
Related Agencies Appropriations bill.
    New Leaders is a national nonprofit organization dedicated to 
ensuring high academic achievement for all children, especially 
students in poverty and students of color, by developing 
transformational school leaders and advancing the policies and 
practices that allow great leaders to succeed. Together with our school 
system partners, we build the capacity of equity-minded school leaders 
who are committed to the success of every child. Our leaders remove 
barriers to success for underestimated and underserved students, 
supporting students in fully realizing their futures as the next 
generation of great thinkers, innovators, and leaders for our society. 
Over the past 20 years, we have trained more than 8,000 equity-focused 
leaders-sixty percent of whom identify as leaders of color. Our leaders 
impact more than 2 million students in our K-12 school system annually 
and serve as powerful and positive forces for change in their 
communities. In addition, our programs are evidence-based. Multiple 
independent studies have found that students who attend New Leader 
schools outperform their peers by statistically significant margins 
specifically because of the strong leadership of their New Leader 
principal.\1\ And a recent review of school leadership interventions 
cited New Leaders as the principal preparation program with the 
strongest evidence of positive impact on student achievement.\2\
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    \1\ Gates, S.M., Baird, M.D., Doss, C.J., Hamilton, L.S., Opper, 
I.M., Master, B.K., Tuma, A.P., Vuollo, M., Zaber, M.A., (2019). 
Preparing School Leaders for Success Evaluation of New Leaders' 
Aspiring Principals Program, 2012-2017. RAND Corporation RR-2812-NL.
    Gates, S., Hamilton, L., Martorell, P., et. al. (2014). Preparing 
Principals to Raise Student Achievement: Implementation and Effects of 
the New Leaders Program in Ten Districts. The RAND Corporation. 
Retrieved from http://www.rand.org/pubs/research_reports/RR507.html.
    \2\ Herman, R., Gates, S. M., Chavez-Herrerias, E. R., and Harris, 
M. (2016). School Leadership Interventions Under the Every Student 
Succeeds Act (Volume I). The RAND Corporation. Retrieved from http://
www.rand.org/content/dam/rand/pubs/research_reports/RR1500/RR1550/
RAND_RR1550.pdf.
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    New Leaders is committed to getting a well-prepared, well-supported 
principal in every school so that our Nation's teachers and students 
can thrive. More than a decade of research shows that well-prepared, 
well-supported principals have a huge influence on teacher practice and 
student success. School leaders account for 25 percent of a school's 
impact on student learning,\3\ and an above-average principal can 
improve student achievement by 20 percentage points.\4\ And school 
leaders transform the lowest-performing schools, where the positive 
effects of strong leadership on student achievement are most 
pronounced.\5\ In fact, a landmark study found ``virtually no 
documented instances of troubled schools being turned around without 
intervention by a powerful leader.'' \6\
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    \3\ Leithwood, K., Seashore Louis, K., Anderson, S., & Wahlstrom, 
K. (2004). How leadership influences student learning: A review of 
research for the Learning from Leadership Project. New York, NY: The 
Wallace Foundation. Retrieved from http://www.wallacefoundation.org/
knowledge-center/Pages/How-Leadership-Influences-Student-Learning.aspx.
    \4\ Marzano, R. J., Waters, T., & McNulty, B. A. (2005). School 
leadership that works: From research to results. Alexandria, VA: 
Association for Supervision and Curriculum Development.
    \5\ Seashore Louis, K., Leithwood, K., Wahlstrom, K., & Anderson, 
S. (2010). Investigating the links to improved student learning. 
Washington, DC: Wallace Foundation. Retrieved from http://
www.wallacefoundation.org/knowledge-center/Pages/Investigating-the-
Links-to-Improved-Student-Learning.aspx.
    \6\ Leithwood, K., Seashore Louis, K., Anderson, S., & Wahlstrom, 
K. (2004).
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    We were pleased that the Biden Administration has proposed funding 
the School Leader Recruitment and Support Program (SLRSP) at $40 
million in FY23, and we strongly encourage Congress to fund the program 
at this level.
    The School Leader Recruitment and Support Program (SLRSP) was 
authorized under ESSA with bipartisan support and is the only Federal 
program with an exclusive focus on evidence-based school leadership 
interventions for high-need schools. SLRSP updates the School 
Leadership Program (SLP), the program included in the previous version 
of the Elementary and Secondary Education Act, and provides districts 
with resources to develop and support dynamic leaders who have a 
measurable, positive impact on student achievement. The program 
empowers eligible entities-including State or local educational 
agencies-to pursue a range of activities in support of school 
leadership for high-need schools, such as the development and 
implementation of leadership training programs, the provision of 
ongoing professional development for school leaders, and the 
dissemination of best practices regarding the recruitment and retention 
of highly effective school leaders. In addition, eligible entities may 
carry out projects in partnership with nonprofit organizations and 
institutions of higher education. Finally, under priorities set forth 
in the reauthorized statute, SLRSP incentivizes eligible entities to 
focus on principal preparation and professional development practices 
for which there is evidence of effectiveness, as demonstrated through 
rigorous research.
    Of critical importance right now, SLRSP can help combat the 
deleterious effects of the COVID pandemic on our educator workforce. 
According to a recent poll conducted by the National Association of 
Secondary School Principals (NASSP), 45 percent of principals report 
that pandemic working conditions are accelerating their plans to leave 
the profession, and nearly four out of 10 principals plan to leave the 
profession in the next 3 years.\7\ Leadership transitions are 
disruptive and negatively impact students' learning experiences. 
Through high-quality professional development and support, we can 
support the steady, determined leadership of experienced principals 
even as we invest in preparing the next generation of school leaders. 
Further, many teachers are burned out and suffering from low morale, 
with more than half of teachers reporting they plan to quit due to 
COVID-related workplace stressors.\8\ Yet we know that effective school 
leaders can make all the difference: 97 percent of teachers list 
principal quality as critical to their retention and career decisions-
more than any other factor.\9\ And we know that strategies to address 
principal burnout, which disproportionately affects high-need 
schools,\10\ can yield huge cost savings for school systems,\11\ which 
can be reinvested in pandemic recovery efforts.
---------------------------------------------------------------------------
    \7\ National Association of Secondary Principals. (2020). NASSP 
Survey Signals a Looming Mass Exodus of Principals From Schools. 
Retrieved from https://www.nassp.org/news/nassp-survey-signals-a-
looming-mass-exodus-of-principals-from-schools/.
    \8\ National Education Association. (2022). Poll Results: Stress 
And Burnout Pose Threat Of Educator Shortages. Retrieved from https://
www.nea.org/sites/default/files/2022-02/NEA percent20
Member percent20COVID-19 percent20Survey percent20Summary.pdf.
    \9\ Scholastic Inc. (2012). Primary Sources: America's Teachers on 
the Teaching Profession. New York, NY: Scholastic and the Bill and 
Melinda Gates Foundation. Retrieved from http://www.scholastic.com/
primarysources/pdfs/Gates2012_full.pdf.
    \10\ According to 2014 data from the National Center for Education 
Statistics, high-need schools must also grapple with an overall 
principal turnover rate of 28 percent, significantly higher than 
schools in more affluent communities.
    \11\ According to School Leaders Network (2014), up to $330K 
annually for a typical urban district.
    School Leaders Network. (2014). Churn: The High Cost of Principal 
Turnover. Retrieved from http://connectleadsucceed.org/sites/default/
files/principal_turnover_cost.pdf#page=1&zoom=
auto,-15,792.
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    The Federal Government has a crucial role to play in advancing 
innovation and sharing best practices with the field so that State and 
local leadership strategies, especially for high-need schools, can be 
strengthened, now and in the future, by a strong and growing evidence 
base. The SLP helped launch and expand some of the country's most 
innovative and effective leadership development programs, including New 
Leaders, New Teacher Center, NYC Leadership Academy, and TNTP. Since 
receiving SLP grants, these organizations have grown exponentially to 
reach many more schools, teachers, and students in high-need 
communities--greatly expanding the impact of the Federal Government's 
initial investment. Further, SLP grantees, including those affiliated 
with the University Council of Educational Administrators (UCEA), have 
demonstrated a remarkable commitment to programmatic evaluation, 
continuous improvement, and transparency. By proactively sharing their 
lessons and resources open-source with the field, these organizations 
have helped to galvanize dramatic changes to the principal preparation 
sector as a whole \12\--inspiring necessary changes to the way 
principals are trained to lead our Nation's schools in States and 
districts across the country.
---------------------------------------------------------------------------
    \12\ University Council for Educational Administration and New 
Leaders. (2016). State Evaluation of Principal Preparation Programs 
Toolkit. Retrieved from www.sepkit.org.
---------------------------------------------------------------------------
    We urge Congress to restore funding for SLRSP at $40 million to 
support innovative, evidence-based school leadership programs that 
promise a return for students and schools that far exceeds this 
targeted investment.
    Thank you for the opportunity to provide the views of New Leaders 
on the FY 2023 appropriations. If you would like to discuss our 
recommendations, please do not hesitate to contact 
[email protected].

    [This statement was submitted by Jean Desravines, CEO, New 
Leaders.]
                                 ______
                                 
 Prepared Statement of the Northwest Portland Area Indian Health Board
    Greetings Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee, for the opportunity to share the Northwest Portland Area 
Indian Health Board's funding priorities for the Department of Health 
and Human Services (HHS) in FY 2023. My name is Nickolaus Lewis, and I 
serve as Council on the Lummi Indian Business Council, and as Chair of 
the Northwest Portland Area Indian Health Board (NPAIHB or Board). I 
thank the subcommittee for the opportunity to provide testimony on FY 
2023 HHS appropriations.
    The NPAIHB is a Tribal organization, established in 1972, under the 
Indian Self-Determination and Education Assistance Act (ISDEAA), Public 
Law 93-638 that advocates on behalf of the 43 federally-recognized 
Indian Tribes in Idaho, Oregon, and Washington on specific health care 
issues. The Board's mission is to eliminate health disparities and 
improve the quality of life of American Indian and Alaska Native (AI/
AN) people by supporting Northwest Tribes in the delivery of culturally 
appropriate, high quality health programs and services. ``Wellness for 
the seventh generation'' is the Board's vision. In order to achieve 
this vision, NPAIHB delegates respectfully ask that this subcommittee 
consider Tribal sovereignty, traditional knowledge, and culture in all 
policy initiatives and funding opportunities.
    These past 2 years, COVID-19 has dramatically impacted Northwest 
Tribes and carries long-term effects physically, mentally, emotionally 
and physically. We are grateful for the diligent service of our 
Congressional representatives in ensuring that Tribal Nations were 
provided with resources, including vaccines and medical supplies, to 
battle this pandemic. We know that working together improved our 
ability to take care of our people despite the long standing systemic 
and funding shortfalls to the Indian health care system. As we emerge 
from the pandemic, I make recommendations that will help rebuild and 
repair the foundational necessities for the Indian health care system.
                          hhs and its agencies
    This subcommittee must honor Tribal sovereignty and trust and 
treaty obligations as to HHS funding to Tribal Nations. For FY 2023, we 
ask this subcommittee to make the legislative changes needed across all 
HHS agencies to move away from grants and allocate funding to Tribes 
through Indian Self-Determination and Education Assistance Act (ISDEAA) 
compacts and contracts. We also request Tribal set-asides and direct 
funding to Tribes--not through State block grants.
    We also request that this subcommittee consider the important role 
that Tribal Epidemiology Centers (TECs) play in the Indian health 
system and support funding to TECs. TECs should be funded across HHS 
agencies to provide support to Tribes in their area for any type of 
data or evaluation component, surveillance support and/or training and 
technical assistance. TECs know the Tribes in their area and should be 
given the opportunity to support Tribes in their roles as public health 
authorities.
       substance abuse and mental health services administration
    Tribal Opioid Response. Through Tribal Opioid Response (TOR) 
funding, NPAIHB coordinated a TOR consortium of 28 Northwest Tribes. 
Our Tribes have developed innovative opioid programs with positive 
outcomes reflecting the resilience in our area. For example, the Lummi 
Nation brought on success coaches (peers) for those using or in 
recovery and 18 of the 28 TOR consortium Tribes have made medication-
assisted treatment (MAT) available. However, a funding increase is 
needed for a more robust opioid response in Tribal communities. In FY 
2023, we request an increase in TOR funding to $75 million; and an 
increase in the Tribal MAT funding to $20 million.
    Other Grant Programs. Thank you for the increases to the AI/AN Zero 
Suicide Initiative funding, and Tribal Behavioral Health Grants in FY 
2022. For FY 2023, we request the following amounts for Tribal Specific 
Programs: fund the Tribal Behavioral Health Grant program at least $50 
million--$25 million for mental health and $25 million for substance 
use disorder; fund the Garrett Lee Smith Suicide Prevention Tribal Set 
Aside at $3.5 million; fund Zero Suicide Initiative at $3 million; and 
fund the National Child Traumatic Stress Initiative Tribal Set Aside at 
$1.5 million.
    Designated Resources for Youth Behavioral Health Programs. In order 
to comprehensively address the need for whole person mental health and 
substance use disorder services for AI/AN youth, there must be 
dedicated funding streams for culturally-centered prevention, 
intervention, treatment, aftercare and transitional living support. 
Funding for Youth Residential Treatment Centers that provide aftercare 
and transitional living for both substance use disorder and mental 
health are a priority for Portland Area Tribes and current facilities 
in the area do not meet demand. For FY 2023, we request $25 million in 
funding for youth-specific outpatient and inpatient mental health and 
substance use programs.
                        office of the secretary
    Minority HIV/AIDS Fund. The Minority HIV/AIDS Fund is a significant 
funding source for communities of color that have not traditionally 
been supported by mainstream opportunities, and includes important 
funding to IHS for HIV and hecpatitis C (HCV) prevention, treatment, 
outreach and education. Tribes in the Portland Area appreciated the 
$1.5 million MHAF Tribal set-aside in FY 2022. For FY 2023, we request 
that funding for Minority HIV/AIDS Fund be increased to $80 million 
with a $15 million Tribal set-aside. This is a step toward addressing 
the impact that HIV has in Indian Country and continuing. the important 
program work that is already in place. We thank OASH for the 
relationship it has created with IHS and Tribes over the past 15 years.
    Climate Change. Climate change has been significantly impacting our 
Northwest Tribes. Tribal communities are facing increased flooding that 
impacts our health care operations and continually threatened by 
increased forest fires year after year. We request that this 
subcommittee provides additional funding to support Tribal capacity 
building and training for Tribal communities. This would allow Tribes 
to be in charge of collecting and monitoring their own scientific data. 
We also request a 5 percent set aside of all climate change funding for 
Tribes.
               centers for disease control and prevention
    Public Health Infrastructure & Environmental Impacts. COVID-19 has 
demonstrated the under-investment made by the Federal Government in 
public health and medical care infrastructure in the Indian, Tribal, 
and Urban (I/T/U) health system. The I/T/U system is underfunded, and 
lacks capacity to respond effectively to public health emergencies like 
COVID-19. We can no longer allow population density as the primary 
consideration in the allocation of emergency preparedness resources. In 
FY 2023, we request at least $1 billion for a Tribal Public Health 
Emergency Fund established through the Secretary of HHS that Tribes can 
access directly for tribally-declared public health emergencies. 
Through the Tribal Public Health Emergency Fund, disease intervention 
services--which played such a vital role in COVID-19--could be used to 
respond to the syphilis outbreaks across Tribal communities.
    Include Tribes in HIV/HCV Funding Opportunities. HIV/HCV prevention 
and education generally flows to States via block grants. This leaves 
many Tribes with limited or no resources and forces Tribes to compete 
with States for funding. For FY 2023, we recommend that the 
subcommittee set-aside at least $25 million for HIV and HCV prevention 
for Tribal communities.
    Fund Good Health and Wellness in Indian Country (GHWIC). The GHWIC 
initiative supports AI/AN communities in the implementation of holistic 
and culturally adapted approaches to reduce and prevent chronic disease 
through policy, system and environment changes. With COVID-19, Tribal 
communities are more focused than ever on the importance of healthy, 
culturally appropriate and locally-produced foods and the nutritional 
and healing qualities of these food in a time of crisis. Likewise, the 
importance of protecting and promoting our traditional first food, 
human milk for our youngest members. Additional funding is needed to 
address food access issues, food insecurity, and support traditional 
food and local food system initiatives beyond COVID-19. NPAIHB 
recommends that the subcommittee allocate at least $32 million in 
fiscal Year2023 to the Good Health and Wellness in Indian Country.
               centers for medicare and medicaid services
    Medicare and Medicaid Legislative Initiatives. HHS must work with 
Congress to pass legislation that: expands Part B coverage for services 
furnished by licensed marriage and family therapists, licensed 
professional counselors, peer counselors, and our CHAP behavioral 
health aides; creates the authority for States to extend Medicaid 
eligibility to all AI/AN people with household incomes up to 138 
percent of the Federal poverty level; authorizes Indian Health Care 
Providers (IHCP) in all States to receive Medicaid reimbursement for 
health care services delivered to AI/AN people under IHCIA; extends 100 
percent FMAP permanently to States for Medicaid services furnished by 
urban Indian providers permanently; excludes Indian-specific Medicaid 
provisions in Federal law from state waiver authority; and removes the 
limitation on billing by IHCP for services provided outside the four 
walls of a Tribal clinic.
    Medicare Telehealth Reimbursement. Medicare telehealth expansion is 
set to expire at the end of the current public health emergency. 
Telehealth provided a way to care for our people during the pandemic 
and should be made permanent to increase access. We request that this 
subcommittee support legislation to make all Medicare telehealth 
services and flexibilities permanent at the OMB encounter rate at I/T/U 
facilities, authorize Medicare telehealth furnished services by 
federally qualified health centers and rural health clinics be 
reimbursed at the encounter rate, expand telephone-only telehealth 
visits, direct physician supervision of non-physician providers be 
provided remotely via telephone, and expand ``originating site'' 
locations from which telehealth services can be received.
              health resources and services administration
    Provider Shortages and Needs. The Broken Promises Report, National 
Tribal Behavioral Health Agenda, National Tribal Budget Formulation 
Workgroup Recommendations for 2021, and the IHS Strategic Plan all 
detail how culturally responsive care is critical for the health and 
well-being of AI/AN people. There are significant vacancy rates and 
challenges in filling vacancies at I/T/U facilities. Some of these 
challenges include: the rural location of Tribal facilities, lower 
salaries, lack of incentives, and insufficient housing for providers.
    For these reasons, we strongly recommend that the subcommittee 
support funding for HRSA, as follows:
  --Increase Tribal Set-Aside for Loan Forgiveness Program. Increase 
        Tribal set-asides for loan forgiveness and include mid-level 
        health care professionals such as Community Health Aide Program 
        providers in the program.
  --Support Community Health Aide Program Expansion. As IHS is 
        expanding the CHAP program in the lower 48, HRSA must create 
        new funding opportunities that support national CHAP expansion. 
        For fiscal Year2023, we request additional funding to support 
        our CHAP education programs including, $4.2 million for the 
        Dental therapy education programs with a $1.7 million earmark 
        for Portland Area and $2.5 million to support Alaska and $5 
        million to build clinical classrooms to train community health 
        aide providers throughout the Portland Area.
    Provider Relief Funds. Many Tribal health programs are facing 
significant administrative burdens on reporting their Provider Relief 
Funds. The Tribal health programs need additional time and support to 
compile the necessary information for reporting. We request that the 
subcommittee supports legislation that allows health care providers to 
expend all Provider Relief Funds by at least 90 days after the 
conclusion of the Public Health Emergency and to direct HRSA to 
simplify reporting requirements for Tribal health programs.
                     national institutes of health
    The Native American Research Centers for Health (NARCH) national 
program has catalyzed multiple tribal-academic partnerships that have 
resulted in many successful research projects and training 
opportunities for AI/AN people interested in science and health of AI/
AN people. The NPAIHB's NARCH programs have supported and developed 
countless Native researchers through this program. We request that 
NARCH be a congressionally mandated funding priority as it supports 
Tribal health research with the development of Tribal health leaders to 
design and implement research that is responsive to Tribal needs. In FY 
2023, we recommend increased funding for the NARCH program to $20 
million and request that 30 percent of the funding be directed to 
enhance AI/AN workforce development in parity with priorities of NIH 
institutes and centers.
    Thank you for this opportunity to provide recommendations to the 
subcommittee on FY 2023 funding for HHS. We invite you to visit 
Portland Area Tribes to learn more about the communities, utilization 
of HHS funding, and health care needs in our Area. We look forward to 
working with the subcommittee on our requests. For more information, 
please contact Candice Jimenez, [email protected].

    [This statement was submitted by Nickolaus Lewis, Chair, Northwest 
Portland Area Indian Health Board.]
                                 ______
                                 
         Prepared Statement of the Nursing Community Coalition
    As the Nation evaluates lessons learned from COVID-19, we recognize 
how crucial Federal investments for the nursing workforce and the 
nursing pipeline are to our patients and the health of our Nation. 
Given these realities, the Nursing Community Coalition (NCC) 
respectfully requests that Congress continues robust and bold 
investments in nursing education, workforce, and research in Fiscal 
Year (FY) 2023 by supporting at least $530 million for the Nursing 
Workforce Development programs (authorized under Title VIII of the 
Public Health Service Act [42 U.S.C. 296 et seq.] and administered by 
HRSA), and at least $210 million for the National Institute of Nursing 
Research (NINR), one of the 27 Institutes and Centers within NIH.
    The Nursing Community Coalition is comprised of 63 national nursing 
organizations who work together to advance health care issues that 
impact nursing education, research, practice, and regulation. 
Collectively, the NCC represents Registered Nurses (RNs), Advanced 
Practice Registered Nurses (APRNs),\1\ nurse leaders, students, 
faculty, and scientists, as well as other nurses with advanced degrees. 
As the largest segment of the health care profession,\2\ nursing is 
involved at every point of care, which was further exemplified during 
the COVID-19 pandemic. Together, we reiterate the bold request for 
increased funding for Title VIII Nursing Workforce Development programs 
and NINR, especially during these unprecedented times.
---------------------------------------------------------------------------
    \1\ APRNs include certified nurse-midwives (CNMs), certified 
registered nurse anesthetists (CRNAs), clinical nurse specialists 
(CNSs) and nurse practitioners (NPs).
    \2\ United States Census Bureau. (2021) Who are our Health Care 
Workers? Retrieved from: https://www.census.gov/library/stories/2021/
04/who-are-our-health-care-workers.html.
---------------------------------------------------------------------------
       through the nursing lens: providing care to all americans
    As we continue to confront today's health care challenges and plan 
for tomorrow, increased Federal resources for our Nation's current and 
future nurses are even more imperative. As the largest dedicated 
funding for nursing, Title VIII programs are instrumental in bolstering 
and sustaining the Nation's diverse nursing pipeline by addressing all 
aspects of nursing workforce demand. The Bureau of Labor Statistics 
(BLS) projected that by 2030 demand for RNs would increase 9 percent, 
illustrating an employment change of 276,800 nurses,\3\ and demand for 
most APRNs is expected to grow by 45 percent.\4\
---------------------------------------------------------------------------
    \3\ U.S. Bureau of Labor Statistics. (2021). Occupational Outlook 
Handbook- Registered Nurses. Retrieved from: https://www.bls.gov/ooh/
healthcare/registered-nurses.htm.
    \4\ U.S. Bureau of Labor Statistics. (2021). Occupational Outlook 
Handbook-Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. 
Retrieved from: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-
nurse-midwives-and-nurse-practitioners.htm.
---------------------------------------------------------------------------
    The need for nurses and APRNs is not only outlined by BLS, but can 
be seen in communities across the Nation, including rural and 
underserved areas. In fact, the American Association of Critical-Care 
Nurses outlined, ``92 percent of nurses surveyed said they believe the 
pandemic has depleted nurses at their hospitals and, as a result, their 
careers will be shorter than they intended.'' \5\ Further, the American 
Nurses Foundation's second COVID-19 impact study noted that 52 percent 
of nurses during the pandemic considered leaving their position, up 
from 40 percent a year earlier! \6\ If that was not enough, ``more than 
one-fifth of all nurses reported they plan to retire from nursing over 
the next 5 years.'' \7\
---------------------------------------------------------------------------
    \5\ American Association of Critical-Care Nurses. (2021). Hear Us 
Out Campaign. Retrieved from: https://www.aacn.org/newsroom/hear-us-
out-campaign-reports-nurses-covid-19-reality.
    \6\ American Nurses Foundation. (2022). Pulse on the Nation's 
Nurses Survey Series: COVID-19 Two-Year Impact Assessment Survey. 
Retrieved from: https://www.nursingworld.org/492857/contentassets/
872ebb13c63f44f6b11a1bd0c74907c9/covid-19-2-year-impact-assessment-
written-report-final.pdf.
    \7\ National Council of State Boards of Nursing and the National 
Forum of State Nursing Workforce Centers (2021) The 2020 National 
Nursing Workforce Survey. Retrieved from: https://
www.journalofnursingregulation.com/article/S2155-8256(21)00027-2/
fulltext.
---------------------------------------------------------------------------
    Funding for Title VIII is essential, but especially crucial during 
public health emergencies as these programs connect patients with high-
quality nursing care in community health centers, hospitals, long-term 
care facilities, local and State health departments, schools, 
workplaces, and patients' homes. Each program under Title VIII is 
unique and plays an important role in supporting our nursing workforce. 
For example, in Academic Year 2020-2021, the Advanced Nursing Education 
programs, which help APRN students and nurses to practice on the 
frontlines and in rural and underserved areas throughout the country, 
supported more than 8,800 students, many of whom were trained in 
medically underserved areas and primary care settings.\8\
---------------------------------------------------------------------------
    \8\ Health Resources and Services Administration. Fiscal Year 2023, 
Pages 164-170. Budget Justification. Retrieved from: https://
www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-
justification-fy2023.pdf.
---------------------------------------------------------------------------
    Together, Title VIII Nursing Workforce Development programs serve a 
vital need and help to ensure that we have a robust nursing workforce 
that is prepared to respond to public health threats and ensure the 
health and safety of all Americans. With more than four million nurses 
throughout the country,\9\ we strongly urge historic support for these 
programs in FY 2023.
---------------------------------------------------------------------------
    \9\ National Council of State Boards of Nursing. (2021). Active RN 
Licenses: A profile of nursing licensure in the U.S. as of February 9, 
2021. Retrieved from: https://www.ncsbn.org/6161.htm.
---------------------------------------------------------------------------
    Therefore, the Nursing Community Coalition respectfully requests at 
least $530 million for the Title VIII Nursing Workforce Development 
programs in FY 2023.
   improving patient care through scientific research and innovation
    For more than thirty years, scientific endeavors funded at the 
National Institute of Nursing Research (NINR) have been essential to 
advancing the health of individuals, families, and communities. NINR's 
research is aimed at reducing the impact of social determinants of 
health and creating a more equitable health care system by promoting 
patient-centered care across the life continuum. The translational 
research by our Nation's nurses and scientists is essential to 
developing new evidence-based practices to care for all patients. It is 
imperative that we continue to support the necessary scientific 
research, which is why the Nursing Community Coalition respectfully 
requests at least $210 million for NINR in FY 2023.
    Now, more than ever, it is vital that we have the resources to meet 
today's public health challenges, such as COVID-19. Investing in Title 
VIII Nursing Workforce Development programs and NINR are essential to 
meeting that need. By providing bold funding for Title VIII and NINR, 
Congress can continue to reinforce and strengthen the foundational care 
nurses provide daily in communities across the country. Thank you for 
your support of these crucial programs.
59 Members of the Nursing Community Coalition Submitting this Testimony
    Academy of Medical-Surgical Nurses
    Academy of Neonatal Nursing
    American Academy of Ambulatory Care Nursing
    American Academy of Nursing
    American Association of Colleges of Nursing
    American Association of Critical-Care Nurses
    American Association of Heart Failure Nurses
    American Association of Neuroscience Nurses
    American Association of Nurse Anesthesiology
    American Association of Nurse Practitioners
    American Association of Post-Acute Care Nursing
    American College of Nurse-Midwives
    American Nephrology Nurses Association
    American Nurses Association
    American Nursing Informatics Association
    American Organization for Nursing Leadership
    American Public Health Association, Public Health Nursing Section
    American Psychiatric Nurses Association
    American Society for Pain Management Nursing
    American Society of PeriAnesthesia Nurses
    Association for Radiologic and Imaging Nursing
    Association of Community Health Nursing Educators
    Association of Nurses in AIDS Care
    Association of Pediatric Hematology/Oncology Nurses
    Association of periOperative Registered Nurses
    Association of Public Health Nurses
    Association of Rehabilitation Nurses
    Association of Veterans Affairs Nurse Anesthetists
    Association of Women's Health, Obstetric and Neonatal Nurses
    Commissioned Officers Association of the U.S. Public Health Service
    Dermatology Nurses' Association
    Emergency Nurses Association
    Friends of the National Institute of Nursing Research
    Gerontological Advanced Practice Nurses Association
    Hospice and Palliative Nurses Association
    Infusion Nurses Society
    International Association of Forensic Nurses
    International Society of Psychiatric-Mental Health Nurses
    National Association of Clinical Nurse Specialists
    National Association of Hispanic Nurses
    National Association of Neonatal Nurse Practitioners
    National Association of Neonatal Nurses
    National Association of Nurse Practitioners in Women's Health
    National Association of Pediatric Nurse Practitioners
    National Association of School Nurses
    National Black Nurses Association
    National Council of State Boards of Nursing
    National Forum of State Nursing Workforce Centers
    National Hartford Center of Gerontological Nursing Excellence
    National League for Nursing
    National Nurse-Led Care Consortium
    National Organization of Nurse Practitioner Faculties
    Nurses Organization of Veterans Affairs
    Oncology Nursing Society
    Organization for Associate Degree Nursing
    Pediatric Endocrinology Nursing Society
    Society of Pediatric Nurses
    Society of Urologic Nurses and Associates
    Wound, Ostomy, and Continence Nurses Society

    [This statement was submitted by Rachel Stevenson, Executive 
Director, Nursing Community Coalition.]
                                 ______
                                 
    Prepared Statement of the Nutrition and Medical Foods Coalition
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Please provide the National Institutes of Health (NIH) with at 
        least $49 billion.
    --Please provide proportional funding increases for individual NIH 
            Institutes and Centers to advance efforts like those being 
            led by the Office of Nutrition Research.
    --Please provide additional, distinct funding for the emerging 
            Advanced Research Projects Agency for Health (ARPA-H) at 
            NIH, which would facilitate implementation of this 
            important program without supplanting ongoing NIH research 
            activities.
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least $11 billion.
  --Please enhance support for the Centers for Medicare and Medicaid 
        Services (CMS) and work with the administration on innovative 
        models to facilitate coverage and access for medical foods.
_______________________________________________________________________

    Thank you for the opportunity to submit testimony on behalf of the 
Nutrition and Medical Foods Coalition and the diverse community of 
patients that rely on medical foods. Chairwoman Murray, Ranking Member 
Blunt, and distinguished members of the subcommittee, thank you for 
continuing to invest in medical research, public health, and patient 
care through the FY 2022 appropriations process. Please maintain this 
commitment and further enhance support for medical research and public 
health programs as you work with your colleagues on appropriations for 
FY 2023. Please also continue to include committee recommendations 
encouraging ongoing scientific progress and appropriate coverage and 
access for medical foods.
                          about the coalition
    The Nutrition and Medical Foods Coalition (NMFC) is a 
collaborative, multi-stakeholder effort to promote and advance proper 
use of safe and effective medical foods. Medical foods occupy a unique 
niche in healthcare and are used to manage many rare and chronic 
conditions for patients with unmet medical needs. NMFC is committed to 
educating policymakers and the general public about the role of medical 
foods in the healthcare ecosystem, while advancing an agenda focused on 
increasing medical research, improving regulation and oversight, and 
increasing access through appropriate insurance coverage and 
reimbursement.
                          about medical foods
    As defined by the Orphan Drug Act of 1988, a medical food is, ``a 
food which is formulated to be consumed or administered enterally under 
the supervision of a physician, and which is intended for the specific 
dietary management of a disease or condition for which distinctive 
nutritional requirements, based on recognized scientific principles, 
are established by medical evaluation.''
                         policy recommendations
    Due to the tireless work of the patient advocacy community, there 
is a growing awareness of the challenges to patient access that impact 
individuals and families in need of medical foods. At this time, we ask 
that you consider the following:
  --Due to advancement in science and the advent of medical foods for a 
        variety of conditions, a timely opportunity exists to promote 
        and provide access by removing outdated restrictions in 
        Medicare Part D.
  --The Centers for Medicare and Medicaid Innovation (CMMI) at CMS are 
        interested in evaluating a variety of options to improve proper 
        coverage of meritorious medical foods and Congress should 
        encourage and collaborate on these efforts.
  --Please promote coverage and access across all forms of coverage by 
        supporting legislation that seeks to enhance access to medical 
        foods and work with your colleagues to consider options to 
        provide a regulatory framework for medical foods that is 
        distinct from the drug approval pathway and capable of 
        identifying safe and effective products.
  --There exist persistent misperceptions about medical foods that 
        often jeopardize coverage, including the mis-categorization of 
        medical foods as ``over the counter'' products in contravention 
        of FDA guidance, and opportunities exist to identify and 
        correct barriers stemming from incorrect information or a lack 
        of understanding. HHS through a variety of public health and 
        patient care mechanisms can raise awareness of medical foods 
        and address current gaps in understanding and care delivery.
                      recommended report language
Centers for Medicare and Medicaid Services Program Management
    Medical Foods.--The Committee recognizes ongoing scientific 
advancement and innovation in the medical foods space that has 
demonstrated the impact of nutrition and related interventions to a 
variety of patient communities, in addition to digestive and metabolic 
health. The Committee also notes the potential cost-effectiveness of 
many medical foods as part of a physician-directed treatment, including 
with potential applications for non-opioid pain management. CMS is 
encouraged to engage with the medical foods stakeholder community on 
efforts to better understand health and cost effectiveness and approach 
proper coverage paradigms that reflect the growing relevance of medical 
foods within the broader treatment and care landscape.
                               conclusion
    Please consider NMFC a resource as you work on relevant funding 
issues for FY 2023 and work with your colleagues to advance health 
policy legislation. If you have any questions or if you would like to 
discuss medical foods coverage and access policy further with the 
coalition, please consider us a resource.

    [This statement was submitted by P. Keith Daigle, Acting Director, 
Nutrition and Medical Foods Coalition.]
                                 ______
                                 
                   Prepared Statement of PACER Center
    PACER Center would like to thank the subcommittee on Labor, Health 
and Human Services, Education and Related Agencies (LHHS) for 
soliciting the views and recommendations of public witnesses on Fiscal 
Year (FY) 2023 funding.
    PACER is a Statewide and national parent center founded in 1978 and 
based in Minneapolis, Minnesota. PACER's mission is to enhance the 
quality of life and expand opportunities for children, youth, and young 
adults with all disabilities and their families so each person can 
reach his or her highest potential. PACER is staffed primarily by 
parents of children with disabilities. PACER also works to strengthen 
engagement between families and their schools to ensure that parents 
can be fully involved in the education of their children.
    This testimony highlights several critical issues. First, we 
respectfully request that the subcommittee match the President's FY 
2023 request of $45 million for the Parent Information Centers (PIC) 
program, provide $20 million for the Statewide Family Engagement 
Centers program, match the President's FY 2023 request of $2.9 billion 
for Part B of the Individuals with Disabilities Education Act (IDEA) 
and $1.4 million for the Parent Center program funded under the 
demonstration authority of the Rehabilitation Act of 1973. Second, we 
request that the subcommittee maintain bill language that was included 
in the FY 2022 bill that would permit States to subgrant funds under 
Part C of IDEA and report language that ensures that no less than the 
level provided in FY 2022 for the parent center program under 
Rehabilitation Act of 1973 be provided through the FY 2023 bill.
IDEA Parent Information Centers
    PACER respectfully requests that the subcommittee provide $45 
million for the PIC program at the U.S. Department of Education (ED). 
This level of funding is in line with President Biden's budget request 
for a $15 million increase for the program. The PIC program provides 
crucial assistance to families of children with disabilities, helping 
parents navigate the special education process and ensuring that they 
have the opportunity, knowledge, and skills to help their children with 
disabilities succeed. It also assists parents in navigating the early 
intervention system for infants and toddlers with disabilities and 
developmental delays from birth to age three.
    The PIC program funds Parent Training and Information Centers 
(PTIs), Community Parent Resource Centers (CPRCs), and technical 
assistance for parent centers. Under this program, each State has at 
least one PTI, with a combined total of nearly 100 centers, technical 
assistance centers, and CPRCs targeting underserved populations. 
Centers funded under this program make valuable contributions at the 
State and local level by helping schools improve services and outcomes 
for students with disabilities and providing critical information on 
resolving disputes that may arise between schools and families.
    We appreciate the $2.7 million increase provided for the Parent 
Information Centers program in FY 2022. Prior to FY 2022, the PIC 
program was level funded for a decade. Despite the level funding of 
this program, the number of IDEA-eligible students has increased 
dramatically. In 2010, approximately 6.6 million students were served 
under IDEA. In its most recent Congressional Justification, ED 
estimates that nearly 7.4 million eligible students will be served in 
2023. The PIC program also serves students who are eligible under 
Section 504 of the Rehabilitation Act. Such students numbered 1.4 
million in 2017-2018 and represented 2.7 percent of school enrollment. 
These increased numbers have required the Centers funded under the PIC 
program to try to do more with less. We believe that the rising 
enrollment of students with disabilities warrants the requested 
increase in funding for the institutions such as PACER and other PTIs 
that provide crucial support to the families of students with 
disabilities.
    In addition to the general increase in the number of children with 
disabilities and their families seeking services from centers funded 
under the PIC program, ED has cited rising service demands on centers 
due to the COVID-19 pandemic. In the Administration's FY 2023 budget 
proposal, ED cited that the ``demand for PTI services has increased 
dramatically'' during the COVID-19 pandemic including the need for 
increased virtual trainings. Children with disabilities were also one 
of the hardest hit populations during the pandemic, often having subpar 
access to online learning opportunities and having the most disruption 
to services, supports and accommodations they need to succeed 
academically.
Statewide Family Engagement Centers
    PACER Center also requests $20 million in funding for the Statewide 
Family Engagement Centers (SFEC) program to help achieve the goal of 
having an SFEC in every State and territory. PACER, in addition to 
serving as a PTI center, also serves as an SFEC and as such provides 
much-needed technical assistance and partnership development to States 
and school districts to foster meaningful engagement with families to 
further their children's academic and developmental progress. As with 
the PTI program, PACER Center appreciates the $2.5 million increase 
included for the SFEC program in the FY 2022 funding bill.
    SFECs provide vital direct services to improve engagement between 
children, parents, teachers, school leaders, counselors, 
administrators, and other school personnel. While SFECs work with all 
parents and schools throughout their state, many, including PACER 
Center, focus on students of color, English learners, and recent 
immigrant children working to integrate into their new communities. 
Research has shown that family engagement in a child's education 
increases student achievement, improves attendance, reduces the dropout 
rate, and advances the emotional and physical well-being of children. 
Students whose families are involved in their children's academic 
success attend school more regularly, earn better grades, enroll in 
more challenging academic programs, and have higher graduation rates. 
The SFEC program harnesses effective practices to help schools and 
districts implement systematic family engagement programs that build 
ties between the community, families, students, and schools.
                                  idea
    We also request a $2.9 billion increase in Part B of the 
Individuals with Disabilities Education Act (IDEA), matching President 
Biden's FY 2023 budget proposal. IDEA funding for Part B is critical in 
our home state of Minnesota and around the country. The Federal 
resources provided to meet the guarantee of a free appropriate public 
education under IDEA are critical as States and local school systems 
construct their annual budgets. This is especially true now as 
educators help children with disabilities recover lost learning time 
resulting from the COVID-19 pandemic. As stated above, the pandemic hit 
children with disabilities among the hardest and States, school 
districts, and schools need this significant increase in Federal 
resources to meet the needs of their children.
    While this focus on pandemic recovery and the need for resources is 
more recent, IDEA's current funding level continues to fall short of a 
path to full funding of Part B of IDEA. The Administration's budget 
estimates that their call for a $2.9 billion increase will raise the 
Federal share to 15 percent. This amount of a funding increase will 
restart the program on a path to full funding.
    With respect to Part C of IDEA, we request that the subcommittee 
maintain bill language that would permit States to subgrant Part C 
funds to organizations to carry out Part C State-level activities. This 
authority has been extremely useful in Minnesota to allow the State to 
reach families eligible for Part C across the State by avoiding the 
need to conduct such activities via a contract.
       rehabilitation act parent training and information centers
    We also support the Administration's request to increase funding by 
$1.4 million under the Demonstration and Training Authority in the 
Rehabilitation Act of 1973 for the National Parent Training and 
Information Center as well as the eight Regional Parent Training and 
Information Centers. The Administration's FY 2023 budget request 
documents how existing funding levels are insufficient to support the 
current workload. The budget request would allow the Regional Parent 
Training and Information Centers to expand collaboration and enhance 
services to consumers in their respective regions.
                                 
                                 ______
                                 
                 Prepared Statement of Peel Ann D. deg.
                   Prepared Statement of Ann D. Peel
    Madam Chairwoman,
    Amyloidosis is a rare and usually fatal disease. There is no known 
cure for amyloidosis, an abnormal folding protein disease that can 
destroy various major organs. I am submitting this testimony to request 
that the Committee include language in the fiscal year 2023 Labor, 
Health and Human Services report expanding NIH research funding and 
awareness efforts on amyloidosis.
    The COVID pandemic has brought about an awareness of the need to 
address health issues through increased investment in research. This 
investment in COVID has resulted in research that is saving lives 
through vaccines, early diagnosis and programs of awareness. It has 
heightened the need to accelerate research and awareness of 
amyloidosis, to prevent deaths, and to help patients with amyloidosis 
related multi-organ dysfunction.
    A further commitment to amyloidosis research, I believe, would 
prove to be a lifesaving investment.
    I want to thank this subcommittee for its efforts to raise 
awareness and funding for issues related to amyloidosis. Progress has 
been made on research into treatment and awareness. Efforts made by NIH 
and amyloidosis centers around the country are resulting in many more 
people being diagnosed and treated for amyloidosis than a decade ago.
    However, the causes of amyloidosis remain elusive. Amyloidosis can 
cause heart, kidney, or liver dysfunction and failure and severe 
neurological problems. Left untreated, the average survival is just 
months from the time of diagnosis.
    I have endured two stem cell transplants and chemotherapy in order 
to fight the deadly disease amyloidosis and have been one of the lucky 
ones to survive the disease for 19 years. This was due to the 
intensive, life-saving treatment that I have received through the 
Amyloidosis Center at Boston University School of Medicine and Boston 
Medical Center.
    I continue to participate in a clinical trial that looks for ways 
to diagnose and treat amyloidosis.
                          what is amyloidosis?
    I have been treated for primary amyloidosis, which is 
immunoglobulin light chain (AL) amyloidosis. This type of amyloidosis 
occurs when cells in the bone marrow produce an abnormal amyloidogenic 
protein and these form amyloid fibrils that are deposited in major 
organs, such as the heart, kidney and liver.
    These misfolded proteins clog the organs until they are no longer 
able to function-sometimes at a very rapid pace.
    In addition to AL amyloidosis, a blood or bone marrow disorder, 
there are also cases of inherited or familial amyloidosis and secondary 
or reactive amyloidosis. Familial amyloidosis may be present in a 
significant number of African Americans. Secondary or reactive 
amyloidosis occurs in patients with chronic infections or inflammatory 
diseases.
    All three types of amyloidosis, left undiagnosed or untreated, are 
fatal.
    There is no explanation for how or why amyloidosis develops and 
there is no known reliable cure. Thousands of people die because they 
were diagnosed too late to obtain effective treatment.
    Thousands of others die never knowing they had amyloidosis. The 
small numbers of those with amyloidosis who are able to obtain 
treatment face challenges that can include high dose chemotherapy and 
stem cell replacement or organ transplantation.
    Researchers have not been able to determine the root cause of the 
disease or an effective low-risk treatment. Amyloidosis can literally 
kill people before they even know that they have the disease.
    Older Americans are susceptible to heart disease due to amyloid 
formed from the non-mutated form of the same protein.
    One of the major concerns is that current methods of treatment are 
risky and unsuitable for many patients. Even with successful initial 
treatment, amyloidosis remains a threat since it can recur years later.
                      how is amyloidosis treated?
    Boston University School of Medicine and other centers for 
amyloidosis treatment have found that high dose intravenous 
chemotherapy followed by stem cell replacement, or rescue, is an 
effective treatment in selected patients with AL amyloidosis.
    Abnormal bone marrow cells are killed through high dose 
chemotherapy and the patient's own extracted blood stem cells are 
replaced in order to improve the recovery process.
    The high dose chemotherapy and stem cell transplantation and other 
new drugs have increased the remission rate and long-term survival 
dramatically. However, this treatment can also be life threatening and 
more research needs to be done to provide less risky forms of 
treatment.
               fiscal year 2023: more research is needed
    The COVID pandemic has illustrated the need to accelerate research 
and treatment on diseases such as amyloidosis. Here are the main points 
for taking action in the fiscal year 2023 bill:
    1. Thousands of people die because they were diagnosed with 
amyloidosis too late to obtain effective treatment. Many people are 
diagnosed after the point that they are physically able to undertake 
treatment.
    2. Thousands of others die never knowing they had amyloidosis.
    3. The small numbers of those with amyloidosis who are able to 
obtain treatment face challenges that can include high dose 
chemotherapy and stem cell replacement or organ transplantation.
    4. Additional funding for amyloidosis research and equipment is 
needed to increase the survival rate and to find safe treatments to 
help more patients.
    5. Although amyloidosis is often fatal, Federal and foundation 
support over the past years has given hope for successful new 
treatments.
    6. More efforts are needed to alert health professionals to 
identify this disease, to accelerate research and awareness of the 
disease, and to help patients with amyloidosis related multi-organ 
dysfunction.
    Amyloidosis is vastly under-diagnosed. Although I was diagnosed at 
a very early stage of the disease, many people are diagnosed after the 
point that they are physically able to undertake treatment.
    I believe there are many more cases of amyloidosis than are known, 
as the disease can escape diagnosis and patients die of ``heart 
failure,'' ``liver failure,'' etc. In reality, some of these people had 
amyloidosis.
    Perhaps amyloidosis is not as rare a disease as we think.
    Through the leadership of this Committee and the further 
involvement of the U.S. Government, several positive developments have 
occurred. Research supported by the National Institute of Neurologic 
Disorders and Stroke at NIH and the Office of Orphan Products 
Development at the Food and Drug Administration led to successful 
repurposing of a generic drug that markedly slows progression of 
familial amyloidosis.
    Madam Chairwoman, the United States Congress and the Executive 
branch working together are key to finding a cure for and alerting 
people to this terrible disease. Expanding funding for research and 
treatment of amyloidosis is key to preventing death from amyloidosis.
    I want to use my experience with this rare disease to help save the 
lives of others. With your support, more can be done to help me achieve 
this dream.
                                 ______
                                 
       Prepared Statement of the Personalized Medicine Coalition
    Chairwoman Murray, Ranking Member Blunt and distinguished members 
of the subcommittee, the Personalized Medicine Coalition (PMC) 
appreciates the opportunity to submit testimony on the National 
Institutes of Health (NIH) fiscal year (FY) 2023 appropriations and to 
highlight the importance of NIH-funded research to personalized 
medicine. PMC is a nonprofit education and advocacy organization 
comprised of more than 220 institutions from across the health care 
spectrum who have come together to support this growing field. We 
appreciate the sustained, robust funding for NIH provided by the 
subcommittee in recent years, which has allowed NIH to continue 
building the foundation of scientific knowledge underpinning 
personalized medicine in the midst of unprecedented challenges. 
Sustaining this momentum will be essential to support further discovery 
of targeted health care interventions for patients with cancer as well 
as rare, common, and infectious diseases. As the subcommittee begins 
work on the FY 2023 Labor, Health and Human Services, Education and 
Related Agencies appropriations bill, we request at least $49.048 
billion for NIH's base program level budget. We also urge you to ensure 
that funds for targeted programs, like those supporting the new 
Advanced Research Projects Agency for Health (ARPA-H) and pandemic 
preparedness, supplement this request for NIH's base program level 
budget.
    Our funding request for FY 2023 amounts to a $4.1 billion (or 
nearly 8 percent) increase to the NIH budget, including funding for 
specific initiatives under the 21st Century Cures Act (Cures Act). This 
request would allow for meaningful growth above inflation in NIH's base 
budget and expand NIH's capacity to support progress in personalized 
medicine.
    Personalized medicine, also called precision or individualized 
medicine, is an evolving field in which physicians use diagnostic tests 
to determine which medical treatments will work best for each patient 
or use medical interventions to alter molecular mechanisms that impact 
health. By combining data from diagnostic tests with an individual's 
medical history, circumstances, and values, health care providers can 
develop targeted treatment and prevention plans with their patients. 
Personalized medicine promises to detect the onset of disease, pre-empt 
its progression, and improve the quality, accessibility, and 
affordability of health care.\1\ By increasing the government's 
investment in science at this pivotal moment, Congress can help advance 
a new era of personalized medicine that promises a brighter future for 
patients and health systems.
---------------------------------------------------------------------------
    \1\ http://www.personalizedmedicinecoalition.org/Userfiles/PMC-
Corporate/file/PMC_The_
Personalized_Medicine_Report_Opportunity_Challenges_and_the_Future.pdf.
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              i. the role of nih in personalized medicine
    Decades of NIH-funded biomedical research on the genetic and 
biological underpinnings of disease have contributed to the development 
of personalized treatments that patients are benefitting from today. As 
of 2020, this research has informed the development of more than 286 
personalized treatments \2\ and over 166,703 genetic testing 
products.\3\ These numbers continue to grow, with personalized 
medicines accounting for more than a quarter of all new drugs approved 
by FDA each of the past 7 years and with more than half of new 
personalized treatments being approved for indications outside of 
oncology.\4\ Nearly 20 years since the historic completion of the Human 
Genome Project in 2003, researchers recently finished deciphering the 
final 8 percent of the roughly 3-billion-base human genome sequence 
that was previously impossible to decode.\5\ Having a complete, gap-
free reference sequence of human DNA will further improve our 
understanding of how genes influence human health. In recent years, 
scientists have also made notable progress in assessing biomarkers 
beyond the genome, such as proteomic and metabolic biomarkers.\6\ 
Harnessing the power of personalized medicine to better diagnose, 
treat, and prevent disease will require a continued commitment by 
Congress to fund NIH's basic and translational research.
---------------------------------------------------------------------------
    \2\ http://www.personalizedmedicinecoalition.org/Userfiles/PMC-
Corporate/file/PMC_The_
Personalized_Medicine_Report_Opportunity_Challenges_and_the_Future.pdf.
    \3\  https://doi.org/10.1002/ajmg.c.31881.
    \4\ https://www.personalizedmedicinecoalition.org/Userfiles/PMC-
Corporate/file/Personalized_
Medicine_at_FDA_The_Scope_Significance_of_Progress_in_2021.pdf.
    \5\ https://www.nih.gov/news-events/nih-research-matters/first-
complete-sequence-human-
genome.
    \6\ https://www.personalizedmedicinecoalition.org/Userfiles/PMC-
Corporate/file/PMC_The_
Personalized_Medicine_Report_Opportunity_Challenges_and_the_Future.pdf.
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   ii. sustaining basic and translational research for personalized 
                                medicine
    NIH is leading much of the scientific discovery for personalized 
medicine, which begins with basic research that generates fundamental 
knowledge about the molecular basis of a disease and with translational 
research aimed at applying that knowledge to develop a treatment or 
cure. Many institutes and centers at NIH are contributing research 
informing the development of personalized medicines, including the 
National Human Genome Research Institute (NHGRI), the National Cancer 
Institute (NCI), the National Institute on Aging (NIA), the National 
Heart, Lung and Blood Institute (NHLBI), the National Institute of 
Diabetes and Digestive and Kidney Diseases (NIDDK), the National Center 
for Advancing Translational Sciences (NCATS), and the National 
Institute on Minority Health and Health Disparities (NIMHD). A robust 
base budget for NIH in FY 2023 would protect the agency's foundational 
role in the identification and development of treatments, technologies, 
and tools for personalized medicine.
    Cancer care has been and will continue to be profoundly influenced 
by new personalized medicine approaches for detecting and treating 
early- and late-stage cancers. In 2021, for example, FDA approved two 
new chimeric antigen receptor (CAR) T-cell-based immunotherapies for 
patients with refractory large B-cell lymphoma and refractory multiple 
myeloma.\7\ These treatments work by genetically re-engineering a 
patient's own immune cells to combat cancer. Over the past decade, 
personalized treatments harnessing the immune system have also driven 
declines in mortality for lung cancer and melanoma. Recognizing the 
potential of multi-cancer early-detection tests designed to find 
evidence of cancer wherever it occurs in the body from a simple blood 
draw, NCI is also exploring large national trials to evaluate these 
novel tests and is already funding the collection of blood samples to 
serve as controls. These tests may provide less invasive testing 
options that could detect a patient's cancer at early stages when 
treatment may be more effective and less costly.
---------------------------------------------------------------------------
    \7\ https://www.personalizedmedicinecoalition.org/Userfiles/PMC-
Corporate/file/Personalized_
Medicine_at_FDA_The_Scope_Significance_of_Progress_in_2021.pdf.
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    Basic and translational research also offers opportunities for 
personalized medicine beyond oncology, especially for rare diseases. 
Although individually rare, rare diseases collectively affect an 
estimated 25 to 30 million Americans. With advances in genomics, the 
molecular causes of 6,500 rare diseases have been identified--but only 
about 5 percent have an FDA-approved treatment. Over the past decade, 
programs at NCATS have helped shift the scientific approach to 
researching rare diseases from one disease at a time to many diseases 
at a time. Pooling patients, data, experiences, and resources promises 
to lead to more successful clinical trials sooner for rare disease 
patients who presently have few or no treatment and diagnostic options. 
Accelerating this research can help shorten the average of 6 years it 
takes for a rare disease patient to find the correct diagnosis and 
lower the nearly $1 trillion annual economic burden of rare 
diseases.\8\
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    \8\ https://everylifefoundation.org/burden-study/.
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    Other patients are living with highly prevalent diseases where 
personalized medicine can offer better treatments or a cure. For 
example, the Alzheimer's Association estimates that 6.2 million 
Americans are living with Alzheimer's disease.\9\ Despite increasing 
numbers of Alzheimer's diagnoses, researchers still need to study the 
genetic underpinnings of Alzheimer's disease to more fully understand 
its complexity. To shorten the time between the discovery of potential 
drug targets and the development of new drugs, the Accelerating 
Medicines Partnership (AMP) for Alzheimer's disease, led by NIH, has 
identified over 500 drug targets, and in 2021 the public-private 
partnership launched a second iteration to enable a personalized 
medicine approach to researching new treatments.\10\ Other new and 
ongoing AMP projects aim to facilitate the development of gene 
therapies for rare diseases as well as treatments and diagnostics for 
type 2 diabetes, rheumatoid arthritis, lupus, Parkinson's disease, 
common metabolic diseases like kidney and heart disease, and 
schizophrenia.
---------------------------------------------------------------------------
    \9\ https://www.alz.org/media/Documents/alzheimers-facts-and-
figures.pdf.
    \10\ https://www.nih.gov/research-training/accelerating-medicines-
partnership-amp/alzheimers-disease.
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    Ensuring that scientific breakthroughs in personalized medicine are 
impactful to all patients will require the inclusive and equitable 
representation of patients with diverse characteristics and health 
needs in research and clinical trials. Multiple initiatives at NIH to 
improve research policies and incorporate diverse perspectives into 
solving complex scientific problems--such as through the UNITE 
initiative, NHGRI's action agenda for a diverse genomics workforce, and 
the forthcoming NIH-Wide Diversity, Equity, Inclusion, and 
Accessibility Strategic Plan--will play a key role in addressing these 
disparities, as will the research led by NIMHD on improving minority 
health and understanding factors contributing to health disparities.
            iii. accelerating personalized medicine research
    Increasing NIH's base budget will also ensure that the agency has 
the resources necessary to advance the longstanding aspects of its 
mission without de-prioritizing supplemental initiatives in 
personalized medicine provided for by Congress in the Cures Act.
    The first of these initiatives made possible in part by the Cures 
Act, the All of Us\TM\ Research Program, was launched in 2018 to begin 
collecting genetic and health information from one million volunteers 
as part of a decades-long research project. As of March 2022, over 
475,000 individuals consented to participate, with more than 326,000 
being fully enrolled.\11\ More than 80 percent of the enrolled 
individuals are from groups historically underrepresented in 
research\12\ such as seniors, women, Hispanics and Latinos, African 
Americans, Asian Americans, and members of the LGBTQ community. 
Extensive efforts are also underway to engage American Indian and 
Alaska Native communities. Reaching a significant milestone, the 
program recently released its first dataset of nearly 100,000 whole 
genome sequences,\13\ and over 1,100 research projects have been 
launched using the program's groundbreaking dataset. Later this year, 
the program also plans to begin sharing results with participants on 
their hereditary disease risk and medication-gene interactions. Pooling 
health care data across large datasets that span populations and 
disease areas will play a key role in advancing research for 
personalized medicine approaches to care.
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    \11\ https://www.joinallofus.org/newsletters/2022/march.
    \12\ https://officeofbudget.od.nih.gov/pdfs/FY23/br/
Overview%20of%20FY%202023%20Presidents percent20Budget.pdf.
    \13\ https://directorsblog.nih.gov/2022/03/29/nihs-all-of-us-
research-programs-first-nearly-100000-complete-human-genome-sequences-
set-stage-for-new-discoveries/.
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    The second initiative spurred by the Cures Act, the Beau Biden 
Cancer Moonshot, aims to transform the way cancer research is conducted 
by fostering collaboration and data sharing. As it enters its seventh 
year, the Cancer Moonshot has grown to support over 240 new research 
projects \14\ and has established a significant infrastructure for 
conducting cancer research and sharing resources.\15\ Collaborations 
formed by the program include the Partnership for Accelerating Cancer 
Therapies (PACT), which consists of 12 pharmaceutical companies, the 
Foundation for NIH, and FDA working together to identify, develop, and 
validate biomarkers advancing the discovery of new immunotherapy 
treatments. This year, President Biden announced a bold new goal for 
the initiative of ending cancer as we know it. Funding provided by the 
Cures Act ends in FY 2023, and additional base budget funding will help 
NCI sustain this progress that has already been made in cancer research 
once the Cures Act funding expires.
---------------------------------------------------------------------------
    \14\ https://doi.org/10.1016/j.ccell.2021.04.015.
    \15\ https://www.cancer.gov/research/annual-plan/directors-message.
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                             iv. conclusion
    PMC appreciates the opportunity to highlight NIH's importance to 
the continued success of personalized medicine. PMC believes that basic 
and translational research at NIH is key to bringing us closer to a 
future in which every patient benefits from an individualized approach 
to health care. Therefore, we urge the subcommittee to appropriate at 
least a $49.048 billion budget to support existing centers and programs 
at NIH, in addition to funding Congress may provide for targeted 
initiatives.

    [This statement was submitted by Cynthia A. Bens, Senior Vice 
President, Public Policy, Personalized Medicine Coalition.]
                                 ______
                                 
  Prepared Statement of the Physician Assistant Education Association
    The Physician Assistant Education Association (PAEA), representing 
the 287 accredited PA programs in the United States that graduate more 
than 10,000 students each year, appreciates the opportunity to submit 
the following testimony on the Association's funding priorities for 
Fiscal Year (FY) 2023. Throughout the COVID-19 pandemic, the issue of 
provider shortages, particularly in historically underserved 
communities, has received renewed attention. As practicing providers 
have experienced unprecedented strain during the past 2 years, 
increasing rates of burnout and attrition has made congressional action 
to support workforce development an urgent imperative. To address these 
challenges and mitigate further projected workforce shortages, it is 
critical that Congress make bold investments in both proven and new 
programs that support the development of a sufficient supply of well-
trained, diverse providers in the communities where they are needed 
most.
    PAEA joins with the Health Professions and Nursing Education 
Coalition, a national alliance of more than 90 organizations, to 
request a total of $1.51 billion in FY23 for the Title VII health 
professions and Title VIII nursing workforce development programs 
administered by the Health Resources and Services Administration 
(HRSA). This funding level, a significant increase from the $799 
million allocated for Title VII and VIII in FY22, would provide the 
resources necessary to meet workforce demand and promote equitable 
outcomes for all patients.
            background on the pa profession and pa education
    As Congress seeks to bolster the health workforce following the 
pandemic, PAs are uniquely equipped to be a key part of the solution 
given the accelerated training model and wide practice flexibility that 
has characterized the profession since its inception. Following their 
baccalaureate-level education, all PA students complete a rigorous 
graduate-level curriculum based upon the more than 100-year-old model 
of medical student training. The typical PA program curriculum consists 
of approximately 1 year of classroom-based training followed by 1 year 
of clinical rotations under the supervision of practicing preceptors. 
During their clinical year, students complete placements in family 
medicine, emergency medicine, surgery, pediatrics, women's health, and 
behavioral health in a wide array of practice settings. This generalist 
approach to PA education provides graduates with the necessary 
knowledge and experience to switch specialties over the course of their 
careers based upon workforce needs without additional required post-
graduate training.
    In recognition of the quality of services rendered by PA graduates 
and in response to significant projected physician shortages, the 
number of PA programs has risen significantly in the past decade, 
growing from 149 in 2010 to 287 as of 2022. While the promise of this 
expansion to combat workforce shortages is considerable, its 
sustainability depends upon PA programs having access to the resources 
necessary to provide high-quality training to students. Despite 
widespread vaccine availability and reduced pressure on health systems 
as COVID-19-related hospitalizations have fallen, nearly 85 percent of 
PA programs indicate that their existing clinical training sites 
continue to take fewer students than prior to the pandemic.\1\ This 
reduction in clinical education capacity is the most daunting challenge 
facing PA programs across the Nation and, if left unaddressed, 
threatens the ability of programs to meet demand for graduate services.
---------------------------------------------------------------------------
    \1\ Physician Assistant Education Association. (2021). COVID-19 
Rapid Response Report 3. https://paea.edcast.com/insights/ECL-c621408d-
c82a-43f5-a067-75a03494d8be..
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    In response to this challenge, HRSA has taken steps to expand 
clinical site access but currently has limited resources to address the 
crisis. In September 2021, HRSA released the Primary Care Training and 
Enhancement--Physician Assistant Rural Training funding opportunity, 
explicitly allowing grantees to pay preceptors to train students in 
rural communities in order to expand access to placements. While this 
program is well-aligned with the needs of PA education, current PCTE 
funding levels only allowed 7 PA programs to receive an award through 
this competition. If the program is to meaningfully achieve its 
intended aim, significantly increased funding will be needed to broaden 
the scope of this opportunity.
    Beyond PCTE grants, an additional critical source of support to 
expand clinical education capacity is Area Health Education Centers 
(AHECs), which facilitate clinical placements for PA and other health 
professions students in underserved areas through community 
partnerships. In academic year 2020-2021, AHEC grantees facilitated 
over 27,000 clinical rotations for health professions students with 
approximately 70 percent taking place in medically underserved 
communities and 60 percent occurring in primary care settings.\2\ To 
further expand clinical education capacity and meet workforce demand, 
PAEA urges the subcommittee to support a funding level of $98 million 
for PCTE grants and $86 million for AHECs in FY23.
---------------------------------------------------------------------------
    \2\ Health Resources and Services Administration. (2022). 
Justification of Estimates for Appropriations Committees. https://
www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-
justification-fy2023.pdf.
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                     promoting workforce diversity
    As Congress works to address the toll that COVID-19 has taken on 
the Nation's health workforce, particular emphasis must be placed on 
reducing barriers that prevent the workforce from reflecting the 
communities that it serves. Across disciplines, students from 
marginalized communities often face daunting socioeconomic challenges 
to successfully entering the health professions and practicing in the 
communities where their services are needed most. In the case of PA 
education, only 3.9 percent of first-year PA students identify as Black 
or African American and 9.1 percent identify as Hispanic or Latino as 
of 2019.3 Representation steadily declines among graduates with 3 
percent identifying as Black or African American and 6.8 percent 
identifying as Hispanic or Latino.\3\
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    \3\ Physician Assistant Education Association. (2020). By the 
Numbers: Student Report 4: Data from the 2019 Matriculating Student and 
End of Program Surveys. https://paeaonline.org/wp-content/uploads/
imported-files/student-report-4-updated-20201201.pdf.
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    To combat these trends and promote the availability of culturally 
competent care for patients, PAEA believes it is critical to 
significantly increase the scale of HRSA's existing workforce diversity 
programs, which aim to provide support to marginalized students 
throughout the continuum of their education. Specifically, the Health 
Careers Opportunity Program (HCOP) provides targeted K-16 programming 
targeted to marginalized students to expose them to the possibility of 
pursuing a career in the health professions and ensure they have the 
resources necessary to matriculate into a program. In FY20, HCOP 
grantees provided this type of support to 2,452 underrepresented 
minority students interested in pursuing careers in the health 
professions.\2\
    Beyond HCOP, HRSA programs also seek to ensure that students are 
retained in their programs through graduation. The Scholarships for 
Disadvantaged Students (SDS) program provides financial support to meet 
this aim. In FY20, SDS supported more than 2,600 disadvantaged health 
professions students with 65 percent being from underrepresented 
minority communities.\2\ To ensure that these programs are scaled to 
meet patient demand for a diverse health workforce, PAEA urges the 
subcommittee to fund HCOP and SDS at a level of $30 million and $103 
million, respectively, for FY23.
                combating maternal mortality disparities
    While COVID-19 has been the predominant focus of national public 
health policy since 2020, other long-standing public health challenges 
have persisted throughout the pandemic. Currently, the United States 
has one of the highest maternal mortality rates among industrialized 
nations at a rate of 23.8 deaths per 100,000 live births as of 2020 
with many deaths concentrated in historically underserved areas.\4\ 
Black or African American women continue to be disproportionately 
affected by this crisis with a mortality rate of 55.3 deaths per 
100,000 live births--nearly three times the rate of non-Hispanic white 
women.\4\ While the causes of maternal mortality disparities are 
multifactorial, a key concern is limited access to well-trained 
providers with the capacity to provide the culturally competent care 
that patients deserve.
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    \4\ Centers for Disease Control and Prevention. (2022). Maternal 
Mortality Rates in the United States, 2020. https://www.cdc.gov/nchs/
data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm.
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    Ensuring the availability of a high-quality workforce requires 
investments in clinical training in the communities where care is most 
needed. However, at a time when providers are most needed to address 
this issue, the availability of training opportunities for students is 
significantly declining. Nearly 75 percent of PA programs indicate that 
it is either harder or much harder to secure clinical rotations in 
obstetrics/gynecology/women's health than prior to the COVID-19 
pandemic--a critical threat to the ability of PA education to respond 
to demand for providers.\1\
    Recognizing this challenge, Congress authorized a new Rural 
Maternal and Obstetric Care Training demonstration program in the 
omnibus appropriations legislation enacted for FY22. This program is 
intended to provide funding to PA education and other health 
professions programs to support clinical training opportunities in 
community-based settings with the aim of strengthening the pipeline and 
increasing the supply of providers practicing in these communities. 
PAEA strongly supports this program's authorization and urges the 
subcommittee to provide $5 million for its initiation in FY23.
                    fiscal year 2023 recommendation
    To mitigate the toll that COVID-19 has taken on providers across 
the country, Congress must seize the opportunity to make bold 
investments to strengthen the supply and diversity of the health 
workforce and ensure access to high-quality care for all patients. The 
Association joins the Health Professions and Nursing Education 
Coalition in requesting $1.51 billion in funding for the Title VII 
health professions and Title VIII nursing workforce development 
programs in FY23. PAEA thanks the subcommittee for the opportunity to 
submit testimony and looks forward to the opportunity to serve as a 
resource to members and staff.

    [This statement was submitted by Kara Caruthers, MSPAS, PA-C, 
President, Physician Assistant Education Association.]
                                 ______
                                 
Prepared Statement of the Physicians Committee for Responsible Medicine
    On behalf of the Physicians Committee for Responsible Medicine, 
thank you for the opportunity to submit this written testimony. The 
Physicians Committee is a nonprofit organization with more than 175,000 
members worldwide that works to make medical research more effective 
and ethical. As the subcommittee crafts the FY 2023 Labor, Health and 
Human Services, Education, and Related Agencies Appropriations bill, 
the Physicians Committee asks that you please consider the following 
provision to increase transparency and public accountability regarding 
research funded by the National Institutes of Health (NIH).
                              the problem
    Research transparency and accountability are vital to ensure that 
the United States remains a global leader in medical research. While 
the governments of other countries-including the United Kingdom, 
Canada, and the entire European Union-collect and publish detailed 
information on the number of animals used in research and testing, the 
United States lags far behind. Estimates of the number of animals used 
each year in U.S. laboratories vary wildly-from 10 million to 110 
million \1\--and the vast majority of those animals are utilized by 
federally funded labs. The drastic difference in estimates demonstrates 
that accurate reporting is needed.
---------------------------------------------------------------------------
    \1\ Carbone, L. Estimating mouse and rat use in American 
laboratories by extrapolation from Animal Welfare Act-regulated 
species. Sci Rep 11, 493 (2021). https://doi.org/10.1038/s41598-020-
79961-0.
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    The U.S. commitment to the ``3Rs'' principles of refinement, 
reduction, and replacement of animals in research is described in the 
Guide for the Care and Use of Laboratory Animals,\2\ the use of which 
is required by the Public Health Service Policy. Integral to this 
commitment are the accurate counting of animals used in experiments and 
the accurate reporting of Federal funding dedicated to projects 
involving animals. It has been the NIH's policy since 1985 to collect 
an ``average daily inventory'' \3\ of vertebrate animals housed in 
research facilities that wish to receive agency funding. This 
``average'' is highly inaccurate; it is only a crude estimate of how 
many animals are present in the facility on any given day, not an 
annual total, and facilities are only required to file such 
documentation every 4 years as part of an Animal Welfare Assurance. 
Further, copies of these documents are available to the public only 
through Freedom of Information Act requests, making large-scale 
tracking and accountability efforts impossible.
---------------------------------------------------------------------------
    \2\ National Research Council. 2011. Guide for the Care and Use of 
Laboratory Animals: Eighth Edition. Washington, DC: The National 
Academies Press. https://doi.org/10.17226/12910.
    \3\ National Institutes of Health, Office of Laboratory Animal 
Welfare. PHS Policy on Humane Care and Use of Laboratory Animals. 
https://olaw.nih.gov/policies-laws/phs-policy.htm.
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                              the solution
    Congress must improve the accuracy and transparency of animal use 
in federally funded research by instructing the NIH to do two things:
      1. NIH must provide a plan to Congress detailing how the agency 
        will annually collect an accounting of vertebrate animals from 
        all agency-funded researchers, organized by species and pain 
        and distress category. The plan should also require the NIH to 
        detail how it will provide public access to this information.
      2. NIH must also provide a plan for tracking and publishing 
        information on NIH-funded projects involving the use of 
        vertebrate animals. The NIH currently collects such information 
        with every grant application using the Research & Related Other 
        Project Information form, which asks applicants to answer 
        ``Yes'' or ``No'' to the question ``Are Vertebrate Animals 
        Used?'' \4\ Making the answer to this question searchable for 
        each funded project via the NIH's Research Portfolio Online 
        Reporting Tools website \5\ or a similar database is a vital 
        step toward greater transparency of Federal research spending.
---------------------------------------------------------------------------
    \4\ National Institutes of Health. ``G.220--R&R Other Project 
Information Form.'' Accessed August 20, 2020. https://grants.nih.gov/
grants/how-to-apply-application-guide/forms-e/general/g.220-r&r-other-
project-information-form.htm.
    \5\ National Institutes of Health. ``RePORTER.'' Accessed February 
4, 2022. https://reporter.nih.gov/.
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                             recent history
    A similar requirement was included in the House-passed H. Rpt. 117-
96 and the Senate draft FY 2022 committee report.\6\ However, the 
finalized text in the omnibus joint explanatory statement (JES) failed 
to include important specifics included in the aforementioned committee 
reports, and detailed in the requested language below, including the 
directives to (1) create plans for collecting and reporting animal 
numbers and species used and (2) identifying which NIH grants involve 
animals. Instead, the omnibus FY 2022 JES language requested a report 
from the NIH outlining a plan to ``increase the accuracy and 
transparency of the data collected'' and to detail ``how NIH will 
address any incomplete reporting of NIH-funded research with animals.'' 
To ensure that the forthcoming report meaningfully achieves the goals 
described above, it is crucial that these specifics are restored.
---------------------------------------------------------------------------
    \6\ United States Senate Committee on Appropriations, ``Chairman 
Leahy Releases Remaining Nine Senate Appropriations Bills.'' https://
www.appropriations.senate.gov/imo/media/doc/LHHSREPT_FINAL3.PDF.
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                       requested report language
    ``Collection and Reporting of Animal Research Numbers and Agency 
Funding.--The Committee recognizes that Congress has long expressed an 
interest in reducing the use of nonhuman animals in NIH-funded research 
and replacing animals with valid, reliable alternatives. In the 
National Institutes of Health Revitalization Act of 1993, Congress 
first requested that the agency create a plan for doing so. The 
Committee also recognizes the scientific community's stated commitment 
to the ''three Rs'' of replacement, reduction, and refinement. Integral 
to that commitment are the accurate counting of animals used in 
research and testing and the accurate reporting of NIH funding 
dedicated to projects involving animals. The Committee recognizes that 
it has been NIH's policy since 1985 to collect an ''average daily 
inventory'' of vertebrate animals housed in research facilities that 
wish to receive agency funding. The Committee understands that domestic 
facilities are required to file such documentation every 4 years as 
part of an Animal Welfare Assurance and that copies of the documents 
are available to the public only through Freedom of Information Act 
requests. The Committee anticipates the report requested in the Joint 
Explanatory Statement for the Consolidated Appropriations Act, 2022 
(Public Law 117-103) outlining a plan to improve the accuracy and 
transparency of collected data. However, the Committee directs NIH to 
include in the forthcoming report how the agency plans to annually 
collect from each research facility that receives NIH funding the total 
number of animals bred, housed, and used in the previous year, sorted 
by species and pain and distress categories. Further, the Committee 
directs NIH to include in the report a draft form for collecting this 
information annually. NIH should also include details on how the agency 
will create a publicly accessible online database for dissemination of 
the information collected via the new annual forms. The Committee 
directs NIH to include in its report a plan for implementing a system 
that identifies which agency-funded projects involve the use of animals 
and makes the information publicly accessible. The Committee recognizes 
that NIH currently collects such information with every grant 
application using the Research & Related Other Project Information 
form, which asks applicants to answer ''Yes'' or ''No'' to the question 
''Are Vertebrate Animals Used?'' NIH's plan should ensure that the 
answer to that question for each funded project is searchable via the 
Expenditures and Results module of NIH's Research Portfolio Online 
Reporting Tools website.''

    [This statement was submitted by Ryan Merkley, Director of Research 
Advocacy, Physicians Committee for Responsible Medicine.]
                                 ______
                                 
          Prepared Statement of the Population Association of 
               America/Association of Population Centers
    Thank you, Chair Murray and Ranking Member Blunt for this 
opportunity to express support for the National Institutes of Health 
(NIH), National Center for Health Statistics (NCHS), Institute of 
Education Sciences (IES), and Bureau of Labor Statistics (BLS). These 
agencies are important to the members of the Population Association of 
America (PAA) and Association of Population Centers (APC) because they 
provide direct and indirect support to population scientists and the 
field of population, or demographic, research overall. In fiscal year 
2023, we urge the subcommittee to adopt the following funding 
recommendations for agencies under its jurisdiction: $49 billion, NIH; 
$210 million, NCHS; $815 million, IES; and $814 million, BLS. In 
addition, we urge the subcommittee to accept report language, 
previously submitted, regarding population research programs and 
surveys supported by the National Institute on Aging and Eunice Kennedy 
Shriver National Institute on Child Health and Human Development at the 
National Institutes of Health.
                     national institutes of health
    Demography is the study of populations and how or why they change. 
The health of our population is fundamentally intertwined with the 
demography of our population. Recognizing the connection between health 
and demography, NIH supports population research programs primarily 
through the National Institute on Aging (NIA) and the National 
Institute of Child Health and Human Development (NICHD). PAA and APC 
thank Chair Murray and Ranking Member Blunt for their bipartisan 
leadership and for working together in recent years to provide the NIH 
with robust, sustained funding increases. As members of the Ad Hoc 
Group for Medical Research, PAA and APC recommend the subcommittee 
continue to prioritize NIH funding by endorsing an appropriation of at 
least $49 billion for the NIH, a $4.1 billion increase over the NIH's 
program level funding in fiscal year 2022. In addition, we urge the 
Committee to ensure that any funding for the new Advanced Research 
Project Agency for Health (ARPA-H), supplements the $49 billion 
recommendation for NIH's base budget, rather than supplants the 
essential foundational investment in the NIH. Finally, we urge that NIA 
and NICHD, as components of the NIH, receive commensurate funding 
increases (7.9 percent) in fiscal year 2023.
                      national institute on aging
    The NIA Division of Behavioral and Social Research (DBSR) is the 
primary source of Federal support for basic population aging research. 
The NIA Division of Behavioral and Social Research (DBSR) supports a 
scientifically innovative population aging research portfolio that 
reflects some of the Institute's, and nation's, highest scientific 
priorities including Alzheimer's disease and social inequality in 
health and the aging process. With additional support in fiscal year 
2023, DBSR could expand its existing research portfolio to encourage 
more research on the short and long-term social, behavioral, and 
economic health consequences of COVID on older people and their 
families. The population research community is especially eager to see 
NIA use existing large-scale, longitudinal and panel surveys, such as 
the Health and Retirement Study, the National Health and Aging Trends 
Study, and Understanding America Study, to facilitate scientific 
research on the complex, multifaceted effects of the pandemic on older, 
diverse populations. Further, the field believes NIA should sustain its 
support for developing data infrastructure to promote research on 
racial, ethnic, gender, and socioeconomic disparities in health and 
well-being in later life and the long-term effects of early life 
experiences. With additional funding in fiscal year 2023, DBSR could 
support these activities as well as fully fund the NIA Centers on the 
Demography and Economics of Aging, which are conducting research on the 
demographic, economic, social, and health consequences of U.S. and 
global aging at 12 universities nationwide and proceed with plans to 
integrate the population sciences into the Institute's Geroscience 
research agenda.
  eunice kennedy shriver national institute on child health and human 
                              development
    Since the Institute's inception in 1962, NICHD has had a clear 
mandate to support a robust research portfolio focusing on maternal and 
child health, the social determinants of health, and human development 
across the lifespan. The NICHD Population Dynamics Branch meets this 
mandate by supporting innovative and influential population science 
initiatives, including: 1) large-scale longitudinal surveys, with 
population representative samples, such as The National Longitudinal 
Study of Adolescent to Adult Health and Fragile Families and Child Well 
Being Study; 2) a nationwide network of population science research and 
training centers; and, 3) numerous scientific research initiatives that 
have advanced our understanding of specific diseases and conditions, 
including obesity, autism, and maternal mortality, and, further, how 
socioeconomic and biological factors jointly determine human health. 
Given the dearth of data being collected regarding the short and long-
term social, economic, developmental, and health effects of the COVID 
pandemic on children and families, the field of population research 
urges NICHD to consider expanding data collection through existing 
surveys and the NICHD Population Dynamics Centers Research 
Infrastructure Program. Population scientists support NICHD exploring 
the use of existing and new mechanisms to enhance research regarding 
the effects of COVID on fertility trends and reproductive health 
overall and developing informed frameworks for conceptualizing and 
measuring social determinants of health, including structural racism. 
With additional funding in fiscal year 2023, the Institute could 
sustain its existing population research activities as well as pursue 
our field's recommendations regarding these additional research 
activities related to COVID and social determinants of health.
                 national center for health statistics
    NCHS is the Nation's principal health statistics agency, providing 
data on the health of the U.S. population. Population scientists rely 
on large NCHS-supported health surveys, especially the National Health 
Interview Survey and National Health and Nutrition Examination Survey, 
to study demographic, socioeconomic, and behavioral differences in 
health and mortality outcomes. They also rely on the vital statistics 
data that NCHS releases to track trends in fertility, mortality, and 
disability. NCHS health data are an essential part of the Nation's 
statistical and public health infrastructure. In order for NCHS to 
continue monitoring the health of the American people and to allow the 
agency to make much-needed investments in the next generation of its 
surveys and products, PAA and APC, as members of the Friends of NCHS, 
recommend the agency receive $210 million in fiscal year 2023, which is 
$30 million above its fiscal year 2022 appropriation, restoring the 
agency to its FY2010 inflation adjusted level. In addition, our 
organizations urge the subcommittee to reiterate its support for the 
agency's participation in the Centers for Disease Control (CDC) Data 
Modernization Initiative (DMI). NCHS should be benefitting from DMI 
funds, as the Committee intended, and applying them to make long 
overdue and necessary systematic and technological upgrades as well as 
facilitating enhanced use of Electronic Health Records. PAA and APC are 
especially supportive of NCHS using additional funding to improve the 
quality of vital statistics data to inform research regarding the 
underlying causes of mortality and health disparities across different 
population and geographies.
                       bureau of labor statistics
    Population scientists who study and evaluate labor and related 
economic policies use BLS data extensively. The field also relies on 
unique BLS-supported surveys, such as the American Time Use Survey and 
National Longitudinal Surveys, to understand how work, unemployment, 
and retirement influence health and well-being outcomes across the 
lifespan. As members of the Friends of Labor Statistics, PAA and APC 
are grateful to the subcommittee for providing the agency with steady 
increases since fiscal year 2018-especially after years of flat 
funding. We are also pleased that the subcommittee included language in 
its fiscal year 2022 report expressing support for a new youth cohort 
for the National Longitudinal Survey of Youth (NLSY). As the 
subcommittee knows, the current NLSY 1979 and 1997 cohorts cannot 
provide adequate information about teens and young adults entering the 
labor market. PAA and APC are enthusiastic about the new NLSY cohort 
and urge the subcommittee to sustain its support for its development. 
We urge the subcommittee to provide BLS with $814 million in fiscal 
year 2023 and to adopt, once again, report language urging the agency 
to maintain its plans for a new NLSY cohort.
                 institute of education sciences (ies)
    The Institute of Education Sciences (IES) plays a critical role in 
supporting research used in developing and examining the effectiveness 
of education programs and curricula. The National Center for Education 
Statistics (NCES), the statistical arm of IES, provides objective data, 
statistics, and reports on the condition of education in the U.S. 
Population scientists rely on NCES surveys to conduct research on an 
array of topics, such as linkages between educational access/attainment 
to health outcomes of specific populations, economic well-being, and 
incarceration rates. PAA and APC were pleased that Congress enacted a 
substantial, nearly 15 percent increase for IES in fiscal year 2022, 
which, in addition to investments in other priorities, will allow the 
agency to finally address longstanding staffing shortfalls. We were 
disappointed that the President's Budget Request (PBR) would reverse 
that investment by recommending an overall cut of 10 percent at IES. 
Although the National Center for Education Statistics (NCES) was not 
targeted for a cut per the PBR, we assume this is due to NCES not 
receiving an increase in fiscal year 2022. Adoption of the PBR line 
item for NCES would represent three consecutive years of flat funding; 
the last increase, enacted in fiscal year 2021, was less than 1 percent 
over fiscal year 2020. We therefore urge the committee to provide IES 
with at least $815 million in fiscal year 2023, an amount recommended 
by the Friends of IES, and to ensure that NCES receives an increase 
over its fiscal year 2022 level, $291.5 million.
    Thank you for considering our support for these agencies as the 
subcommittee drafts the fiscal year 2023 Labor, Health and Human 
Services and Education Appropriations bill.

    [This statement was submitted by Mary Jo Hoeksema, Director, 
Government and Public Affairs, Population Association of America/
Association of Population Centers.]
                                 ______
                                 
                     Prepared Statement of PrEP4All
    On behalf of PrEP4All, thank you for the opportunity to comment on 
fiscal year (FY) 2023 appropriations for a National PrEP Program. 
Founded in March 2018, PrEP4All is an organization of community 
members, healthcare professionals, lawyers, and academics all dedicated 
to increasing access to lifesaving HIV medications. Every member of 
PrEP4All has been personally affected by the HIV epidemic, and most of 
us rely on HIV treatment and pre-exposure prophylaxis (PrEP) 
medications every day. As patients ourselves, we have all experienced 
the shortcomings in the domestic HIV response first hand.
    We are calling on Congress to allocate $400M for a National PrEP 
Program to the Department of Health and Human Services (HHS) in its 
FY23 budget, a necessary first step to implementing the ambitious 
reforms to PrEP access proposed in President Biden's FY23 budget.
    The nation will not meet the goals of its Ending the HIV Epidemic 
initiative without a new approach to PrEP. In 2019, nearly 37,000 
people in the U.S. were diagnosed with HIV. Black and Latinx/Hispanic 
individuals comprised 42 percent and 29 percent of new diagnoses, 
respectively. Despite the availability of PrEP--antiretroviral 
medication that if taken regularly drastically reduces the risk of 
acquiring HIV--since 2012, relatively few people in the U.S. are able 
to access it. In 2020, only 25 percent of people who could benefit from 
PrEP actually received it, with large and growing disparities by race, 
ethnicity, gender, and geography. Sixty-six percent of White Americans 
recommended for PrEP received a prescription in 2020, compared to only 
16 percent of Latinx/Hispanic Americans and just nine percent of Black 
Americans.
    A National PrEP Program must move away from a patchwork approach to 
access that requires uninsured individuals to navigate a set of 
separate and confusing programs for PrEP medications, labs, and 
necessary ancillary services. A National PrEP program must create 
simple pathways to PrEP access for those who need it most and engage a 
broader network of PrEP providers. Over 20 national HIV organizations 
have signed onto a letter supporting a National PrEP Program and 
calling for a program to be guided by the following core principles: 
accessibility, equity, simplicity, affordability, sustainability, and 
adaptability.
    We urge Congress to recognize the urgency of addressing the 
Nation's broken and inequitable PrEP financing and delivery system and 
allocate $400M for this program in its FY23 budget.
    Please reach out to me if I can be of any assistance; I can be 
reached at 185 Hall Street #105, Brooklyn, NY 11205, 
[email protected].
    Sincerely.

    [This statement was submitted by Jeremiah Johnson, PrEP Project 
Manager, PrEP4All.
                                 ______
                                 
                Prepared Statement of Prevent Blindness
    Chairman Murray, Ranking Member Blunt, and Committee Members: I 
appreciate the opportunity to submit testimony to the subcommittee on 
behalf of Prevent Blindness--the Nation's leading nonprofit, voluntary 
organization committed to preventing blindness and preserving sight for 
Americans of all ages, racial and ethnic backgrounds, communities, and 
socioeconomic circumstances. We stand ready to work with the 
subcommittee and Members of Congress to advance policies that seek to 
improve our Nation's vision and eye health.
    Prevent Blindness respectfully requests the following allocations 
in Fiscal Year (FY) 2023 to vision and eye health programs at the 
Centers for Disease Control and Prevention (CDC), National Center for 
Chronic Disease Prevention and Health Promotion:
  --$5,000,000 for Vision and Eye Health to conduct necessary national-
        level surveillance of vision impairment and eye disease, and 
        continue state and community partnerships that promote early 
        detection and access to eye care treatment; and
  --$4,000,000 for Glaucoma, which will help to achieve a reduction in 
        the incidence of glaucoma in high-risk patient populations 
        through screening, referral, and treatment.
    We are grateful to and applaud this Committee's recognition of the 
importance of the CDC's Vision and Eye Health program with an 
allocation of a much-needed increase in FY 2022. This new funding level 
of $1.5 million will better inform interventions--particularly around 
the social, economic, and environmental contexts as related to eye 
health care disparities--and allow for stronger integration of vision 
and eye health into current and ongoing community approaches around 
aging, childhood development, mental health services, referral to care 
and care coordination, and chronic disease prevention.
    In order to improve upon existing State- and community-based data, 
to fully capture what is happening at the National-level, and get ahead 
of the most serious consequences of preventable vision loss, Prevent 
Blindness respectfully calls on the Senate to build upon the 
investments made in FY 2022 with a total allocation of $5 million to 
the CDC's Vision and Eye Health program. This funding will serve two 
purposes:
      (1) It will allow the CDC to place ophthalmology examinations and 
        visual content on The National Health and Nutrition Examination 
        Survey (NHANES) and collect national-level examination-based 
        data that will identify those who are unaware of their risk for 
        vision loss or eye disease; thus, creating a much more accurate 
        and authentic illustration of prevalence, and
      (2) Use this data to improve health equity through State and 
        community partnerships by determining the burden of vision loss 
        against demographic factors like racial or ethnic background, 
        age, socioeconomic circumstances, geography, or health status 
        and improving existing interventions to include these 
        approaches to preventing vision loss and blindness.
    Currently, the CDC relies on a patchwork of best-available data 
pieced together through claims, registries, and self-reported national-
level surveys. The 2005-2008 data set is the last collection of 
reliable, national-level prevalence estimates of vision impairment and 
eye diseases; meaning that our best available data on our National 
vision loss and eye disease burden is nearly 15 years old with current 
state and community interventions based on 10 to 14-year-old data. We 
cannot respond to the needs of patients who may not know that they are 
living with blinding eye disease, low vision, or vision loss using data 
that predates such trends as our rapidly aging population, skyrocketing 
rates of chronic disease, our National mental health crisis, new 
stresses to our eye health such as prolonged and frequent use of 
technology, and rising costs of health care. In the long term, not 
having this critical information base will create gaps in our knowledge 
of COVID-19 and other infectious diseases--the consequences of which 
may include gaps in research at the National Institutes of Health.
    Vision is a critical sensory enabler that allows us to live and 
function in our daily lives. From early in life as a part of childhood 
development and enabling readiness to learn in school, for adults who 
seek a sense of well-being through economic independence, pursuit of 
professional and personal interests, and recreational activities, and 
for older Americans to age healthfully and independently with a high 
quality of life and strong social connections, good vision enables all 
aspects of a productive, satisfying, engaging, and healthy life. New 
research published by CDC in 2022 estimates that the annual economic 
burden of vision loss and blindness was $134.2 billion, including over 
$40 billion in excess and potentially avoidable long-term care 
expenses, and $16.2 billion resulting from reduced labor force 
participation.\1\
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    \1\ Rein DB, Wittenborn JS, Zhang P, et al. The Economic Burden of 
Vision Loss and Blindness in the United States. Ophthalmology. Apr 
2022;129(4):369-378. doi:10.1016/j.ophtha.2021.
09.010.
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    Forthcoming research, using the federally funded American Community 
Survey (ACS), the Behavioral Risk Factor Surveillance System (BRFSS), 
and available data from NHANES, has found that vision loss is strongly 
associated with social determinants of health and regional variation at 
the community level. That research illustrates that presenting vision 
loss is strongly associated with poor economic conditions, and could be 
addressed nationwide with additional support. Those with incomes lower 
incomes, educational attainment, food security were significantly more 
likely to have evaluated presenting vision problems or to self-report 
being blind or having serious difficulty seeing compared to those with 
higher incomes and educational attainment and those with fewer issues 
with food security. People living in rural areas were more likely to 
experience vision problems than their urban counterparts, as were 
unmarried persons (whether they were single, divorced, or widowed). 
Using ACS data, the research found that approximately 20% of the 
variation in self-reported vision problems was explained by community 
level differences beyond those described by economic and demographic 
variables in the ACS. Additional research is required to understand the 
social determinants of vision health at the community level, and to 
design public health programs that help all Americans maintain the 
highest level of vision possible.
    And yet, despite its significance, we tend to accept vision loss as 
inevitable to aging, a consequence of chronic disease, family history, 
personal risk, socioeconomic circumstances, or a result of under-
development in childhood or adolescence. Vision loss and eye disease 
often come at significant cost to the patient and to our National 
health care system as they contribute to or worsen many conditions like 
diabetes, stroke, hypertension, cardiovascular problems, mental health 
concerns like anxiety, depression, social isolation, cognitive decline, 
and injury related to falls. Incidents of avoidable vision loss each 
represent a missed opportunity when considered that timely diagnosis 
and early treatment could prevent up to 98% \2\ of visual impairment 
and blindness in the U.S.
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    \2\ Centers for Disease Control and Prevention, 2018: https://
www.cdc.gov/media/releases/2018/a0726-vision-health.html.
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    Unfortunately, vision loss and eye disease are often left on the 
margins of important policy conversations around social determinants of 
health, health equity, access to care including coverage and costs of 
obtaining eye care, and improving health outcomes, which creates a 
significant disadvantage in efforts to improve our National public 
health and lower personal and national health expenditures. Vision loss 
and eye disease are linked to numerous social determinants of health, 
including: lower income levels, lower levels of attained education, 
residence in low-quality housing or an unsafe neighborhood which limits 
physical activity and increases psychological distress, and inability 
to access care due to cost, lack of coverage, transportation issues, 
and refusal of services by providers. Lack of provider availability is 
a major complication in access to eye care as it is estimated that 721 
of 3,006 (roughly 24%) American counties have no ophthalmologist or 
optometrist,\3\ even as approximately one-fifth of the Nation's 
population lives in rural America and only 10% of the country's 
physicians currently practice in rural communities.\4\
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    \3\ https://pubmed.ncbi.nlm.nih.gov/25602911/.
    \4\ https://www.ruralhealthweb.org/.
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    A May 2021 \5\ analysis from the CDC and the NORC at the University 
of Chicago that summarizes these data sources, as well as data from the 
last use of visual content on NHANES from 1999--2008, has found that 
over 7 million in the U.S. are living with vision loss or blindness and 
1.62 million people who live with vision loss or blindness are under 
age 40. This same study determined that vision loss or blindness is 68% 
higher than previous published estimates, with higher prevalence among 
Black and Hispanic populations and women more than men. This data 
analysis is based on best estimates of vision loss only, and its 
authors conclude that examination-based information would create 
stronger national-level and State-based data that can lend better to 
more targeted efforts to prevent and treat vision loss and eye disease.
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    \5\ https://jamanetwork.com/journals/jamaophthalmology/fullarticle/
2779910?guestAccessKey= fb84d04c-a5f4-4753-a5f8-
835f528ea50e&utm_source=For_The_Media&utm_medium= 
referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=051321.
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    Our nation needs a strong, public health approach to vision and eye 
health that includes surveillance, evidence-informed early detection 
and interventions, public awareness and community-level education, and 
measures to address and eliminate barriers in access to eye care. will 
create a stronger understanding of how vision loss intersects with 
other chronic health conditions, population demographics, and social 
determinants of health. We urge the Committee to direct $5 million to 
the CDC's Vision and Eye Health program to ensure we are doing 
everything we can to protect Americans' vision and eye health.
                          glaucoma at the cdc
    Glaucoma is known as the ``thief sneak of sight'' due to its 
progressive nature that is often undetectable until changes to vision 
are noticed by the patient-which is often when vision loss has become 
irreversible and permanent. According to the National Eye Institute,\6\ 
women account for 61% of glaucoma cases in the U.S. with black 
Americans over the age of 40 at highest risk for developing glaucoma. 
In addition, according to the CDC,\7\ Hispanics and Latinos are the 
largest and fastest-growing minority group in the United States, by 
2050, half of people living with glaucoma will be Hispanic or Latino.
---------------------------------------------------------------------------
    \6\ https://www.nei.nih.gov/learn-about-eye-health/outreach-
campaigns-and-resources/eye-health-data-and-statistics/glaucoma-data-
and-statistics.
    \7\ https://www.cdc.gov/visionhealth/resources/features/hispanic-
latino-vision-health.html#::text 
=High%20blood%20pressure%20can%20cause,will%20be%20Hispanic%20or%20Latin
o.
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    Glaucoma is the second leading cause of blindness worldwide. 
Treatment has been shown to reduce the progression of visual field loss 
from glaucoma, but population-based studies suggest that even in 
developed countries, half of the people with glaucoma do not know that 
they have the disease. Because glaucoma is usually asymptomatic until 
the very late stages, affected individuals may not have a reason to 
seek eye care before the optic nerve is irreversibly damaged. 
Unfortunately, people in whom glaucoma is diagnosed late in the disease 
process are at greatest risk for going blind.
    There are two main pathways for high-risk minority populations to 
result in blindness due to glaucoma. The first is through low community 
resources, which leads to a lack of program funding, lack of 
transportation systems, and low paying jobs that do not provide 
adequate health benefits. Lack of program funding and lack of 
transportation converge directly on a lack of primary health care 
clinic locations, whereas low paying jobs includes the mediators of 
lack of education and lack of adequate healthcare coverage, to lack of 
available eye care providers that can provide treatment in a timely 
manner. A lack of access to health care providers leads directly to 
lower rates of routine screening for glaucoma. These lower screening 
rates cause delayed detection of glaucoma. A lack of eye care providers 
also leads to delayed treatment, even in the absence of lower screening 
rates. Delayed treatment for glaucoma causes higher rates of permanent 
vision impairment or blindness both directly and through a lack of 
treatment options. A lack of treatment options is also affected by a 
lack of healthcare, making it a major compounding factor.
    The second pathway for high-risk minority populations is a lack of 
education. A lack of education refers specifically to a lack of proper 
information of glaucoma risk and maintaining proper vision health. A 
lack of overall education likely compounds the effects of each link of 
the pathway. A lack of subject specific education leads to lower rates 
of routine glaucoma screening, delayed detection of disease during a 
treatable stage, and increased social isolation due to vision 
impairment. Social isolation is a compounding factor in reduced 
capacity to maintain one's health, be a productive member of society, 
and engage in appropriate physical activity.
    The pathways between high-risk minority populations and higher 
rates of vision loss due to glaucoma are complex, and there are many 
opportunities for intervention. The most promising intervention comes 
from a change in the location where glaucoma screening is performed. 
Until recently, the most reliable way to detect and initiate treatment 
of glaucoma was through a comprehensive eye examination performed by 
and optometrist or an ophthalmologist--something which data 
demonstrates is not done in this high-risk population. The advent of 
teleretinal eye screenings in a primary health care and community 
settings provide an increased opportunity to identify glaucoma in high-
risk populations and properly refer individuals for treatment of this 
eye disease.
    Several research studies funded by the CDC since 2014 have 
initiated and refined the protocols for the addition of teleretinal 
vision screening services in primary health care and community settings 
of minority and underserved populations. As such, we ask the Committee 
to maintain the CDC's glaucoma program at $4 million in FY 2023, which 
will improve glaucoma screening, referral, and treatment particularly 
for populations that face disparity in access to glaucoma care through 
innovative, community-based approaches and models of care that connect 
glaucoma patients to sight-saving glaucoma care.
    Thank you.

    [This statement was submitted by David B. Rein, PhD, MPA, NORC, at 
the 
University of Chicago.]
                                 ______
                                 
                  Prepared Statement of ProvenTutoring
    As providers of scalable research-proven tutoring models designed 
to rapidly recover from the negative impact of COVID on student 
learning, we propose the following legislative language to encourage 
application of funds to needed approaches:
Proposed Language
    High-Quality Tutoring.--The Committee notes that to address 
significant learning loss due to disruptions caused by Covid-19, 
particularly among historically disadvantaged students, many LEAs have 
dedicated Title I and other Federal resources to support academic 
tutoring. It is estimated that more than $3.6 billion in Federal relief 
funds could be spent on tutoring between 2022 and 2024. Research shows 
that using high-quality tutoring programs with evidence of 
effectiveness as defined in the 2015 ESSA law can have a significant 
impact on addressing learning loss. These integrated systems include 
three to five half-hour (or longer) sessions a week, delivered by a 
human tutor to a group of 1 to not more than 4 students at a time, and 
use a well-structured process, high-quality materials designed for 
tutoring during the school day, ongoing professional development and 
coaching for tutors, and assessment tools to benchmark student 
achievement. Proven tutoring models can close the gap and bring 
struggling students up to the level of their peers. The Committee 
encourages the Department to promote and provide technical assistance 
to LEAs to ensure the implementation of tutoring models that have 
evidence of effectiveness.
                               background
Introduction
    The educational crisis created by the pandemic and the 
unprecedented Federal funding to address it have generated widespread 
attention toward the most effective tool to accelerate learning: 
research-proven tutoring models. Now is the time to ensure districts 
are making solid investments of Federal dollars by encouraging the 
adoption of tutoring programs that have evidence of increasing student 
achievement. This outside witness testimony outlines the crucial 
features of high quality tutoring models and proposes language for the 
Committee to consider including in the FY 2023 budget to encourage the 
adoption of such tutoring models.
    Research shows that high-quality tutoring programs that have been 
evaluated and proven to improve student achievement can have a strong 
impact on learning loss when they are delivered by a human tutor during 
the school day. Therefore, funding that is available for tutoring 
should be invested in these models to ensure that tutoring is advancing 
an equitable learning recovery.
Road-Tested Tutoring Models
    There is a critical need at the State and local levels for guidance 
around the characteristics and value of high-quality tutoring models. 
Dozens of State and district tutoring programs launched this year, but 
many lack crucial features: a replicable tutoring system, delivered by 
a human tutor during the school day, that has evidence of improved 
student achievement compared to a control group.
    A replicable tutoring system is essentially a road-tested model 
that possesses several interdependent, essential components:
  --Structured instructional process
  --High dosage format (3-5 times a week)
  --Professional development and ongoing coaching for tutors
  --High-quality materials designed for tutoring
  --A system of assessment and data collection tools for measuring 
        student achievement
    Each component supports the other to ensure optimal impact on 
achievement. The professional development and coaching are specific to 
the program's procedures and materials. A system of regularly-scheduled 
assessments and data collection ensures that students are working at 
the appropriate levels and helps to move them through a program 
efficiently. The high dosage format ensures the program is delivered 
consistently, providing students with ongoing support.
    Road-tested models are distinct from other tutoring initiatives 
because they have been shown to make meaningful gains in student 
achievement in studies that meet the evidence standards of the Every 
Student Succeeds Act (ESSA). Tutoring during the school-day with 
proven, integrated models can double the rate of growth in reading 
skills for struggling readers--students tutored for half a year can 
grow a full year more in reading skills than similar students not 
receiving tutoring. Similar growth is possible in secondary math. With 
evidence of effectiveness, these models provide the greatest promise of 
impact.
A Human Tutor
    Human tutors are a crucial component of effective tutoring 
programs. An invested, trained, and qualified tutor can develop a human 
connection with a student in the way that a technology platform never 
can, can answer questions on the spot, and can adapt instruction to 
address student needs. The human connection can provide students with 
emotional support and bring joy to the process. Successful tutors can 
be paraprofessionals employed by the school or external staff. When 
they are highly trained and guided by an evidence-based program, tutors 
support the classroom teacher in their efforts to accelerate learning 
for struggling students. Online tutoring platforms are tempting for 
many districts because they are affordable and easy to adopt, but a 
large number of students who need the intervention do not engage with 
these platforms. Human tutors provide structure, consistency, and the 
in-person connection that students lost during the pandemic. Of course, 
human tutors can serve in-person, or can connect remotely to students 
in the schools on platforms designed to recreate in-person 
relationship-based tutorials.
School Day Tutoring
    In order for tutoring to be delivered consistently and reach the 
students who need it the most, it must be conducted during the school 
day. Out-of-school time tutoring contends with issues of attendance and 
students having to ``opt-in'' to the intervention. Embedding tutoring 
during the school day guarantees access to the students who need it, 
particularly those students who have been disproportionately impacted 
by the pandemic.
Signatories:
    Nancy Madden, Founder of ProvenTutoring, Professor, School of 
Education, Johns Hopkins University
    Alan Safran, CEO and co-founder, Saga Education
    Dr. Claire Hagen Alvarado, Director, Literacy First at UT Austin
    Kate Bauer Jones, Executive Director, Future Forward Literacy
    Julie Wible, Executive Director, Success for All Foundation
                                 ______
                                 
      Prepared Statement of the Pulmonary Hypertension Association
      pha's fiscal year 2023 l-hhs appropriations recommendations
_______________________________________________________________________

  --At least $49 billion in program level funding for the National 
        Institutes of Health (NIH).
    --Proportional funding increases for NIH's National Heart, Lung, 
            and Blood Institute (NHLBI); the National Institute of 
            Child Health and Human Development (NICHD), and the 
            National Center for Advancing Translational Sciences 
            (NCATS).
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt and distinguished members 
of the Subcommittee, thank you for your time and your consideration of 
the priorities of the pulmonary hypertension (PH) community as you work 
to craft the FY2023 L-HHS Appropriations bill.
                      about pulmonary hypertension
    Pulmonary hypertension (PH) is high blood pressure that occurs in 
the arteries of the lungs. It reflects the pressure the heart must 
apply to pump blood from the heart through the arteries of the lungs. 
As with a tangled hose, pressure builds up and backs up forcing the 
heart to work harder and less oxygen to reach the body. PH symptoms 
generally include fatigue, dizziness and shortness of breath with the 
severity of the disease correlating with its progression. If left 
undiagnosed or untreated it can lead to heart failure and death. In 
recent years, innovative treatment options have been developed and 
approved for PH. The effectiveness of current treatment options depends 
on accurate diagnosis and early intervention.
                               about pha
    Headquartered in Silver Spring, Md., the Pulmonary Hypertension 
Association (PHA) is the country's leading PH organization. PHA's 
mission is to extend and improve the lives of those affected by PH. PHA 
achieves this by connecting and working together with the entire PH 
community of patients, families, health care professionals and 
researchers. The organization supports more than 200 patient support 
groups; a robust national continuing medical education program; a PH 
clinical program accreditation initiative; and a national observational 
patient registry.
              health resources and services administration
    Due to the serious and life-threatening nature of PH, it is common 
for patients to face drastic health interventions, including heart-lung 
transplantation. To ensure HRSA can continue to make improvements in 
donor lists and donor-matching please provide HRSA with an increase in 
discretionary budget authority in FY 2023.
                     national institutes of health
    Please provide NIH with meaningful increases--including at least 
$49 billion in program funding in FY 2023--to facilitate expansion of 
the PH research portfolio and continued improvement in diagnosis and 
treatment. NHLBI and PHA have partnered on a groundbreaking clinical 
study, the Redefining Pulmonary Hypertension through Pulmonary Vascular 
Disease Phenomics (PVDOMICS) program (RFA-HL-14-027 and RFA-HL-14-030). 
By collecting information from nearly 1,200 participants with various 
types of PH, subjects at risk for PH, and healthy controls, PVDOMICS 
hopes to find new similarities and differences between the current WHO 
classifications of PH. This research is intended to lead to 
identification of both endophenotypes of lung vascular disease and 
biomarkers of disease that may be useful for early diagnosis or for 
assessment of interventions to prevent or treat PH.
    Data from the original cohort is currently being prepared for 
publication and the rich resources of PVDOMICS have spurred many 
presentations at national and international meetings. With its novel 
approach to enrollment and data analysis, PVDOMICS is poised to change 
our thinking about pulmonary hypertension and its classification in the 
upcoming years.
                    proper health coverage and acces
    The PH community is concerned that the Centers for Medicare and 
Medicaid Services (CMS) is allowing insurance payers to refuse to 
accept charitable copay and premium assistance on behalf of patients 
with complex, chronic and life-threatening conditions like PH. Because 
of breakthroughs in research, PH patients are able to utilize life-
sustaining treatments that allow them to manage this potential fatal 
condition and lead relatively normal lives. When patients are denied 
access to financial assistance they are forced to choose between 
necessities: between dramatically shortening their lives by giving up 
medication in order to afford housing and food or continuing medication 
while starting their families on the road to bankruptcy. We aware of 
the subcommittee's continued requests for an explanation of this 
practice targeting rare disease patients. We ask that this subcommittee 
once again ask CMS to explain this decisions and encourage them to fix 
this problem that is greatly affecting the rare disease community.
    PHA also asks the subcommittee to urge CMS to increase incentives 
for the supply of oxygen that affects all oxygen modalities including 
both liquid and portable supplies. This increased flexibility will 
increase patient's quality of life at home and in their communities.
                          patient perspectives
    Chandani's 3-year-old son was diagnosed with severe PH in July 2020 
at the age of two. Chandani is a physician herself and so she 
understands all too well the seriousness of her son's prognosis. Since 
his diagnosis last year, her son's medical care team has tried 
progressively increasing therapies in a stepwise fashion, which is 
often required by insurance companies but is known to lead to worse 
outcomes than when patients are allowed to immediately begin the 
treatment prescribed by their doctor.
    Currently, Chandani's toddler is receiving three oral drugs in 
addition to a subcutaneous infusion, all for PH. As of the end of 
April, he has not been responsive to these therapies which 
unfortunately indicates a poor prognosis. Currently, without a 
transplant, her son has a 60 percent chance of survival over the next 5 
years, and if he were to receive a double-lung transplant, it would 
statistically add 2.7 years to his life. Studies show that self-
reported quality of life for patients with pulmonary hypertension ranks 
worse than cancer patients. Research and treatment are vitally needed 
for this disease that has such a fatal prognosis and a poor quality of 
life.
    Denise has a health insurance plan with a $3,000 deductible. She 
uses a manufacturer copay card to pay for the first of her life-
sustaining pulmonary hypertension (PH) medications. However, Denise's 
health insurance plan will not apply the copay card to her deductible, 
so when Denise fills the prescription for her second medication, she is 
responsible for her entire deductible out-of-pocket. When Denise was 
renewing her health insurance coverage for the year, this information 
was hidden from her. She was told about other changes to the plan, but 
the shift to a copay accumulator was never mentioned, nor could Denise 
find the relevant information online.
    Barbara has lived with PH for 21 years and with the treatment of 
liquid oxygen, she has managed to develop a comparatively active life 
filled with volunteer work and visits with her children and 
grandchildren. However, that changed in April 2021 when Barb's 
Medicare-contracted oxygen supplier stopped delivering liquid oxygen 
without notice. Instead, they began providing compressed oxygen gas 
tanks.
    Liquid oxygen tanks are light enough to be carried hands-free 
strapped to the back and hold a sufficient volume of oxygen to provide 
a continuous stream for 6-8 hours at a time so that Barb is able to 
breathe easily while still walking around. By contrast, compressed 
oxygen tanks are heavier and hold a smaller volume of oxygen, so they 
sustain her for only a fraction of the time that liquid oxygen tanks 
do. To carry a compressed oxygen tank with her, she must wheel it 
behind her or struggle with the weight and bulk of the tank if 
attempting to carry them on her back and change them out every couple 
of hours.
    These new limitations to her lifestyle due to the loss of 
appropriate treatment for her PH have caused a steep decline in her 
mood and quality of life and she has quickly become depressed; at a 
recent visit with her physician, she was told ``I've never seen you 
this bad.'' The mobility and ease that using a liquid oxygen tank 
provides Barb is the difference between struggling to complete one 
errand in a day, versus running multiple errands, feeling capable of 
going out to have lunch with friends, or being able to comfortably 
visit her seven grandchildren.
    In the past weeks, Barb has spent precious energy calling 30 
suppliers within a 100-mile radius of her home searching unsuccessfully 
for anyone else to provide her with the correct treatment for her PH 
condition. In her efforts to find out more about the loss of access to 
liquid oxygen, Barb has heard from many other PH patients from across 
the country who are experiencing the same situation. This restriction 
of access to liquid oxygen represents a collective loss in quality of 
life for the community of PH patients that could have long-lasting and 
far-reaching consequences for an already serious, degenerative disease.
    Thank you again for your consideration of the PH community's 
priorities as you develop the FY 2023 L-HHS Appropriations bill.
                                 ______
                                 
        Prepared Statement of Rebuilding America's Middle Class
    On behalf of (RAMC), a coalition of State and individual community 
college systems from across the Nation--representing over 120 colleges 
and 1.5 million students, I appreciate the opportunity to provide 
written comments on the funding in the fiscal year 2023 Labor, Health 
and Human Services, Education and Related Agencies (LHHS) 
appropriations bill that is essential to community colleges and the 
students that we serve.
    Community colleges have an unparalleled commitment to 
accessibility, which encourages traditionally underrepresented 
audiences to pursue a college degree. We serve 45 percent of all first-
time freshmen, and 40 percent of our students are the first in their 
family to attend college. Forty two percent of all African American 
undergraduates, nearly half of all Hispanic undergraduates, and 56 
percent of Native American undergraduates attend community colleges.
    Community colleges are open access, seek to make higher education 
accessible and affordable for everyone, and matches employers' need for 
a larger, more diverse workforce. Preparing more Americans to enter the 
workforce with the skills necessary to compete for in-demand jobs, 
especially during difficult economic times, is a top priority for all 
RAMC members. With this in mind, we make the following recommendations 
to improve Federal financial aid policies to support community college 
students, particularly those from nontraditional background who 
continue to rely on our schools for access to higher education:
Increase the Maximum Pell Grant.
    RAMC members believe that the Pell Grant program is the key to 
ensuring low-income students can afford college. Community colleges are 
the most affordable of the many options facing students; yet, even at 
our institutions, low-income community college students overwhelmingly 
rely on this critical Federal student aid program. Even with our low 
tuition institutions, Pell grants allow such students to afford books 
and supplies and help with housing, childcare, food and other basic 
needs. For these reasons we urge the subcommittee to adopt the 
discretionary portion of the Administration's call for a $1,775 
increase in the maximum Pell grant as part of the President's fiscal 
year 2023 budget request.
    We also strongly support the expansion of Pell to cover short-term 
certificates that open pathways to high paying employment options. 
While we are working closely with the House and Senate Conference 
Committee on the United States Innovation and Competition Act to 
maintain House language on this matter, we welcome the opportunity to 
work with that conference Committee or the House and Senate 
appropriations committee to achieve this important policy goal. The 
expansion of Pell to allow short-term credentials will provide an 
immediate boost to a significant number of our students focused on 
obtaining the workforce skills they need to earn middle class incomes.
Increase Career Technical Education State Grants.
    The Administration's fiscal year 2023 request proposes to decrease 
CTE State Grants by $25 million compared to the fiscal year 2022 level. 
RAMC believes that career and technical education certificates and 
degrees provide essential value to those that earn them. Accordingly, 
RAMC believes that Congress should again provide an increase in funding 
to the CTE grant program as part of the fiscal year 2023 appropriations 
process.
Support the Title III Strengthening Institutions Program.
    The fiscal year 2023 budget request includes an increase of $98.9 
million for the Strengthening Institutions Program (SIP). RAMC 
institutions utilize SIP funds to increase student retention, provide 
enhanced faculty professional development and expand access to high-
demand STEM programs through the conversion of high-demand courses. We 
strongly support the Administration's request for an increase and urge 
the subcommittee to include it in the fiscal year 2023 LHHS 
appropriations bill.
Expand Strengthening Community Colleges Program.
    The Strengthening Community College Training Grant program provides 
vital capacity building resources at community colleges to build 
training programs that partner with industry. Community colleges are 
always at the forefront of developing and supporting education and 
training opportunities that enable individuals to acquire the skills 
they need to obtain jobs for which businesses are hiring. The 
Administration's budget calls for a $55 million increase for this 
initiative. RAMC supports this increase and urges the subcommittee to 
include it in the fiscal year 2023 LHHS appropriation bill.
Support Apprenticeships and Innovative Partnerships.
    As community college leaders, RAMC members are at the forefront of 
working to expand apprenticeships and create opportunities for students 
to earn while they learn. As such, we applaud the fiscal year 2023 
proposal that includes $303 million for the Apprenticeship Program, an 
increase of $68 million above the fiscal year 2022 funding level. We 
support the President's proposal and would urge the subcommittee to 
consider the $68 million increase for this program in the fiscal 
Year2023 appropriations process.
    Thank you for your consideration of our comments. RAMC members 
stand ready and willing to help you in any way we can as the fiscal 
year 2023 Appropriations process moves forward.

    [This statement was submitted by Dr. Monty Sullivan, President, 
Rebuilding America's Middle Class: A Coalition of Community Colleges.]
                                 ______
                                 
               Prepared Statement of Refugee Council USA
    Chairwoman Murray, Ranking Member Blunt, and members of the 
subcommittee, thank you for this opportunity to submit these funding 
and oversight recommendations for Fiscal Year (FY) 2023 on behalf of 
the 29-member organizations of Refugee Council USA (RCUSA) dedicated to 
refugee protection, welcome, and integration and representing the 
interests of refugees, refugee families, and volunteers and community 
members across the country who support refugees and resettlement. RCUSA 
recommends FY 2023 funding levels of $9,991,000,000 for the Department 
of Health and Human Services' (HHS) Refugee and Entrant Assistance 
(REA) account.
    The REA account funds the Office of Refugee Resettlement (ORR) 
within HHS' Administration of Children and Families (ACF). ORR funding 
provides critical Federal investments in the States and local 
communities that welcome refugees and is a crucial component of 
fostering refugee integration and economic contributions. In addition 
to new refugee arrivals, ORR provides essential services to refugees 
who have arrived in recent years, asylees, Cuban and Haitian Entrants, 
Iraqi and Afghan recipients of Special Immigrant Visas (SIVs), 
trafficking and torture survivors living in the United States, certain 
Amer-Asians, Afghan humanitarian parolees who arrived under Operation 
Allies Welcome, and unaccompanied refugee and immigrant children.
    RCUSA recommends an increase for the Transitional Medical 
Assistance (TAMS) program to $2,530,000,000 to fund critical initial 
assistance to refugees and other new arrivals, programs for vulnerable 
unaccompanied refugee children, and the highly effective Matching Grant 
program, which leverages public funds with private donations, 
empowering refugees to secure employment within 6 months. RCUSA also 
recommends increases for Refugee Support Services (RSS) programs to 
$1,400,000,000; for domestic and foreign-born trafficking survivor 
services to $50,000,000; for torture survivor assistance to 
$28,000,000; and for unaccompanied children to $5,100,000,000. We also 
recommend the creation of an emergency contingency fund for needs 
across ORR-eligible populations appropriated at $100,000,000.
    In addition, we recommend new funding for family reunification for 
separated asylum-seeking families ($533,00,000) and legal 
representation needs for Afghans evacuated to the U.S. under Operation 
Allies Welcome ($250,000,000).
Robust Appropriations to Support the Rapid Rebuild and Expansion of the 
        Resettlement Network
    Throughout the previous administration, the U.S. Refugee Admissions 
Program (USRAP) was steadily dismantled: refugee admissions decreased 
by 80 percent and one-third of all resettlement offices in the U.S. 
closed. From the outset, the Biden administration committed to 
rebuilding a robust and innovative USRAP and set an ambitious refugee 
admissions goal of 125,000 for FY 2022. There were soon new and urgent 
demands on resettlement service providers: following the U.S. military 
withdrawal from Afghanistan, over 75,000 U.S.-affiliated and at-risk 
Afghans have been welcomed into the United States under Operation 
Allies Welcome. The domestic network of resettlement agencies was 
quickly mobilized to receive and support the integration of this newly 
arrived Afghan population. There are currently 271 resettlement offices 
providing Reception & Placement (R&P) services to refugees--an over 35 
percent increase from 199 offices at the beginning of 2021.
    Six of the nine voluntary agency networks are faith-based and 
harness the energy of many faith communities to help welcome newcomers 
to their new communities. These community organizations ensure the 
provision of a core set of services during someone's first months in 
the U.S., including the provision of food, housing, clothing, 
employment services, follow-up medical care, and other necessary 
services. After this initial period, ORR funds integration services 
through both the States and resettlement providers around the country.
    Once refugees arrive in the U.S., they are supported in orienting 
to their new community, learning English, enrolling their children in 
school, and finding employment. With this crucial support, they often 
are not only able to support themselves and their families but also 
become contributors to their new communities, integrating with and 
bringing innovation to our neighborhoods. The following highlights 
critical needs within the REA account but does not include all program 
activities:
Legal Services for Afghans Arriving Under Operation Allies Welcome
    The needs of newly arrived Afghan evacuees are distinct from other 
groups served by ORR. Unlike immigrant visas or the refugee program, 
humanitarian parole is not a pathway to permanent status; it is a 
temporary allowance to enter and remain in the United States. As such, 
Afghans who have been or will enter the U.S. with humanitarian parole 
under Operation Allies Welcome find themselves under a cloud of legal 
uncertainty and must seek an existing immigration pathway in order to 
remain in lawful status once their parole expires. In all likelihood, 
many will need to pursue asylum. This is a complex legal process for 
any immigrant to navigate, let alone for the many Afghans who arrived 
with little more than the clothes on their backs. It is essential that 
these Afghan neighbors have access to reliable legal counsel to assist 
them in their immigration process.
    While resettlement agencies across the country are practiced at 
assisting refugees in adjusting their immigration status, requiring 
their existing legal service providers to assist with hundreds of 
asylum applications--simultaneously--will overburden available 
resources. Resettlement agencies do not have enough Department of 
Justice accredited representatives and on-staff immigration attorneys 
to meet this need. Indeed, even with legislation to provide a pathway 
to lawful permanent residency, such as an Afghan Adjustment Act, the 
reliance on these providers will be substantial.
    As such, RCUSA is recommending $250,000,000 for legal 
representation needs for Afghans evacuated to the U.S. under Operation 
Allies Welcome.
Trauma-Informed Care for Unaccompanied Children
    Unaccompanied children (UC) are immigrant children who arrive in 
the U.S. without legal guardians and who require special protections. 
Care for unaccompanied children is mandated by the Trafficking Victims 
Protection Reauthorization Act (TVPRA) and governed by the TVPRA, the 
Homeland Security Act of 2002, and the Flores Settlement Agreement. ORR 
is the legal caretaker of unaccompanied children until they can be 
reunited with family. ORR funds a network of shelters where UC stay 
while reunification happens and ORR's primary goal is the safe and 
secure placement of each child with a sponsoring family.
    In FY 2021, 121,000 unaccompanied children arrived in the United 
States, an all-time high. RCUSA's recommendation of $5,100,000,000 will 
provide for an increased number of beds in licensed facilities. The 
increased arrivals over FY 2021 led to the use of both influx 
facilities and Emergency Intake Sites due to lack of online licensed 
bedspace. While the pandemic took many beds offline, ORR still needs to 
increase licensed placements. This funding will allow the necessary 
network growth in small-scale shelters, which are much better suited to 
meeting the needs of UC.
    This critical funding will also provide universal access to post-
release services (PRS) for both children and their sponsors. Post-
release services are bridging services that assist children and 
sponsors adjust to their new lives together after reuniting. We know 
that trauma responses from migration or home-country experiences often 
manifest after the initial ``honeymoon'' period ends, and access to 
social workers and community services is critical in these cases. 
Historically, around 25 percent of UC have received PRS; ORR intends to 
provide these services to 85 percent of UC in FY22 and 100 percent of 
UC by FY23.
    RCUSA does not support an expansion of detention, including through 
large-scale institutional facilities, or efforts to support forced 
family separation.
                                 ______
                                 
                 Prepared Statement of Research!America
    On behalf of Research!America's alliance, which advocates for 
science, discovery, and innovation to achieve better health for all, 
thank you for this opportunity to share our views on Fiscal Year 2023 
(FY23) appropriations under the jurisdiction of the subcommittee on 
Labor, Health and Human Services, Education, and Related Agencies.
    And, to all members of the subcommittee, thank you for all your 
work to include strong FY22 funding levels for critically important 
Federal health research agencies, including the National Institutes of 
Health (NIH), the Centers for Disease Control and Prevention (CDC), and 
the Agency for Healthcare Research and Quality (AHRQ); and for 
including funding to get ARPA-H off the ground. We were also so pleased 
that the subcommittee was able to include language naming the Roy Blunt 
Center for Alzheimer's Disease and Related Dementias Research Building 
in the FY22 Omnibus Appropriations Act.
                   the national institutes of health
    We are particularly concerned about funding for the National 
Institutes of Health. While there were many positive provisions in the 
President's FY23 budget proposal, Research!America was deeply 
disappointed by the shockingly low (0.6% percent) funding increase 
included for the NIH. We recommend that the subcommittee allocate at 
least $49.1 billion, an increase of $4.1 billion over FY22, for our 
Nation's flagship research institution. This funding level, inclusive 
of 21st Century Cures funding, would empower NIH to grow the number of 
progress-fueling grants the Institutes can support. The American people 
need and value fast-paced medical progress, which cannot be 
accomplished without funding barrier-breaking, foundational research.
    The NIH is the world's leading funder of basic biomedical research, 
and Americans recognize the value of this research. Since 1992, 
Research!America has commissioned national and State-level surveys to 
assess public sentiment on issues related to research and innovation. 
According to a January 2022 national survey commissioned by 
Research!America, 85% of Americans believe it is important for Congress 
and the President to prioritize achieving faster medical progress. 
Americans want medical progress, and they want the U.S. to drive it.
    NIH awards more than 80% of its funding in the form of 50,000 
competitive grants to more than 300,000 researchers at over 2,500 
universities, medical schools, and other research institutions in every 
State and around the world. Research supported by NIH is directed at 
the early, non-commercial stages of the research pipeline, which 
complements later-stage research funded primarily by the private 
sector. NIH-funded research fuels the entry of new drugs into the 
market, providing an estimated return to public investment of $1.43 for 
every dollar invested. Among its many success stories, the NIH 
supported research which helped create the first kinases-targeted 
category of cancer treatment drugs, launching a new wave of drug 
development targeting similar molecules to treat cancer and other 
diseases. In the case of the COVID-19 pandemic, the NIH had already 
invested in research to develop vaccine platforms, which enabled it to 
jumpstart development of powerful COVID-19 vaccines and treatments once 
the pandemic hit.
    NIH advances our Nation's interests in other important ways. For 
example, the All of Us Research Program at NIH is advancing the largest 
clinical trial in our Nation's history to accelerate precision medicine 
and advance a host of other medical and health research objectives. NIH 
has also prioritized diversity, equity, inclusion, and accessibility 
through its implementation of its NIH Cross-agency DEIA Strategic Plan. 
Its Human Genome Project has produced $1 trillion of economic growth-a 
178-fold return on investment. The Helping to End Addiction Long-term, 
or HEAL, Initiative is conducting interdisciplinary research to end the 
opioid epidemic. The National Institute of Aging supports research on 
the health and well-being of older Americans and, through its 
Alzheimer's Disease Education and Referral Center, provides information 
on age-related cognitive changes and neurodegenerative disease. The 
Accelerating Medicines Partnerships combines contributions from both 
private and public sectors to streamline collaboration between the NIH, 
FDA, life science companies, and non-profit organizations working to 
develop treatments for Alzheimer's, Type 2 diabetes, rheumatoid 
arthritis, lupus, and Parkinson's disease. The NIH also invests in 
educating and training America's future scientists and medical 
innovators by sponsoring training grants and fellowships for 
biomedical- and health-focused graduate and medical students, 
postdoctoral researchers, and young investigators.
            the advanced research projects agency for health
    Research!America is grateful to members on both sides of the aisle 
for providing $1 billion in FY22 to stand up this new agency. We 
support the goal of developing ARPA-H into an entity that supports high 
risk, high reward public-private R&D, and we support an FY23 funding 
allocation of $5 billion for ARPA-H that complements but does not 
supplant funding for the NIH.
    By funding transformative high-risk, high-reward research, ARPA-H 
has the potential to drive biomedical and health breakthroughs-ranging 
from molecular to societal-to revolutionize treatments for all 
patients. This health innovation incubator, modeled after DARPA and 
ARPA-E, will empower the public and private sector to pursue 
transformative, cross-disease R&D advances. We believe ARPA-H can bring 
about progress that saves millions of lives around the globe while 
significantly strengthening U.S. competitiveness in the global economic 
arena.
             the centers for disease control and prevention
    The threats posed by COVID-19, Ebola, Zika, dengue fever, 
influenza, the opioid epidemic, measles outbreaks, and other emerging 
health threats have demonstrated the critical role the CDC plays in 
protecting Americans. They have also revealed the enormity of 
challenges the agency faces as it works to safeguard American lives. To 
protect our Nation, CDC scientists must be on the ground fighting 
public health challenges wherever and whenever they occur. We recommend 
an allocation of at least $11 billion for the CDC in FY23, an increase 
of $2.6 billion over FY22, to carry out its crucially important 
responsibilities.
    The CDC is tasked with protecting and advancing Americans' health. 
Over the past 70 years it has worked diligently to thwart deadly 
outbreaks, costly pandemics, and debilitating disease. The CDC also 
plays a key role in research that leads to life-saving vaccines, 
bolsters our Nation's response to the opioid crisis, and improves 
health tracking and data analytics.
    The CDC's work has benefited Americans in a myriad of ways. For 
example, the CDC has successfully eliminated the endemic spread of 
rubella within the United States; played a lead role in addressing the 
growing threat of antibiotic resistance; dramatically reduced the 
incidence of child lead poisoning; addressed disparities in health and 
health care; tracked and contained dangerous pandemics and epidemics; 
reduced deaths from motor vehicle accidents; and expanded newborn 
hearing and other screening tests,
             the agency for healthcare research and quality
    AHRQ is the lead Federal agency responsible for ensuring medical 
progress translates into better patient care. This investment improves 
the care received by patients and saves taxpayer dollars. We recommend 
the subcommittee allocate $500 million for the AHRQ in FY23, a 30% 
increase over FY22.
    AHRQ has a proven track record in using evidence-based approaches 
to improve health care delivery. Using AHRQ's research and how-to 
tools, the U.S. health care system prevented 1.3 million errors, saved 
50,000 lives, and avoided $12 billion in wasteful spending from 2010 to 
2013. For example, AHRQ-funded research has contributed to infection 
control strategies in long-term care facilities by identifying 
methicillin-resistant Staphylococcus aureus (MRSA) in these facilities. 
AHRQ-funded research has played a pivotal role in reducing hospital-
acquired infections by nearly 1 million from 2014-2017. It has made 
important contributions to patient-centered outcomes research (PCOR) by 
investing in PCOR method training grants, including PCOR application in 
opioid use disorder, and by promoting the implementation of PCOR in 
clinical decision making.
    We appreciate your consideration of our funding requests and thank 
you for your stewardship over these critically important Federal 
spending priorities. Please call on us if we can be of any assistance. 
Contact: Sheila Murphy, Senior Policy and Advocacy Officer, 
Research!America, [email protected].
    Sincerely.

    [This statement was submitted by Mary Woolley, President and CEO, 
Research!America.]
                                 ______
                                 
      Prepared Statement of the Restless Legs Syndrome Foundation
    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, as you work to develop the fiscal year (FY) 2023 
Labor-Health and Human Services Appropriations bill, thank you for 
considering the views of the community of physicians, researchers, 
patients, and caregivers affected by Restless Legs Syndrome (RLS). 
Please keep the needs of this community in mind, especially as you 
continue to work to address the opioid crisis.
                        about the rls foundation
    The Restless Legs Syndrome Foundation is a nonprofit Sec. 501(c)(3) 
organization dedicated to improving the lives of men, women, and 
children living with this often-devastating neurological condition. The 
Foundation works to increase awareness, improve treatments, and support 
research to find a cure. From a few volunteers meeting in a member's 
home in 1992, the Foundation has grown steadily; it now has members in 
every State, local support groups, and a track record that includes 
nearly $2 million provided to support translational research.
                               about rls
    Restless legs syndrome (RLS) is essentially an irregular biological 
drive, like hunger or thirst, that forces affected individuals to keep 
moving, thus reducing their ability to rest. Patients with this disease 
experience a deep, viscerally irritating sensation in the legs that 
continues to increase until they are literally forced to move their 
legs or get up and walk; and this sensation only abates so long as the 
individual keeps moving. RLS is best characterized as a neurological, 
sensory-motor disorder with symptoms that are triggered from within the 
brain itself. It is estimated that up to 5 to 7 percent of the U.S. 
population may have RLS, of which half will have moderate to severe 
stages of the disease. RLS impacts men, women, and children, though it 
is 3 to 4 times more common in women and twice as common in older 
Americans.
    Due to the inability to sleep and work, RLS can cause disability, 
depression, and suicidal ideation, as well as increased risk for co-
morbid conditions such as heart attack, stroke, and Alzheimer's. There 
is no cure, and the current standard of care features several 
medications, which do not provide life-long coverage. One of the 
established effective treatment options for this disease is low-total- 
daily dose opioid medication; a class of medication used when all other 
drug classes have failed due to augmentation, inadequate efficacy, or 
adverse side-effects. Research and clinical experience indicate that 
the dose of opioids typically used to manage RLS effectively without 
addiction or drug tolerance issues is significantly lower than dosages 
used to treat chronic pain.
                 fy 2022 appropriations recommendations
    The RLS Foundation joins the broader medical research community in 
thanking Congress for continuing to support the National Institutes of 
Health with sustainable growth. Please continue to advance scientific 
progress through proportional funding increases by providing at least a 
$3 billion funding increase for FY 2023 to bring NIH's budget up to $49 
billion.
    In this regard, please provide proportional funding increases for 
all NIH Institutes and Centers, including, but not limited to the 
National Institute of Neurological Disorders and Stroke (NINDS), the 
National Heart, Lung, and Blood Institute (NHLBI), the National 
Institute on Drug Abuse (NIDA), and the National Institute of Mental 
Health (NIMH). Research on RLS and similar neurological movement 
disorders is directly related to efforts targeting the opioid epidemic, 
as many patients with these disorders utilize very low total daily 
doses of opioid therapies to manage their condition. Additionally, 
related sleep disorders research activities impact many conditions and 
are studied across various Institutes and Centers at NIH.
    Please provide $5 million for the National Neurological Conditions 
Surveillance System (NNCSS) for FY 2022. The NNCSS at the Centers for 
Chronic Disease Control and Prevention (CDC) collects and synthesizes 
data to help increase our understanding of neurological disorders and 
to support further neurologic research. RLS remains a severely 
misunderstood and underdiagnosed neurological disorder, and increased 
surveillance is vital to improving patient outcomes.
    Please provide at least $6,000,000 for the Chronic Diseases 
Education and Awareness Program at the Centers for Disease Control and 
Prevention (CDC). With the cessation of the National Healthy Sleep 
Awareness Project (NHSAP), CDC presently has no active public health 
activities dedicated to sleep or sleep disorders, even though sleep 
affects nearly every body system and many chronic diseases. Please 
allow the valuable scientific and public health efforts started during 
the NHSAP to continue.
                       rls and the opioid crisis
    While you consider the Committee's work to address the opioid 
epidemic through this fiscal year's appropriations bill, the RLS 
Foundation asks that you protect the needs of patient communities who 
depend on appropriate access to low total daily doses opioid therapy to 
manage their debilitating condition. RLS is not a chronic pain 
condition, and many in our community utilize these medications to treat 
underlying neuropathology issues and not sensations of pain. Studies 
have shown that appropriate access to these therapies allows patients 
to live productive lives without an increased risk of developing opioid 
use disorder. As you consider various legislative proposals and work 
with Federal agencies, please consider the needs of patients who rely 
on the regular use of low total daily doses of opioids to manage RLS by 
supporting a diagnosis-appropriate safe harbor for RLS patients, so 
they do not face arbitrary barriers.
    I would like to share with you the experience of Stephen Smith from 
Colorado, a RLS Foundation Discussion Board Moderator. Like all those 
with RLS, night can bring a feeling of dread. Is this going to be one 
of those nights when my RLS acts up and I don't get any sleep, or will 
it just be one of those standard nights when my sleep is just poor?
    About a year ago, I had one of those nights when my RLS acted up 
and I knew that I wasn't going to get any sleep at all. So, I called my 
doctor's night service and was instructed to go to the local hospital's 
Emergency Room and to tell them to call my doctor.
    Contrary to hospital policy, the ER doctor decided not to call and 
also didn't understand RLS or my insomnia complaints. But he jumped on 
my depressed feelings from insufficient sleep combined with my RLS 
pacing, which he assumed was agitation, and the opioid that I take for 
RLS. He then incorrectly concluded I had a drug problem and was 
suicidal in spite of being told that I was not. So, he placed me under 
a 72 hour psychiatric hold and sent me to a psychiatric hospital 3 
hours away. I was shipped 180 miles confined to the back seat of a car 
with raging RLS. The psych hospital didn't carry one of my RLS meds, 
Tramadol, and forced me to go into withdrawal rather than go to the 
effort to replace it. The abrupt withdrawal from Tramadol led to hours 
of shakes and sweats followed by even more hours of RLS-like pacing for 
the second night in a row. Since Tramadol also acts as an SNRI anti-
depressant, the abrupt withdrawal caused me to develop SNRI Withdrawal 
Syndrome. This caused migraine headaches, severe anxiety and 
depression, nightmares and dreams centered on the horrible experience 
of being involuntarily confined to the psych hospital due to a 
neurological disorder. These symptoms went on for months and required 
drug treatment for anxiety and psychotherapy for the severe depression. 
So, now nightfall brings a feeling of trepidation. Is this going to be 
another night when my RLS acts up or I cannot fall asleep? If I do 
manage to sleep, will I once again dream of the nightmare of being 
confined to the psych hospital all due to failure of a number of 
doctors to understand RLS or to even listen to their patient who is 
trying to educate them?
    Thank you again for the opportunity to share the views of the RLS 
community.

    [This statement was submitted by Karla M. Dzienkowski, RN, BSN, 
Executive 
Director, Restless Legs Syndrome Foundation.]
                                 ______
                                 
              Prepared Statement of the Rotary Foundation
    Chairwoman Murray, Ranking Member Blunt, and members of the 
subcommittee: Rotary appreciates the opportunity to encourage 
continuation of funding for FY 2023 to support the polio eradication 
activities of the U.S. Centers for Disease Control and Prevention 
(CDC). The CDC is a spearheading partner of the Global Polio 
Eradication Initiative (GPEI),\1\ an unprecedented model of cooperation 
among national governments, civil society and UN agencies which reach 
the most vulnerable children through the safe, cost-effective polio 
immunization. Rotary International requests the subcommittee provide 
$276 million for the polio eradication activities of the CDC to 
capitalize on the historic opportunity of unprecedented low levels of 
endemic polio virus transmission which is simultaneously threatened by 
the diversion of critical resources toward the COVID-19 pandemic. These 
funds will support the GPEI's immediate priority of stopping all form 
of polio virus transmission through procurement of vaccines, including 
the recently introduced novel oral polio vaccine, a new tool that is 
being rolled out to accelerate control of circulating vaccine derived 
polio. These funds will also provide vital support for surveillance 
activities which provide confidence in both the presence and absence of 
polio virus transmission.
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    \1\ The Global Polio Eradication Initiative (GPEI) is a partnership 
led by Rotary International, the Centers for Disease Control and 
Prevention (CDC), the World Health Organization (WHO), the United 
Nations Children's Fund (UNICEF), the Bill and Melinda Gates 
Foundation, and Gavi, the Vaccine Alliance.
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    The 300,000 members of Rotary clubs in the U.S. appreciate the 
United States' generous support and longstanding leadership toward a 
polio free world. Rotary, including matching funds from the Gates 
Foundation, has contributed more than $2.4 billion and thousands of 
hours of volunteer service to protect children from polio; and will 
continue this work until the world is certified polio free. Continued 
U.S. leadership will help achieve a polio free world and ensure the 
continued global health contribution of polio eradication 
infrastructure and resources.
 unprecedented progress presents the best opportunity we have ever had 
                         to achieve eradication
    Since the launch of the GPEI in 1988, eradication efforts have led 
to more than a 99.9 percent decrease in cases. Thanks to this 
committee's support, 20 million people have been spared disability, and 
over 900,000 polio-related deaths have been averted. In addition, more 
than 1.5 million childhood deaths have been prevented, thanks to the 
systematic administration of Vitamin A during polio campaigns.
    In 2021, for the first time in history, there were no cases of wild 
polio virus in the entire world for more than 7 months. In addition, 
Pakistan didn't record a new case of wild polio virus for over a year. 
Wild poliovirus polio incidence hit an all-time low in 2021 with only 
five cases recorded in the two remaining endemic countries of Pakistan 
and Afghanistan- a 96 percent reduction from 2020.
    Outbreaks of circulating vaccine derived polio virus (CVDPV) which 
affected more than 20 countries in 2020 are being brought under control 
with fewer cases in fewer places in 2021 as compared to 2020 (638 cases 
in 22 countries for 2021 vs 1087 cases in 26 countries in 2020). The 
novel oral polio vaccine type 2 (nOPV2) is also being introduced to 
accelerate progress in bringing these outbreaks under control.
    Despite this progress, the GPEI and countries it supports face 
significant challenges. In February 2022, a 3-year-old girl from Malawi 
was confirmed as having contracted the first case of wild polio in 
Africa since 2016. The virus that infected the child in Malawi was of 
Pakistani origin underscoring the fact that as long as polio exists 
anywhere, it is a threat everywhere. Fortunately, the case in Malawi 
does not change Africa's status as a region certified free from wild 
poliovirus because the virus originated in Pakistan and is considered 
to be an imported case as opposed to locally circulating/endemic virus. 
In April 2022, Pakistan reported its first cases of wild poliovirus 
(WPV1) in nearly 15 months. The ongoing COVID-19 pandemic continues to 
hamper the efforts of countries to sustain high levels of population 
immunity which poses increased risk for outbreaks at a time of 
unprecedented constraints on human and financial resources on the 
ground and from the global community. Conflict and instability also 
jeopardize progress, hampering efforts to organize and conduct polio 
eradication activities. These challenges threaten thirty years of 
progress and the cumulative U.S. investment of U.S. $4.2 billion which 
has brought us to the threshold of a polio free world.
    This combination of progress in the midst of ongoing challenges 
underscores the urgency of continued focus to protect the vulnerable 
gains made toward polio eradication as the COVID-19 pandemic continues 
to disrupt polio immunization and eradication activities; and to stop 
polio virus transmission in these most complex environments while 
sustaining high levels of population immunity in polio free areas. 
Continued support for global surveillance is also essential to monitor 
and detect cases and virus transmission and provide confidence in the 
absence of cases.
         cdc's vital role in global polio eradication progress
    The United States is the leader among donor nations in the drive to 
eradicate polio globally. Congressional support to CDC has supported 
the following essential polio eradication activities:
    Leadership on surveillance and disease detection: CDC's Atlanta 
laboratories serve as a global reference center and training facility, 
providing expertise in virology, diagnostics, and laboratory 
procedures, including quality assurance, and genomic sequencing of 
samples obtained worldwide, and training virologists from around the 
world in advanced poliovirus research and public health laboratory 
support. CDC also provides the largest volume of operational 
(poliovirus isolation) and technologically sophisticated (genetic 
sequencing of polio viruses) lab support to the 145 laboratories of the 
Global Polio Laboratory Network (GPLN). CDC also developed methods to 
directly detect poliovirus from patient stool specimens, allowing 
faster detection.
    Essential technical capacity and program management expertise: CDC 
directly contributes to polio eradication activities and is also used 
to build in-country capacity. This includes the international 
assignment of technical staff on direct 2-year assignments to WHO and 
UNICEF to assist polio-endemic and polio-reinfected priority countries. 
CDC's Stop Transmission of Polio (STOP) members continue to play a key 
role in providing expertise on polio surveillance, data management, 
campaign planning, implementation and evaluation, program management, 
and communications in high-risk countries. In 2021, STOP has trained 
and deployed more than 2,200 public health professionals to work on 
polio surveillance, data management, campaign planning and 
implementation, program management, and communications in high-risk 
countries. STOP also provided support to 42 countries on responding to 
COVID-19 in 2020-2021.
    Vital Country-level Capacity: In Pakistan, CDC supported 81 
National Stop the Transmission of Polo (NSTOP) officers for the 
Expanded Program on Immunization (EPI), and data usage and risk 
assessment officers distributed in 66 very high, high, and medium risk 
communities in 3 provinces, and 10 managers/officers to support the 
National Ministry of Health.
                    fiscal year 2023 budget request
    Rotary respectfully requests $276 million in FY 2023 for the polio 
eradication activities of CDC. These funds will ensure that CDC 
provides technical and management expertise in polio endemic, outbreak 
and at-risk countries; builds country level capacity to build 
population immunity to prevent future outbreaks as well as capacity to 
quickly identify and respond to outbreaks.
    Increased funding is needed to address three specific areas 
critical to protecting existing progress and capitalizing on the window 
of opportunity to stopping transmission of all polio viruses: Outbreak 
Response, Surveillance and Vaccine Procurement.
Outbreak Response
    Increased funding is needed to maximize the effectiveness of 
outbreak response campaigns and fully leverage the use of nOPV2 through 
improvements in response planning, execution and monitoring to ensure 
rapid, high-quality activities including those which:
  --utilize and expand existing in country government coordination 
        mechanisms to establish polio control rooms, enabling the use 
        of real-time data for decision-making and an incident 
        management structure to streamline emergency operations;
  --accelerate emergency outbreak response through the establishment of 
        incident command structures at global, regional and country 
        level to guide and direct outbreak response;
  --digitize the entire outbreak response, from planning to campaign 
        monitoring and utilizing an evidence-based approach for clear 
        assessments of response coverage and quality, including age- 
        and sex disaggregated monitoring data; and
  --ensure a stronger role for women in outbreak response operations 
        through increased participation in outbreak response oversight, 
        management, supervision and delivery.
Surveillance
    Additional funding will support the expansion of surveillance 
activities which provide confidence in both the presence and absence of 
polio virus transmission, and specifically to:
  --implement a new direct detection strategy and augment investment in 
        lab infrastructure and data information management to increase 
        regional and country capacity to detect and respond to 
        outbreaks and improve the quality and timeliness of 
        surveillance, and
  --expand active surveillance, enhance the use of community-based 
        surveillance in hard to reach areas; and expand use of 
        environmental surveillance.
Vaccine Procurement
    Additional funds will support procurement of vaccines, including 
the recently introduced novel oral polio vaccine (nOPV2), a tool that 
is being rolled out to accelerate control of circulating vaccine 
derived polio. Twenty-five countries are already qualified to use this 
vaccine, 12 have already conducted campaigns and up to forty countries 
are preparing for use of this vaccine.
                    the role of rotary international
    Rotary is a global network of leaders who connect in their 
communities and take action to solve pressing problems. Since 1985, 
polio eradication has been Rotary's flagship project, with members 
donating time and money to help immunize nearly 3 billion children in 
122 countries. Rotary's chief roles are fundraising, advocacy 
(including resource mobilization and political advocacy), raising 
awareness and mobilizing volunteers. There are nearly 300,000 members 
throughout the United States who have raised more than U.S. $417 
million of the more than U.S. $2.4 billion Rotary has contributed to 
the Global Polio Eradication Initiative. This represents the largest 
contribution by an international service organization to a public 
health initiative ever. These funds have benefited 122 countries to buy 
vaccine and the equipment needed to keep it at the right temperature, 
and support the means to ensure it reaches every child. More 
importantly, tens of thousands of our volunteers have been mobilized to 
work together with their national ministries of health, UNICEF and WHO, 
and with health providers at the grassroots level in thousands of 
communities.
    Rotary also plays a key role in encouraging country level 
accountability. Rotary has National PolioPlus Committees, in the 
endemic countries and over 20 outbreak/at-risk countries. These 
national committees work to keep the spotlight on polio eradication 
amidst competing priorities from the community level to the National 
level.
                     benefits of polio eradication
    Since 1988, tens of thousands of public health workers have been 
trained to manage massive immunization programs and investigate cases 
of acute flaccid paralysis. Cold chain, transport and communications 
systems for immunization have been strengthened. The global network of 
146 laboratories and trained personnel established by the GPEI also 
tracks measles, rubella, yellow fever, meningitis, and other deadly 
infectious diseases including COVID-19 and will do so long after polio 
is eradicated. $27 billion in health cost savings has resulted from 
eradication efforts since 1988. Investing in polio eradication now may 
cumulatively save an estimated $33.1 billion by 2100 in the form of 
reduced costs of surveillance and vaccination. The costs to control 
polio at today's low levels, plus costs to treat the survivors, would 
be over U.S. $1 billion per year for decades to come. Without 
investment now, by 2032 the world would be spending more to control the 
virus. Polio eradication is a cost-effective public health investment 
with permanent benefits. As many as 200,000 children could be paralyzed 
annually in the next decade if the world fails to capitalize on the 
more than $19 billion already invested in eradication. Success will 
ensure that the investment made by the U.S., Rotary International, and 
many other countries and entities, is protected in perpetuity.
                                 ______
                                 
    Prepared Statement of the Ryan White Medical Providers Coalition
    Chairwoman Murray, Ranking Member Blunt, and members of the 
subcommittee, my name is Dr. Jehan Budak and I serve as the Assistant 
Medical Director and as an HIV primary care physician for the Madison 
Clinic at Harborview Medical Center in Seattle, Washington. I am 
pleased to submit testimony on behalf of the Ryan White Medical 
Providers Coalition (RWMPC), for which I serve as a Steering Committee 
member. RWMPC is a national coalition of medical providers and 
administrators who work in healthcare agencies supported by the Ryan 
White HIV/AIDS Program funded by the HIV/AIDS Bureau (HAB) at the 
Health Resources and Services Administration (HRSA) in the Department 
of Health and Human Services.
    First, I would like to thank the subcommittee for increasing FY22 
funding for several of the Ryan White Program parts that support access 
to HIV care and treatment, as well as increasing funding for the Ending 
the HIV Epidemic (EHE) initiative at both the HIV/AIDS Bureau and the 
Bureau of Primary Health Care at HRSA. These increases will help ensure 
access to effective, comprehensive HIV care and treatment through the 
Ryan White Program nationwide as well as support target EHE initiative 
jurisdictions scale up their ability to end the HIV epidemic by 
increasing access to HIV testing, prevention, care, and treatment 
services critical to reducing HIV transmission. Increasing funding for 
the Ryan White Program parts in FY23 would help jurisdictions 
nationwide continue to deliver comprehensive, effective HIV care and 
treatment as well as engage and retain new patients in a challenging 
environment impacted by rising care and workforce costs. To sustain and 
expand these critical services, I request $231 million (a 12 percent or 
$25.5 million increase) in FY23 for Ryan White Part C, which supports 
approximately 350 HIV medical clinics nationwide.
    RWMPC also requests additional resources for the EHE initiative to 
expand access to HIV prevention, care, and treatment, including $462.3 
million for HRSA's EHE program. This funding would include $290 million 
for the Ryan White Program EHE initiative to provide additional HIV 
care and treatment, as well as $172.3 million for the Bureau of Primary 
Health Care EHE intiative to support HIV prevention services, including 
providing Pre-Exposure Prophylaxis (PrEP), medication to prevent HIV. 
These funding levels also were requested by the President's FY23 budget 
request.
    It is important that increases for Ryan White Part C and for the 
EHE initiative be new, additional funding and not a repurposing of 
current resources. The additional pressure on the medical and public 
health infrastructure in the wake of the COVID-19 pandemic, including 
Ryan White clinics, is significant and limited resources cannot be 
further stretched.
    In fact, COVID-19 has demonstrated why our Nation needs to 
strengthen the public heath infrastructure and medical clinics serving 
people with HIV. Ryan White clinics were critical to responding to 
COVID-19 and many Ryan White medical providers were pulled in as 
leaders of the pandemic response in their jurisdictions. This worked 
well as these providers are infectious diseases experts with 
significant experience caring for vulnerable populations. These same 
providers also have been key to addressing the overdose crisis in their 
regions as well as increasing viral hepatitis and sexually transmitted 
infections, all which intersect with the domestic HIV epidemic.
    The flexibility of the Ryan White Program and the knowledge and 
innovation of its medical providers also has allowed Part C clinics to 
respond to the changing needs of patients and the health care system 
throughout the transitions and challenges of the COVID-19 pandemic as 
well as the escalating overdose crisis. Part C clinics have helped 
people living with HIV by sustaining access to health care and 
medication through telehealth and other services, such as case 
management and transportation; by enrolling new patients who have lost 
health insurance as a result of economic disruption; and by providing 
overdose prevention and behaviroal health care to patients living with 
HIV and mental health and/or substance use disorders.
Madison Clinic at Harborview Medical Center in Washington State has 
        Expanded Access to HIV Prevention, Care, & Treatment
    Since 1986, the Madison Clinic has served as the leading source of 
HIV primary care in the Pacific Northwest when its HIV care program was 
expanded with the assistance of Ryan White Program funding. Since then, 
the clinic has grown dramatically and now serves over 3,000 individuals 
with HIV, most with complex medical and psychosocial needs. 
Approximately 30 percent of our population is Black or African American 
(Seattle overall has 7 percent Black representation), 15 percent is 
Latinx, and 10 percent is Asian, Pacific Islander, or Native American. 
47 percent of patients live at or below the Federal poverty level. Like 
other HIV clinics across the US, ours serves an increasingly aging 
population, with 60 percent of patients over the age of 45. As a 
result, the burden of co-morbid illnesses, such as cancer, 
cardiovascular disease, and metabolic complications such as diabetes is 
extremely high. Alarmingly, 12 percent of patients lack permanent 
housing, and many patients were negatively impacted by the intersection 
of housing instability; the opioid and other drug crisis and HIV 
epidemics; and the COVID-19 pandemic. Madison Clinic, like most Ryan 
White Part C clinics, also receives support from other parts of the 
Ryan White Program that help us provide medications, additional medical 
care, and support services, such as case management and transportation, 
all key to the comprehensive Ryan White care model that produces 
outstanding outcomes.
    Madison Clinic also provides Pre-Exposure Prophylaxis (PrEP) 
services across the clinic to approximately 500 individuals at risk for 
HIV. This critical HIV prevention tool is integrated at Madison Clinic 
as part of prevention and primary care services. However, more support 
for the PrEP program, including for PrEP navigators and lab tests, is 
needed to scale up these services to meet patient needs.
    Many Harborview patients struggle with HIV, substance use disorder 
(SUD), and related infectious diseases, such as hepatitis C. In 
response, in partnership with the Public Health Department for Seattle-
King County, the MAX Clinic was established to provide incentivized, 
drop-in care for people living with HIV who have not yet achieved viral 
suppression and who experience multiple barriers to care. The MAX 
Clinic serves approximately 200 patients, and receives support from 
Part B of the Ryan White Program as well as funding from the local 
Health Department.
Ryan White Part C Clinics are Effective Medical Homes and Public Health 
        Programs
    Ryan White Part C directly funds approximately 350 community health 
centers and clinics that provide comprehensive HIV medical care 
nationwide, serving more than 300,000 patients each year. These clinics 
are the primary method for delivering HIV care to rural jurisdictions--
approximately half of all Part C providers serve rural communities. The 
program's comprehensive services engage and keep people in HIV care and 
treatment. This is critical, because HIV is infectious, so identifying, 
engaging, and retaining individuals with HIV in effective care and 
treatment saves lives and benefits public health by stopping HIV 
transmission when individuals are virally suppressed.
    In 2020, 89.4 percent of Ryan White patients were virally 
suppressed--a 28.6 percent increase in the program-wide viral 
suppression rate since 2010. In 2021, 92.8 percent of Madison Clinic 
patients were virally suppressed in spite of the complex challenges 
presented by the COVID-19 pandemic. The Ryan White Part C program's 
comprehensive services engage and keep people in HIV care and 
treatment. For example, 98 percent of HIV patients are on 
antiretroviral therapy at Madison Clinic. Early, reliable access to HIV 
care and treatment helps patients living with HIV live healthy and 
productive lives and is more cost effective.
Part C Clinics are on the Frontlines of the Opioid Crisis and Provide 
        SUD Treatment
    Ryan White clinics serve a significant number of individuals living 
with both substance use disorder (SUD) and HIV. The majority of Madison 
Clinic providers have the credentials to prescribe buprenorphine 
therapy (medication assisted treatment for Substance Use Disorder), and 
our providers treat viral hepatitis, supported by a multidisciplinary 
team in our clinic. Part C clinics are able to deliver a range of 
medical and support services, including overdose prevention and harm 
reduction services, needed to prevent, intervene, and treat substance 
use disorder as well as related infectious diseases, including HIV, 
hepatitis C, and sexually-transmitted infections. The experience and 
expertise of Ryan White Part C medical providers should be leveraged to 
effectively respond to the overdose crisis and to help rapidly expand 
access to urgently needed SUD services.
Funding for Prevention and Harm Reduction at CDC and Research at NIH is 
        Critical
    While my testimony has focused on HRSA programs, the ability to 
effectively respond to the syndemics of HIV, substance use disorder, 
and related infectious diseases such as hepatitis C; sexually 
transmitted infections; and skin, soft tissue, and endovascular 
infections depends on CDC funding to enhance surveillance and 
prevention activities, and on NIH to continue to improve the tools to 
prevent and treat HIV and SUD and to learn how to effectively implement 
them. The AIDS Clinical Trials Unit, a member of the AIDS Clinical 
Trials Group funded by the NIH, is co-located within Madison Clinic and 
provides direct access for our patients to participate in research that 
pushes the envelope on HIV and viral hepatitis treatment, including a 
focus on HIV remission/cure strategies.
    We request $310 million for CDC to provide surveillance, response, 
and other HIV prevention services as part of the EHE initiative, as 
well as $150 million for CDC to address the infectious diseases 
consequences of the opioid and other drug epidemic, including by 
supporting and expanding access to syringe services programs, harm 
reduction, and overdose prevention. Finally, we support continued 
robust funding for NIH, including for HIV research. This funding 
supports discoveries that will help to end the HIV, hepatitis C, and 
opioid and other drug epidemics and that informed the treatment and 
prevention of COVID-19.
    Thank you for your time and consideration of these requests, and 
please do not hesitate to contact me or Jenny Collier, Convener of the 
Ryan White Medical Providers Coalition, at 
[email protected], if you have any questions or need 
additional information.

    [This statement was submitted by Jehan Budak, MD, Assistant Medical 
Director, Madison HIV Clinic at the Harborview Medical Center in 
Seattle, Washington.]
                                 ______
                                 
                 Prepared Statement of Safer Foundation
    Thank you, Chairwoman Murray, Ranking Member Blunt, and members of 
the subcommittee, for inviting me to submit testimony on behalf of the 
Safer Foundation. My name is Kevin Brown and I serve as the Director of 
Policy, Advocacy, and Legislative Affairs for the Safer Foundation. For 
50 years, Safer has provided comprehensive workforce development and 
reentry services for individuals with criminal legal histories seeking 
employment. There is dignity in work, and Safer Foundation believes 
that individuals who have made mistakes should have the opportunity to 
be self-sufficient and contribute to their families and communities 
through gainful, living wage employment. Clients come to Safer 
Foundation because they want and need to work, and Safer helps clients 
discover career path employment that is personally fulfilling and that 
pays a living wage.
    A critical Federal program that supports these efforts is the 
Reentry Employment Opportunities (REO) program (also known as the 
Reintegration of Ex-Offenders (RExO) program) within the Department of 
Labor's Employment & Training Administration. I thank the subcommittee 
for providing REO with $102 million in FY22. Given the need to train 
people for the jobs our economy requires in industries such as health 
care, technology, and logistics; to help employers identify the 
qualified workers they need now; and to help people with criminal legal 
histories find living wage employment to support successful, long-term 
reentry, I urge the subcommittee to provide $200 million for the REO 
program in FY23.
    Authorized by section 169 of the Workforce Innovation and 
Opportunity Act (WIOA), the REO program provides workforce preparation 
and reentry services for both adults and young people. REO includes a 
set-aside to provide services to prepare youth who are justice-system 
involved and/or who have not completed school or other educational 
programs for employment. Research has found that incarceration reduces 
a formerly incarcerated person's earning potential by more than 52 
percent,\1\ making workforce development services essential for long-
term employment and reentry success. In light of the costs of the 
criminal legal system at the State, local, and Federal levels, the REO 
program is crucial to incubating community-based models of successful 
reentry through employment.
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    \1\ Craigie Terry-Ann; Grawert, Ames; Kimble, Cameron, Stiglitz, 
Joseph (2020); Conviction, Imprisonment, and Lost Earnings: How 
Involvement with the Criminal Justice System Deepens Inequality: 
https://www.brennancenter.org/our-work/research-reports/conviction-
imprisonment-and-lost-earnings-how-involvement-criminal.
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    REO is the only Federal program that focuses specifically on 
workforce development and employment for people with records. As the 
economy recovers and workforce needs continue to evolve and change, it 
is essential to ensure that the significant number of people with 
criminal legal histories has the reentry supports and workforce 
training needed to achieve gainful employment and long-term reentry 
success. Developing this pool of trained, talented, and motivated 
workers also will help fill the workforce gaps employers currently 
face, especially in sectors with critical worker shortages. For these 
reasons, Congress should significantly expand the program in FY23 to 
$200 million.
      employment reduces recidivism and improves reentry outcomes
    1 in 3 adults in the United States has a criminal record that 
interferes with their ability to find a job.\2\ Research shows that 
sustained, living wage employment and life skills are critical 
components to long-term reentry success. One study found that 
individuals who were employed and earning higher wages after release 
were less likely to return to prison within the first year.\3\ The REO 
program improves reentry success by working with individuals to 
overcome employment barriers with training for jobs in local high-
demand industries through career pathways and industry-recognized 
credentials and by providing needed reentry supports. Increasing REO 
funding would expand access to these comprehensive workforce 
development and reentry services that are especially needed now.
---------------------------------------------------------------------------
    \2\ ``Research Supports Fair-Chance Policies'' (March 2016), 
National Employment Law Project, footnote 1 on p. 7. Available at 
http://www.nelp.org/publication/researchsupports-fair-chance-policies.
    \3\ Visher, C., Debus, S., & Yahner, J. Employment After Prison: A 
Longitudinal Study of Releasees in Three States. Washington, DC: Urban 
Institute (2008).
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safer's reo-supported services increase employment by working with both 
                        employers and employees
    Safer Foundation offers comprehensive workforce development and 
reentry services that train individuals, address their reentry 
obstacles and needs, and help them obtain sustained employment. This 
holistic approach has rendered outstanding results for both 
participants and employers. In 2006, decades of experience and success 
led Safer to become one of the original REO grantees.
    In addition to working with reentering individuals and their 
communities, Safer works closely with employers to identify what types 
of trained employees are needed. In December 2021, the National 
Federation of Independent Business (NFIB) reported that 60 percent of 
businesses overall (and 95 percent of those hiring or trying to hire) 
reported few or no qualified applicants for available positions. While 
the demand for qualified workers exists, many newly unemployed 
individuals may not meet the qualifications for particular industries. 
Safer can be responsive to employer needs by tailoring its programs to 
develop skilled, qualified workers for specific employment sectors and 
has partnered with hundreds of employers to do so.
    Safer's Training to Work (T2W) program, that was funded in part 
with a REO grant, improved long-term employment prospects for clients 
at Safer's Adult Transition Centers (ATC). Participants received case 
management, education, and training that led to industry-recognized 
credentials for in-demand employment, such as forklift operation, 
welding, computer numerical control (CNC) operation, licensed 
commercial driving (CDL) occupations, and Microsoft technologies 
training. Given the program's strong employer and credentialing 
components, REO is uniquely positioned to assist local organizations in 
developing and providing services that meet the needs of both the local 
business community and reentering individuals. Increasing REO funding 
in FY23 to $200 million, including funding for earn and learn 
apprenticeship opportunities for in demand skills development, would 
expand these efforts and help provide employers with more qualified 
employees who are trained, talented, motivated to work.
safer's reo grant produced outstanding employment outcomes and reduced 
                               recidivism
    Safer's REO grant for the Training to Work (T2W) program 
significantly outperformed employment targets and dramatically reduced 
recidivism. For the first cohort of REO T2W participants, 69 percent of 
participants obtained employment--15 percent higher than the grant's 
employment target. Given the success of this first cohort of 
participants, T2W was expanded to include a second cohort who did even 
better with an employment rate of 78 percent--30 percent higher than 
the grant's target. Safer's REO T2W grant also reduced recidivism rates 
beyond original targets. T2W's first participant cohort had an 11 
percent recidivism rate, and its second participant cohort had a 9 
percent recidivism rate -75 percent and 80 percent lower respectively 
than the National recidivism rate of 44 percent.\4\
---------------------------------------------------------------------------
    \4\ Durose, Matthew R., Alexia D. Cooper, and Howard N. Snyder, 
Recidivism of Prisoners Released in 30 States in 2005: Patterns from 
2005 to 2010 (pdf, 31 pages), Bureau of Justice Statistics Special 
Report, April 2014, NCJ 244205.
---------------------------------------------------------------------------
    Safer's REO grant for their Advancing Careers & Employment program 
also saw great outcomes with 577 enrolled clients. The ACE program 
provided workforce development, education, trauma-informed case 
management, and occupational training to adults (25 and older) who had 
been released from incarceration within 180 days or who were currently 
under supervision. Of the enrolled clients 93 percent developed an 
employment plan and 60 percent completed job training in the areas of 
carpentry, commercial driving, IT, hospitability, and solar panel 
installation.
    Program evaluation has shown that such success is related to the 
comprehensive service model that REO grantees such as Safer provide. 
Effective, comprehensive services can include interventions such as 
relationship building between staff and participants, employment 
verification, trauma-informed training, life skills training, 
employment preparation, mentoring, intensive case management, strong 
training provider relationships and support, family involvement, and 
post-release follow-up and support. These comprehensive services are 
cost-effective--a recent study found that in Illinois the average cost 
associated with just one recidivism event is $151,662. Another study 
found that individuals who were employed and earning higher wages after 
release were less likely to return to prison within the first year. By 
increasing and improving employment outcomes, the REO program invests 
in formerly incarcerated people and their families, provides for a more 
equitable recovery, and improves public safety.
investments in reo as a reentry and workforce development programs will 
             help ensure a more equitable economic recovery
    Black people and other people of color are disproportionately 
impacted by the criminal legal system. Black people are incarcerated at 
more than 5 times the rate of white people. In 2018, the incarceration 
rate of Black men was 5.8 times higher than that of white men, and 
Black young men ages 18-19 years old were 12.7 times as likely to be 
incarcerated as white young men in the same age group. In 2018, Black 
women were almost twice as likely to be incarcerated as white women, 
and Black girls were 3 times more likely to be incarcerated than white 
girls.
    Upon release, these disparities persist as a result of systemic and 
institutional racism and discrimination; collateral consequences of 
conviction that ban or limit legal access to employment, licensure, and 
education supports; and a limited investment in resources for the large 
number of people returning each year who come back to their communities 
without the basic support and tools needed for long-term success. 
Providing Federal resources for workforce development and reentry helps 
to ensure greater success and helps to address unfair barriers that 
exist as a result of systemic racism and inequities that disadvantage 
individuals directly impacted by the criminal legal system. Reentry and 
workforce development programs, such as REO, are critical to ensuring a 
more equitable economic recovery for people with criminal legal 
histories, especially Black people and people of color who are 
disparately impacted by the criminal legal system.
                               conclusion
    By making effective workforce development and reentry services a 
priority, we fulfill labor market demands, contribute to the economy, 
and build strong and safe communities. Given the extensive employment 
and reentry needs nationwide, as well as the significant return on 
investment related to reduced incarceration costs and reduced crime 
costs borne by victims, families, and communities, I urge Congress to 
allocate $200 million to the REO program in FY23.
    Thank you so much for your time and consideration of this important 
program. If you have questions or need additional information, please 
don't hesitate to contact me at [email protected] or 
Jenny Collier at colliercollective.org.

    [This statement was submitted by Kevin Brown, Director of Policy, 
Advocacy, and Legislative Affairs, Safer Foundation.]
                                 ______
                                 
                Prepared Statement of Save the Children
    Chairwoman Murray, Ranking Member Blunt, and honorable Members of 
the subcommittee, thank you for the opportunity to provide testimony on 
behalf of Save the Children about the critical investments in the 
Departments of Health and Human Services and Education to ensure robust 
investment in early childhood education programs and to support 
unaccompanied children seeking safety and security in the U.S. In the 
United States and around the world, Save the Children works every day 
to give children a healthy start in life, the opportunity to learn and 
protecting children in crisis. We do whatever it takes for children--
every day and in times of crisis--transforming their lives and the 
future we share. We urge the subcommittee to support robust 
appropriations for the Department of Health and Human Services, 
specifically the Office of Refugee Resettlement and the programs of 
Head Start/Early Head Start, Child Care and Development Block Grants, 
and Preschool Development Grants, as well as the Department of 
Education programs--21st Century Community Learning Centers and Promise 
Neighborhoods.
                administration for children and families
Child Care and Development Block Grant (CCDBG)
            Request: $12.3 billion for the Child Care and Development 
                    Block Grant.
    Families continue to struggle to afford child-care and childcare 
providers operate on razor thin margins. Despite significant 
investments in recent years, fewer than 1 in 7 eligible families 
received a subsidy under CCDBG. The much-needed relief provided by the 
American Rescue Plan has been essential to keep the child care sector 
afloat, and these temporary funds must be supplemented with an 
expansion to the base CCDBG budget. States face significant pressures 
on their existing CCDBG and child care relief funds: they must use a 
portion of CCDBG funds for quality improvement, as well as implementing 
new health and safety requirements, increasing payment rates, serving 
more children, and expanding eligibility.
    An additional $6.17 billion is needed--for a total of $12.3 
billion--to avoid damaging funding cliffs, and support States in making 
targeted investments to their child care systems aligned with longer-
term recovery needs.
Head Start and Early Head Start
            Request: $15.4 billion for Head Start and Early Head Start.
    Head Start and Early Head Start are key to providing and expanding 
comprehensive early care and education to our poorest children. At the 
current level of funding, Head Start serves less than half of eligible 
preschoolers, and Early Head Start only serves approximately one in 10 
eligible infants and toddlers. During the pandemic the remarkable Head 
Start staff across the country have stepped up in order to maintain 
quality programming by modifying both their in-home and in-person early 
education programs. Without increased funds, the realities of a 
competitive market will require programs to choose between cutting 
access for children or underpaying and risk losing experienced and 
skilled staff.
    An additional investment of $4.4 billion--for a total of $15.4 
billion--is needed for Head Start and Early Head Start in order to 
maintain the high-quality early education opportunities the program 
provides. Specifically, $1 billion is needed for expansion of Early 
Head Start and Early Head Start-Child Care Partnerships, $596 million 
to sustain the workforce through a cost-of-living adjustment, $2.5 
billion for workforce compensation realignment, $262 million to provide 
flexibility to address local quality improvement priorities, including 
facilities, and $10 million to help develop the most effective and 
appropriate staff for American Indian/Alaska Native programs.
Preschool Development Grants (PDG)
            Request: $500 million for Preschool Development Grants 
                    Birth through Five (PDG B-5) program.
    Expanded investments in Preschool Development Grants will enable 
more children to take advantage of early learning opportunities that 
encourage their learning and growth and will support efforts to further 
strengthen the quality of these programs. Research has demonstrated 
that high-quality early education has long-term benefits for children, 
especially low-income children, which far exceed the costs. And yet, 
despite the proven benefits of high-quality early education in general 
and the PDG program in particular, funding constraints mean that only 
28 of the 46 planning grant recipients have received renewal grants.
    An additional $210 million is needed--a total of $500 million--for 
Preschool Development Grants to allow state and territories to increase 
the quality and efficiency of existing early learning programs and 
systems, while thinking strategically about how to optimize Federal and 
State funding streams. Through PDG B-5, Congress has the unique 
opportunity to foster state-led early learning initiatives, which is 
particularly necessary as States continue to recover from the pandemic.
                  office of refugee resettlement (orr)
Pilot Grant Program for Federally Funded Respite/Welcoming Centers
            Request: $50 million for the Grant Program for the 
                    humanitarian reception of individuals and families 
                    who have been released from DHS custody.
    In order to create a more humane processing system at our Southern 
border, the department should establish an ORR-administered Non-
Custodial Migrant Shelter Grant Program to support the establishment 
and operation of shelters by non-profit, non-governmental organizations 
at the border for families and single adults released from DHS custody. 
These welcome centers would be run by local community and faith based 
nonprofit organizations where families and adults can receive legal 
orientations and other services, reducing time in CBP custody. The 
funds for this program shall provide humanitarian assistance to 
individuals and families encountered and released by DHS, including 
basic medical care, psychosocial support, orientation to legal 
responsibilities and rights, referrals to community-based case 
management services at destination cities, and facilitation of onward 
travel.
Increased Funding for Legal Services, Child Advocates, and Post-Release 
        Services
            Request: $400,000,000 for the provision of legal services 
                    for all unaccompanied children in the UC program, 
                    $12 million for the appointment of a Child 
                    Advocates, and $250 million shall remain available 
                    to ensure rapid access to and high quality of post-
                    release services.
    Unaccompanied children are uniquely vulnerable and face daunting 
challenges in the immigration system. Many unaccompanied children have 
valid claims for relief from deportation owing to past or feared harm, 
abuse, abandonment, neglect, or human trafficking; and all children 
have a right to a fair hearing in immigration court. Services provided 
by qualified and independent legal counsel to unaccompanied children 
increase the efficiency and effectiveness of immigration proceedings 
and significantly reduce the failure-to-appear rate of children who are 
released from HHS custody. Along these lines, independent Child 
Advocates appointed pursuant to the TVPRA provide a vital resource to 
the most vulnerable unaccompanied and separated children in Federal 
custody and to Federal agencies charged with their care, release and 
safe repatriation. While the additional funding recently appropriated 
for family reunification services has helped, there continue to be 
significant gaps in adequate home study and post-release service 
provision.
Creation of Ombudsperson Within HHS to Advocate for the Rights of 
        Immigrant Children
            Request: $10 for the creation of the Office of Ombudsperson 
                    within HHS to provide independent child-welfare 
                    focused recommendations to ORR and the Secretary 
                    regarding the care of unaccompanied children.
    Save the Children supports the creation of the Office of the 
Ombudsperson for Immigrant Children in Federal Custody to advocate for 
the quick, safe, and efficient release of immigrant children from 
government custody whenever possible, including the right to review 
placement decisions. Additionally, the Ombudsperson shall have access 
to facilities data, reviews, and recommendations of the HHS Office of 
Inspector General, in order to investigate systemic issues or 
improvements of facilities or grantees. Other longstanding problems-
such as lagging reunifications or inappropriate placements in 
restrictive settings-also merit additional scrutiny and escalation 
mechanisms, as children and sponsors are often left with little to no 
recourse to bring their concerns to bear. The office would support 
Congress' longstanding view that family separation and detention are 
generally not in a child's best interest and, in cases in which 
detention or government custody is required, ensure that immigrant 
children are only detained or held in government custody in the least 
restrictive setting. In particular, this office would help mitigate and 
promptly address conditions that adversely impact children's safety, 
health, and wellbeing.
Restrictions on Use of Unlicensed Facilities
            Request: None of the funds made available under the heading 
                    ``Department of Health and Human Services-
                    Administration for Children and families-Refugee 
                    and Entrant Assistance'' may be used to house 
                    unaccompanied children in any facility that is not 
                    State-licensed or any proposed facility ineligible 
                    for state licensure for the care of unaccompanied 
                    children.
    State licensing is an essential and irreplaceable guardrail to 
ensure the safety of children in government custody. When the number of 
children arriving at the border increased during 2021, the Biden 
Administration opened new unlicensed facilities called ``emergency 
intake sites'' to quickly transfer children from Customs and Border 
Protection custody. These emergency intake sites were opened and have 
been operating without adherence to legal standards or ORR policies 
regarding services and safeguards, leading multiple whistleblowers to 
speak out against deplorable conditions for children. State actions 
like those taken by Texas and Florida to strip ORR facilities of state 
licenses are concerning, as they leave facilities without an 
independent oversight and monitoring mechanism to ensure the safety and 
well-being of children.\1\ It is critical that ORR continues to 
challenge these state decisions through litigation while also 
proactively working with other States to expand its licensed capacity 
of family- and community-based settings. Congress must ensure that ORR 
is prepared for fluctuating numbers of arrivals at the border by 
expanding its system of State-licensed facilities that are compliant 
with the Flores Settlement and implementing policies that ensure 
children's safe and prompt release from custody; it is never acceptable 
to deprioritize child welfare.
---------------------------------------------------------------------------
    \1\ https://www.texastribune.org/2021/08/10/texas-child-migrant-
facilities-licenses/.
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                 department of education appropriations
21st Century Community Learning Centers (CCLC)
            Request: $1.789 billion for 21st Century Community Learning 
                    Centers.
    Every day 11.3 million children are alone after school and are 
unsupervised for an average of seven hours per week. Parents of more 
than 19.4 million youth say their children would participate in an 
afterschool program if one were available in their community. Programs 
like CCLC help working families, keep young people safe during the 
hours after school when juvenile crime peaks, and improve academic 
achievement. Without funding for afterschool and summer learning 
programs, students will lose out on essential learning opportunities 
that help them prepare for school, college and careers, and can make up 
for time lost during the pandemic. The pandemic has shown how important 
robust afterschool and summer learning programs are to working families 
and our most vulnerable students, and how vital resources are to 
support these programs to ensure they are available and effective for 
the children who need them.
Promise Neighborhoods
            Request: $118 million for Promise Neighborhoods.
    The Promise Neighborhoods program supports the implementation of 
innovative strategies that improve outcomes for children in the 
Nation's most distressed communities. To do so, communities must build 
a continuum of supports for children, from cradle to career. This 
holistic approach to improving the educational achievement of low-
income students ensures sustainable, community-driven changes and 
interventions.\2\ Since its creation in 2010, this innovative program 
has proven a to be strategic investment in high-needs communities, 
funding communities with demonstrated success as well as new 
communities who create plans for change. This funding would allow for 
expansion of existing grants and new implementation grants, full 
funding for extension grants, and the creation of new capacity-building 
grants to strengthen communities' ability to deliver critical services 
to children and families while also scaling city and regional 
investment strategies.
---------------------------------------------------------------------------
    \2\ https://www.brookings.edu/research/the-harlem-childrens-zone-
promise-neighborhoods-and-the-broader-bolder-approach-to-education/.
---------------------------------------------------------------------------
                               conclusion
    On behalf of Save the Children, and our advocates across the 
country, I want to thank the subcommittee for its continued leadership 
and bipartisan work on these programs. I ask that you continue to make 
a robust investment in children in FY23, increasing access to 
opportunity, and ensuring a more prosperous America for generations to 
come.

    [This statement was submitted by Christy Gleason, Vice President of 
Policy, 
Advocacy, and Campaigns, Save the Children.]
                                 ______
                                 
         Prepared Statement of the Seattle Indian Health Board
    Chair Murray, Ranking Blunt, and members of the Senate Committee on 
Appropriations--Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies, my name is Esther Lucero. I am Dine, 
of Latino descent, and third generation in my family living outside of 
our reservation, I strongly identify as an urban Indian. I serve as the 
President & CEO of the Seattle Indian Health Board (SIHB), one of 41 
Urban Indian Organizations (UIO) nationwide. I have had the privilege 
of serving SIHB for 6 years and have been providing congressional 
testimonials for the past 4 years. I am honored to have the opportunity 
to submit my testimony today requesting: the permanent authorization of 
100 percent Federal Medical Assistance Percentage (FMAP) for UIOs; 
encouraging behavioral health parity and integration through workforce 
development initiatives across the U.S. Department of Health and Human 
Services (HHS) and Health Resource and Services Administration (HRSA); 
modifying the Substance Abuse and Mental Health Services Administration 
(SAMHSA) Government Performance and Results Act (GPRA) tool; increasing 
access to traditional health services through the Centers for Medicare 
and Medicaid Services (CMS); and increasing administrative time under 
the Indian Health Service (IHS) Loan Repayment Program. Addressing 
these key issues can advance the health of urban American Indian and 
Alaska Native (AI/AN) population.
    SIHB is an Indian Health Service (IHS)-designated UIO and a HRSA 
330 Federally Qualified Health Center, which serves nearly 5,000 AI/AN 
living in the Greater Seattle Area in Washington state. Nationwide, 
UIOs operate 74 health facilities in 22 States and offer services to 
over 5.4 million AI/AN people in select urban areas. As a culturally 
attuned service provider, we offer direct medical, dental, traditional 
health, behavioral health services, and a variety of social support 
services on issues of gender-based violence, youth development, and 
homelessness. We are part of the Indian healthcare system and honor our 
responsibilities to work with our Tribal partners to serve all Tribal 
people, wherever they may reside.
    We are home to a Tribal public health authority, Urban Indian 
Health Institute (UIHI), 1 of 12 Tribal Epidemiology Centers (TEC) in 
the country and the only TEC with a national purview-serving both rural 
and urban AI/AN's. For over 20 years, UIHI has managed public health 
information systems, managed disease prevention and control programs, 
communicated vital health information and resources, responded to 
public health emergencies, and coordinate these activities with other 
public health authorities and UIO's nationwide. Due to a lack of access 
to disease surveillance data, UIHI released the only AI/AN COVID-19 
Data Dashboard,\1\ providing critical disease surveillance data to the 
45 UIO service areas ensuring AI/AN communities have access to 
culturally informed data collection, research, and evaluation.
---------------------------------------------------------------------------
    \1\ Urban Indian Health Institute (April 2022) COVID-1 Data 
Dashboard. Retrieved from: https://www.uihi.org/covid-19-data-
dashboard/.
---------------------------------------------------------------------------
Extend 100 percent Federal Medical Assistance Percentage (FMAP)
    The American Rescue Plan act of 2021 temporarily extended 100 
percent Federal Medical Assistance Percentage (FMAP) to UIOs. For 
Washington state, the 2-year temporary extension has resulted in $18 
million in Federal cost savings that will be captured in the Indian 
Health Improvement Reinvestment Account. The investment account will be 
able to expand its funding to activities, programming, and initiatives 
that improve the health of AI/AN people across the State of Washington.
    The permanent extension of 100 percent FMAP to UIOs upholds the 
political status of Tribal citizens to ensure Federal dollars provide 
Medicaid-coverage to urban AI/AN Medicaid beneficiaries. Permanent 
extension of 100 percent FMAP reduces State Medicaid expenditures, 
honors Federal trust and treaty responsibility to AI/AN people and 
creates innovative healthcare delivery and systems changes to address 
social determinants of health experienced in AI/AN communities.
Encourage Behavioral Health Parity and Integration
    We request HHS improve partnerships and invest resources with the 
Indian healthcare system to support recruitment and retention of health 
care professionals to support health integration, consumer demand, and 
identify need. A HRSA report found significant shortages of 
psychiatrists, psychologists, social workers, school counselors, and 
therapists across the country resulting in severe workforce deficits 
for Indian County.\2\ For Washington state, HRSA has identified our 
area as having a Mental Health Professional Shortage Area, with 
only16.8 percent of mental health needs being met.\3\
---------------------------------------------------------------------------
    \2\ U.S. Department of Health and Human Services--Health Resources 
and Services Administration. (2016). National Projections of Supply and 
Demand for Selected Behavioral Health Practitioners: 2013-2025. 
Retrieved from: https://bhw.hrsa.gov/sites/default/files/bureau-health-
workforce/data-research/behavioral-health-2013-2025.pdf.
    \3\ KFF. (2021). Mental Health Care Health Professional Shortage 
Areas (HPSA). Retrieved from: https://www.kff.org/other/state-
indicator/mental-health-care-health-professional-shortage-areas-hpsas/
?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:
%22asc%22%7D.
---------------------------------------------------------------------------
    We ask that HHS encourage behavioral health parity and integration 
by supporting initiatives to dual credential our providers to support 
vacancies. We request HHS mirror the Veterans Benefits Administration 
(VBA) dual certification process to support our providers. As AI/AN 
people are disproportionately represented in poor behavioral health 
outcomes, including higher rates of behavioral health conditions such 
as mental health, substance use, or suicide,\4\ it is necessary for HHS 
to invest in behavioral health parity through workforce developments 
for Indian healthcare clinics.
---------------------------------------------------------------------------
    \4\ U.S. Department of Health and Human Services--Office of 
Minority Health. (2021). Mental and Behavioral Health--American 
Indians/Alaska Natives. Retrieved from: https://minorityhealth.hhs.gov/
omh/browse.aspx?lvl=4&lvlID=39.
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    To address the workforce shortage of the Indian healthcare system 
as a whole, we support the National Tribal Budget Formulation Workgroup 
Recommendations, which includes $1 billion to the Indian healthcare 
workforce development program to recruit and retain health 
professionals to address chronic and pervasive health care provider 
shortages. In addition, we ask that HHS advocate for, prioritize, and 
support workforce development incentives at IHS, SAMHSA, and HRSA.
Increase Partnerships and Resources to Address Provider Shortages
    As previously mentioned, we recommend HRSA support investments into 
the Indian healthcare system through workforce development and 
supporting dual credentialing of providers to address our workforce 
deficits and meet the needs of Indian Country.
    In order to ameliorate the significant vacancy rates for the Indian 
healthcare system, and address challenges to filling the vacancies in 
our facilities, SIHB has a strong workforce development program which 
includes 6 family medicine residents, 6 public health interns, and 4 
Master of Social Work program students. Of our 6 family residents, 4 
identify as AI/AN and recent graduation rates show 80 percent of our 
previous residents go on to work in communities of color and 50 percent 
go on to work in Native communities. These types of training programs 
increase AI/AN representation in provider positions.
    As we develop the next generation of Indian Health Care Providers, 
we must ensure that barriers for American Indian and Alaska Native 
providers are eliminated, and we must increase leadership and 
management opportunities for all Indian Health Care Providers in the 
LRP program. We recommend that IHS modify LRP program requirements to 
allow providers additional administrative time. Additionally, HRSA 
investments can support vacancies, salary comparison, incentives, 
training programs, and dual credentialing needed to support recruitment 
and retention of AI/AN representation in the healthcare workforce.
Mandate CMS Reimbursement for Traditional Health Services
    We request CMS support the integration of Traditional health 
services as reimbursable services to improve access to quality health 
services for AI/AN populations. Improved access to Traditional health 
services support equity-based health care initiatives that are outcome-
oriented, patient-centered, and support primary and preventative 
healthcare services.
    In 2021, SIHB secured a SAMHSA grant to launch a Traditional Indian 
Medicine (TIM) pilot that will code Traditional health services into 
our Electronic Health Records (EHR) system and will replicate 
reimbursable services. UIHI will provide evaluation on the pilot to 
document the health benefits of integrating Traditional Practitioners 
as part of our wraparound services. SIHB has uniquely integrated our 
Traditional Practitioners into our clinical and social services teams 
to provide over 39,000 encounters through assessments, counseling, 
hospital visits, and group services. In March 2023, SIHB will release a 
report documenting our methods to credential Traditional Practitioners, 
code Traditional health services into EHR, replicate reimbursable 
billing, and health outcomes from this pilot.
    The pilot will demonstrate how integrating traditional services in 
relatives' (patients) primary and preventative care can support and 
improve health outcomes of our relatives. Traditional health services 
can complement Western healthcare to support culturally attuned care 
for AI/AN people and BIPOC communities across the Nation. We will 
utilize our success story to advocate for Traditional health services 
being a standard practice across healthcare systems in the Nation to 
advance health equity by supporting outcome-oriented, patient-centered, 
and primary and preventative healthcare services.
Modify the GPRA Tools for Low-Barrier and Culturally Attuned Services
    The GPRA Modernization Act of 2010 modified the GPRA tool to better 
serve the needs of providers. Twelve years later, we desperately need 
the GPRA tool to be remodified to meet the modern needs of providers. 
The Administration, Congress, and local elected officials have all 
announced their efforts to address rising Substance Use Disorder (SUD) 
rates. However, the GPRA tool continues to be a burden to SUD access 
and treatment for our relatives due to the trauma triggering 
questionnaire. Additionally, the GPRA tool places a strain on our 
providers to meet required quotas. To ensure continued funding for our 
critical services, providers must commit their time and resources to 
fulling the requirements of the GPRA tool despite it not informing 
multidisciplinary teams of local clinics.
    Today, the GPRA performance tool is burdensome to patients and 
providers. From providers in the Indian healthcare system, we have 
heard the GPRA tool is trauma triggering for patients, time intensive 
for patients and providers, and collects data that is solely beneficial 
for the Federal Government. The GPRA tool must be modified to be 
patient-centric, consider the time of our patients and providers, and 
avoid collecting unnecessary data that does not benefit local clinics. 
For example, UIHI and our medical division, are recipients of GRPA 
funds and certain questions related to behavioral health do not benefit 
our clinical team or research division.
    We request HHS and SAMHSA modify the GPRA tool to be culturally 
attuned and low barrier to support the needs of our relatives. 
Additionally, we request HHS and SAMHSA modify the tool with the input 
of providers, patients, and Native experts to shorten the screening 
tool, ensure it is patient-centered, holds validity, administratively 
considerate, and informs providers of the immediate and long-term care 
of relatives.
Increase Administrative Time under the IHS Loan Repayment Program (LRP)
    IHS has notified me amending the Loan Repayment Program (LRP) 
structure is a legislative fix that must be addressed by Congress. As 
the Indian healthcare system is severely understaffed, we must continue 
to implement unique initiatives to support our providers, which 
includes amending the IHS LPR to increase administrative time.
    Under the current IHS LPR structure, medical providers are limited 
to 20 percent of FTE allocated to administrative time. While direct 
clinical care training is essential to the development of healthcare 
providers, we must acknowledge that administrative time is an 
opportunity to develop skillsets in leadership and operations 
management. I believe this amendment will support providers in the 
Indian healthcare system.

    [This statement was submitted by Esther Lucero (Dine), MPP, 
President & CEO, Seattle Indian Health Board.]
                                 ______
                                 
           Prepared Statement of the Sex Education Coalition
    Dear Chairwoman Murray and Ranking Member Blunt,
    As we honor Sex Education for All month this May, the undersigned 
55 organizations, committed to supporting the sexual and reproductive 
health and rights of young people, request your support for fiscal year 
(FY) 2023 funding that helps to ensure the health of our Nation's 
youth. We urge you to protect the integrity of the Teen Pregnancy 
Prevention Program (TPPP) and increase support for the Centers for 
Disease Control and Prevention's (CDC) school-based HIV and STI 
prevention efforts. We also encourage the elimination of the 
abstinence-only ``sexual risk avoidance'' competitive grant program.
    In the wake of numerous attacks on a young person's right to 
evidence-based, accurate information and services, young people face 
increased barriers, it is all the more critical that Congress address 
the resulting persistent inequity and health disparities. While a young 
person's health and wellbeing is about more than just the absence of 
disease, or in the case of sexual health, the absence of HIV and other 
STIs, unintended pregnancy, or sexual violence, the adolescent data on 
these points alone, remain largely unchanged and alarming in recent 
years.
    You have likely seen some of these statistics: young people under 
the age of 25 account for more than 1 in 5 new HIV infections; \1\ half 
of the nearly 20 million estimated new STI cases each year in the U.S. 
occur among those aged 15-24; \2\ 75 percent of pregnancies among young 
people ages 15-19 are unintended compared to an overall unintended 
pregnancy rate of 45 percent across all age groups; \3\ and 7 percent 
of high school students reported being sexually assaulted by a 
partner.\4\
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    \1\ Centers for Disease Control and Prevention (CDC), U.S. 
Department of Health and Human Services (HHS), HIV among youth, 2017, 
www.cdc.gov/hiv/group/age/youth/index.html.
    \2\ National Center for HIV/AIDS, Viral Hepatitis, STD, and TB 
Prevention, CDC, HHS, Sexually Transmitted Disease Surveillance 2017: 
STDs in Adolescents and Young Adults, Atlanta: CDC, 2018, https://
www.cdc.gov/std/stats17/adolescents.htm#ref1.
    \3\ Guttmacher Institute, Adolescent sexual and reproductive health 
in the United States, Fact Sheet, New York: Guttmacher Institute, 2017, 
www.guttmacher.org/fact-sheet/american-teens-sexual-and-reproductive-
health.
    \4\ Kann L et al., Youth risk behavior surveillance--United States, 
2017, Morbidity and Mortality Weekly Report (MMWR), 2018, Vol. 67, No. 
8, https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf.
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    Marginalized young people, such as young people of color, lesbian, 
gay, bisexual, transgender, and queer (LGBTQ+) young people, and young 
people with differing abilities, face disproportionate indicators of a 
lack of systemic support for their sexual health. Lesbian, gay, and 
bisexual high school students, for example, are more than twice as 
likely as their heterosexual peers to experience partner violence, be 
sexually assaulted by a partner, or be forced to have sex.\5\ Further, 
35 percent of transgender students report experiencing bullying at 
school, and the same percentage have attempted suicide.\6\
---------------------------------------------------------------------------
    \5\ Kann L, Sexual identity, sex of sexual contacts, and health-
related behaviors among students in grades 9-12-United States and 
selected States, 2015, MMWR, 2016, Vol. 65, No. 9, www.cdc.gov/mmwr/
indss_2016.html.\6\ Johns MM et al., Transgender Identity and 
Experiences of Violence Victimization, Substance Use, Suicide Risk, and 
Sexual Risk Behaviors Among High School Students--19 States and Large 
Urban School Districts, 2017, https://www.cdc.gov/mmwr/volumes/68/wr/
mm6803a3.htm.
    \6\ Johns MM et al., Transgender Identity and Experiences of 
Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk 
Behaviors Among High School Students--19 States and Large Urban School 
Districts, 2017, https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a3.htm.
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    This data continues to highlight the importance of additional 
resources to better meet the needs of young people, particularly as the 
availability and quality of sexual health information and sexuality 
education varies drastically across the country. Less than 43 percent 
of all high schools and only 18 percent of middle schools in the U.S. 
provide education on all of the 20 topics the CDC has deemed essential 
to ensuring sexual health.\7\
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    \7\ Centers for Disease Control and Prevention. School Health 
Profiles 2018: Characteristics of Health Programs Among Secondary 
Schools. Atlanta: Centers for Disease Control and Prevention; 2019.
    Secura GM et al., Provision of no-cost, long-acting contraception 
and teenage pregnancy, New England Journal of Medicine, 2014.
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    Fortunately, research has shown us how we can better assist young 
people in leading healthy lives. Access to medically accurate programs 
that include sexual health information beyond abstinence works to 
promote adolescent health. These programs help young people determine 
if and when to have sex, teach them how to use condoms and 
contraception when they do so, and reduce unintended pregnancies.\8\ 
Programs that are inclusive of LGBTQ+ youth and LGBTQ+-related 
resources ultimately promote academic achievement and overall 
health.\9\ Equipping young people with sexual decision-making and 
relationship skills results in safer sexual behaviors. Additionally, 
promoting gender equity reduces physical aggression between intimate 
partners and improves safer sex practices for all genders.\10\
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    \8\ 371(14):1316-1323; Community Preventive Services Task Force, 
HIV/AIDS, other STIs, and teen pregnancy: group-based comprehensive 
risk reduction interventions for adolescents, 2012, 
www.thecommunityguide.org/hiv/riskreduction.html.
    \9\ Schalet AT et al., Invited commentary: broadening the evidence 
for adolescent sexual and reproductive health and education in the 
United States, Journal of Youth and Adolescence, 2014, 43(10):1595-
1610, http://link.springer.com/article/10.1007/s10964-014-0178-8.
    \10\ Ibid.
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           support congressional intent and funding for tppp
    Provide $150 million in programmatic funding and $6.8 million in 
evaluation transfer authority to support the continuation of a wide-
range of evidence-based and informed community approaches to healthy 
youth development and unintended pregnancy prevention. Support bill and 
report language that protects the integrity of the program, which has 
been subject to unlawful attacks by the Trump administration.
    TPPP was established in 2010 to support community-driven, evidence-
based or informed, medically accurate, and age-appropriate approaches 
to preventing pregnancy among adolescents, involving parents, 
educators, researchers, and providers. In the program's first round of 
grants, TPPP served over 500,000 young people, trained more than 7,000 
professionals, and partnered with more than 3,000 community-based 
organizations. In the second round of grants, 84 organizations in 33 
States, the District of Columbia, and the Marshall Islands were awarded 
funds to replicate evidence-based programs in communities with the most 
need; conduct rigorous evaluation of new and innovative approaches to 
prevent unintended pregnancy among teens; or build capacity to support 
implementation of evidence-based programs.\11\
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    \11\ OAH, HHS, HHS Office of Adolescent Health Fiscal Year 2016 
Annual Report, Rockville, MD: HHS, 2016, www.hhs.gov/ash/oah/sites/
default/files/2016-annual-report.pdf.
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    Beginning in 2017, The Trump Administration sought to eliminate and 
undermine the integrity of the TPPP Program, including by proposing the 
elimination of the program in the annual President's budget, attempting 
early termination of ongoing projects, and awarding Tier 1 funding to 
organizations implementing abstinence-only ``sexual risk avoidance'' 
programs. Prior to the Trump Administration's attacks, the second 
program round was on track to reach 1.2 million young people. Courts 
have ruled that these attacks were unlawful, as was the April 20, 2018, 
Tier 1 Funding Opportunity Announcement, which violated TPPP's 
appropriations language.
    This funding would support the work of trained educators and 
community partnerships, serve young people, and expand the body of 
evidence available to best meet their needs in alignment with the 
program's original intent. Further, funding for the Teen Pregnancy 
Prevention Program and related evidence review and evaluation funding 
will help to restore evidence-based implementation of grants by 
supporting adequate technical assistance and high-quality evaluation, 
reviving the evidence review, allowing grantees to meet the needs of 
young people in the wake of COVID-19, and serving approximately 125,000 
more young people.
    In addition, TPPP evaluation funds have been used to examine the 
efficacy of programs to inform new and innovative adolescent health 
promotion approaches. The findings from evaluations of the first TPPP 
grant cycle contributed to the body of evidence that guides educators 
in making program decisions and highlighted the importance of continued 
investment in new programs and strategies for various settings and 
audiences.\12\ Learning both what works and what doesn't to support 
adolescent health is equally important; in building this evidence base 
and sharing it with communities and educators, TPPP uses a science-
based approach to the prevention of unintended pregnancy among young 
people.
---------------------------------------------------------------------------
    \12\ Margolis AL and Roper YV, Practical experience from the Office 
of Adolescent Health's large scale implementation of an evidence-based 
Teen Pregnancy Prevention Program, Journal of Adolescent Health, 2014, 
54(3):S10-S14, www.jahonline.org/article/S1054-139X(13)00791-X/
fulltext.
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         support funding for cdc's school based hiv prevention
    Provide $100 million for CDC's school-based HIV and STI prevention 
efforts within the Division of Adolescent and School Health (DASH) to 
enable robust assistance and to States, districts, and schools in their 
efforts to support student health and to lead research on school health 
and a range of adolescent health behaviors.
    The CDC provides a unique source of support for adolescent health 
education in our Nation's schools by seeking to promote education, 
health access, and environments where young people can gain fundamental 
health knowledge and skills and establish healthy behaviors. Currently, 
DASH provides funding to 28 school districts across the country to 
implement school-based HIV and STI prevention programs in schools, 
integrating substance use prevention, violence prevention, and other 
public health approaches. The work within DASH expands the research and 
evidence base of how to best meet the needs of young people, including 
LGBTQ+ youth, youth of color and disabled youth. Currently, DASH 
reaches 2 million young people at less than $10 per student.\13\ With 
$100 million in appropriations, DASH could directly reach 20 percent of 
all 56 million middle and high school students in the Nation, and reach 
the other 80 percent of young people indirectly through widespread 
implementation of safe and supportive environments in schools. This 
funding increase would allow DASH to fund the 100 largest local 
education agencies in the country, as well as all 57 State and 
territorial education agencies.
---------------------------------------------------------------------------
    \13\ DASH, Centers for Disease Control and Prevention https://
www.cdc.gov/healthyyouth/about/cdc-dash-health-program-impact.htm.
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                      end abstinence-only funding
    Eliminate funding for the abstinence-only-until-marriage ``sexual 
risk avoidance'' competitive grant program, putting an end to harmful 
programs, regardless of new packaging, that have been proven 
ineffective at their primary goal of young people delaying sex until 
marriage.
    Despite more than two decades of rigorous research demonstrating 
that programs with the sole aim of promoting abstinence until marriage 
are ineffective at this primary goal, over $2 billion in Federal 
funding alone has been wasted on this stigmatizing approach. In 
addition to violating young people's human rights, federally funded and 
independent analyses alike have found that youth participating in such 
programs were no more likely to abstain from premarital sexual activity 
than those who did not participate in the program.\14\ Moreover, 
regardless of what they are called, abstinence-only programs withhold 
necessary and lifesaving information that allow young people to make 
informed and responsible decisions about their own health. These 
programs have been found to include content that reinforces gender 
stereotypes, ostracizes and denigrates LGBTQ+ youth, stigmatizes 
sexually active young people and pregnant or parenting youth, and fails 
to respect the needs of youth who have experienced sexual abuse or 
assault.\15\ Rather than supporting the needs of young people, 
abstinence-only programs undermine opportunities to empower youth to 
make informed decisions about their health and wellbeing.
    Young people deserve access to the information, education, and 
resources they need to make healthy decisions about their lives. 
Significantly more can, and needs to, be done to support the sexual 
health education of our Nation's youth. Supporting these requests in 
the FY 2023 funding is an essential step in the right direction.
    Thank you for your consideration of our request to support the 
health and wellbeing of young people.
    Sincerely,

    AAUW IL
    Advocates for Youth
    AIDS Alliance for Women, Infants, Children, Youth & Families
    AIDS Foundation Chicago
    AIDS United
    American Academy of HIV Medicine
    American Sexual Health Association
    APLA Health
    Black Women for Wellness
    Caracole
    Catholics for Choice
    Center for Reproductive Rights
    CHLP
    EducateUS
    Equality California
    ETR
    EyesOpenIowa
    Families USA
    Girls Inc.
    Girls Inc. of Omaha
    Healthy Teen Network
    HIV+Hepatitis Policy Institute
    If/When/How: Lawyering for Reproductive Justice
    Ipas Partners for Reproductive Justice
    Jacobs Institute of Women's Health
    Michigan Organization on Adolescent Sexual Health (MOASH)
    NARAL Pro-Choice America
    NASTAD
    National Family Planning & Reproductive Health Association
    National Health Law Program
    National Institute for Reproductive Health
    National Partnership for Women & Families
    National Women's Law Center
    North Carolina AIDS Action Network
    North Dakota Women's Network
    Planned Parenthood Action Fund of New Jersey
    Planned Parenthood Federation of America
    Positive Women's Network-USA
    Power to Decide
    Reproductive Health Access Project
    SIECUS: Sex Ed for Social Change
    Silver State Equality
    The AIDS Institute
                                 ______
                                 
               Prepared Statement of SHEPHERD Foundation
    Thank you for the opportunity to submit this testimony in support 
of increasing funding for rare cancer research and for utilization of 
molecular diagnostics in cancer care. These issues are deeply personal 
for me. While undergoing Navy SEAL selection training at age 27, I 
collapsed, and upon subsequent examination, was diagnosed with a rare 
cancer called adenoid cystic carcinoma (ACC). I quickly discovered that 
the options I had for treatment were extremely limited. While I was 
able to get my tumor surgically removed, my disease is very likely to 
return. I will have no choices for treatment beyond more surgery, 
radiation, chemotherapy that is ineffective in treating ACC, and other 
treatments which have not been proven to work for this cancer.
    I found that I was not alone in facing this dire situation--the 
lack of treatment options is the unfortunate reality for most rare 
cancer patients. Frustrated at these shortcomings in ``modern'' 
medicine, I started a rare-cancer focused biotech company called 
SHEPHERD Therapeutics and an associated nonprofit. We may be the only 
pan rare-cancer focused organization in the world. I am extremely proud 
of the work our team has accomplished. SHEPHERD is comprised of 
patients and caregivers, those who have lost loved ones to rare 
cancers, and those who are still fighting. Our mission centers on 
ensuring that cancer patients have the treatments and diagnostics they 
need to survive. To achieve this mission, funding for cancer research 
must be robust and include directed funding streams for rare cancers 
and those cancers currently without therapies. We believe one of the 
best ways to accomplish these goals is the study of commonalities 
across subsets of cancer to bring forth platform solutions that can 
save lives near term. The use of broad-spectrum diagnostics, new 
technologies such as AI, and precision medicine including molecular 
diagnostics will ensure patients have access to the most effective 
treatments, reduce the use of costly and ineffective therapies, and 
enable physicians to select targeted treatments that improve outcomes.
    From our research, we know 380 out of the 400 forms of cancer meet 
the most conservative estimate of what constitutes a rare cancer, the 
American Cancer Society's metric of fewer than six new diagnoses per 
100,000 people per year. Rare cancers account for over 550,000 new 
diagnoses each year--almost 1 in 3 new patients. Not only are all 
pediatric cancers and primary brain cancers rare, but so are the 
majority of cancers experienced by service members. Almost 70 percent 
of the more than 60 forms of cancer that disproportionately affect 
those who have served our country are rare forms, and only 25 of them 
have an FDA approved targeted therapy. Many of those cancers are linked 
to service-related exposures, such as asbestos, burn pits, radiation 
and Agent Orange. Evidence suggests that even children of veterans who 
were exposed to Agent Orange may have an increased risk of certain 
cancers, like acute myeloid leukemia, according to the National Academy 
of Sciences.
    Beyond the pervasive impact of rare cancer, the lack of treatments 
is abominable. Over 100 cancers are not even mentioned in the NCCN 
treatment guidelines. The vast majority of new cancer patients--over 80 
percent--who lack an FDA-approved targeted therapy for their cancer, 
are rare cancer patients. In other words, 182 cancers lacked even one 
FDA-approved targeted therapy, and 181 of them were rare cancers, as of 
February 2019. That means that in 2019 almost 200,000 new rare cancer 
patients faced their diagnosis without a modern treatment. Part of the 
challenge is the lack of development due to insufficient financial 
incentives to develop rare cancer therapies. This is in part is due to 
a dearth of clinical trials that include rare cancer patients. 
SHEPHERD's analysis of all cancer clinical trials between 2012 and 2016 
showed that approximately 75 percent of all trials did not include even 
one rare cancer by name. Only 13 percent of all rare cancers were 
specifically named as a focus of a phase III clinical trial in those 5 
years. More than four times as much money in that time frame was spent 
on non-rare cancer trials than on trials which included a rare cancer. 
Clinical trials are expensive to run, and pharmaceutical companies are 
unlikely to choose to run a clinical trial in a small indication with 
few patients when a drug will work for a large population, even if that 
population already has dozens of drugs available for use, and even if 
that drug is a ``me too'' therapy which provides little benefit over 
the current standard of care. Most companies decide that the cost of 
drug development cannot be justified by the potential market for a rare 
cancer like mine, ACC, which has around 1,200 new patients a year.
    Fortunately, in the last few years, the FDA has encouraged new 
trial designs that allow trials to be run that target the molecular 
drivers of a cancer, allowing all patients whose tumors exhibit that 
genomic trait to potentially be included in the trial, regardless of 
their specific diagnosis. More good news: This approach can reach 
hundreds of thousands of additional patients right now via the 
utilization of molecular diagnostics. These tests can identify the 
presence of specific genomic alterations in a tumor that can be treated 
with an FDA-approved therapy today. Unfortunately, most patients are 
never even offered the option to receive these tests. Though broad 
spectrum molecular diagnostics cost less than a single round of 
chemotherapy, they are not reimbursed by CMS until the cancer has 
metastasized or reoccurred. In the absence of these tests, patients who 
lack a standard of care are most frequently put on generic chemotherapy 
protocols that are highly toxic and have very low odds for success.
    The incorporation of molecular diagnostics into the standard of 
care protocol for cancer patients would improve treatment outcomes, 
reduce the use of costly and ineffective drugs, and increase the 
availability of data related to little-studied cancers like mine. 
Providing molecular diagnostics to patients at the time of cancer 
diagnosis, and especially to rare cancer patients, is the single most 
powerful tool currently available to improve outcomes and advance the 
science of oncology care. Underutilization of these readily available 
technologies due to lack of awareness or lack of insurance coverage 
needlessly puts the lives of cancer patients--including patients with 
my cancer--at risk. Moreover, failure to provide CMS coverage of 
molecular diagnostics is not just an issue of adequate care, it is also 
an issue of equity. The majority of cancer patients are treated in 
community hospitals that are unable to pay for diagnostics out of 
pocket on behalf of patients. Patients treated at large NCI care 
centers and academic hospitals, in contrast, more frequently conduct 
and cover the costs of these tests. Surely, we can all agree that a 
patient's specific diagnosis, geographic location, income level, or 
form of insurance should not dictate the quality of their cancer care 
or their odds of survival.
    I respectfully request that you make the commitment in the FY 2023 
Labor, Health and Human Services, and Education Appropriations bill to 
changing the system to properly address rare cancer and help all cancer 
patients. This would require a substantial increase in Federal spending 
on rare cancers (following the well-established six new diagnoses per 
100,000 people per year definition) and prioritize research, data 
sharing, and translational development for cancers that lack an FDA 
approved targeted therapy. Additionally, these changes must strive to 
greatly increase the utilization of molecular diagnostics at both 
diagnosis and reoccurrence to ensure that patients are receiving 
appropriate therapies. Synergistic efforts to close the rare cancer 
equity gap would also encompass the following: (1) CMS and private 
insurance coverage of molecular diagnostics for all cancer patients at 
the time of diagnosis and when the cancer reoccurs (2) Education on the 
use and interpretation of molecular diagnostics for oncology care 
providers, and (3) Establishment of more clinical trials that 
specifically include rare cancers, either as an indication or via 
mutational target inclusion criteria.
    Behind the statistics there are over half a million Americans who 
at this moment do not know that during the course of this year they 
will be diagnosed with a cancer for which there is frequently no 
treatment beyond what their parents or even their grandparents would 
have been offered. Science sees no second-class citizens, only patients 
in need of help. We ask Congress to do the same and take the necessary 
steps to make cancer a thing of the past. Thank you.

    [This statement was submitted by David Hysong, Founder & Chairman 
of the Board, SHEPHERD Foundation.]
                                 ______
                                 
            Prepared Statement of the Sleep Research Society
            fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --The sleep community joins the broader research community in 
        requesting $49 billion in discretionary funding for the 
        National Institutes of Health (NIH), an increase of $3.5 
        billion over FY 2022. Sleep impacts nearly every system of the 
        body and various disease processes, please provide proportional 
        funding increases for all NIH Institutes and Centers to further 
        support sleep, circadian, and sleep disorders research 
        activities.
    --Please provide distinct, additional funding to further support 
            and implement the new Advanced Research Projects Agency for 
            Health (ARPA-H).
  --The sleep community joins the broader public health community in 
        requesting $11 billion in overall funding for the Centers for 
        Disease Control and Prevention (CDC) to reinvigorate meaningful 
        professional education, public awareness, and surveillance 
        activities.
    --Please provide the emerging CDC Chronic Disease Education and 
            Awareness (CDEA) program with $6 million, an increase of $3 
            million over FY 2022, to facilitate additional cooperative 
            agreements to advance timely public health efforts with 
            community stakeholders.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for considering the views of the sleep, 
circadian, and sleep disorders advocacy community as you work on FY 
2023 appropriations for medical research and public health programs. We 
would like to take this opportunity to thank you for providing ongoing 
investment in the National Institutes of Health (NIH) and the Centers 
for Disease Control and Prevention (CDC) through FY 2022 
appropriations, particularly for increasing funding for the new CDC 
Chronic Disease Education & Awareness Program, which is now supporting 
a 3-year cooperative agreement on obstructive sleep apnea and can 
support additional public health projects related to healthy sleep. 
Please maintain the commitments to NIH, CDC, and the CDEA program and 
increase funding as you and your colleagues work on appropriations for 
FY 2023.
                    about the sleep research society
    The Sleep Research Society (SRS) was established in 1961 by a group 
of scientists who shared a common goal to foster scientific 
investigations on all aspects of sleep, circadian rhythmicity, and 
sleep disorders. Since that time, SRS has grown into a professional 
society comprising over 1,300 researchers nationwide. From promising 
trainees to accomplished senior level investigators, sleep and 
circadian research has expanded into areas such as psychology, 
neuroanatomy, pharmacology, cardiology, immunology, metabolism, 
genomics, and healthy living. SRS recognizes the importance of 
educating the public about the connection between sleep, circadian 
rhythmicity, and health outcomes. SRS promotes training and education 
in sleep and circadian research, public awareness, and evidence-based 
policy, in addition to hosting forums for the exchange of scientific 
knowledge pertaining to sleep and circadian rhythms.
                          about project sleep
    Project Sleep is a 501(c)(3) non-profit organization raising 
awareness about sleep health and sleep disorders by working with 
affected individuals and families across the country. Believing in the 
value of sleep, Project Sleep aims to improve public health by 
educating individuals and policymakers about the importance of sleep 
health and sleep disorders. Project Sleep will educate and empower 
individuals using events, campaigns, and programs to bring people 
together and talk about sleep as a pillar of health.
                     nih sleep research activities
    Sleep research activities at NIH and across the government are 
coordinated through the National Center on Sleep Disorders Research 
(NCSDR). Recently, NCSDR released its next 5-year plan for sleep 
research and welcomed a dynamic new Director, Dr. Marishka Brown.
    As a result of sustained investment in NIH and the scientific 
opportunities in the field of sleep research, the research portfolio 
has doubled in size from $233 million in FY 2014 to $470 million today. 
This support has led to significant advancements in basic science, 
including the 2017 Nobel Prize in Medicine. However, research gaps 
remain in individual sleep disorders, such as narcolepsy, restless legs 
syndrome, and Kleine Levin syndrome, and patients lack innovative 
treatments, biomarkers, and new diagnostic tools. Team-based science 
and translational research is now needed to build on the momentum in 
sleep research and secure progress that benefits patients and the 
healthcare system. To effectively and comprehensively move sleep 
research forward in accordance with the goals of the new research plan, 
the community recommends support for a sleep research network at NIH.
Sleep Research Network
    The sleep/circadian health sciences field requests the 
establishment of a Sleep Research Network that would allow for rapid 
assembly of research investigators and support. This will facilitate a 
prompt response to opportunities for multi-center clinical trials that 
address key unmet public health needs pertaining to sleep health and 
sleep disorders. Our members have the expertise necessary to implement 
a network across key domains including; data informatics, recommended 
measurement survey tools and technologies, site initiation/quality 
control, protocol assessment, and commercial/industry partnerships. 
Research networks like this can encourage development in emerging 
priority areas via conferences, pilots, educational activities, 
diversity/inclusion and public education/community engagement with the 
ultimate goal of accelerating transformative research and intervention 
to reduce risks and improve treatments.
Underserved Sleep Disorders State of the Science Conference.
    While research in sleep and circadian has moved forward in 
significant ways (including the 2017 Nobel Prize in Medicine), research 
into specific sleep disorders at NIH remains relatively modest. 
Narcolepsy, hypersomnia, Kleine Levin syndrome and many other sleep 
disorders have only a few active grants at any given time. To ensure 
scientific progress in sleep is translated to innovative therapies, 
improved diagnostic tools, and meaningful health information, the time 
is now for a State-of-the-Science conference on sleep disorders. This 
collaborative opportunity will help create a long-range research plan 
across NIH that features specific activities for various sleep 
disorders. Committee recommendations and related interest in this 
regard would be timely.
NIH Sleep Research Plan
    To recognize NIH for its leadership on sleep research and to ensure 
ongoing support for advancing sleep research activities, the community 
asks for inclusion of the following report language for the National 
Heart, Lung, and Blood Institute at NIH.
    Sleep Research Plan.--The Committee commends the National Center on 
Sleep Disorders Research for the release of the NIH Sleep Research 
Plan. The Committee requests information on the resources and 
assistance NCSDR will need to fully implement the plan and advance 
stated goals. The Committee supports the use of infrastructure capable 
of conducing multi-center sleep network studies and clinical trials 
related to the Sleep Research Plan.
Sleep Health and Health Equity
    Sleep is a critical component of efforts to promote health equity 
and address health disparities. To raise awareness of ongoing efforts 
and to encourage emerging activities, the community asks for inclusion 
of the following report language for the National Institute of Health, 
National Institute on Minority Health and Health Disparities.
    Sleep Health and Health Disparities.--The Committee applauds 
ongoing and emerging efforts by the NIMHD to advance health equity and 
address health disparities, including cross-institute initiatives and 
the initiatives identified by the recent Minority Health and Health 
Disparities Research Framework. The Committee notes the 
disproportionate impact of sleep deficiencies among populations that 
experience health disparities in the United States, including American 
Indians/Alaska Natives, Asian Americans, Blacks/African Americans, 
Hispanics/Latinos, Native Hawaiians and other Pacific Islanders, sexual 
and gender minorities, the socioeconomically disadvantaged; and those 
living in underserved rural areas. The Committee encourages further 
work in and collaboration with community stakeholders on the issue of 
sleep health disparities.
CDC Chronic Disease Education & Awareness Program
    Thank you for establishing the CDC CDEA program in FY 2021 by 
providing an initial investment of $1.5 million and then doubling that 
investment to $3 million for FY 2022. With the initial round of 
funding, CDC is now supporting four meritorious 3-year cooperative 
agreements in psoriasis, hearing loss, lymphedema, and sleep apnea. 
With additional funding for FY 2022, there is an expectation that CDC 
will fund another round cooperative agreements in critical public 
health areas. To ensure that there can be another competition to meet 
the growing demand for this important program for the third year, 
please provide $6 million in funding for FY 2023. Further, the 
community asks that report language for this program encourage the 
participation of rare conditions in the CDC process and ensure that 
broader categories, such as sleep health, can be supported along with 
the current project on sleep apnea.
                             stacy's story
    Stacy Edwards, of Langley, Washington, first started seeing doctors 
for fatigue at the age of 15. As she got older, her health declined 
significantly and she couldn't figure out why. Stacy could sleep 15-18 
hours and still felt tired. Doctors were sympathetic, but usually 
tested for anemia and mono and sent her on her way with no solutions. 
At age 31, Stacy was finally referred for a sleep study. The results 
showed that she woke up 29 times per hour due to breathing 
obstructions, making her diagnosis of sleep apnea on the high side of 
moderate (almost severe). Once diagnosed, Stacy started using a CPAP 
machine and now raises awareness and reduces stigma via her website and 
social media campaign called CPAP Babes. More recently, at age 34, 
Stacy was diagnosed with a second sleep disorder, idiopathic 
hypersomnia. She continues to look for better treatment options to 
reduce her daytime sleepiness, brain fog, and other associated 
symptoms. Stacy is passionate about sleep research and awareness 
because she believes that she lost many years of her life in bed and 
doesn't want others to suffer for years without answers the way she 
did. Educating the public and the medical community is a high priority 
for Stacy.
                            brittany's story
    One February afternoon during Brittany Matthews' senior year of 
high school, she awoke on her bedroom floor to her mom frantically 
screaming at her for skipping school for the 20th time that year. 
Brittany hadn't moved from the spot on the floor where she was doing 
her makeup at 7 am when her mom left for work. However, Brittany was 
confused because just a few minutes before this, she had thought she 
actually was at school and this ``hypnopompic hallucination'' 
experience felt just as real as now finding herself still at home. When 
the school informed Brittany's parents that she needed to go to court 
for her truancy issues and was not likely to graduate on time, Brittany 
was sent to live with her dad, who thought he could ``straighten her 
out.'' That was one of the last straws in a sequence of events that 
finally led Brittany to receiving a diagnosis of narcolepsy at age 19, 
which was about 12 years after she began experiencing symptoms at the 
young age of 7. Narcolepsy is a misunderstood and under-diagnosed 
chronic neurological disorder affecting the brain's ability to regulate 
the sleep/wake cycle with a prevalence of 1 in 2,000 people worldwide. 
During the 5 years that followed, Brittany struggled in every aspect of 
her life until eventually finding a more effective treatment regimen, 
which allowed her to re-consider her dream of finishing college. Two 
years ago, Brittany graduated with her Bachelor of Science degree at 
the age of 26. Now, she is working full-time and is in the process of 
applying for graduate school programs for speech language pathology. 
Despite the progress she has made, Brittany still grapples daily with 
excessive daytime sleepiness, as well as cataplexy (sudden muscle 
weakness brought on by emotions). Advancements in research, treatments, 
and awareness are critical to improve the lives of those living with 
narcolepsy and other sleep disorders.

    [This statement was submitted by Namni Goel, PhD, President-Elect, 
Sleep 
Research Society, Project Sleep, and the stakeholder community.]
                                 ______
                                 
    Prepared Statement of the Society for Human Resource Management
    As the voice of all things work, workers and the workplace, SHRM is 
the foremost expert, convener and thought leader on issues impacting 
today's evolving workplaces. One such issue is employee mental health 
and wellness. This year, Congress has an opportunity to make a modest 
change that will have a significant impact in combating the mental 
health crisis across the Nation.
    To accomplish this, we urge the inclusion of Committee Report 
language that will accompany the FY 2023 Department of Labor, Health 
and Human Services (LHHS) and Related Agencies' Appropriations bill to 
enable grant recipients under the Community Mental Health Block Grant 
(MHBG) program overseen by the Substance Abuse and Mental Health 
Services Administration (SAMHSA) to aid in workplace mental health.
    As the country continues to recover and adapt to new norms in our 
daily lives and how we work, workplaces and employers are a critical 
nexus to improve mental health in America. Congress should take 
meaningful steps to bolster SAMHSA's mission and reduce the impact of 
substance abuse and mental illness should extend into our workplaces. 
Adding explicit language that workplace-based programs are eligible for 
funding through MHBG is a critical first step
    Burnout, exhaustion and hopelessness are more common among workers 
than ever before, and pandemic-related stresses are chipping away at 
productivity. As millions of Americans return to physical worksites or 
adjust to hybrid and fully remote work environments, mental health 
issues will continue to mount. Employers are leading the charge to 
improve mental health in the United States and are poised to do more 
for the workforce with access to the necessary resources. The mental 
health crisis is multi-faceted and requires commitment from Congress 
and the private sector to address this pressing issue.
    The proposed report language will not require additional funding or 
increases to current allocations to SAMHSA, but it will allow for 
programs to address workplace mental health and wellness. Throughout 
the pandemic, organizations have relied heavily on their human 
resources (HR) professionals as the primary function and stakeholder in 
guiding employees and employers. These professionals proved themselves 
invaluable by providing the necessary leadership, empathy and human 
touch to keep workers connected while adapting to the pandemic and 
evolving needs of the workforce. The infrastructure is in place for 
effective workplace mental health programs and resources. The inclusion 
of this report language would ensure that this framework is well-
utilized to meet the evolving needs of the Nation's workforce. The 
proposed language addition to the Committee Report is provided below:

      The Committee notes that undiagnosed and untreated mental 
        illnesses among America's workforce results in increased 
        absenteeism, lowered productivity at work, higher turnover, and 
        other factors that affect productivity. According to the 
        Society for Human Resource Management (SHRM) Foundation, this 
        lack of productivity amounts to an estimated loss of $23 
        billion every year in the United States. The Committee believes 
        that workforce mental health is an important part of ensuring 
        the overall mental health of our larger communities. To address 
        workforce mental health in the community context, the Committee 
        sees value in SAMHSA encouraging the use of Community Mental 
        Health Block Grant (MHBG) funds for this purpose. Therefore, 
        the Committee directs SAMHSA to issue guidance to State 
        agencies receiving MHBG funds to encourage public and nonprofit 
        organizations to use a portion of their MHBG funds to implement 
        evidence-based programs designed to educate and aid employers 
        in providing mental health assistance to their employees to 
        reduce the stigma and encourage the treatment of mental health 
        illness in the workplace.
    In April 2022, the SHRM Foundation released a report on mental 
health in the workplace. The report found that the extent of America's 
mental health crisis is alarming. Tens of millions of U.S. workers are 
experiencing mental health issues and are less productive because of 
it, inundating organizations with a vast array of new challenges. 
Mental health issues such as burnout and stress are hampering short-
term productivity and long-term business growth.
    Without mental health resources, employees will keep struggling to 
add value to their organizations. Employers that fail to offer mental 
health benefits to their workers will struggle to stay afloat. Hundreds 
of billions of dollars are at stake. In many ways, the U.S. economy-not 
to mention public health-hangs in the balance.
    We cannot afford to wait, as the following statistics demonstrate:
  --The World Health Organization estimates that the global economy has 
        lost $1 trillion due to anxiety and depression alone.
  --41 percent of HR professionals believe their organization does not 
        currently offer enough support for employees' mental health 
        care.
  --Nearly 78 percent of organizations currently offer workplace mental 
        health resources or plan to offer such resources in the next 
        year.
  --94 percent of HR professionals believe organizations can improve 
        the health of employees by offering mental health programs. 
        They point to increased productivity, employee retention and 
        attracting new talent as additional reasons to support mental 
        health.
    The United States will continue to grapple with the ongoing effects 
of the pandemic for an unknown period. Congress must continue to be 
proactive in supporting its constituent communities, as it has 
throughout the pandemic Granting SAMHSA the ability to issue workplace 
mental health grants is the right place to start. Thank you for 
considering our request.
                                 ______
                                 
     Prepared Statement of the Society for Maternal-Fetal Medicine
    The Society for Maternal-Fetal Medicine (SMFM) is pleased to submit 
testimony in support of the pivotal work of the Department of Health 
and Human Services (HHS) to optimize the health of birthing people and 
infants. SMFM urges Congress to ensure that the National Institutes of 
Health (NIH), Centers for Disease Control and Prevention (CDC), Health 
Resources and Services Administration (HRSA), and Agency for Healthcare 
Research and Quality (AHRQ) are adequately funded in fiscal year (FY) 
2023. Specifically, SMFM urges the Committee to provide at least the 
following in base program level funding:
  --$49.048 billion for the NIH, with at least $1.816 billion of that 
        funding to support the Eunice Kennedy Shriver National 
        Institute of Child Health and Human Development (NICHD);
  --$11 billion for the CDC, including $164 million for the Safe 
        Motherhood Initiative, $100 million for the Surveillance for 
        Emerging Threats to Moms and Babies initiative, and $210 
        million for the National Center for Health Statistics (NCHS);
  --$9.8 billion for the HRSA, including $1 billion for the Title V 
        Maternal and Child Health Services Block Grant; and
  --$500 million for AHRQ.
    Established in 1977, SMFM is the National voice for clinicians and 
researchers with expertise in high-risk pregnancies. A non-profit 
association representing more than 5,500 individuals, the core of 
SMFM's membership is comprised of maternal-fetal medicine (MFM) 
subspecialists. MFM subspecialists are obstetricians with additional 
training in caring for individuals experiencing high-risk pregnancies. 
Additionally, SMFM welcomes physicians in related disciplines, nurses, 
genetic counselors, ultrasound technicians, MFM administrators, and 
other individuals working toward optimizing the care of people with 
high-risk pregnancies. SMFM members see the most at-risk and complex 
patients, with the goal of optimizing outcomes for pregnant people and 
their infants.
                             hhs secretary
    Task Force Specific to Pregnant Women and Lactating Women (PRGLAC): 
SMFM urges Congress to continue its strong support for NIH's efforts to 
advance the inclusion of pregnant and lactating people in clinical 
trials and research, specifically by taking necessary steps to 
implement the recommendations of the PRGLAC Task Force. PRGLAC 
submitted its report to the Secretary in the fall of 2018 with 15 
recommendations on including pregnant and breastfeeding people in 
clinical trials and broad research initiatives, and the Task Force 
further outlined how to implement those recommendations in a follow-up 
report submitted to the HHS Secretary in 2020. Since that time, various 
agencies across HHS have taken steps to implement PRGLAC 
recommendation, but there has been no coordinated effort across HHS. 
This disjointed implementation lends itself to potential duplication 
and missed opportunities. As such, SMFM recommends that Congress 
provide $200,000 in FY 2023 for the creation of an HHS advisory 
committee to monitor and report on implementation of PRGLAC 
recommendations.
    The COVID-19 pandemic again emphasized the importance of including 
pregnant and lactating people in clinical research. This population was 
largely excluded from clinical trials for treatments and vaccines, 
leaving them and their health care providers without clear evidence on 
safety and efficacy to guide clinical decision-making. It is essential 
that Congress support broader inclusion of pregnant and lactating 
people in research, so that mothers have access to necessary 
medications.
                               nih/nichd
    The NICHD's investment in maternal and child health outcomes is 
essential to understanding and combatting the rising maternal mortality 
and severe morbidity rates and to optimizing maternal and child health.
    Maternal-Fetal Medicine Units Network (MFMU): SMFM urges continued 
strong support of the MFMU and asks that Congress allocate $30 million 
to support the Network's ongoing work. Established in 1986, MFMU 
pursues the development of treatments for medical complications during 
and after pregnancy, including maternal mortality and morbidity, 
preterm birth, low birth weight, fetal growth abnormalities, and fetal 
mortality. MFMU is a critical resource to stemming the Nation's growing 
maternal health crisis and addressing emerging threats to maternal and 
infant health. For instance, during the COVID-19 pandemic, the MFMU was 
able to quickly pivot resources to monitor the health impact of COVID-
19 on pregnant people and their infants, as well as researching 
effective treatments for pregnant populations. We hope that the NICHD 
will ensure the MFMU's continued success by maintaining its highly 
efficient structure of multicenter collaborative research. The MFMU has 
a strong history of changing and improving clinical practice and 
obstetric management, improving outcomes of pregnant people and babies 
in the United States, and is extremely successful. 25.6 percent of all 
publications from the network are cited in clinical practice 
guidelines. These guidelines are relied upon by Medicaid and Medicare 
programs to define evidence-based services covered under the plans. The 
work of the network is even more urgent given the recent increase in 
maternal mortality and severe morbidity in the United States. We urge 
Congress to ensure stable and sustained funding and infrastructure for 
the MFMU, and to ensure that any proposed change in the funding 
mechanism or structure for the MFMU not compromise the ability of the 
network to remain nimble and directly address the changing landscape of 
women's health, including to reduce health disparities.
    Preterm Birth: Delivery before 37 weeks gestation is associated 
with increased risk of death in the immediate newborn period as well as 
in infancy and can cause long-term complications. Although the survival 
rate is improving, many preterm infants have life-long disabilities 
including cerebral palsy, intellectual disabilities, respiratory 
problems, and hearing and vision impairment. Preterm birth costs the 
United States $25.2 billion annually.\1\ Great strides are being made 
through NICHD-supported research to address the complex situations 
faced by mothers and their babies. One of the most successful 
approaches for testing research questions is the NICHD research 
networks, which allow researchers from across the country to 
collaborate and coordinate their work to change the way we think about 
pregnancy complications and to change medical practice across the 
country.
---------------------------------------------------------------------------
    \1\ Waitzman NJ and Jalali A. Updating National Preterm Birth Costs 
to 2016 with Separate Estimates for Individual States. Salt Lake City, 
UT: University of Utah; 2019. Available at: https://
www.marchofdimes.org/peristats/documents/Cost_of_Prematurity_2019.pdf.
---------------------------------------------------------------------------
                                  cdc
    The CDC's Division of Reproductive Health (DRH) and National Center 
for Birth Defects and Developmental Disabilities (NCBDDD) are doing 
important work related to pregnancy. Data collection efforts related to 
pregnancy outcomes, maternal mortality, and medications in pregnancy 
must continue.
    Maternal Mortality: CDC's ongoing support for State-based perinatal 
quality collaboratives and new funding for state maternal mortality 
review committees (MMRCs) is essential to address the Nation's 
unacceptable maternal death rate. According to the NCHS, the maternal 
mortality rate in 2020 was 23.8 deaths per 100,000 live births, and 
racial disparities persisted with a maternal mortality rate of 55.3 
deaths per 100,000 live births among non-Hispanic black women compared 
to 19.1 among non-Hispanic white women.\2\ SMFM fully supports 
Congress' attention to reducing maternal mortality through CDC's Safe 
Motherhood Initiative, and we ask that you meet the President's budget 
request by providing at least $164 million for this work.
---------------------------------------------------------------------------
    \2\ Hoyert DL. Maternal mortality rates in the United States, 2020. 
NCHS Health E-Stats. 2022.Available at https://www.cdc.gov/nchs/data/
hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm.
---------------------------------------------------------------------------
    Emerging Threats Initiative: SMFM also urges Congress to allocate 
$100 million for the CDC's Surveillance for Emerging Threats to Moms 
and Babies initiative housed at the NCBDDD. The State-level 
surveillance infrastructure supported by the initiative allows state 
public health departments to monitor health threats stemming from 
maternal exposures, including infectious diseases such as COVID-19.
                                  hrsa
    The work of HRSA is critical to maternal and child health. HRSA's 
initiatives reduce infant mortality, improve maternal health and 
wellbeing, and serve more than 50 million people through the Maternal 
and Child Health (MCH) Block Grant. The funds provided through the MCH 
Block Grant increase access to comprehensive prenatal and postnatal 
care--especially for patients who are most at risk for adverse health 
outcomes. The Title V MCH Block Grant programs save Federal and State 
governments money by expanding the delivery of preventive services to 
avoid more costly chronic conditions later in life. Additionally, 
HRSA's family planning initiatives ensure access to comprehensive 
family planning and preventive health services for more than 4 million 
people, thereby reducing unintended pregnancy rates. Finally, HRSA's 
support for the Alliance for Innovation in Maternal Health Care (AIM) 
reduces maternal mortality through implementation of care bundles at 
the State and institutional level. These bundles help reduce maternal 
mortality through quality improvement in various areas including 
postpartum hemorrhage and hypertension. We encourage Congress to 
provide at least $1 billion for this important program that will help 
improve maternal and infant health across the United States.
                                  ahrq
    Projects conducted at AHRQ are critical to translate research from 
bench to bedside through comprehensive implementation in the everyday 
practice of medicine. AHRQ is the only Federal agency that funds 
research on ``real-life'' patients--those with comorbidities and co-
existing conditions, including high-risk pregnant people. The agency's 
work is instrumental in collecting data; funding health services 
research; and, most importantly, disseminating findings to clinicians 
to improve maternal health care. Together, AHRQ's intramural programs, 
such as the Healthcare Cost and Utilization Project (HCUP), Evidence-
Based Practice Center Program and Safety Program in Perinatal Care, and 
extramural research are essential to reducing maternal deaths and 
adverse pregnancy outcomes. By providing at least $500 million to AHRQ 
in FY 2023, Congress will allow AHRQ to expand its maternal health 
portfolio, improving care for nearly 4 million pregnant patients each 
year.
                               conclusion
    The COVID-19 pandemic has further exposed existing inequities and 
gaps within our healthcare system for people across the country, 
including pregnant people. It is more important than ever to prioritize 
the needs of pregnant people and their infants in Federal programs from 
research, to public health surveillance, to care. We urge HHS to 
prioritize and adequately fund maternal health efforts for that aim to 
reduce maternal mortality and severe morbidity during and after the 
pandemic.
    With your support of vital HHS programs, obstetric researchers, 
clinicians, and patients can address the complex problems of pregnancy 
and truly improve the health and wellbeing of mothers and infants. 
Please direct any inquiries about this testimony to Rebecca Abbott, 
SMFM's Director of Government Relations ([email protected]).
                                 ______
                                 
           Prepared Statement of the Society for Neuroscience
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee, on behalf of the Society for Neuroscience (SfN), we are 
honored to present this testimony in support of robust appropriations 
for biomedical research at the National Institutes of Health (NIH). SfN 
urges you to provide at least $49 billion, a $4 billion increase over 
FY22, in funding for the NIH for FY23, including the full release of 
funding for the NIH Innovation Account for 21st Century Cures programs 
and $680 million for the Brain Research through Advancing Innovative 
Neurotechnologies (BRAIN) Initiative. As both a researcher and a 
Professor in the Department of Biology at Brandeis University, I 
understand the critical importance of Federal funding for neuroscience 
research in the United States. My own research identified the ability 
of brain circuits to ``tune themselves'' to maintain the appropriate 
level of excitability, which is critical for healthy brain function.
    My research group, supported by NIH funding, made fundamental 
discoveries in how neurons self-adjust their excitability, making it 
easier or harder to send electrical messages to other neurons. Over the 
past two decades, we have unearthed a family of mechanisms that allow 
for this unique flexibility called ``homeostatic plasticity,'' so 
neurons can change the rate they send messages and protect 
communication in the face of outside disturbances. Our work has many 
wide-reaching implications: We are studying how learning and memory 
suffer when these mechanisms malfunction; We are exploring how being 
awake or asleep affects these mechanisms; and we are investigating how 
States of being too excitable or not excitable enough contribute to 
disorders like epilepsy and autism spectrum disorder. Basic research, 
like my own, is paramount to understanding the brain at a level deep 
enough to develop treatments and interventions for diseases and 
disorders.
    SfN believes strongly in the research continuum: basic science 
leads to clinical innovations, which leads to translational uses 
impacting the public's health. Basic science is the foundation upon 
which all health advances are built. To cure diseases, we need to 
understand them through fundamental discovery-based research. However, 
basic research depends on reliable, sustained funding from the Federal 
Government. SfN is grateful to Congress for its investments in 
biomedical research and increases for NIH over the last 6 years. 
Growing the NIH budget over $9 billion in that period is exactly the 
sustained effort that is needed, and your continued support will pay 
dividends for years to come.
                the importance of the research continuum
    NIH funding for basic research is critical for facilitating 
groundbreaking discoveries and for training researchers at the bench. 
For the United States to remain the leader in biomedical research, 
Congress must continue to support basic research that fuels discoveries 
as well as the economy. The deeper our grasp of basic science, the more 
successful those focused on clinical and translational research will 
be. We use a wide range of experimental and animal models not used 
elsewhere in the research pipeline. These opportunities create 
discoveries--sometimes unexpected discoveries--expanding knowledge of 
biological processes, often at the molecular level. This level of 
discovery reveals new targets for research to treat all kinds of brain 
disorders affecting millions of people in the United States and beyond.
    NIH basic research funding is also a key economic driver of science 
in the United States through funding universities and research 
organizations across the country. Federal investments in scientific 
research fuel the Nation's pharmaceutical, biotechnology and medical 
device industries. The private sector utilizes basic scientific 
discoveries funded through NIH to improve health and foster a 
sustainable trajectory for America's research and development 
enterprise. Basic science generates the knowledge needed to uncover the 
mysteries behind human diseases, which leads to private sector 
development of new treatments and therapeutics. Industry typically does 
not fund research on this important first step given the long-term path 
of basic science and pressure for shorter-term return on investments. 
Congressional investment in basic science is irreplaceable on the 
pathway for development of drugs, biologics, devices, and other 
treatments for brain-related diseases and disorders.
    For example, in January 2022, NIH launched Phase 1 of Neuromod 
Prize to increase the development of neuromodulation therapies. 
Neuromodulation treatments act directly on peripheral nerves to improve 
organ function and have the potential to treat a variety of conditions, 
including heart failure. The Neuromod Prize is part of the SPARC 
(Stimulating Peripheral Activity to Relieve Conditions) NIH initiative. 
With SPARC, NIH will combine early-stage research and clinical 
applications to provide targeted treatments for multiple organ 
functions.
    Another example of NIH's success in funding neuroscience is the 
BRAIN Initiative. While only one part of the research landscape in 
neuroscience, the BRAIN Initiative has been critical in promoting 
future discoveries across neuroscience and related scientific 
disciplines. By including funding in 21st Century Cures, Congress 
helped maintain the momentum of this endeavor. Note, however, using 
those funds to supplant regular appropriations is counterproductive. 
There is no substitute for robust, sustained, and predictable funding 
for NIH. SfN appreciates Congress' ongoing investment in the BRAIN 
Initiative and urges its full funding in FY23. Some recent exciting 
advancements in NIH funded neuroscience research include the following:
     covid-19 and its impact on adolescent mental health & drug use
    Since March 2020, Covid-19 has had a profound impact on our lives, 
physically and mentally. Adolescence is a challenging transition 
period, and researchers recognized the need to determine the impact of 
the pandemic on early adolescent's mental health. Using data from the 
Adolescent Brain Cognitive Development (ABCD) study, researchers fitted 
machine learning models that considered factors for adolescent 
psychological distress and emotional wellbeing during the Covid-19 
pandemic. Factors that predicted adolescent psychological distress 
during the pandemic included being female, pre-pandemic internalizing 
symptoms, and sleep problems. They also found healthy habits (exercise, 
better sleep) and social support reduced detrimental effects of the 
pandemic on adolescent mental health. This study stresses the 
importance of mental health in vulnerable populations to complement 
investigations into the physical manifestations of the pandemic.
    While adolescent mental health challenges have increased during the 
pandemic, adolescent drug use significantly decreased in 2021 since the 
start of the Covid-19 pandemic. These results come from the Monitoring 
the Future survey, funded by the National Institute of Drug Abuse. 
Since 1975, the Monitoring the Future has recorded drug and alcohol 
intake of adolescents across the United States at three time periods: 
lifetime, past year, and past month use. Findings from the survey show 
10th and 12th graders alcohol, marijuana, nicotine, and illicit drug 
use decreased significantly from 2020 to 2021. This decrease was the 
largest 1-year decrease recorded in the Monitoring the Future survey 
since 1975. The results taken from the survey demonstrate how the 
pandemic has impacted drug use in adolescents. It will be interesting 
to see how adolescent drug use changes from 2021-2022, with the 
continuation of the pandemic.
congress & nih must support access to models necessary for neuroscience 
                               discovery
    SfN urges the Committee to appropriate funding for biomedical 
research without restriction on the use of animal models. Adequate NIH 
funding is necessary to advancing our understanding of the brain; 
however, full realization of this funding's promise requires 
appropriate access to research models, including non-human primates and 
other animal models. Animal research is highly regulated to ensure the 
ethical and responsible care and treatment of the animals. SfN and its 
members take their legal and ethical obligations related to this 
research very seriously. While SfN recognizes the goal of the 
reduction, refinement, and eventual replacement of nonhuman primate 
models in biomedical research, much more research and time is needed 
before such a goal is attainable. Premature replacement of non-human 
primate and other animal models may delay or prevent the discovery of 
treatments and cures-not only for neurological diseases like 
Alzheimer's disease, addiction, and traumatic brain injury, but also 
for communicable diseases and countless other conditions. There are 
currently no viable alternatives available for studying biomedical 
systems that advance our understanding of the brain and nervous system; 
or when seeking treatments for diseases and disorders like depression, 
addiction, Parkinson's Disease, and emotional responses. This research 
is critically important and has the opportunity to benefit countless 
people around the world. SfN urges Congress to work with the NIH to 
ensure this important well-regulated research can continue.
                        funding in regular order
    SfN joins the biomedical research community supporting an increase 
in NIH funding to at least $49 billion for existing NIH institutes and 
centers, a $4 billion increase over FY22. This increase is consistent 
with those provided by this committee for the past few years and 
provides certainty to the field of science, allowing for the 
exploitation of more scientific opportunity, more training of the next 
generation of scientists, more economic growth and more improvements in 
the public's health. Equally as important as providing a reliable 
increase in funding for biomedical research is ensuring funding is 
approved before the end of the fiscal year. Your success in 2018 in 
completing appropriations prior to the start of the fiscal year was a 
tremendous benefit to research. Continuing Resolutions have significant 
consequences on research, including restricting NIH's ability to fund 
new grants and to fully fund continuation grants. For some of our 
members, this means waiting for a final decision to be made on funding 
before knowing if their perfectly scored grant will be realized, or 
operating a lab with 90 percent of the awarded funding until 
appropriations are final. All of the positive benefits research 
provides in this country may be negatively impacted by these real time 
considerations. SfN strongly supports the appropriation of NIH funding 
in a timely manner, which avoids delays in approving new research 
grants or causes reductions in funding for already approved research 
funding. Meeting the example Congress set in 2018 would be another 
substantial benefit to science.
    SfN thanks the subcommittee for its continued support of biomedical 
research and looks forward to working with you to ensure the United 
States remains the global leader in neuroscience research and 
discovery. Collaboration among Congress, the NIH, and the scientific 
research community has created great benefits for not only the United 
States but also for people around the globe suffering from brain-
related diseases and disorders. On behalf of the Society for 
Neuroscience, we urge you to continue your strong support of biomedical 
research.

    [This statement was submitted by Gina Turrigiano, PhD, President, 
Society for Neuroscience.]
                                 ______
                                 
     Prepared Statement of the Society for Women's Health Research
    The Society for Women's Health Research (SWHR)--a more than 30-
year-old national nonprofit with a mission of promoting research on 
biological sex differences in disease and improving women's health 
through science, policy, and education--is pleased to submit testimony 
outlining SWHR's funding requests for fiscal year (FY) 2023. While SWHR 
believes that all Federal research is complementary and thus supports 
robust funding across all Federal research and public health agencies, 
we specifically urge appropriators in FY 2023 to support a program 
level of at least $49 billion for the National Institutes of Health 
(NIH), at least $62.5 million for the Office of Research on Women's 
Health (ORWH) and $1.816 billion for the Eunice Kennedy Shriver 
National Institute of Child Health and Human Development (NICHD).
    Biological sex differences influence disease development, 
progression, and response to treatment, while social determinants of 
health, including gender, affect disease risk, health care access, and 
outcomes. Yet, due to years of insufficient research addressing women, 
we have limited knowledge about women's health relative to men's 
health.
    This lack of prioritization, or inattention, to women's health has 
not only affected our understanding about key aspects of women's health 
and overlooked a critical portion of the population, but it has also 
amounted to tremendous money lost for the U.S. economy. Recent research 
conducted by the RAND Corporation revealed that ``even a slight 
increase in capital invested in basic research into women's health 
would unleash staggering returns...'' The study's simulations, which 
examined the potential return on investment if NIH were to double the 
budget for studies specifically assessing the health of women, showed 
the tremendous opportunity that lies in women's health:

      ``By doubling the NIH budget for research on coronary artery 
        disease in women from its current $20 million, we could expect 
        an ROI of 9,500 percent. Studies focused on rheumatoid 
        arthritis in women receive just $6 million a year. Doubling 
        that would deliver an ROI of 174,000 percent and add $10.5 
        billion to our economy over the 30-year timespan.''--Chloe 
        Bird, Fortune

    Robust, sustained funding for Federal research entities that 
prioritize research into diseases, conditions, and life stages that 
differently, disproportionately, or solely affect women across the 
lifespan is critical to achieve health equity for women. The COVID-19 
pandemic served as an important reminder that sex and gender 
differences that exist across diseases (e.g., men are more at risk for 
worse outcomes from COVID-19 and have a heightened risk of death, while 
women are more likely to be diagnosed with post-acute sequelae of 
COVID-19 and report more adverse events following vaccinations) and 
that health disparities are still widespread, with women 
disproportionately affected by socioeconomic challenges, food 
insecurity, domestic violence, and mental health concerns related to 
COVID-19.
    To continue building on the progress made and to ensure women's 
needs are represented in Federal research, SWHR urges Congress to 
prioritize women's health across the lifespan and women's health 
research by supporting NIH, ORWH, and NICHD in fiscal Year2023 funding 
legislation.
                   the national institutes of health
    The NIH is the premier medical research agency in the United States 
and the largest source of funding for biomedical and behavioral 
research in the world. As such, its mission is vital to promote the 
overall health and well-being of Americans by fostering creative 
discoveries and innovative research; training and supporting the next 
generation of researchers to ensure a diverse, strong research pipeline 
to continue scientific progress; and expanding the scientific and 
medical knowledge base.
    Continued support for the NIH is necessary to drive women's health 
forward. Across NIH, researchers conduct and support basic, clinical, 
and translational research on diseases and conditions that impact women 
across the life stage. Among the NIH initiatives specifically aimed at 
improving women's health is the Trans-NIH Strategic Plan for Women's 
Health Research. Released in 2019, the 5-year Strategic Plan laid out 
broad NIH goals to complement its more targeted women's health 
programs, advancing women's health research, developing a well-trained 
biomedical research workforce, and promoting the role of sex and gender 
influences in research. Initiatives like these--along with the NIH's 
continued emphasis on improving standard research methodologies to 
address sex and gender and providing funding for women's health 
research--will help us achieve consequential progress in making women's 
health mainstream.
    SWHR urges Congress to provide a program level of at least $49 
billion for the NIH, a $3.5 billion increase in the NIH appropriation 
plus funding from the 21st Century Cures Act for specific initiatives, 
in FY 2023. Additionally, SWHR asks that appropriators ensure that any 
funding for the new Advanced Research Projects Agency for Health (ARPA-
H) or other targeted programs like pandemic preparedness supplement 
this base budget recommendation rather than supplant the foundational 
investment in NIH. This funding level, which is supported across the 
public health and scientific research communities, would allow for 
meaningful growth above inflation in the base budget and would expand 
NIH's capacity to support promising science in all disciplines 
(including women's health research) across the agency, keeping the NIH 
competitive on the world stage.
                the office of research on women's health
    The biomedical sciences for decades have treated men and women as 
interchangeable subjects. Research on diseases and treatments were 
conducted almost exclusively on male subjects as researchers sought to 
avoid the presumed ``complications'' introduced by including female 
subjects in their work. This approach ignored the impact of sex and 
gender on human development and disease progression, overlooking a 
critical slice of the population and leaving untapped important areas 
of scientific opportunity.
    As the NIH hub for coordinating women's health research, ORWH 
ensures women are represented across all NIH research and works to 
improve representation of women and women's health issues within 
federally funded research. ORWH provides critical leadership on 
programs, such as the Specialized Centers of Research Excellence, or 
SCORE, which advances translational research on the role of sex 
differences in the health of women, and the Implementing a Maternal 
health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative, 
which coordinates interdisciplinary research on factors impacting 
maternal mortality.
    SWHR recommends that Congress provides $62.5 million in funding for 
ORWH in FY 2023. This increase will allow ORWH to build upon its 
existing programs, take steps in realizing a vision where sex and 
gender are integrated into research and where women receive 
personalized, evidence-based prevention and treatment, and continue its 
efforts coordinating and elevating women's health research across NIH.
the eunice kennedy shriver national institute of child health and human 
                              development
    The NICHD, founded to investigate human development throughout the 
life process, also provides a home for women's health research in areas 
across reproductive sciences and maternal health, including 
infertility, pregnancy, and menopause. The Institute's research 
portfolio is critical for addressing pressing public health issues, 
such as pregnancy outcomes, gynecological health issues, such as 
uterine fibroids and endometriosis, and the environmental, behavioral, 
and social factors that shape women's health.
    Among NICHD's myriad contributions to women's health research is 
its work with respect to pregnant and lactating individuals. Nearly 94 
percent of women take at least one medicine during pregnancy, and 50 
percent take at least one medication during the postpartum period. Yet, 
pregnant and lactating women are often excluded from biomedical 
research. Consequently, these women and their health care providers do 
not have access to the information they need to make confident 
decisions about their health care.
    As part of its efforts to support these populations is NICHD's 
Maternal and Pediatric Precision in Therapeutics (MPRINT) Hub, which 
will serve as a national resource for expertise in maternal and 
pediatric therapeutics to conduct and foster therapeutics-focused 
research in obstetrics, lactation, and pediatrics while enhancing 
inclusion of people with disabilities. The MPRINT Hub will aggregate, 
present, and expand the available knowledge, tools, and expertise in 
maternal and pediatric therapeutics to the broader research, regulatory 
science, and drug development communities.
    SWHR calls on Congress to provide at least $1.816 billion for NICHD 
in fiscal Year2023 so the Institute can continue driving advancements 
in women's reproductive health and funding research and training 
activities that help address some of the Nation's leading public health 
issues.
                                  ***
    SWHR appreciates the opportunity to submit this testimony and 
thanks the subcommittee of considering our requests of a program level 
of at least $49 billion for NIH, at least $62.5 million for ORWH and 
$1.816 billion for NICHD. We look forward to working with you to ensure 
the highest possible support for Federal research agencies in FY 2023. 
If you have questions or need any additional information, please 
contact SWHR President and CEO Kathryn G. Schubert at [email protected].
                                 ______
                                 
       Prepared Statement of the Society of Gynecologic Oncology
    The Society of Gynecologic Oncology thanks the subcommittee for the 
opportunity to submit comments for the record. Enclosed are our report 
language recommendations to encourage the National Cancer Institute to 
prioritize research activities to address endometrial cancer 
disparities in people of color. The Society of Gynecologic Oncology 
(SGO) is the premier medical specialty society for health care 
professionals trained in the comprehensive management of gynecologic 
cancers. The SGO's 2,000 members, who include physicians, nurses, and 
other advanced practice providers, represent the entire oncology team 
dedicated to the treatment and care of patients with gynecologic 
cancers. The SGO's strategic goals include advancing the prevention, 
early diagnosis, and treatment of gynecologic cancers by establishing 
and promoting standards of excellence. Key priorities for the SGO are 
to advocate for more equitable care for all patients and to support 
research aimed at improving outcomes for diverse patient populations.
    Endometrial cancer is the most common gynecologic cancer in the 
United States, and the fourth most common malignancy among American 
women, behind breast, lung, and colorectal cancers. According to the 
American Cancer Society, the incidence and mortality rate of uterine 
corpus cancers, over 90 percent of which arise from the endometrium, is 
rising. In 2012, there were an estimated 47,000 cases of uterine cancer 
and 8,000 deaths. This has increased by more than 140 percent over the 
last 10 years, with 65,950 expected new cases and 12,550 expected 
deaths in 2022.\1\ While the majority of other cancers have seen 
improvement in survival rates, survival rates for endometrial cancer 
have worsened annually since 2010. Greater prevalence of key risk 
factors, such as obesity and delayed childbearing may be contributing 
to the increased incidence of endometrial cancer, but do not explain 
the worsening mortality.
---------------------------------------------------------------------------
    \1\ American Cancer Society. Cancer Facts & Figures 2022. Atlanta: 
American Cancer Society; 2022. file:///C:/Users/mjc92028/Downloads/
cancer-facts-and-figures-2012.pdf; American Cancer Society. Cancer 
Facts & Figures 2022. Atlanta: American Cancer Society; 2022. https://
www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-
statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-
figures.pdf].
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    Endometrial cancer was previously thought to be more common in 
White women, however as of 2007, the incidence of endometrial cancers 
in Black women surpassed that of White women and continues to increase 
each year.\2\ The majority of endometrial cancers are the result of 
obesity, making this one of the only preventable cancers. Additionally, 
some of the distressing disparity between lower survival and outcomes 
for women who have endometrial cancer is missed opportunities at early 
detection. Bleeding, often accompanied by debilitating menstrual pain, 
is a symptom that allows early detection, but is sometimes misdiagnosed 
as fibroids, uterine cysts, or perimenopause. Unfortunately, fewer than 
70 percent of endometrial cancers are now diagnosed while still 
confined to the uterus.\3\ Thirty-eight percent (38 percent) of 
endometrial cancers are diagnosed at advanced stages in Black women 
compared to 25 percent in White women.\4\
---------------------------------------------------------------------------
    \2\ National Cancer Institute. Surveillance, Epidemiology, and End 
Results Program. Cancer Stat Facts: Uterine Cancer. Available at: 
https://seer.cancer.gov/statfacts/html/corp.html. Last queried February 
13, 2020.
    \3\ Memorial Sloan-Kettering Cancer Center, Stages of Uterine 
(Endometrial) cancer. https://www.mskcc.org/cancer-care/type/uterine-
endometrial/diagnosis/stages.
    \4\ American Cancer Society. Cancer Facts & Figures 2022. Atlanta: 
American Cancer Society; 2022. https://www.cancer.org/content/dam/
cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-
and-figures/2022/2022-cancer-facts-and-figures.pdf].
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    Additionally, black women are less likely to receive evidenced 
based care. Moreover, disparities exist regarding social determinants 
of health, access to genetic testing, preventive services, and other 
aspects of care for patients with endometrial cancer. These disparities 
are creating enormous inequities in outcomes and survivorship in our 
health care system, particularly for endometrial cancer. Black women 
are more likely to be diagnosed with aggressive subtypes of endometrial 
cancer and the mortality and 5-year survival rates are much worse for 
black women than white women. The five-year survival rate in black 
women is 63 percent compared to an 84 percent 5-year survival rate in 
white women.\5\ Black women are two times more likely to die from this 
disease compared to White women.\6\
---------------------------------------------------------------------------
    \5\ American Cancer Society. Cancer Facts & Figures 2022. Atlanta: 
American Cancer Society; 2022. https://www.cancer.org/content/dam/
cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-
and-figures/2022/2022-cancer-facts-and-figures.pdf].
    \6\ Giaquinto Obstet & Gynecol Feb 2022.
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    Disparities in endometrial cancer outcomes may be furthered by 
inequities in access to appropriate screening, genetic testing, and 
preventive services. Identifying actionable targets to mitigate 
disparities in early detection and receipt of timely, guideline-
concordant care remain critical to improving endometrial cancer 
outcomes among underserved populations. Research is critically needed 
to help understand barriers to care; elucidate differences in tumor 
biology; discover new approaches to screening, prevention, and 
treatment; and promote wider implementation of known strategies to 
facilitate optimal treatments to improve survival for all patients with 
endometrial cancer
    Therefore, the SGO urges the subcommittee to adopt the following 
report language on endometrial cancer in the report accompanying the 
Fiscal Year 2023 Labor-HHS-Education appropriations bill.

                       National Cancer Institute

      Endometrial Cancer.--The Committee remains concerned about the 
        significant disparities in mortality rates for endometrial 
        cancer that adversely impact Black women. The age-adjusted 
        mortality rate for Black women with endometrial cancer is much 
        worse than it is for White women, which is partly attributed to 
        cancer stage at diagnosis. The Committee urges the NCI to 
        conduct research activities that will lead to the development 
        of targeted interventions to improve early diagnosis among 
        Black women with endometrial cancer and improved access to high 
        quality care through innovative community-based outreach 
        methods to increase the enrollment and participation by Black 
        women in clinical trials. The Committee requests an update on 
        NCI's activities regarding endometrial cancer in the fiscal 
        year 2024 Congressional Justification, including progress made 
        in endometrial cancer early diagnosis, survival rates, and 
        clinical trial enrollment by ethnicity.

    Thank you in advance for your favorable consideration of this 
report language request. The SGO believes that pursuit of these 
important research objectives will help alleviate disparities in 
endometrial cancer outcomes and remove barriers to health equity for 
all underserved women diagnosed with this lethal disease.
                                 ______
                                 
  Prepared Statement of the Society of Nuclear Medicine and Molecular 
                                Imaging
    Chair Murray, Ranking Member Blunt, and members of the 
subcommittee, I am Richard L. Wahl, MD, President of the Society of 
Nuclear Medicine and Molecular Imaging and the Elizabeth E. 
Mallinckrodt Professor and head of radiology at Washington University 
School of Medicine in St. Louis, MO.
    The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is a 
nonprofit scientific and professional organization that promotes the 
science, technology, and practical application of nuclear medicine and 
molecular imaging. Research in this field has led to breakthroughs for 
diagnosing and treating patients with deadly conditions such as cancer, 
heart disease, and Alzheimer's disease. SNMMI strives to be a leader in 
unifying, advancing, and optimizing molecular imaging, with the 
ultimate goal of improving human health through noninvasive procedures 
and therapeutic approaches utilizing internally-administered 
radiopharmaceuticals. With over 15,000 members worldwide, SNMMI 
represents nuclear medicine and molecular imaging professionals, 
including physicians, physicists, radiochemists, pharmacists, and 
technologists, all of whom are committed to the advancement of the 
field. It is my pleasure to submit this testimony on behalf of SNMMI.
    We strongly support at least $49.048 billion for the National 
Institutes of Health's base appropriation. This figure represents an 
increase of $3.5 billion over FY 2022 plus the release of the 21st 
Century Cures funds. SNMMI also supports a proportional increase to the 
National Institute of Biomedical Imaging and Bioengineering (NIBIB), 
resulting in at least $458.5 million for FY 2023--a $33.6 million 
increase over the FY 2022 enacted level. Further, should the Advanced 
Research Projects Agency for Health (ARPA-H) or pandemic preparedness 
efforts progress, funding should be designated separately from NIH's 
base and should supplement, not supplant, investment in basic research. 
Through consistent, strong funding for NIH and our National research 
infrastructure we can continue to make advancements that will improve 
the lives of patients with a wide spectrum of diseases and disorders. 
SNMMI is grateful for the subcommittee's past support of NIH and 
encourages the subcommittee to continue advancing discovery and 
innovation in nuclear medicine and molecular imaging.
    Nuclear medicine, in particular, is undergoing a renaissance as a 
precision medicine specialty, with new radiopharmaceuticals, 
radiopharmaceutical therapies, and instrumentation to elucidate biology 
and benefit patients. Federal research funding allows our members, 
partners, and stakeholders to improve imaging tools and therapies, 
which, in turn, broadens the resources available to address many 
challenging conditions. As a physician/clinician-scientist, my work has 
been greatly impacted by NIH funding, resulting in 18 patents, over 450 
peer-reviewed scientific manuscripts, and several FDA-approved 
theranostic (therapy + diagnostics) drugs and devices. I use state-of-
the-art technologies like positron emission tomography (PET) combined 
with computer tomography (CT) and other advanced imaging modalities to 
improve the diagnosis and treatment of cancer types, including 
prostate, breast, neuroendocrine, and pancreatic, while also 
researching rare and orphan diseases.
   nuclear medicine and molecular imaging: precise and personalized 
                                medicine
    Nuclear medicine and molecular imaging procedures are used in a 
wide array of diseases and disorders, including cancer, Alzheimer's and 
Parkinson's Diseases, and cardiac disease, among others.\1\ Congress's 
support of NIH has helped to advance the science and the researchers 
who make these discoveries. NIH support is often the foundation of the 
newest technologies that go on to help patients. This subcommittee's 
continued support of the NIH, especially the National Cancer Institute 
(NCI), NIBIB, National Institute on Aging (NIA), National Institute of 
Neurological Disorders and Stroke (NINDS), National Institute of Mental 
Health (NIMH), and National Heart, Lung, and Blood Institute (NHLBI), 
will help scientists address many unmet medical needs. Some of the 
advances from the nuclear medicine and molecular imaging community in 
detecting and treating cancer and selecting the right patient for the 
right therapy are detailed below.
---------------------------------------------------------------------------
    \1\ Wahl RL, Chareonthaitawee P, Clarke B, Drzezga A, Lindenberg L, 
Rahmim A, Thackeray J, Ulaner GA, Weber W, Zukotynski K, Sunderland J. 
Mars Shot for Nuclear Medicine, Molecular Imaging, and Molecularly 
Targeted Radiopharmaceutical Therapy. J Nucl Med. 2021 Jan;62(1):6-14. 
doi: 10.2967/jnumed.120.253450. PMID: 33334911.
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Improved Imaging and Therapy for Cancer using Molecularly Targeted 
        Radiopharmaceuticals
    Major nuclear medicine advances in the fight against prostate 
cancer have appeared in the news. In the past year, three cancer-
targeted radioactive imaging agents (Pylarify, Illuccix, and 
Locametz) received FDA approval and have entered commercial 
distribution for greatly improved detection of prostate cancer. These 
radiotracers seek out prostate cancer cells throughout the body, 
allowing the active foci of cancer to be seen on a PET/CT scan. This 
class of agents targeting prostate specific membrane antigen or PSMA, 
can identify cancer months or years ahead of standard imaging such as 
CT or MRI, allowing patients to receive appropriate treatment sooner 
when it can be more effective. The FDA has also recently approved a 
companion targeted radiotherapeutic, Pluvicto\TM\ (\177\Lu-PSMA-617), 
for men with late-stage castrate-resistant prostate cancer that had 
spread. The PSMA part of the drug makes it act like a guided missile or 
geotag to seek out prostate cancer cells. The attached lutetium-177 
radioisotope destroys the cancer cells while leaving healthy tissue 
intact. Combined, the radiopharmaceutical therapy is in effect a 
``smart bomb'' to selectively destroy foci of prostate cancer. The men 
treated with \177\Lu-PSMA had a four-month longer median survival than 
men receiving best standard of care alone. These results prompted FDA 
to label the treatment as a breakthrough therapy which accelerated its 
approval time and allow it to reach patients in need faster. None of 
this would have been possible without the early support of 13 NIH 
grants.\2\
---------------------------------------------------------------------------
    \2\ Szabo Z, Mena E, Rowe SP, et al. Initial Evaluation of 
[(18)F]DCFPyL for Prostate-Specific Membrane Antigen (PSMA)-Targeted 
PET Imaging of Prostate Cancer. Mol Imaging Biol. 2015;17:565-574.
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    Imaging and therapy molecule pairs, such as those using PSMA 
molecules as targeting agents, are often referred to as theranostics, a 
rapidly developing area of personalized medicine. If the diagnostic 
version of the molecule can find the cancer with a PET scan, then the 
same molecule with a therapeutic isotope can be used to attack the 
cancer. Further advancements in the theranostics space are anticipated. 
This treatment principle is being applied to cancer types for which we 
have no or few treatment options, such as pancreatic cancer. An 
exciting new class of theranostic molecules are those targeting 
fibroblast-activation-protein (FAP).\3\ This protein (FAP) is 
overexpressed in many cancer types including breast, pancreas, lung, 
kidney, and ovarian. The FAP molecule can be labeled as a diagnostic 
agent and then as a therapy. This treatment paradigm gives doctors a 
new tool in the fight against cancer. The NCI is currently supporting a 
phase 1 clinical trial (NCT04457258) on this promising new agent.
---------------------------------------------------------------------------
    \3\ Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, 
Mier W, Adeberg S, Rathke H, Rohrich M, Winter H, Plinkert PK, Marme F, 
Lang M, Kauczor HU, Jager D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI 
PET/CT: Tracer Uptake in 28 Different Kinds of Cancer. J Nucl Med. 2019 
Jun;60(6):801-805. doi: 10.2967/jnumed.119.227967. Epub 2019 Apr 6. 
PMID: 30954939; PMCID: PMC6581228.
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    None of these advances would be possible without the support of 
radiochemistry and isotope production research. The next generation of 
radioisotopes, alpha emitting therapeutic isotopes, which have much 
greater cancer killing power per radioactive decay, are in clinicals 
trials and are expected to provide better patient outcomes. Support of 
that research is critical.
Quantitative Molecular Imaging
    A PET scanner is often thought of as an imaging tool; however, it 
is inherently a highly specific measuring tool. Recent advances in PET 
technology such as PET/MRI and total-body PET, where the whole body can 
be imaged at once, have opened new research possibilities.\4\ To 
realize the full potential of these advances, quantitative analysis 
will be required to appreciate the sensitivity of the scanner and the 
tracers it measures. The NCI has supported the harmonization of PET/CT 
scanners through numerous grants including NIH R01CA169072, and for the 
last decade, the NCI, through their Cancer Imaging Program has 
developed and supported a consortium of academic sites called the 
Quantitative Imaging Network performing and advancing quantitative 
imaging mostly in support of clinical trials.
---------------------------------------------------------------------------
    \4\ Meikle SR, Sossi V, Roncali E, Cherry SR, Banati R, Mankoff D, 
Jones T, James M, Sutcliffe J, Ouyang J, Petibon Y, Ma C, El Fakhri G, 
Surti S, Karp JS, Badawi RD, Yamaya T, Akamatsu G, Schramm G, Rezaei A, 
Nuyts J, Fulton R, Kyme A, Lois C, Sari H, Price J, Boellaard R, Jeraj 
R, Bailey DL, Eslick E, Willowson KP, Dutta J. Quantitative PET in the 
2020s: a roadmap. Phys Med Biol. 2021 Mar 12;66(6):06RM01. doi: 
10.1088/1361-6560/abd4f7. PMID: 33339012.
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Imaging of the brain in Alzheimer Disease
    About a year ago, the FDA approved an innovative antibody therapy 
for Alzheimer's disease which removes amyloid plaque from the brain. At 
present, PET scanning using radiotracers that target the amyloid 
protein or the abnormal tau protein seen in dementias of the Alzheimer 
type have been key to identifying patients who may be suitable 
candidates for such clinical trials and these emerging therapies. The 
support of the NIH was key to developing these brain imaging agents and 
continued NIH support is essential to allow PET to probe the earliest 
changes of dementia and to monitor the effects of emerging innovative 
therapies. There are now several FDA approved PET imaging agents to 
identify patients with amyloid or tau deposition, helping identify how 
to best target limited resources to patient groups most likely to 
benefit from such therapies. The ability to select patients most likely 
to respond to therapy is expected to save tens of billions in 
healthcare dollars per year.
Immuno-oncology Imaging
    In 1980, the NCI added $13.5M to their budget for new Biological 
Response Modifiers, this triggered a search for agents able to modify a 
body's response to tumor cells.\5\ That investment spawned the multi-
billion-dollar drug class of immune checkpoint inhibitors (ICI), 
starting with the approval of Yervoy (ipilumimab) in 2011. In the U.S. 
in 2020, a year severely impacted by the COVID-19 pandemic, sales of 
the top three ICI topped $17B. ICIs are generally considered to be safe 
and effective treatment options for numerous cancer types including 
lung cancers and melanoma, and some people like former U.S. President 
Jimmy Carter had a remarkable response to ICI therapy. However, they do 
not work in all patients; indeed over half of patients treated with 
these agents die of their disease. New radiotracers are in development 
to image the immune system in conjunction with a PET or SPECT camera. 
Clinical trials with these tools have demonstrated the ability to 
predict response to ICI therapy after just one cycle of therapy. Future 
studies will aim to pre-select, with imaging, patients who are likely 
to respond to immune checkpoint inhibitors thus enabling effective 
therapy earlier and eliminating side effects of futile treatments. The 
ability to select patients likely to respond to therapy will also save 
billions in healthcare dollars.
---------------------------------------------------------------------------
    \5\ https://www.whatisbiotechnology.org/index.php/timeline/science/
immunotherapy/80.
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Data Science and Workforce
    The field of nuclear medicine and molecular imaging is rapidly 
expanding with new diagnostic imaging tracers, radiopharmaceutical 
therapies (RPT), and technologies. With new diagnostic tracers comes a 
need to properly interpret the innovative scans. Artificial 
intelligence (AI) algorithms can assist with the tedious components of 
image interpretation and even help with quality report generation. 
Development of well-credentialed registries of studies to train and 
validate such AI algorithms, reflecting diverse sets of patients will 
help advance this field. Radiopharmaceuticals therapies (RPTs), like 
other oncology therapies, are often studied in and approved for 
patients with late-stage disease, for example, after all other 
treatments have failed. To harness the full potential of RPTs, use 
earlier in the disease course may be advisable. Image and clinical data 
registries are needed to capture post-approval information on the use 
of RPTs and the patient outcomes to further guide their use. Recent 
imaging and therapy FDA approvals in prostate cancer and Alzheimer's 
disease, two highly prevalent conditions, require that the highly 
specialized field of nuclear medicine and molecular imaging train a 
cadre of qualified individuals to diagnose and treat these patients. It 
is critical for the NIH to fund and expand training grants so that our 
brightest scientists have the skills to develop a sustainable career 
pathway. Funding for AI technologies and registries will improve 
patient care and outcomes.
                         summary and conclusion
    Robust NIH funding is crucial to advancing our efforts to detect 
and treat serious medical conditions. NIH investments help to sustain 
both our local and national research institutions across every State in 
the Nation. China is advancing rapidly in the high technology medical 
space notably in AI. Funding NIH's base program with at least $49.048 
billion will help researchers, scientist and physicians retain its 
competitive edge.
    Thank you for your strong, continued support of NIH, NCI, NIMH, 
NIBIB and all the Institutes and Centers working to advance molecular 
imaging and radiopharmaceutical therapies to improve the lives of 
patients worldwide. On behalf of the Society of Nuclear Medicine and 
Molecular Imaging, I urge you to continue your strong support of our 
Nation's research and innovation enterprise.

    [This statement was submitted by Richard L. Wahl, MD, President, 
Society of 
Nuclear Medicine and Molecular Imaging.]
                                 ______
                                 
     Prepared Statement of the Spina Bifida Association of America
Shoshana Siegel of Hollywood, Florida
    My name is Shoshana Siegel and I'm a 17-year-old, and I was born 
with Spina Bifida. I have had seven major surgeries in my life 
beginning at the age of 3 months. These surgeries include neurosurgery 
to detether my spine and brain surgery due to a related condition 
called Chiari Malformation. I am hospitalized 4-6 times a year for on-
going foot infections that are a result of lack of feeling in my legs. 
Sometimes children with Spina Bifida are called million-dollar babies; 
by the time I was 6 months old my medical costs were half a million 
dollars. At the age of 17, between my surgeries, medications and 
hospitalizations, we estimate my medical costs are about $3 million. I 
am fortunate to have always had private medical insurance through my 
mom's employers. I am on-track to graduate high school early and want 
to go into medical science as my career. I would like to be a forensic 
medical examiner or forensic psychologist. There are instances of 
people with Spina Bifida suddenly dying in their 40s with no 
explanation. I want to find out why and help us all live longer.
    I'm here today to talk about the importance of funding for the 
CDC's National Spina Bifida program which funds research and clinics 
around the country. At the age that I'm at, I have around seven doctors 
who talk to each other openly through our local children's hospital 
system. My doctors include wound care specialists, two different 
neurologists, a neurosurgeon, an orthopedic surgeon, urologist and a 
primary doctor. Also, I see two mental health specialists to help me 
navigate life. If all goes well, I can go to these experienced doctors 
who know about my condition until I'm 20 years old. After I'm 20, I 
will no longer be able to receive care from these experts or be 
entitled to this quality care from my experienced and personalized 
medical team when I have an infection and need to be hospitalized. At 
17 one of my doctors is already starting to transition me to an adult 
doctor for my next surgery which will take place before I am 18. This 
is not usually how it is done. Typically, a 20-year-old would be solely 
responsible for seeking doctors who may have experience with my 
condition and needs and it could take years to find the right fit for 
my type of Spina Bifida. It is not as easy as googling ``spina bifida 
doctor''. Spina Bifida is referred to as a snowflake condition because 
no two cases are alike. So for me it would be finding doctors who can 
specifically understand my body, my conditions and work with my other 
doctors. This is hard to do outside of a medical clinic situation. And 
there are not many Spina Bifida medical clinics at adult hospitals.
    No one with Spina Bifida should have to fight to have basic medical 
care or be penalized because a condition which was once pediatric is 
now witnessing its first generation of adults. The medical system must 
figure out how to keep pace with a growing, aging and surviving Spina 
Bifida population.
    Funding the National Spina Bifida Program at $11 million would help 
prevent individuals like myself from falling over the care cliff that 
happens when a child with Spina Bifida makes the move from a 
coordinated pediatric system of care into a fragmented and fractured 
system for adult care. Establishing more adult care clinics would help 
individuals transition and provide for coordination among doctors so we 
could secure employment and enrich our lives.
    With the support of my family, I have had excellent medical care my 
whole life. This care has allowed me to thrive and excel in life. I 
would like to keep my life on track for success without being consumed 
by healthcare stress. Thank you for listening to my story and for your 
support.
Charlotte Mountz of Harpers Ferry, West Virginia
    My name is Charlotte Mountz, and I am 18 years old and I have Spina 
Bifida. I am just like any other young woman, with hopes, dreams, and 
fears. I love animals and would like to be a zookeeper. Like most other 
siblings. My younger brother and I will argue about petty things. But 
one of my greatest concerns is the lack of healthcare for adults with 
Spina Bifida.
    I have grown up going to fantastic pediatric doctors, who know how 
to treat people with Spina Bifida. However, Spina Bifida used to be 
thought of as a pediatric condition because kids would not live until 
adulthood, happily that has changed and we are seeing adults living 
into their senior years. Unfortunately, the adult healthcare system 
hasn't caught up. That is why I am writing to you today.
    The Spina Bifida community experiences what is called a care cliff, 
meaning that when a child becomes an adult, they lose their care, and 
because of the lack of education about care for adults with Spina 
Bifida, there are a lack of providers, both PCPs, and specialist 
including, but not limited to, Urologists, Nephrologists, Neurologists, 
Neurosurgeons, Orthopedics, and more. Access to these providers is 
necessary for people with Spina Bifida to live happy and healthy.
    I would like you to support an increase to $11 million dollars for 
the National Spina Bifida Program at the CDC. This increase will allow 
the NSBP to find more research into care for adults with Spina Bifida 
so that we can better educate doctors and lessen the care cliff.
                                 ______
                                 
   Prepared Statement of theAmerican Association of Neuromuscular & 
                       Electrodiagnostic Medicine
                    fiscal year 2023 recommendations
_______________________________________________________________________

  --Please continue to provide meaningful, annual funding increases for 
        healthcare fraud and abuse programs at the Centers for Medicare 
        and Medicaid Services (CMS) while allowing for flexibility and 
        innovation to address emerging challenges.
  --Please continue to include timely recommendations in the Committee 
        Report accompanying the annual Labor-Health and Human Services-
        Education (LHHS) Appropriations Bill encouraging CMS to take 
        substantive action to systematically address fraud, abuse, and 
        the quality of patient care in electrodiagnostic (EDX) 
        medicine.
  --Please provide the National Institutes of Health (NIH) with $49 
        billion in discretionary funding, an increase of $3.5 billion 
        over FY 2022. Please also provide proportional increases for 
        various NIH Institutes and Centers, including the National 
        Institute of Arthritis and Musculoskeletal and Skin Diseases 
        (NIAMS), the National Institute of Allergy and Infectious 
        Diseases (NIAID).
  --Please provide distinct, additional funding to support and further 
        implement the new Advanced Research Projects Agency for Health 
        (ARPA-H) at NIH to facilitate robust and swift scientific 
        progress on a variety of neuromuscular conditions.
  --Please provide the Centers for Disease Control and Prevention (CDC) 
        with $11 billion to bolster support for public health programs 
        that support patient communities, such as the National 
        Neurologic Conditions Surveillance System.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished Members 
of the subcommittee, thank you for the opportunity to present the views 
of the American Association of Neuromuscular & Electrodiagnostic 
Medicine (AANEM) during the consideration of FY 2023 L-HHS 
appropriations. First and foremost, thank you for the ongoing 
investment in medical research, patient care, and healthcare fraud 
prevention programs. Please maintain this investment and provide 
further support for FY 2023.
    Concerning fraud and abuse, the challenges and opportunities that I 
will review today are not unique to AANEM but impact a variety of 
medical professional societies and patient communities who rely on 
proper EDX testing. My comments are provided in the interest of 
spotlighting serious issues that continue to undermine patient care and 
waste Federal healthcare resources, while advancing policy tools to 
efficiently and effectively address these issues. In this regard, 
please consider the AANEM a resource moving forward. Thank you again 
for this important opportunity.
                              about aanem
    AANEM is a nonprofit membership association dedicated to the 
advancement of neuromuscular, musculoskeletal, and EDX medicine. Our 
members--primarily neurologists and physical medicine and 
rehabilitation (PMR) physicians--are joined by allied health 
professionals and PhD researchers working to improve the quality of 
medical care provided to patients with muscle and nerve disorders. 
Founded in 1953, AANEM currently has nearly 6,700 members across the 
country. Our mission is to improve quality of patient care and advance 
the science of neuromuscular (NM) diseases and EDX medicine by serving 
physicians and allied health professionals who care for those with 
muscle and nerve disorders. Our members are dedicated to diagnosing and 
managing a variety of nerve and muscle disorders including, but not 
limited to, amyotrophic lateral sclerosis, muscular dystrophies, and 
neuropathies, as well as more common conditions, such as pinched nerves 
and carpal tunnel syndrome.
                           about edx medicine
    When functioning properly, nerves send electrical impulses to the 
muscles to activate them. A nerve disorder means that signals are not 
getting through like they should. A muscle disorder means that muscles 
aren't responding to the signals correctly. To determine whether your 
nerves and muscles are working properly, your doctor may recommend you 
have EDX testing, which generally includes both a nerve conduction 
study (NCS) and needle electromyography (EMG) testing. Other tests may 
include imaging, genetic testing, biopsies, biochemical tests, and 
strength testing. The results of these tests help your doctor diagnose 
your condition and determine the best treatment.
    NCS.--These studies evaluate how quickly and efficiently electrical 
impulses move through the nervous system. While it may sound straight-
forward, proper testing requires sophisticated equipment, an 
understanding of the patient's health history, and, most importantly, 
the ability to design/perform the study and interpret the results.
    EMG.--These tests evaluate muscles and nerves through the use of 
electrodes under the skin. Since the procedure is invasive and highly 
technical, it is considered to be the practice of medicine by the 
American Medical Association, requiring training, study, and experience 
to ensure patient safety and testing efficacy.
                       about edx fraud and abuse
    In 2014, the HHS OIG published a report entitled, Questionable 
Billing for Medicare Electrodiagnostic Tests, which found roughly $140 
million in suspicious activity annually. But experience tells us that 
this is just the tip of the iceberg. And the toll of patient suffering 
and hardship as the result of fraudulent EDX testing is incalculable. 
Unfortunately, since this report was released, the situation has 
deteriorated rather than improved. Our members have anecdotally noted 
an increase in fraud activity (both through solicitations and by re-
testing patients that were victims of improperly performed tests), 
which appears to be supported by CMS utilization data. CMS revised the 
EDX codes in 2013 which has actually made it harder to identify 
systematic fraud and abuse in this area. Bad actors are aware of the 
gaps in the current CMS regulatory and enforcement framework that 
create unique blind spots for EDX testing, and this deficiency 
continues to be exploited with many criminal endeavors operating in the 
open for years as sham professional service providers (the small number 
that are caught and convicted annually has not served as a deterrent). 
To be clear, the victims continue to be the patients that are 
improperly tested, subjected to a battery of studies, and over-billed, 
with no intention of receiving an accurate diagnosis or who were never 
in need of testing in the first place.
                         current opportunities
    CMS, the FBI, and the HHS OIG have been doing tremendous work to 
root out fraud and abuse in EDX medicine, but these dedicated public 
servants are limited by the constraints of the current pay-and-chase 
model. Additional resources for ongoing CMS efforts to address 
healthcare fraud and abuse will facilitate incremental improvements and 
further protect patients, but modernization is needed as well. Over 
recent appropriations cycles, Congress has called on CMS to work with 
the EDX community on innovative solutions that could better identify 
bad actors conducting EDX testing or simply prevent payments for 
improper studies before they are made. Please continue to work with CMS 
through the FY 2023 appropriations process to recommend greater 
community collaboration and to encourage meaningful and timely progress 
in the area of EDX fraud and abuse.
            statement of aanem member dr. vince tranchitella
    New NCS codes became effective on January 1, 2013. The new codes 
were developed as a direct response to fraudulent activity that 
resulted in the exponentially increased billing for NCSs. 
Unfortunately, the new NCS codes failed to have the desired effect. My 
most recent case involved 56 EDX studies, all of which were performed 
AFTER the NCS codes were changed in 2013, and every single one of the 
reports were deemed so far below the standard of care that none of them 
could be considered a reliable representation of the true medical 
status of the patients who received those tests. Therefore, none of 
those tests should have been billed or reimbursed.
                  recent examples from dr. peter grant
    EDX fraud not only wastes healthcare dollars, but, more 
importantly, the quality of patient care suffers severely. As an 
example, a recent case in which I testified in Houston working for the 
FBI and the US Attorney's Office, many patients' insurance companies 
were being billed more than $30,000 for a study that should cost $800 
to $1200. Of note, when a detailed review was performed, more than 85 
percent of the diagnoses arrived at with these fraudulent studies were 
incorrect and unreliable. These inappropriate and inaccurate studies 
did not help these patients in finding appropriate treatments or 
solutions to their medical problems. In fact, they often sent the 
patients down costly and ineffective paths of treatment. In this case 
alone the perpetrators were convicted of EDX fraud totaling nearly $5 
million.
    As is invariably the case with mobile EDX laboratories, quality of 
care suffers while costs skyrocket and the real losers are, 
unfortunately, the patients. In a case I had in California, a 47 year 
old man had a mobile EDX study done that cost him (and his insurance 
company) more than $7,500 and told him his symptoms were from a 
``pinched nerve in his leg''. When I performed the correct study 
(charging about $750) I found his true diagnosis to be ALS (or Lou 
Gehrig's disease).
    A case in Alabama earlier this year recently led to a guilty plea. 
According to the Justice Department, the provider conspired with... a 
Huntsville-based testing company, to bill insurers millions of dollars 
for electro-diagnostic testing that its technicians performed, 
regardless of whether there was a medical need for them. Insurers were 
then billed using the providers National Provider Identifier (NPI) 
number, even where they did not conduct the tests, supervise the tests, 
interpret the test results, or have anything to do with the tests 
beyond allowing the NPI number to be used for billing purposes. The 
fraud identified by the FBI for this case alone is $28 million.
    https://www.justice.gov/usao-ndal/pr/huntsville-doctor-charged-
health-care-fraud-conspiracy.

    [This statement was submitted by Peter A. Grant, MD, EDX Fraud and 
Abuse Consultant for FBI and OIG, AANEM Past-President.]
                                 ______
                                 
            Prepared Statement of Today's Student Coalition
    Dear Chairwoman Murray, Ranking Member Blunt, Chairwoman DeLauro, 
and Ranking Member Cole:
    The Today's Student Coalition (TSC) respectfully requests the 
following funding levels within the Fiscal Year (FY) 2023 Labor, Health 
and Human Services, Education, and Related Agencies (LHHS) 
appropriations bill. The TSC--a collective of 34 cross-cutting higher 
education policy, advocacy, and membership organizations--appreciates 
the steps that Federal policymakers have taken to support students 
through the pandemic. Yet, as our Nation looks to turn the corner and 
begin the process of rebuilding our economy for a post-pandemic world, 
Federal investments must continue to enhance the capacities of 
postsecondary institutions while ensuring student access to the support 
necessary for success in higher education.
    As you begin to work on FY 2023 appropriations legislation, the TSC 
would like to express our support for investments in the key child 
care, financial aid/support, and campus mental health programs outlined 
below. As our coalition strives to create a system of higher education 
that better reflects and supports the needs of today's students, we 
believe that investments in these programs represent a chance to not 
merely repair the damage caused by the pandemic, but to provide real 
educational and economic opportunity to all.
  --Emergency Aid Grants: Create a permanent Emergency Aid Grant 
        program to provide grants to institutions with the explicit 
        purpose of providing direct student emergency financial aid. 
        This funding would allow institutions to provide direct 
        financial assistance to ensure an emergency cost does not 
        derail a student's ability to complete college, similar to the 
        assistance provided to students through the Higher Education 
        Emergency Relief Fund (HEERF).
    An emergency financial aid grant can help students cover any 
unexpected expenses so these emergencies do not suspend or halt their 
education. The Coronavirus Aid, Relief, and Economic Security Act and 
the two other subsequent COVID-19 aid packages provided resources for 
institutions of higher education to provide financial support in the 
form of emergency aid grants for students related to the pandemic. This 
aid enabled millions of students to stay in school despite the 
increased costs of living through the pandemic in a postsecondary 
environment. This authority proved that even a relatively small amount 
of financial aid can ensure students have a chance to stay in school.
  --Pell Grants: Pell Grants have served as the cornerstone of Federal 
        financial aid for students from low-income backgrounds, 
        providing crucial support for roughly 7 million students each 
        year. We urge Congress to consider a significant increase in 
        the maximum Pell Grant award in both discretionary and 
        mandatory funding--continuing the trajectory towards a full 
        doubling of the maximum award amount in the coming years.
  --Child Care Access Means Parents in School: Increase funding to $500 
        million for the Child Care Access Means Parents in Schools 
        (CCAMPIS)--the amount needed to provide child care support to 
        about six percent of Pell-eligible student parents of children 
        ages 0-5. The CCAMPIS program provides vital support for the 
        participation and success of low-income parents in 
        postsecondary education through the provision of campus-based 
        child care, widely recognized as one of the most important 
        supports for parenting college students. Increasing CCAMPIS 
        funding to $500 million would ensure that roughly 100,000 more 
        parenting college students receive the child care assistance 
        they need to continue their educational journeys.
  --Garrett Lee Smith Memorial Act Campus Suicide Prevention Grant: 
        Finally, increase the Garrett Lee Smith Campus Suicide 
        Prevention Grant (GLS CSPG) to $15 million, as this funding did 
        not receive an increase in the FY 22 package.
    In June 2020, data from the CDC showed that more than half of 
adults aged 18-24 had at least one adverse mental or behavioral health 
symptom, with more than a quarter considering suicide in the past 30 
days. The GLS CSPG provides vital funding in colleges' efforts to not 
only address the unique needs of students experiencing mental health 
challenges or contemplating suicide, but support them in reaching their 
academic goals. As the mental health challenges on college campuses 
have grown, funding for this important program has become even more 
critical.
    As you consider programmatic funding levels for FY 2023 
appropriations, we urge you to reaffirm Congress's historic, bipartisan 
commitment to postsecondary education and to today's students. Thank 
you for the consideration of important requests. We look forward to 
continued work with you to advance programmatic funding that meets the 
needs of our students and the Nation as a whole.
    Sincerely.
                     the today's students coalition
Higher Learning Advocates
Achieving the Dream
Advance Vermont
America Forward
Association of Young Americans
Center for First-generation Student Success
Coalition on Adult Basic Education
Cornell University Student Assembly
Institute for Higher Education Policy
The Jed Foundation
Jobs for the Future
Let's Get Ready
National Association of Student Personnel Administrators
National College Attainment Network
National Skills Coalition
New America Higher Education Program
Student Veterans of America
Swipe Out Hunger
uAspire
University of California Student Association
University Professional and Continuing Education Association
Veterans Education Success
Young Invincibles
                      
                                 ______
                                 
                Prepared Statement of TRIO Talent Search
    ``You're so smart. It's too bad you can't go to college,'' my dad 
sighed, a sad look on his face. I was a freshman in high school when he 
said that to me after reviewing my first report card. Up until that 
point, I hadn't really thought about college. I had assumed I would 
probably go because that's what people did after high school. I felt 
shocked by my dad's words; why wouldn't I go? His answer was ``money,'' 
of course. There was no money for college.
    I would soon come to learn that it wasn't just about money. Well-
meaning though they were, my parents, who themselves struggled to 
complete high school and worked blue collar jobs, didn't have any idea 
of how to help prepare me for college. When it came to grades, it was 
simply ``do your best.'' If homework was challenging, my mom jokingly 
reminded me she flunked out of algebra. There would be no SAT prep 
courses, no private education, no unpaid internships ``for the 
experience.'' The time I had for extracurricular activities was shared 
with the 25 hours per week I worked at a pizza shop. I was smart, yes, 
but that was about all I had in my favor.
    While I was in high school, I was informed that I was eligible to 
participate in a program called TRIO Talent Search (TTS). My ETS 
advisor, Carolyn, provided me with critical guidance I didn't get 
anywhere else. I'd had no idea that college applications cost money, 
but Carolyn helped me get fee waivers and meet application deadlines, 
schedule campus tours, and jump through all the hoops I had never known 
existed, and certainly couldn't have figured out on my own. With her 
help, I was accepted to the University of New Hampshire Honors Program 
with a partial scholarship.
    In my first year of college, my dad experienced a significant 
mental health crisis that would ultimately lead to his becoming 
permanently psychiatrically institutionalized. His illness also 
resulted in a loss of income that ultimately led to foreclosure on our 
family home during my sophomore year. I took out extra loans to help 
with the mortgage, but it simply wasn't enough. These family stressors, 
coupled with my socioeconomic background, often made me feel ``other'' 
than my peers, who seemed so carefree by comparison.
    As in high school, I worked through college and was fortunate to 
complete my work-study in TTS's administrative office. During that 
time, I became familiar with the many services provided by other TRIO 
programs. My TRIO supervisors and mentors encouraged me to apply for a 
tutor-counselor position at Upward Bound, another TRIO program that 
helped low-income, first generation, and ethnic minority students 
become competitive for college, in part through their intensive summer 
college preparatory program. I spent the summer before my junior year 
working as a teaching assistant for classes and providing mentorship, 
leadership, and individual tutoring to a fantastically bright and funny 
group of high school students. It was the first meaningful job I could 
put on my resume--a dramatic departure from Papa Gino's, Subway, and 
the Getty gas station off of exit 14.
    That wasn't the end of what TRIO had to offer. Right before my 
senior year, an TTS mentor asked me if I had applied for TRIO's McNair 
Postbaccalaureate Achievement Program. I hadn't because I had never 
heard of it. Learning about the program, it seemed too good to be true: 
a summer spent living and conducting funded research on campus, a free 
GRE prep course, attending research conferences and college tours, 
personalized mentorship, graduate school application fee waivers, and 
peer support. I could barely contain my excitement. When I was accepted 
into the McNair Program, I felt like I had won the lottery, and in a 
sense, I really had. The summer I spent with McNair was among the most 
memorable of my life. I am certain that without that experience, their 
guidance, and the financial assistance, I would not have been 
competitive in graduate school application pools saturated with high-
pedigree students with stunning CVs. Good grades and a passion for 
learning are simply not enough for success. With their help, I was 
accepted to The New School's clinical psychology program with a 75 
percent tuition scholarship. I graduated with my BA in psychology summa 
cum laude, first in my class, with the honor of being designated a 
Dean's Fellow and Class Marshal. I had the privilege of carrying my 
college banner in our graduation march, which was one of the proudest 
moments of my life.
    I went on to earn my MA and PhD in Clinical Psychology. While at 
the New School, I served as lab manager for a psychology lab that 
studied the psychophysiology of complex trauma. In short, we worked to 
understand how people with a lifetime of traumatic exposure (such as 
abuse and neglect) experience and manage their emotions. By also 
including measures of psychobiology, we were able to better understand 
the biological mechanisms underlying their emotional processes. A 
highlight of my time in the lab was when I was able to serve as project 
coordinator for a 5-year, multi-site NIMH-funded grant study on the 
common factors underlying various mental health issues, with a focus on 
the role of trauma in diagnosis and emotional processing. In 
understanding how people with various mental health concerns process 
emotional information, we can develop better, more sensitive treatment 
interventions. My dissertation research, which focused on how people 
with trauma histories use physical pain to manage emotional distress, 
has clinical implications in helping patients reduce self-harming 
behavior while still coping with intense negative emotions. My research 
also served to de-stigmatize those who engage in self-harm by showing 
that many people use benign forms of pain to cope with stress. The main 
findings from this research have been presented at the Society for 
Affective Science conference, where I won an award for my talk. My 
results have since been published in Emotion, a highly regarded 
psychology research journal, and have been picked up by two psychology 
research digests.
    During my graduate school years, I also completed 3 years of 
predoctoral training at the Manhattan VA hospital, where I provided 
therapy for veterans, including those with PTSD and traumatic brain 
injuries. After graduating with my PhD summa cum laude, I completed 2-
year postdoctoral fellowship at NYU Langone's World Trade Center Health 
Program for first responders to the 9/11 attacks. During my time there, 
I provided therapy and assessment for first responders, and founded a 
therapy group for responders with 9/11-related cancers. I also had the 
opportunity to co-author an integrative mental health treatment manual 
to help providers meet the unique needs of this population.
    After completing this training, I accepted a full-time position at 
Bellevue Hospital's World Trade Center Health Program for survivors of 
the 9/11 attacks, where for 2 years I provided psychotherapy to 
survivors with trauma-related disorders and co-morbid medical 
conditions, such as cancer. I was given my first faculty appointment as 
a Clinical Instructor at NYU School of Medicine and continued to pursue 
and publish my own research. My time in both the responder and survivor 
World Trade Center Health Programs was humbling and deeply meaningful, 
fueling my passion to continue helping people thrive in the wake of 
trauma.
    In October 2021, I accepted an Associate Clinical Director position 
at the Center for Stress, Resilience, and Personal Growth (CSRPG) at 
Mount Sinai's Icahn School of Medicine. This also came with a promotion 
to Assistant Professor of Psychiatry at the School of Medicine. CSRPG 
conducts resilience-building outreach and provides immediately 
accessible mental health care to front-line healthcare workers at Mount 
Sinai. In my role, I coordinate all day-to-day clinical operations, 
conduct outcome research, engage in outreach, provide clinical 
supervision, and provide individual psychotherapy and resilience-
building workshops to healthcare workers. It has been an immense 
privilege to provide care to those impacted by these chronic traumatic 
stressors.
    As someone who benefited immensely from the mentorship and guidance 
of others, I feel strongly about carving out time away from therapy and 
research to give back to students. During my college years, I served as 
a youth mentor to a troubled middle school student. During my years as 
lab manager, I helped masters- and doctoral-level students develop and 
hone their research interests and skills, while also working to build a 
sense of community within the lab. As a teaching assistant, I provided 
both group and individualized support to master's students working on 
their theses. During my time as a postdoctoral fellow, I began 
supervising psychology trainees on their clinical cases. At Bellevue, I 
continued to stay active the training program, providing supervision 
and mentorship to pre-doctoral psychologists in training on both 
trauma-related and general outpatient cases. I also led several 
didactics and seminars throughout the year on how to understand and 
treat complex trauma cases. Now, I supervise a group of 10 social 
workers in their clinical work.
    The McNair program's naming after an astronaut is apt, because 
reaching the exit velocity required to ascend out of the working class 
requires force akin to a rocket engine and jet fuel. Obtaining my PhD 
(the first in my family) was of course the result of my own hard work--
my ``engine'', so to speak. But TRIO programs provided the jet fuel and 
mapped my course, without which I would certainly not be where I am 
today. I am privileged now to be doing a meaningful job that I love, 
with only a continued upward ascent ahead of me.
    In addition to what TRIO has helped me accomplish, I am also 
immensely grateful to know that my future children, and their children 
in turn, will grow up with the knowledge and resources required to 
pursue their own educations and build fulfilling careers. TRIO helps 
individuals, yes--and I am one of those lucky ones. But TRIO's impact 
goes far beyond the individual, radiating outward to the patients I can 
now treat as a result of their assistance, and far into the future. I 
am so incredibly grateful for all TRIO has done for me; I would not be 
where I am today without these programs.

    [This statement was submitted by Ashley Doukas, PhD, Alumna, TRIO 
Talent Search and Ronald E. McNair Postbaccalaureate Achievement.]
                                 ______
                                 
        Prepared Statement of TRIO Upward Bound, Math & Science
    As a native Missourian, TRIO Upward Bound Math and Science alumna, 
former Obama Administration staffer, current TRIO Student Support 
Services (SSS) Director at Washington University in St. Louis, and 
Jennings City Council Member in St. Louis, MO, I am a true testament to 
how #TRIOWorks and shapes lives. I have been and educator and public 
servant for over two decades because of my wonderful TRIO experience.
    As a high school student in Upward Bound Math and Science, the TRIO 
program helped me think about why I wanted to attend college; my 
advisor assisted me as I navigated college applications and figuring 
out which path to take. Being in the TRIO family, I was encouraged to 
not only receive an undergraduate degree from the University of Central 
Missouri, but also get a master's degree in Teaching, Social Science 
from Webster University, and to pursue a PhD in Educational Management-
Higher Education from Hampton University.
    While in the Upward Bound Math and Science program, I was able to 
cultivate meaningful friendships and met my best friends at the 
University of Northern Iowa where we attended summer classes through 
the program. Thanks to Upward Bound Math and Science, most of us 
attended college and graduated, and some of us went on to attain 
graduate degrees. Four of us from my TRIO cohort became Obama staffers. 
One friend who did not immediately attend college, went to and taught 
at cosmetology school. Because of that persistent spirit that TRIO 
programs instill in students, I am proud to have witnessed this very 
friend graduate from the only HBCU in St. Louis this past May 2022. She 
had the foundation of TRIO Upward Bound Math & Science. My TRIO cohort 
friend group is full of successful career paths: we have an urban 
farmer and food justice advocate, a healthcare worker, a CEO of a tech 
company, an education advocate, and a defense attorney. We all 
attribute our success to the support of the TRIO program and its 
advisors along our journeys.
    Having the support during my high school years prepared me to 
attend college. Without the TRIO program, there would not be a Dr. 
Kimberly Morton or the countless other successful TRIO alumni who have 
benefited from this wonderful program. As a staffer in the Obama 
Administration working at the U.S. Department of Education in the 
office of post-secondary in the TRIO department and then as a current 
TRIO SSS director, I understand the impact of TRIO on all sides.
    From a TRIO Director's lens, how we advise and advocate for our 
students throughout their college experience, especially during COVID, 
has been difficult because of mental health challenges among our first-
generation, low-income students, and student with disabilities. We are 
slowly getting back to a new normal, but I think the long-lasting 
impacts of COVID, physically and mentally, will remain for years to 
come. We have also provided programming and three courses to assist 
students with resources on how to navigate WashU, we collaborate with 
campus partners, corporations, non-profits, and researchers to assist 
students with thinking about life post-graduation: whether they plan to 
go to medical school, law school, pursue other graduate degrees, or if 
they plan to join the workforce. We are setting students up with 
mentors and internships while providing them with professional 
development opportunities so that they can be the best versions of 
themselves when they graduate from the institution.
    TRIO needs more funding to provide academic resources and increase 
staffing so that we can also serve as students' 4-year advisors. My 
team takes a holistic approach to advising. As 4-year advisors, we know 
that the students are getting the critical support that they need from 
first-year to graduation, and beyond. I would like to ask for support 
for an increase of $170 million dollars for the FY23 budget because it 
is essential that we increase programming and provide academic 
resources and services to match student needs.
    It has been a true honor for me to understand the TRIO program, on 
all levels. Knowing how many lives the program impacts across the 
country, it would be great if every institution across the country had 
a TRIO program. We must continue and expand this important work of 
ensuring that students who are first-generation, low-income, or have 
disabilities are seen and heard, have the academic support and 
programming, and advocacy to navigate to graduation and beyond. Our 
mission is to develop students who go on to have successful careers and 
become productive citizens who give back to their communities.

    [This statement was submitted by Kimberly Morton, PhD, Alumna, TRIO 
Upward Bound, Math & Science.]
                                 ______
                                 
            Prepared Statement of Trust for America's Health
    Trust for America's Health (TFAH) is pleased to submit this 
testimony on the fiscal year (FY) 2023 Labor, Health and Human 
Services, Education, and Related Agencies (LHHS) appropriations bill. 
TFAH is a non-profit, non-partisan organization that promotes optimal 
health for every person and community. We are funded by philanthropic 
organizations and do not accept government funding and support 
evidence-based investments that strengthen public health, disease 
prevention, and health equity. The pandemic has demonstrated the impact 
of chronic underfunding of public health and prevention. Communities 
across the country have responded to the pandemic with a depleted 
public health infrastructure and workforce, while also responding to 
longstanding issues due to increases in chronic diseases, substance 
misuse and suicide, health disparities, and environmental health risks. 
While Congress has allocated billions of dollars to address COVID-19, 
this funding is short-term and largely for use in response to the 
pandemic. It follows a familiar but inefficient pattern of underfunding 
core public health and then providing significant infusions of 
emergency funding when a disaster hits. This short-term funding cannot 
build cross-cutting capacity or strengthen the underlying 
infrastructure and workforce needed for effective program 
implementation and emergency response. Now is the time to fix an 
underfunded system so we can ensure every community has the chance for 
health and wellbeing. Bold action is needed to strengthen and modernize 
public health. TFAH urges Congress to fund the Centers for Disease 
Control and Prevention (CDC) at $11 billion for the FY 2023 budget, 
including investing in these effective public health programs:
    Emergency Preparedness: The COVID-19 response was hindered in part 
because the CDC's emergency preparedness funding had been repeatedly 
cut, reducing essential training and expert personnel. The Public 
Health Emergency Preparedness (PHEP) cooperative agreement has enabled 
great strides in our Nation's all-hazards preparedness, but the 
pandemic has renewed the urgency in expanded investment in domestic 
health security. Yet, PHEP appropriations has been cut significantly 
from $918 million in FY2002 to $715 million in FY 2022, or 51 percent 
when accounting for inflation. The PHEP cooperative agreement supports 
62 State, local, and territorial recipients to develop and strengthen 
core public health preparedness capabilities. TFAH recommends at least 
$824 million for the PHEP, the level authorized in 2006, to rebuild 
capacity to respond to an escalating number of emergencies.
    The pandemic has also demonstrated the impact of failing to invest 
in comprehensive readiness and surge capacity of the healthcare 
delivery system. Funding for the Hospital Preparedness Program (HPP), 
administered by the Assistant Secretary for Preparedness and Response 
at HHS, supports the readiness of the healthcare delivery system for 
emergencies. HPP provides critical funding and technical assistance to 
health care coalitions (HCCs) across the country to meet the disaster 
healthcare needs of communities, but funding has been cut drastically 
from $515 million in FY2003 to $296 million in FY 2022. TFAH recommends 
at least $474 million for HPP (PHSSEF), the level authorized in 2006, 
to build capacity for the healthcare system to save lives during 
disasters.
    Healthy Outcomes in Schools: Specialized efforts are needed within 
certain age groups as well. CDC's Division of Adolescent and School 
Health (DASH) provides evidence-based health promotion and disease 
prevention education for less than $10 per student. Through school-
based surveillance, data collection, and skills development, DASH 
collaborates with State and local education agencies to increase health 
surveillance and services, promote protective factors, and reduce risky 
behaviors. A February 2022 study found that these programs resulted in 
significant decreases in sexual risk behaviors, violent experiences, 
and substance use, as well as improvements in mental health and 
reductions in suicidal thoughts and attempts.\1\ During the COVID-19 
pandemic, DASH has also leveraged its programs to improve student 
connections to mental health services during virtual learning. TFAH 
recommends at least $100 million for DASH to expand its work to around 
25 percent of all U.S. students and enable them to become healthy 
adults.
---------------------------------------------------------------------------
    \1\ Robin L, Timpe Z, Suarez NA, et al. ``Local Education Agency 
Impact on School Environments to Reduce Health Risk Behaviors and 
Experiences Among High School Students.'' Journal of Adolescent Health, 
February 2022. https://www.sciencedirect.com/science/article/abs/pii/
S1054139X21004006. https://www.liebertpub.com/doi/10.1089/
lgbt.2021.0133.
---------------------------------------------------------------------------
    Suicide Prevention: The COVID-19 pandemic appears to have 
heightened the risk for suicide among certain groups, including girls 
aged 12-17 years,\2\ Black youth,\3\ and Latino males.\4\ Concerningly, 
the recent CDC Adolescent Behaviors and Experiences Survey also found 
that almost 20 percent of youth respondents had seriously considered 
attempting suicide, and 9 percent actually attempted suicide.\5\ The 
complex nature of suicide requires a comprehensive program that focuses 
on disproportionately affected populations, data collection to inform 
efforts, and research on risk factors. CDC's work helps identify and 
disseminate effective strategies for preventing suicide, from 
strengthening access and delivery of suicide care to promoting policies 
and programs that reduce risk. CDC programs consist of multisector 
partnerships, using data to identify populations of focus and risk and 
protective factors, rigorous evaluation efforts, and filling gaps 
through complementary strategies and effective communications. TFAH 
recommends at least $40 million to expand innovative prevention 
activities to at least 25 sites and support State health departments as 
they expand comprehensive suicide prevention and syndromic 
surveillance.
---------------------------------------------------------------------------
    \2\ Yard E, Radhakrishnan L, Ballesteros, M, et al. ``Emergency 
Department Visits for Suspected Suicide Attempts Among Persons Aged 12-
25 Years Before and During the COVID-19 Pandemic--United States, 
January 2019-May 2021.'' Morbidity and Mortality Weekly Report, 
70(24);888-894, June 18, 2021. https://www.cdc.gov/mmwr/volumes/70/wr/
mm7024e1.htm.
    \3\ Protecting Youth Mental Health: The U.S. Surgeon General's 
Advisory. U.S. Surgeon General, December 7, 2021. https://www.hhs.gov/
sites/default/files/surgeon-general-youth-mental-healthadvisory.pdf.
    \4\ Ehlman D, Yard E, et al. ``Changes in Suicide Rates--United 
States, 2019 and 2020.'' Morbidity and Mortality Weekly Report, 
71(8);306-312, February 25, 2022. https://www.cdc.gov/mmwr/volumes/71/
wr/mm7108a5.htm.
    \5\ Everett Jones S, Ethier K, et al. ``Mental Health, Suicidality, 
and Connectedness Among High School Students During the COVID-19 
Pandemic--Adolescent Behaviors and Experiences Survey, United States, 
January-June 2021.'' Morbidity and Mortality Weekly Report, 71(3);16-
21, April 1, 2022. https://www.cdc.gov/mmwr/volumes/71/su/
su7103a3.htm?s_cid=su7103a3_w.
---------------------------------------------------------------------------
    Adverse Childhood Experiences: As the number of adverse childhood 
experiences (ACEs) an individual experiences increases, so does the 
risk for negative health outcomes such as asthma, diabetes, cancer, 
substance use, and suicide in adulthood. CDC estimates that 61 percent 
of adults report having experienced at least one ACE in their lifetime, 
and the prevention of ACEs could reduce cases of depression in adults 
by 44 percent and avoid 1.9 million cases of heart disease.\6\ To help 
address these issues, CDC has worked to build the evidence base by 
supporting innovative research and evaluation, support surveillance and 
data innovation, and identify strategies and build capacity and 
awareness to prevent ACEs across the country.\7\ CDC currently supports 
six State-level offices, institutes, or departments that are 
implementing two or more strategies from its Preventing ACEs guidance 
document, including economic assistance to families, efforts to connect 
youth to care, and short-term and long-term interventions to reduce 
harms.\8\ TFAH recommends at least $15 million to expand surveillance 
and innovative ACEs prevention activities to additional States.
---------------------------------------------------------------------------
    \6\ Justification of Estimates for Appropriations Committees. 
Centers for Disease Control and Prevention, 2022. https://www.cdc.gov/
budget/documents/fy2023/FY-2023-CDC-congressional-justification.pdf.
    \7\ Adverse Childhood Experiences Prevention Strategy FY2021-
FY2024. In Centers for Disease Control and Prevention, September 2020. 
https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-
Plan_Final_508.pdf
    \8\ Preventing Adverse Childhood Experiences: Data to Action. In 
Centers for Disease Control and Prevention, updated August 19, 2021. 
https://www.cdc.gov/violenceprevention/aces/
preventingacedatatoaction.html.
---------------------------------------------------------------------------
    Obesity and Chronic Disease Prevention: The COVID-19 pandemic has 
been exacerbated by preventable, chronic health conditions, including 
obesity. In 2018, 42.4 percent of adults had obesity.\9\ Even though 
obesity accounts for nearly 21 percent of U.S. healthcare spending, 
funding for CDC's Division of Nutrition, Physical Activity, and Obesity 
(DNPAO) is only equal to about 31 cents per person.\10\ This Division 
funds State health departments to protect the health of all Americans 
by promoting healthy eating, active living, and obesity prevention in 
early care and education facilities, hospitals, schools, worksites and 
neighborhoods; building capacity of State health departments and 
national organizations to prevent obesity; and conducting research, 
surveillance, and evaluation studies. However, DNPAO only has enough 
money to implement its State Physical Activity and Nutrition Programs 
(SPAN) in 16 States. TFAH recommends at least $125 million for DNPAO to 
expand SPAN to all 50 States and territories and build State-level 
capacity.
---------------------------------------------------------------------------
    \9\ State of Obesity 2021. Trust for America's Health. Sept 2021. 
https://www.tfah.org/report-details/state-of-obesity-2021/.
    \10\ J. Cawley and C. Meyerhoefer, ``The Medical Care Costs of 
Obesity: An Instrumental Variables Approach,'' Journal of Health 
Economics 31, no. 1 (2012): 219-30, doi: 10.1016/
j.jhealeco.2011.10.003.
---------------------------------------------------------------------------
    Additionally, inequities in social and economic conditions facing 
people of color and Tribal Nations continue to negatively impact health 
outcomes. Among the programs that are effective in reducing racial and 
ethnic health disparities are Racial and Ethnic Approaches to Community 
Health (REACH) program and Healthy Tribes (previously referred to as 
Good Health and Wellness in Indian Country). CDC's REACH program, 
within DNPAO, works in 40 communities across the country by supporting 
innovative, community-centered approaches to develop and implement 
evidence-based and culturally tailored programs that reduce health 
disparities. The REACH program will be going through a re-compete in 
FY23, and increased funding is needed to meet the overwhelming need for 
the program, with over 260 approved but unfunded applications. The 
Healthy Tribes program represents CDC's largest investment in American 
Indian/Alaska Native health by coordinating three separate programs: 
the Good Health and Wellness in Indian Country (GHWIC), Tribal 
Epidemiology Centers for Public Health Infrastructure (TECPHI), and 
Tribal Practices for Wellness in Indian Country (TPWIC). Healthy Tribes 
supports holistic approaches to chronic disease prevention while also 
allowing Tribal leaders to direct public health interventions most 
effective for their communities. TFAH recommends at least $102.5 
million for the total REACH funding line (CDC), with $75.5 million 
directed to REACH and $27 million for Healthy Tribes.
    Social Determinants of Health: Social determinants of health (SDOH) 
such as housing, employment, food security, and education have a major 
influence on individual and community health,\11\ contributing to an 
estimated 80-90 percent of a person's health outcomes.\12\ Public 
health agencies are uniquely situated to build collaborations across 
sectors, identify SDOH priorities in communities, and promote cost-
saving interventions that prevent chronic health conditions. Currently 
most public health departments lack funding and tools to support such 
cross-sector efforts and are limited by disease-specific Federal 
funding. Aligned with the President's budget request, TFAH recommends 
at least $153 million to further develop CDC's Social Determinants of 
Health Program and enable grants to all States and territories. CDC is 
also building out the evidence-base for these interventions. In a 
review of existing multi-sector partnerships addressing SDOH, 29 
organizations projected a savings of $566 million over 20 years from 
saved medical costs and increased productivity levels.\13\
---------------------------------------------------------------------------
    \11\ Taylor, L et.al, ``Leveraging the Social Determinants of 
Health: What Works?'' Yale Global Health Leadership Institute and the 
Blue Cross and Blue Shield Foundation of Massachusetts, June 2015.
    \12\ S. Magnan. Social Determinants of Health 101 for Health Care: 
Five Plus Five. National Academy of Medicine, Oct 9, 2017. https://
nam.edu/social-determinants-of-health-101-for-health-care-five-plus-
five/.
    \13\ CDC, SDOH Evaluation. https://www.cdc.gov/chronicdisease/
programs-impact/sdoh/pdf/GFF-eval-brief-508.pdf.
---------------------------------------------------------------------------
    Environmental Health: Not all emergencies are caused by infectious 
disease. Many occur due to environmental factors. Since CDC's National 
Environmental Public Health Tracking Network began in 2002, grantees 
have taken over 400 data-driven actions to eliminate risks to the 
public. Data includes asthma, drinking water quality, lead poisoning, 
flood vulnerability, and community design. State and local health 
departments use this data to conduct targeted interventions in 
communities with environmental health concerns. Currently, 25 States 
and one city are funded to participate in the Tracking Network. With a 
$1.44 return in health care savings for every dollar invested,\14\ the 
Tracking Network is a cost-effective program that examines and combats 
harmful environmental factors. Yet only half the States receive 
funding. TFAH recommends at least $54 million for National 
Environmental Public Health Tracking Network (CDC), which would enable 
15 additional States to join the network.
---------------------------------------------------------------------------
    \14\ Return on Investment of Nationwide Health Tracking, 
Washington, DC: Public Health Foundation, 2001.
---------------------------------------------------------------------------
    Age-Friendly Public Health: The COVID-19 outbreak has shown that 
collaboration between the public health and aging sectors is vital. 
Every day 10,000 Americans turn 65 years of age, yet there have been 
limited public health approaches to healthy aging. Public health 
interventions play a valuable role in optimizing the health and well-
being of older adults by prolonging their independence, reducing their 
use of expensive health care services, coordinating existing multi-
sector efforts, and identifying gap areas, as well as disseminating and 
implementing evidence-based policies. Yet as of now, there is no 
comprehensive health promotion program for older adults. We recommend 
the Committee provide CDC at least $50 million to administer and 
evaluate an Age Friendly Public Health program to promote and address 
the public health needs of older adults and collaborate with partners 
in the aging sector.

    [This statement was submitted by J. Nadine Gracia, MD, MSCE, 
President & CEO, Trust for America's Health.]
                                 ______
                                 
             Prepared Statement of Tuberculosis Roundtable
    Tuberculosis Roundtable (TBR) thanks the esteemed members of the 
subcommittee for the opportunity to submit testimony regarding funding 
for the U.S. Centers for Disease Control and Prevention (CDC) Division 
of Tuberculosis Elimination (DTBE) for fiscal year 2023 (FY23) 
appropriations. As organizations tasked with protecting the country 
from tuberculosis (TB), TBR members are gravely concerned about the 
long-term impacts of the COVID-19 pandemic on future TB incidence. 
These impacts include significant delays in diagnosis with increasingly 
complicated cases, increases in co-morbidities, the suspension of 
targeted testing and treatment of latent TB infection, and the 
diversion of economic and human resources to the COVID-19 response. We 
respectfully urge you to fund the domestic TB program at CDC at $225 
million for FY23. This funding is vital to recoup lost staff time and 
resources due to the pandemic, focus on identifying and treating latent 
TB, respond to emerging outbreaks and challenges, and strengthen 
national, State, and local efforts to detect, treat, and prevent all 
forms of TB, including drug-resistant TB.
    TB is the world's second most deadly infectious disease, still 
ranking ahead of HIV/AIDS, killing 1.5 million people annually.\1\ In 
the United States, TB remains a serious problem with all 50 States 
continuing to report cases every year. According to CDC, there were an 
estimated 7,860 new cases of TB reported in the United States during 
2021, with many States reporting increases over 2020 case counts.\2\ 
The pandemic severely impacted TB case notifications due to TB program 
staff being reassigned to work on COVID-19 and patients being unable or 
unwilling to seek testing and care under stay-at-home orders and 
similar policies. Many of these delayed diagnoses have resulted in a 
rebound increase of TB cases nationally, but many remain undiagnosed. 
As a direct result, staff and clinicians are seeing much more advanced 
and difficult-to-treat TB, and jurisdictions are seeing increases in TB 
deaths.
---------------------------------------------------------------------------
    \1\ World Health Organization. Global tuberculosis report 2021. 
https://www.who.int/publications/i/item/9789240037021.
    \2\ U.S. Centers for Disease Control and Prevention. U.S. TB 
Statistics. Division of TB Elimination. https://www.cdc.gov/tb/
statistics/default.htm.
---------------------------------------------------------------------------
    Tuberculosis often starts out as a latent, or asymptomatic, 
infection which progresses to active and contagious TB disease when the 
immune system is challenged. Right now in the U.S., there are up to 13 
million individuals with an asymptomatic latent TB infection.\3\ The 
diagnosis and treatment of individuals with latent TB, who are at high 
risk of progression to active and contagious TB disease, could prevent 
an estimated 650,000 to 1,300,000 new cases of active TB as people are 
treated before they risk transmitting the disease to their families and 
communities.
---------------------------------------------------------------------------
    \3\ Ibid.
---------------------------------------------------------------------------
    Antibiotic resistant bacteria are an immense threat to the health 
of the world, and drug resistant tuberculosis counts for one-third of 
all deaths related to antimicrobial resistance globally. Multidrug-
resistant TB (MDR-TB) cases are more difficult and expensive to treat 
and threaten to overwhelm underfunded state TB programs.\4\ Between 
2005 and 2020, there were 1,664 cases of MDR-TB and 40 cases of 
extensively drug-resistant TB (XDR-TB) reported in the United 
States.\5\ MDR-TB regimens are longer, often with more expensive 
medications that include more extensive side effects and require more 
oversight and assistance from healthcare workers. In 2020, CDC 
estimated that the cost of treating a single patient with MDR-TB in the 
United States averaged $182,000, and the average cost of treating a 
patient with XDR-TB was even higher at $568,000, compared with $20,000 
to treat a patient with drug-susceptible TB. CDC also estimated that 
the costs resulting from all forms of TB in the US totaled over $503 
million in 2020. This doesn't begin to address the costs patients and 
communities face in the form of lost wages and opportunities during 
their treatment.\6\
---------------------------------------------------------------------------
    \4\ The Economist. A call to action: It's time to end drug-
resistant tuberculosis. Economist Intelligence Unit. https://
pages.eiu.com/jj-healthcare---2019-healthcare_landing-page-report.html.
    \5\ U.S. Centers for Disease Control and Prevention. U.S. TB 
Statistics. Division of TB Elimination. https://www.cdc.gov/tb/
statistics/default.htm.
    \6\ vi Ibid.
---------------------------------------------------------------------------
    Global crises are also heavily impacting TB in the U.S. as we 
welcome new arrivals from Ukraine, which has one of the highest rates 
of MDR-TB in the world.\7\ Testing and treatment is largely falling 
upon State and local health departments to complete, even while they 
grapple with budget cuts and increasingly overstretched capacity in the 
wake of COVID-19. TB program staff have expressed their desire to help 
during this humanitarian crisis, but fear that an upcoming wave of 
delayed diagnoses from the pandemic coupled with a new population to 
care for could prove impossible for them to adequately handle.
---------------------------------------------------------------------------
    \7\ World Health Organization. Global tuberculosis report 2021. 
https://www.who.int/publications/i/item/9789240037021.
---------------------------------------------------------------------------
    CDC's Division of TB Elimination (DTBE) also contains a research 
arm that houses the TB Trials Consortium (TBTC). Recent TBTC studies 
have led to monumental breakthroughs in shortening and improving 
treatment for latent TB and drug-susceptible TB disease, and other 
studies focus on such priorities as pediatric safety and dosage.\8\ 
Despite TBTC's tremendous value and the dire need for the benefits of 
its work, funding constraints risk limiting this vital research.
---------------------------------------------------------------------------
    \8\ U.S. Centers for Disease Control and Prevention. Tuberculosis 
Trials Consortium. Division of TB Elimination. https://www.cdc.gov/tb/
topic/research/tbtc/default.htm.
---------------------------------------------------------------------------
    We recognize your commitment to careful consideration of the many 
domestic, health, labor, and education programs that require assistance 
in FY23, and thank you for your continued leadership. We urge you to 
make eliminating TB in the U.S. a top priority for your FY23 
appropriations bill by funding CDC's domestic TB program at $225 
million to recover from the COVID-19 pandemic, focus on addressing 
latent TB, and strengthen national, State and local efforts to 
identify, treat, and prevent TB.
                                 ______
                                 
       Prepared Statement of the Tuskegee University College of 
                          Veterinary Medicine
              summary of fiscal year 2023 recommendations
_______________________________________________________________________
Health Resources and Services Administration:
  --$1.51 billion for the Health Resources and Services Administration 
        (HRSA) Title VII health professions and Title VIII nursing 
        workforce development programs.
    --$47.42 million for HRSA's Minority Centers of Excellence
    --$47.95 million for HRSA's Health Careers Opportunity Program.
    --$2 million for HRSA's Minority Faculty Loan Repayment Program.
    --$67 million for HRSA's Scholarships for Disadvantaged Students 
            (SDS).
Centers for Disease Control and Prevention
  --$74 million for the Racial and Ethnic Approaches to Community 
        Health (REACH) Program
National Institutes of Health
  --$49 billion for the National Institutes of Health
    --$1 billion for the National Institute on Minority Health and 
            Health Disparities (NIMHD).
      -- $300 million for the Research Centers at Minority Institutions 
            (RCMI)
    --$200 million in new, annual research funding dedicated 
            specifically targeted at enabling historically black health 
            professions schools to support research that reverses 
            health status disparities among minority Americans.
    --$100 million for NIH's Extramural Research Facilities program
    --$50 million to reinvigorate the NIMHD's Research Endowment 
            Program (REP)
Office of the Secretary
  --$72 million for the Office of Minority Health at the Department of 
        Health and Human Services.
  --$5 billion in new funding designated for Historically Black Health 
        Professions Institutions for the improvement and development of 
        health care infrastructure.
Department of Education
  --$100 million for the Strengthening Historically Black Graduate 
        Institutions (HBGI) Program.
Community Project Funding/Congressional Directed Spending Request 
        (HRSA)
  --$10 million for the Development of a Center for Food Animal Health, 
        Food Safety, and Food Defense in TUCVM
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to submit testimony 
and thank you for your leadership in addressing challenges facing the 
health workforce, health disparities, and medically underserved 
communities. I am Dr. Ruby Perry, Dean and Professor of Veterinary 
Radiology at the College of Veterinary Medicine at Tuskegee University. 
Since its inception in 1945, Tuskegee University College of Veterinary 
Medicine (TUCVM) has educated more than 70 percent of the Nation's 
African American veterinarians, and is recognized as the most diverse 
of all veterinary schools and colleges in the U.S. The College is the 
only veterinary medical professional program located on the campus of a 
historically black college or university (HBCU) in the U.S.
    The pandemic has pulled back the curtain on what TUCVM and other 
Historically Black Graduate Institutions (HBGIs) and HBCUs know and 
work towards everyday: the pitfalls and shortcomings of minority 
health. Given the recent deluge of media coverage surrounding this 
disheartening topic, the country is primed and ready to act in a 
meaningful way. Our funding recommendations are robust and we realize 
ambitious, however there have rightfully been discussion concerning the 
devastating effect of the pandemic on people of color and the need to 
address this effect for any future pandemic. To be as clear we can be, 
there must be more robust investment on minority health and 
disparities. To achieve this we know that it will require the steadfast 
leadership of health equity champions. We stand ready to work with you 
and your colleagues to facilitate these efforts.
    The benefits of increasing diversity in the health professions to 
reduce such disparities have been studied at length, are based on 
empirical data, and are well understood by the medical community. 
Examples of these benefits include:
  --Minority physicians are more likely to practice in medically 
        underserved areas and care for patients regardless of their 
        ability to pay.
  --There is evidence that the intellectual, cultural sensitivity, 
        competency, and civic development of students is enhanced by 
        learning in a diverse educational environment.
  --A diverse health workforce encourages a greater number of 
        minorities to enroll in clinical trials designed to alleviate 
        health disparities.
    There is little left to discover or dispute with respect to the 
benefits of achieving greater racial and ethnic diversity of the 
Nation's health professionals--the attention has once again shifted to 
identifying the most effective and sustainable methods to do so. While 
there are many national campaigns underway to increase diversity in all 
medical and health professions schools particularly during this period 
of enrollment growth, it is imperative that we further recognize and 
leverage the public value of Historically Black Health Professions 
Schools.
    The daunting news that Blacks Americans in the U.S. are 
disproportionately suffering from COVID-19 unfortunately was not a 
tremendous surprise to those of us who regularly monitor and understand 
health status disparities in this nation. There are well-known health 
status challenges faced daily by Black Americans and minority health 
care providers, it also represents a surrogate for the glaring lack of 
health infrastructure in medically under-served communities. At TUCVM 
and other HBGI institutions, we have long been and remain committed to 
addressing these very same disparities in whatever way that we can, 
with an eye first and foremost towards the communities with the 
greatest need across our country.
    Ironically, as a result of their mission focus the financial models 
of historically black health professions schools are uniquely 
disadvantaged compared to most of their peer institutions. Unlike 
subspecialty-oriented, research-intensive institutions--with higher 
margin clinical services, an integrated hospital system, substantial 
research enterprises, sizeable endowments, and a critical mass of 
wealthy donors--these institutions are faced with an unprecedented set 
of adverse factors that challenge their financial viability. 
Consequently, they are disproportionately dependent on the various 
Federal programs that support their core purpose.
    Specifically, these programs include: the Title VII Health 
Professions Training Programs administered by the Health Resources and 
Services Administration (HRSA) of the Department of Health and Human 
Services (HHS); the Research Centers at Minority Institutions (RCMI), 
the Extramural Research Facilities; the Research Endowment; and Centers 
of Excellence programs administered the National Institutes of Health's 
National Institute on Minority Health and Health Disparities; and the 
Historically Black Graduate Institution (HBGI) program administered by 
the Office of Postsecondary Education of the U.S. Department of 
Education (DOE).
    President Biden recently signed the John Lewis NIMHD Research 
Endowment Revitalization Act to revitalize this important initiative, 
and it is our expectation that NIMHD will act swiftly to reinvigorate 
the research endowment program so minority-serving institutions can 
participate in this competitive opportunity to build their research 
endowments in a manner consistent with the statutory goal of assisting 
them in achieving a research endowment that is comparable to the 
endowments of other schools in their health professions discipline. The 
NIMHD Research Endowment Program (REP) allows academic institutions to 
build research infrastructure and recruit, train, and maintain a 
diverse faculty and student body. Robust funding would allow active and 
former NIMHD Centers of Excellence to continue their historic focus on 
research to close the gap between the burden of illness and premature 
mortality experienced more commonly by communities of color, as well as 
other medically underserved populations. It would also help improve 
access to grants to fund research projects, as well as hire staff and 
provide scholarships for students who come from underserved 
communities. To ensure successful implementation, we are asking for the 
Committee to allocate robust funding to NIMHD for this program.
    In addition to the recommendations referenced above, TUCVM has 
submitted a community project funding/congressionally directed spending 
request for Development of a Center for Food Animal Health, Food 
Safety, and Food Defense in TUCVM. We are working with key members of 
Congress to advance this request and ensure its success. Development of 
a Center for Food Animal Health, Food Safety, and Food Defense in the 
TUCVM will position Tuskegee University to play a more vital role in 
supporting Alabama`s Agriculture, and to serve its students and farmers 
in the black-belt region of the State of Alabama more effectively and 
efficiently. The center would enhance TUCVM's ability to facilitate 
teaching, research, and service to benefit students, researchers, and 
the local community, play a pivotal role in assisting the State of 
Alabama`s poultry and fish farmers in adopting modern herd health 
practices to not only increase production and profits but also to 
ensure safety of poultry and fish products, and initiate new strategies 
to encourage DVM students to consider careers in Food Animal 
Production, Food Animal practice and research to combat the current 
shortage of food animal veterinarians.
    Madam Chair, unfortunately, over the past several years funding for 
diversity-focused programs has deteriorated in varying degrees. Absent 
a monumental overall investment the financial position and academic 
viability of historically black health professions schools will 
deteriorate rapidly. The front loaded investment in health professions 
training programs, graduate programs in biomedical sciences and public, 
and safety net providers is more cost effective than absorbing 
uncompensated care originating from minority and underserved 
communities. Now is the time for targeted investments in historically 
black health professions schools to ensure a steady pipeline of 
minority healthcare providers, biomedical scientists, veterinarians, 
and other health practitioners prepared to support and advance the 
delivery of high quality, culturally appropriate, evidence-based health 
care. Thank you all again for the opportunity to share the priorities 
of the College of Veterinary Medicine at Tuskegee University.

    [This statement was submitted by Ruby L. Perry, DVM, PhD, 
Diplomate-ACVR, Dean & Professor of Veterinary Radiology, College of 
Veterinary Medicine, Tuskegee University.]
                                 ______
                                 
    Prepared Statement of the U.S. Hereditary Angioedema Association
              summary of fiscal year 2023 recommendations
_______________________________________________________________________

  --Provide the National Institutes of Health (NIH) with at least a 
        $3.5 billion increase in discretionary funding for FY 2023 to 
        bring overall agency funding up to a minimum of $49 billion 
        annually.
    --Continue to support committee recommendations that encourage 
            advancement and expansion of the hereditary angioedema 
            research portfolio at NIH, as well as research efforts 
            focused on rare conditions more broadly, through timely.
    --Please provide proportional funding increases for NIH's various 
            Institutes and Centers, most notably given the research 
            portfolio; the National Institute of Allergy and Infectious 
            Diseases (NIAID), the National Centers for Advancing 
            Translational Sciences (NCATS, which houses the Office of 
            Rare Diseases Research), and the National Heart, Lung, and 
            Blood Institute (NHLBI)
  --Provide the Centers for Disease Control and Prevention (CDC) with 
        at least a $2.55 billion increase in discretionary funding for 
        FY23 to bring overall agency funding up to a minimum of $11 
        billion annually.
  --Encourage the Centers for Medicare and Medicaid Services (CMS) to 
        prevent discrimination in health coverage by ensuring rare 
        disease patients do not face arbitrary restrictions when 
        seeking charitable assistance to maintain access to life-
        sustaining care and therapy when they have no other options, 
        and to prevent from being steered into Federal need-based or 
        illness-based programs that they would not otherwise qualify 
        for while properly managing their illness (building on 
        committee recommendations included in previous fiscal years).
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to present the views 
of the U.S. Hereditary Angioedema Association (U.S. HAEA) on funding 
and related policy items for NIH, CDC, and CMS during consideration of 
appropriations for FY 2023. First and foremost, thank you for 
supporting these programs in FY 2022. It is our hope that this invest 
will continue for FY 2023 to ensure that meaningful progress can 
continue in specific, promising areas.
                            about u.s. haea
    U.S. HAEA is a patient-driven organization comprised of affected 
individuals and their families. In this regard, we would primarily like 
to recognize this subcommittee for its leadership and commitment to 
providing medical research and public health programs with notable 
funding increases for FY 2020. This investment will have a tangible 
positive impact for patients by significantly improving scientific 
inquiry and public health activities.
    U.S. HAEA is a non-profit patient advocacy organization dedicated 
to serving the estimated 6,000 HAE sufferers in the U.S. We provide a 
support network and a wide range of personalized services for patients 
and their families. We are also committed to advancing clinical 
research designed to improve the lives of HAE patients and ultimately 
find a cure.
                      about hereditary angioedema
    Hereditary angioedema (HAE) is a painful, disfiguring, 
debilitating, and potentially fatal genetic disease that occurs in 
about 1 in 30,000 people. Symptoms include episodes of swelling in 
various body parts including the hands, feet, face and airway. Patients 
often have bouts of excruciating abdominal pain, nausea and vomiting 
that is caused by swelling in the intestinal wall. The majority of HAE 
patients experience their first attack during childhood or adolescence. 
Approximately one-third of undiagnosed HAE patients are subject to 
unnecessary exploratory abdominal surgery. About 50 percent of patients 
with HAE will experience laryngeal edema at some point in their life. 
This swelling is exceedingly dangerous because it can lead to death by 
asphyxiation. The historical mortality rate due to laryngeal swelling 
is 30 percent.
                        a research success story
    There was a time not long ago that HAE was a debilitating, and 
often life-ending, chronic disease. In addition to the serious health 
impacts, affected individuals suffered with trauma, anxiety, and PTSD 
stemming from torturous attacks (and the uncertainty of when the next 
attack might occur). Due to advancements in medical research, HAE 
patients now have access to life-altering and life-sustaining 
medications. Properly medically managing the disease now allows many 
the freedom to work productively, live independently, and thrive.
    While we are appreciative of the scientific progress, much more can 
be done. There is no cure of HAE and treatment is highly 
individualized. More needs to be learned about the underlying disease 
mechanisms and successful treatment often involves personalized care 
and a customized treatment regimen prepared (using trial and error) by 
a leading physician expert.
    NIH has a modest, but meaningful HAE research portfolio. Recent 
annual investments will facilitate growth in this portfolio and have 
led to important new scientific projects. The ongoing research at NIH 
will lead to a time when HAE patients can move beyond their disease. 
However, a key question that remains is how much of this investment is 
going to rare and ultra-rare disease research programs, particularly 
in-light of the ``big ticket'' items that are often now the focus of 
annual research appropriations.
    For FY 2023, please include committee recommendations thanking 
NCATS and NIAID for their leadership on HAE research and asking that 
they continue to prioritize emerging activities to advance our 
scientific understanding in this area moving forward.
          the importance of proper health coverage and access
    The HAE community first became aware of the fact that the Centers 
for Medicare and Medicaid Services (CMS) had allowed private insurers 
offering marketplace plans to deny coverage to individuals receiving 
charitable assistance in 2015 when more than a dozen HAE patients in 
Louisiana received notices that their coverage was being cancelled due 
to the fact someone else had helped them pay their premiums. Since that 
time, the practice has become pervasive and HAE patients are regularly 
informed that they will lose coverage if they receive any charitable 
assistance, that they may be committing fraud, and that they may face 
legal action if they accept assistance. This dynamic has effectively 
become a back door to pre-existing condition discrimination that is 
implemented to steer HAE patients into tax-payer funded healthcare. 
Moreover, the threat now stretches beyond just marketplace plans (to 
Medigap plans and COBRA) due to the inability to address this issue 
when it first began jeopardizing health for patients with no 
alternatives.
    Many HAE patients properly manage their illness when they have 
proper access to healthcare and treatment. HAE patients would typically 
not qualify for need-based or health-based government programs due to 
the life-sustaining nature of their treatment. If, however, proper 
coverage is lost, an HAE patient may have to endure a life-threatening 
experience of waiting while they spend down to qualify for Medicaid or 
become sick enough to apply for disability.
    US HAEA has joined with other patient-driven organizations 
experiencing the harm of current pre-existing condition discrimination 
facilitated by barriers to charitable assistance and the related 
practice of a restrictive co-pay accumulator to form the ad hoc group, 
United for Charitable Assistance (UCA). We join with UCA and all 
stakeholders in asking this subcommittee to once again highlight these 
rare-disease challenges for CMS and request the current barriers are 
resolved to protect patients that have no other reasonable options to 
maintain coverage.
    We thank the subcommittee for including meaningful language in 
previous fiscal years and recommend language similar to the draft 
committee recommendations below for FY 2023.
                      recommended report language
               centers for medicare and medicaid services
                           program management
    Third-Party Charitable Assistance.--The Committee continues to have 
concerns about proliferation of policies that block patient to access 
to premium and copay assistance from qualified independent charities, 
civic groups, and houses of worship. The continued growth of these 
restrictions are expanding beyond marketplace plans and into other 
forms of coverage. These policies can be arbitrarily enforced and too 
easily leveraged against high-cost rare disease patients with the 
greatest need for third-party healthcare safety net programs and 
requirements for continued access to therapies to disrupt or delay 
essential care. We recognize the administration's stated commitment to 
expanding coverage and protecting access for those with complex 
healthcare needs and direct CMS to provide its current position on the 
third-party payer rule, any potential or planned actions to address 
insurance restrictions jeopardizing care for rare disease patients that 
utilize charitable assistance, and how these plans align with 
overarching CMS efforts to improve coverage and access for the patient 
community within 180 days of the enactment of this act.

    [This statement was submitted by Anthony J. Castaldo, President and 
CEO, U.S. Hereditary Angioedema Association.]
                                 ______
                                 
         Prepared Statement of United for Charitable Assistance
       summary of fiscal year 2023 appropriations recommendations
_______________________________________________________________________

  --Please continue to support and advance committee recommendations, 
        as well as related funding and policy initiatives, which 
        further encourage HHS and the Centers for Medicare and Medicaid 
        Services (CMS) to address arbitrary barriers that disrupt 
        patient access to essential charitable assistance in a 
        meaningful and timely way.
  --Please work with your colleagues to encourage HHS to establish a 
        transparent and patient-centered regulatory system formally 
        governing charitable assistance programs that is consistent 
        with the current framework of OIG opinions and ensures all 
        policymakers and stakeholders have appropriate mechanism to 
        address challenges and opportunities in this space.
  --Please continue to support investment in medical research through 
        the National Institutes of Health and public health through the 
        Centers for Disease Control and Prevention to further improve 
        care and health outcomes for patients facing complex illnesses, 
        including providing $49 billion for NIH (with distinct and 
        additional funding for the Advanced Research Projects Agency 
        for Health) and $11 billion for CDC.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished member 
of the subcommittee, thank you for your leadership on health funding 
and patient care issues. On behalf of the dozens of patient 
organizations comprising United for Charitable Assistance (UCA), we 
extend our gratitude and appreciation for the opportunity to provide a 
critical, patient-centered perspective as you consider FY 2023 
appropriations issues that impact healthcare coverage and patient 
access. Most notably, we urge you to continue to support committee 
recommendations that feature and emphasize the value and importance of 
charitable assistance programs that serve patients with no other 
options, while working with your colleagues to maintain and enhance 
access to this critical part of the health safety net. Thank you again 
for this important opportunity. Please consider UCA a resource on these 
issues moving forward.
                 about united for charitable assistance
    We are an ad hoc group of patient community leaders that seek to 
protect access to the charitable financial support programs, which 
serve as a crucial part of the healthcare safety net for individuals 
with rare, chronic, and life-threatening medical conditions. We work 
together to educate policymakers so they understand the value, impact, 
and vital nature of these programs and ultimately support efforts to 
actively defend the lives and livelihoods of those facing serious 
conditions that can now be better managed through proper care and 
innovative therapies.
                      about charitable assistance
    Over recent years, CMS promulgated rules that effectively allow 
private insurance companies to simply deny (or reserve the right to 
deny at will) any premium or related healthcare payments made on behalf 
of a patient. While these restrictions initially started in marketplace 
plans, they have spread to Medigap plans, and various other forms of 
coverage. The tangible result of these policies is that patients are 
often denied access to mission-driven charitable support from non-
profits, civic groups, and houses of worship. Ultimately, these 
restrictions form a back-door to pre-existing condition discrimination 
where they are targeted at the most vulnerable populations and patients 
lose their coverage due to an inability to utilize available support or 
are simply steered towards one of the few remaining plans that has not 
implemented restrictions (if they are available in their state). Most 
recently, the practice of copay accumulators has taken hold where some 
assistance is accepted, but it is never applied to the patient's out-
of-pocket limits, thus rendering the support inconsequential for the 
seriously ill.
    The situation is particularly dire for patients with rare, chronic, 
and life-threatening illness that rely on innovative life-sustaining 
medications and who occasionally turn to charities following a job loss 
or similar hardship to ensure there is no catastrophic disruption in 
access to care. Often times, when properly medicated, these patients 
work and contribute to society, and they do not qualify for Medicaid or 
similar need-based programs. Further, despite the severity of their 
illness, the therapy or medical intervention likely blunts or slows the 
progression of their disease meaning they also do not readily qualify 
for disability programs. When assistance and access to proper care is 
lost, a dangerous situation is created where the dramatic decline in 
health rapidly outpaces the patient's ability to transition on to tax-
payer funded safety net programs.
    We cannot overlook the fact that many patients in the 
aforementioned situation also continue to turn to charitable assistance 
during the process of transitioning on to Federal programs as their 
illness progresses. The disability waiting periods alone would be 
insurmountable for many without charitable assistance. In this regard, 
the need for charitable assistance is certainly not mitigated in 
Medicare and related programs with some patients utilizing charitable 
assistance to make ends meet and cover cost-sharing requirements.
    From our experience, there appears to be dangerous misconceptions 
that alternatives to charitable assistance exist, that manufacturers 
can bridge gaps by voluntarily offering free product as needed, and 
that Medicare Part A and hospital emergency rooms can provide a base 
solution for those in extreme circumstances. The reality is that no 
alternatives exist, there is no comparable or cost-effective substitute 
for properly managing an illness, and charitable assistance programs 
will need to be an integral part of the healthcare safety net for the 
foreseeable future.
    When charitable assistance was started decades ago, it was a 
benevolent response to real and immediate needs facing the seriously 
ill. This assistance was intended to protect those with pre-existing 
conditions, prevent medical bankruptcy, and stop involuntary divorce. 
These were the same goals shared by the core patient protections 
advanced by the Affordable Care Act and supported on a bipartisan basis 
in Congress. These patient protections have been an improvement, but 
they have not supplanted the need for charitable assistance programs.
       contemporary examples of charitable assistance challenges 
                           (patient stories)
    Collen.--Colleen is a working mother with two young children from 
Connecticut. Her family has health insurance through her husband's 
employer. Colleen's family has, relied on a combination of a 
manufacture co-pay coupon and non-profit assistance to make ends meet. 
Now, the non-profit they relied on no longer offers support, leaving 
them with a financial shortfall. To make things worse, their health 
insurance plan now refuses to apply their co-pay assistance to their 
deductible and out-of-pocket maximum.
    Colleen says, ``It is double dipping on the part of the insurance 
giants, and it is unconscionable. These co-pay cards are meant to take 
the pressure off very sick, very expensive patients. And instead we're 
getting hit just as hard, even when we have a co-pay card. We are 
seriously considering pulling my daughter from her preschool for next 
year because we just can't absorb all these extra health care costs.''
    Edith.--Edith is in her 70s and a Medicare recipient from Florida 
who was diagnosed with a rare, chronic, and life-threatening illness 
about 5 years ago. She takes two targeted therapies to manage her 
condition. Recently, the non-profit charity she had relied on stopped 
offering co-pay assistance.
    Edith says, ``after [I stopped getting copay assistance], every 
number that I tried either didn't help with my condition or was out of 
funds. It was scary there for a while because I don't have that kind of 
money to be able to pay that every month. If I didn't have the 
medication I wouldn't be around. I would have passed away.'' Edith's 
husband adds, ``without her medications she cannot breathe. Without 
these drugs I would lose my wife in a day.''
    Irene.--Irene is in her 60s and a former building supervisor from 
Virginia. She now receives Medicare due to disability. Irene's cost 
sharing requirements outpace her fixed income.
    The non-profit organization that had been assisting Irene with her 
co-pay recently stopped offering funds. Irene said, ``I was a single 
mom and over the years worked very hard to support myself and my son, 
but there was never enough to save or put away. My [financial 
assistance] grant runs out... in 21 days. I don't have a clue as to 
what to do...Basically, I have exhausted all means of other resources 
and am mentally preparing myself to die.''
                    fiscal year 2023 recommendations
    Please support committee recommendations like the language outlined 
below. Thank you for your time and for your consideration of UCA's 
input.
                      recommended report language
               centers for medicare and medicaid services
                           program management
    Third-Party Charitable Assistance.--The Committee continues to have 
concerns about proliferation of policies that block patient to access 
to premium and copay assistance from qualified independent charities, 
civic groups, and houses of worship. The continued growth of these 
restrictions are expanding beyond marketplace plans and into other 
forms of coverage. These policies can be arbitrarily enforced and too 
easily leveraged against high-cost rare disease patients with the 
greatest need for third-party healthcare safety net programs and 
requirements for continued access to therapies to disrupt or delay 
essential care. We recognize the administration's stated commitment to 
expanding coverage and protecting access for those with complex 
healthcare needs and direct CMS to provide its current position on the 
third-party payer rule, any potential or planned actions to address 
insurance restrictions jeopardizing care for rare disease patients that 
utilize charitable assistance, and how these plans align with 
overarching CMS efforts to improve coverage and access for the patient 
community within 180 days of the enactment of this act.
                                 ______
                                 
        Prepared Statement of the Urban Indian Health Institute
    Members of the Senate Committee on Appropriations--Subcommittee on 
Commerce, Labor, Health and Human Services, Education, and Related 
Agencies, my name is Abigail Echo-Hawk, and I am an enrolled citizen of 
the Pawnee Nation of Oklahoma, currently living in an urban Indian 
community in Seattle, Washington. I am Executive Vice President of the 
Seattle Indian Health Board (SIHB) and the Director of the Urban Indian 
Health Institute (UIHI) where I oversee policy, research, data, and 
evaluation initiatives. I request the subcommittee support efforts with 
the U.S. Department of Health and Human Services (HHS) to: immediately 
transfer the Healthy Native Babies Program (HNBP) to the CDC; advocate 
for improved access and reimbursement of doula services; expand grant 
edibility from the Administration for Children and Families (ACL) to 
Urban Indian Organizations (UIO) to address the Missing and Murdered 
Indigenous Women and People (MMIWP) crisis, and; uphold Tribal health 
authority status of Tribal Epidemiology Centers (TEC). Targeted 
investments are critical for improving the health of American Indian 
and Alaska Native (AI/AN) people.
    I am an American Indian health researcher with more than 20 years 
of experience in both academic and non-profit settings. I participate 
in numerous local, State, and Federal efforts to support AI/AN 
communities in research, including serving on the Tribal Collaborations 
Workgroup for the National Institutes of Health (NIH) All of Us 
precision medicine initiative. I serve as the only Native 
representative for the NIH Office of AIDs Research Advisory Council. I 
am a co-author to four groundbreaking research studies on sexual 
violence and Missing and Murdered Indigenous Women and Girls (MMIWG) 
where I have called national attention to the institutional barriers in 
data collection, reporting, and analysis of demographic data that 
perpetuate violence against AI/AN people. I am a member of the National 
Academies of Sciences, Engineering, and Medicine (NASEM) Standing 
Committee for the Centers for Disease Control and Prevention (CDC) 
Center for Preparedness and Response (SCPR). Additionally, I was a 
committee member for the NASEM: Framework for Equitable Allocation of 
COVID-19 Vaccine.\1\
---------------------------------------------------------------------------
    \1\ The White House. 2021. Biden-Harris Administration Announces 
Initial Actions to Address the Black and Indigenous Maternal Health 
Crisis. Retrieved from: https://www.whitehouse.gov/briefing-room/
statements-releases/2021/04/13/fact-sheet-biden-harris-administration-
announces-initial-actions-to-address-the-black-maternal-health-crisis/.
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        address barriers to accessing maternal and infant health
    In alignment with the Administration's Initial Actions to Address 
the Indigenous Maternal Health Crisis \1\ and E.O. 13985: Advancing 
Racial Equity and Support for Underserved Communities Through the 
Federal Government and the HHS--Equity Action Plan, we request HHS 
immediately transfer HNBP to the CDC to respond to the disproportionate 
maternal and infant mortality in AI/AN populations.
    Since 2003, NIH has operated the HNBP to provide culturally attuned 
programming and trainings to address AI/AN infant health disparities. 
However, the HNBP's contract expired May 5, 2022. NIH is offering to 
support the transition of HNBP to another Federal agency. As the only 
public health campaign for AI/AN maternal and infant health, HNBP 
aligns with the mission and initiatives of the CDC to reduce rates of 
sudden unexplained infant death (SUID) in marginalized communities. 
Currently the budget for HNBP is $217,000, under 3-year agreements, and 
funds two full-time employees which will have minimal fiscal impact on 
the CDC. The HNBP must be moved to the CDC to continue supporting 
generations of Native families.
    In 2018, SUID rates for AI/ANs were the highest among any racial or 
ethnic population with a rate of 212.1 per 100,000 live births for AI/
AN infants which is more than twice the rate for non-Hispanic white 
infants of 84.9 per 100,000 live births.\2\ In 2020, non-Hispanic AI/AN 
mothers were nearly three times as likely to receive late or no 
prenatal care compared to non-Hispanic white mothers \3\ and the 
highest rate of infant mortality were among non-Hispanic AI/AN infants 
born preterm or low birthweight.\4\ HNBP aims to address the high rates 
of SUID through culturally attuned educational materials, training, 
outreach events, and stipends awarded to Tribes and Native-led 
organizations.
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    \2\ CDC. (2021). Sudden Unexpected Infant Death and Sudden Infant 
Death Syndrome. Data and Statistics. https://www.cdc.gov/sids/data.htm.
    \3\ CDC. (2022). Births: Final Data for 2020. National Vital 
Statistics Reports, 70(17). Table 13. https://www.cdc.gov/nchs/data/
nvsr/nvsr70/nvsr70-17.pdf.
    \4\ CDC 2020. Infant Mortality Statistics from the 2018 Period 
Linked Birth/Infant Death Data Set. National Vital Statistics Reports. 
Table 2.
    https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf.
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               transfer the healthy native babies program
    To support maternal and infant health, I also request HHS evaluate 
and consider reimbursement services for doulas. The Centers for 
Medicaid and Medicare Services (CMS) must increase grant flexibility, 
provide enhanced technical assistance, and ensure more States fully 
reimburse doulas and midwives at financially sustainable levels. For 
Native women, doulas decrease negative childbirth experiences, and 
support their access to health care providers who understand the unique 
cultural, social, and economic burden mothers face. In the 2022 
Legislative session, Washington state passed legislation to credential 
doulas and midwives. A competent credentialing system for doulas allows 
us to continue practicing traditional ways of knowing with their care 
and expertise being vital to improve health outcomes of our people.
    These trends illuminate the need for greater investments and 
targeted approaches for addressing maternal and infant health for AI/AN 
populations. UIOs and Native-led organizations must be included in 
grant eligibility by HHS agencies to continue providing maternal and 
infant health services related to disease prevention, health promotion, 
screen for maternal depression, service delivery, research, and 
healthcare professional education for providers interacting with AI/AN 
communities.
  support public safety for missing and murdered indigenous women and 
                                 people
    In support of Executive Order (E.O)14053: Improving Public Safety 
and Criminal Justice for Native Americans and Addressing the Crisis of 
Missing or Murdered Indigenous People and the U.S. Government 
Accountability Office (GAO) report titled Missing or Murdered 
Indigenous Women: New Efforts are Underway but Opportunities Exist to 
Improve the Federal Response,\5\ we urge HHS and ACF to expand grant 
eligibility of the Family Violence Prevention and Services (FVPS) to 
include UIOs. UIOs are on the front lines of responding to violence, 
sexual abuse, and human trafficking experienced by urban AI/AN 
populations. UIOs must be included in FVPS grant eligibility to support 
our programs, services, and initiatives to support AI/AN individuals, 
families, and communities affected by violence.
---------------------------------------------------------------------------
    \5\ U.S. Government Accountability Office (November 2021). Missing 
or Murdered Indigenous Women:
    New Efforts Are Underway but Opportunities Exist to Improve the 
Federal Response Retrieved from: https://www.gao.gov/products/gao-22-
104045.
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    I am grateful for the HHS recently holding a joint consultation in 
partnership with the Department of Justice and Department of Interior 
related to the GAO report on MMIWG. I request HHS utilize a multi-
pronged approach from all HHS agencies including NIH, Indian Health 
Service (IHS), and CDC to support research and gender-based violence 
services to serve survivors, victims, community-based organizations, 
and families affected MMIWP.
    To inform HHS' MMIWP efforts, UIHI has released several recent 
reports identifying gaps in data collection methods and developing 
culturally attuned frameworks for gender-based violence programming. In 
2021, UIHI released Sacred: Womxn of Resilience,\6\ the report 
documented the COVID-19 impact on Native femme-identifying survivors of 
sexual violence. The report also highlighted the critical need to build 
relationships between law enforcement, providers, and survivors to 
provide culturally responsive intervention and prevention services. The 
report also stresses that gender-based violence prevention, 
programming, and evaluation be led by experts from the Native community 
to adequately offer culturally responsive services to individuals 
impacted by MMIWP.
---------------------------------------------------------------------------
    \6\ Urban Indian Health Institute. (September 2020). Sacred: Womxn 
of Resilience. www.uihi.org/download/supporting-the-sacred-womxn-of-
resilience/?wpdmdl=18261&refresh=6217b40a4ce3e1645720586.
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    In 2022, UIHI released Service as Ceremony: A Journey Toward 
Healing \7\ a national study interviewing gender-based violence direct 
service providers. The report reveals offering culturally attuned 
holistic programming to address physical, psychological, and spiritual 
impacts for clients were essential to building resiliency and 
responding to the spectrum of gender-based violence experienced by 
individuals impacted by MMIWP. This report makes recommendations to 
fund TECs conducting research, assure gender-based violence grant 
funding is non-competitive, multi-year, flexible, and include UIO in 
grant carve outs.
---------------------------------------------------------------------------
    \7\ Urban Indian Health Institute. (February 17, 2022). Service as 
Ceremony: A Journey Toward Healing. www.uihi.org/download/service-as-
ceremony-a-journey-toward-healing/?wpdmdl=19563
&refresh=621d39d2458ae1646082514XX.
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    To support gender-based violence services offered to AI/AN 
survivors, victims, and families, UIHI provides several encompassing 
recommendations HHS can implement including providing flexible grants 
to community-based organizations, investing in research conducted by 
TECs, investing in educational campaigns related to violence 
intervention and prevention, and investing in human services to support 
social determinants of health impacting an individual's safety 
including housing, education, and access to health services.
  honor public health authority status of tribal epidemiology centers
    I recently provided feedback for the GAO report Tribal Epidemiology 
Centers: HHS Actions Needed to Enhance Data Access \8\ highlighting 
necessary actions to be taken by HHS to improve TEC's access to Federal 
public health data. Despite HHS being required to share public health 
data with TECs, TECs continue to experience barriers to accessing data, 
thus limiting available information on AI/AN populations. The report 
recommends HHS: develop a policy clarifying HHS data available to TECs 
as required by Federal law; encourage the CDC Director develop written 
guidance for TECs on how to request data as well as document agency 
procedures on reviewing TECs data requests; encourage the IHS Director 
to develop written guidance for TECs on how to request data, and; 
encourage the IHS Director to develop and document agency procedures on 
reviewing TEC data requests.
---------------------------------------------------------------------------
    \8\ U.S. Government Accountability (March 2022). Tribal 
Epidemiology Centers: HHS Actions Needed to Enhance Data Access. 
Retrieved from: https://www.gao.gov/products/gao-22-
104698#::text=Also%2C%20 
GAO%20was%20asked%20to,documentation%20of%20TECs'%20data
%20requests.
---------------------------------------------------------------------------
    Additionally, several HHS agencies, including the CDC and IHS, have 
failed to recognize the public health authority of TECs and thereby 
ignore or reject data requests by TECs. UIHI has been denied access to 
national and regional data, data collected through the National 
Notifiable Disease Surveillance System (NNDSS), National Violent Death 
Reporting System (NVDRS), and other COVID-19 surveillance data. Failure 
to grant TECs data access perpetuates systemic health inequities in AI/
AN communities by limiting the public health surveillance and 
epidemiological data collected by governmental agencies.
    All HHS agencies must ensure data sharing requirements with TECs 
uphold Congressional intent and recommendations by the GAO report. TECs 
inform decision-making by Tribes, Tribal organizations, UIOs, 
government agencies, and public health agencies to ensure equitable 
distribution of resources and to inform robust policies, planning, and 
programming to address social determinants of health experienced in 
Indian Country.

    [This statement was submitted by Abigail Echo-Hawk, MA,Director, 
Urban Indian Health Institute.]
                                 ______
                                 
                   Prepared Statement of VentureWell
    On behalf of VentureWell, we thank the subcommittee for its support 
of the National Institutes of Health (NIH). VentureWell strongly 
believes that robust investments in scientific research are crucial for 
sustained economic growth and technological innovation. VentureWell 
encourages the subcommittee to provide at least $49 billion for the NIH 
base budget in FY 2023, with any additional funding for the new 
Advanced Research Projects Agency for Health (ARPA-H) to supplement, 
not supplant, core investments in the NIH base budget. VentureWell also 
asks the subcommittee to encourage increased support at NIH for 
programs like the Rapid Acceleration of Diagnostics (RADx) initiative 
that focus on commercialization and innovation.
                           about venturewell
    VentureWell is a global nonprofit organization with more than two 
decades of experience supporting early-stage science and technology 
innovators, helping them to bring inventions or discoveries from lab to 
market in order to offer innovative technological solutions to pressing 
challenges. VentureWell's training programs are distinguished by the 
quality of instruction and mentorship provided by our staff and large 
network of experts in areas such as technology commercialization, 
intellectual property, global supply chains, and financing. VentureWell 
is an active partner in the U.S. innovation ecosystem, providing 
grants, training, and support to early-stage science and technology 
innovators, startups, and entrepreneurship educators. Our programming 
has helped bring groundbreaking technological advancements to millions 
of people across the U.S. and in more than 90 countries, in fields 
including biotechnology, healthcare, information and communications 
technology, sustainable energy and materials, and other sectors 
critical to people and the planet.
    Since our founding more than 26 years ago, VentureWell has 
supported over 12,000 innovators, resulting in more than 2,700 ventures 
that have raised over $2.2 billion in follow on investment. Ongoing 
programs include entrepreneurship grants and training programs focused 
on innovation and commercialization; faculty grants to researchers and 
instructors focused on integrating innovation and entrepreneurship 
teaching in higher education; and competitive national award 
competitions focused on innovation, design, and commercialization. A 
core component of our work is partnering with Federal agencies to 
accelerate the impact and scale of innovation programs and initiatives. 
Among other NIH collaborations, VentureWell has notably worked to 
launch the agency's I-Corps program since 2014, the Design by 
Biomedical Undergraduate Teams (DEBUT) competition with the National 
Institute of Biomedical Imaging and Bioengineering (NIBIB) since 2016, 
the NIH Technology Accelerator Challenge (NTAC) for sickle cell 
diagnostics (2019) and maternal health (2022), and the Rapid 
Acceleration of Diagnostics (RADx) initiative to speed innovation in 
the development, commercialization, and implementation of technologies 
for COVID-19 testing starting in 2020.
       from invention to product: the commercialization ecosystem
    Innovation and entrepreneurship in science and technology is a key 
driver of economic development in the United States. Our country's 
ability to transform breakthroughs from basic research into consumer 
products and scalable businesses has led to enormous benefits for 
society, including new cures for diseases, better communication and 
information sharing technology, and safer food and transportation. In 
recent years, U.S. leadership in science and technology on the world 
stage--and by extension our National security and global economic 
leadership--has been threatened as other countries increase their own 
investments in this area. Our country can address this challenge by 
increasing Federal investments in agencies like NIH and programs that 
close key gaps in the pipeline for developing and commercializing new 
technologies. The U.S. commercialization ecosystem would benefit from 
comprehensive support for early-stage researchers to translate their 
ideas into products, to grow the pipeline of entrepreneurial talent in 
the U.S., and from the reduction of barriers that block the progress of 
individuals or organizations to commercializing innovations.\1\ 
VentureWell partners with Federal agencies to address these needs by 
supporting the ventures, individuals, and ecosystems that drive 
American innovation.
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    \1\ https://www.dayoneproject.org/ideas/closing-critical-gaps.
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   opportunities for innovation at the national institutes of health
    Biological sciences and clinical medicine are key areas of research 
and development linked to entrepreneurial activity. New therapeutics, 
medical devices, and other health-related technologies have enormously 
high potential benefits yet relatively long and complex development 
timelines, making support for venture development in this sector a 
crucial component of bringing products to market quickly and 
efficiently. Given its position as the top funder for biomedical 
research in the U.S., NIH plays a major role in fostering more 
effective and efficient translation of basic scientific discoveries 
into treatments and therapeutics. Not only does NIH support the 
fundamental research that underpins most clinical and commercial 
advances in biomedical research, the agency also funds a portfolio of 
venture acceleration programs specifically aimed at encouraging 
entrepreneurship and innovation at all career stages. Our organization 
has played a key role in NIH's I-Corps program, an intensive start-up 
training program for academic researchers and students that teaches 
participants how to evaluate commercialization potential and develop a 
business model. Our organization also administers the Design by 
Biomedical Undergraduate Teams (DEBUT) challenge in partnership with 
the National Institute of Biomedical Imaging and Bioengineering 
(NIBIB). This competition challenges teams of undergraduate students to 
solve real-world problems in health care by applying their analytical 
and design skills towards the development of a new product. VentureWell 
also partners with the National Institute of Biomedical Imaging and 
Bioengineering (NIBIB) to help improve maternal health around the world 
through the NIH Technology Accelerator Challenge for Maternal Health 
(NTAC: Maternal Health). This challenge seeks to spur and reward the 
development of prototypes for low-cost, point-of-care molecular, 
cellular, and/or metabolic sensing and diagnostic technologies to guide 
rapid clinical decision-making, improve patient outcomes, and 
ultimately prevent maternal morbidity and mortality. VentureWell thanks 
the subcommittee for its ongoing support for these programs and 
encourages continued strong funding for these initiatives at NIH in FY 
2023.
    To truly capitalize on all the talent and potential in the U.S. 
entrepreneurial workforce, we believe that diversity, equity, and 
inclusion must be reflected throughout all Federal efforts in this 
area. We must remove systemic barriers that limit the participation of 
underrepresented groups in innovation and entrepreneurial activities 
and ensure that pathways for commercialization are open to all 
innovators regardless of their racial, ethnic, gender, or socioeconomic 
background. VentureWell is committed to supporting a diverse workforce 
of researchers, faculty, entrepreneurs, and innovators whose voices and 
ventures have been underestimated and under-resourced, and encourages 
the subcommittee to ensure that equity is reflected throughout all 
innovation programs funded by NIH.
   diversity, equity, and inclusion in innovation & entrepreneurship
    In 2019, VentureWell ccommissioned a national study around 
broadening participation in the higher education innovation and 
entrepreneurship ecosystem. Informed by this study, our Advancing 
Equity: Dynamic Strategies for Authentic Engagement in Innovation and 
Entrepreneurship report presents a blueprint for university-based 
entrepreneurship centers that strive to increase diversity, equity, and 
inclusion (DEI) practices. We co-developed with researchers, faculty, 
and center directors, a series of resources for advancing the DEI tools 
and best practices specific to science and technology commercialization 
and training, and our report Advancing Equity: Navigating New Terrain, 
demonstrates ways to apply this blueprint at higher education 
institutions around the country. We continue to provide resources to 
academic, industry, and network partners as part of our Advancing 
Equity webinar series. VentureWell fully supports NIH's efforts to 
broadening participation in biomedical research supports the NIH UNITE 
initiative to address structural racism and promote racial equity and 
inclusion at NIH and within the larger biomedical research enterprise.
                    the radx model: covid and beyond
    The RADx Initiative was officially launched in April 2020 with a 
$500 million investment through emergency appropriations from Congress 
to speed innovation in the development, commercialization, and 
implementation of technologies for COVID-19 testing. RADx leveraged the 
infrastructure developed through NIBIB's Point-of-Care Technologies 
Research Network (POCTRN)--created by NIH in 2007--to quickly bring 
COVID-19 testing technologies to market. Previous investments made by 
Congress in this innovation infrastructure at NIH were critical to 
RADx's ability to bring new diagnostic technologies to the American 
people in record time.
    VentureWell has worked alongside NIH on the RADx program since its 
inception, providing infrastructure support and coordination services, 
clinical evaluation services through contract research organizations, 
and performing important administrative roles including government 
compliance, security testing on platforms, payment processing, sub-
contracting to third parties, and procurement standards. In 2 years, 
VentureWell engaged 869 experts, contracted with 337 vendors/companies/
service providers, issued 201 software licenses, funded 140 RADx 
projects, and have received 44 FDA authorizations. RADx-supported 
companies have increased COVID-19 testing capacity across the United 
States by 1.9 billion tests and condensed the typical multi-year tech 
commercialization process into approximately 6 months. Tests developed 
through RADx, with support from VentureWell, have enabled the U.S. to 
begin to recover from the public health and economic devastation 
brought on by COVID-19. VentureWell has continued to support NIH 
through the RADx initiative by providing online educational tools like 
the whentotest.org Covid-19 calculator, supporting the analysis of test 
performance through variant modeling and analytical testing, and 
working in close collaboration with the Food and Drug Administration 
(FDA) to establish the Independent Test Assessment Program (ITAP) in 
order to accelerate regulatory review and availability of high-quality, 
accurate, and reliable over-the-counter COVID-19 tests.
    We believe that the RADx approach--a nimble and systematic but 
aggressive strategy--should be applied in the development and 
evaluation of diagnostic tools in other therapeutic areas where 
innovative diagnostics and surveillance technologies are much needed. 
This includes applications ranging from HIV to maternal health. To 
prepare for future pandemics and diseases that threaten the public 
health of the population, we must continue to promote the use of 
innovative methods with a proven record of success to accelerate the 
development, commercialization, and implementation of point of care 
tests for COVID-19, new pathogens, and more. VentureWell encourages the 
subcommittee to direct NIH to continue support for the RADx program in 
FY 2023. Sustained investments in RADx will enable NIH--and our country 
as a whole--to be prepared for future public health threats and will 
help the United States to maintain its historic role as a global leader 
in biomedical science and technology.
    VentureWell thanks the subcommittee for its ongoing work in 
advancing biomedical research in the United States and ensuring that 
our country remains a world leader in science and technology. We urge 
the subcommittee to continue its commitment to research and development 
by providing strong funding for NIH in FY 2023, including increased 
support for programs like RADx that focus on commercialization and 
innovation. Thank you for your consideration of VentureWell's 
testimony. For more information about our organization, please see 
https://venturewell.org/.

    [This statement was submitted by Phil Weilerstein, President and 
Chief Executive Officer, VentureWell.]
                                 ______
                                 
                Prepared Statement of the wAIHA Warriors
              summary of fiscal year 2023 recommendations
_______________________________________________________________________

  --Please provide the National Institutes of Health (NIH) with $49 
        billion to facilitate continued growth in rare disease research 
        activities.
    --Please provide proportional increases for the National Institute 
            of Allergy and Infectious Diseases (NIAID), the National 
            Heart, Lung, and Blood Institute (NHLBI), and the National 
            Center for Advancing Translational Sciences (NCATS) to 
            facilitate establishment and advancement of a wAIHA 
            portfolio.
    --Please provide a separate, meaningful increase to advance and 
            adequately support the emerging Advanced Research Projects 
            Agency for Health (ARPA-H).
  --Please provide the Centers for Disease Control and Prevention (CDC) 
        with $11 billion to support public health efforts.
    --Please systematically increase funding for the Chronic Disease 
            Center at CDC to bring the agencies funding up to $3.75 
            billion annually, and please support $6 million in funding 
            for the line-item CDC Chronic Disease Education and 
            Awareness (CDEA) program to ensure additional cooperative 
            agreements are available for stakeholders.
_______________________________________________________________________

    Chairwoman Murray, Ranking Member Blunt, and distinguished members 
of the subcommittee, thank you for the opportunity to present the views 
of the wAIHA Warriors and the community of individuals impacted by Warm 
Autoimmune Hemolytic Anemia (wAIHA). First, thank you for the 
meaningful investment in medical research and public health programs 
through the FY 2022 omnibus appropriations package. For FY 2023, we 
join other rare disease organizations and the broader patient community 
in asking for a sustained and meaningful investment in NIIH, CDC, and 
related Federal programs. We also deeply appreciate this opportunity to 
raise awareness of wAIHA and share the patient experience. Please 
consider us a resource moving forward. Thank you again.
             about warm autoimmune hemolytic anemia (waiha)
    wAIHA is a rare autoimmune disorder in which the immune system 
creates antibodies that destroy healthy red blood cells. The condition 
is progressive, potentially fatal, and difficult to address at later 
stages. It can be idiopathic or occur secondary to another condition. 
wAIHA can impact anyone and affects men and women equally, though it 
most commonly affects individuals over 50. Research has led to 
scientific advancements and potential therapies, but at this time 
treatment options are extremely limited and consist of (1) steroids and 
transfusions, (2) immunosuppression and chimeric anti CD20 antibodies, 
and (3) removal of the spleen. The condition is associated with 
significant morbidity and mortality, and less than 50 percent of 
patients remain in remission following front-line treatment.
                        about the waiha warriors
    The wAIHA Warriors are a patient-driven grassroots organization 
focused on supporting the community of individuals impacted by wAIHA. 
Collectively, we use our stories and experiences to raise awareness, 
advance research, and improve healthcare. We also promote fellowship 
and engagement among community members to overcome the isolation of 
wAIHA and work to educate and mobilize healthcare providers to better 
address this rare disease experience.
                   patient experience; eric, new york
    In February 2011 I had a bad flu just before Super Bowl weekend. I 
was well enough to attend a Super Bowl party but remember not feeling 
myself. A few weeks later I had my regular annual physical with my 
internist. We were away celebrating a friend's 50th birthday, sitting 
at the pool, when my internist called and told me that my blood work 
was totally out of kilter (he used the term ``pancytopenia''). My wife, 
Liz, who is a pediatrician, was nervous and just like when our kids 
were little, I only got nervous when she got nervous. I was very lucky 
that one of my closest friends is a Hematologist/Oncologist. The next 
day I went to see him, he set me up for all sorts of scans and bone 
marrow biopsies and we were off trying to figure out what it was and 
was not.
    Over the next few months he became confident that I did not have 
any sort of acute blood cancer. I still did not feel myself (I was 
tired, not hungry, not sleeping well, and not in a good mood). Most the 
blood tests became normal except for the hemaglobin/hematocrit. My 
spleen was very large. My friend thought I had AIHA (but my Coombs 
tests, which are typically what seal the AIHA diagnosis) were negative. 
Over the summer, I had one Coombs that was barely positive. In August 
2011, my hemoglobin was going down and I had a blood transfusion.
    In September 2011, my friend/hematologist wanted me to get another 
opinion, so he referred me to another hematologist who is more of a 
``benign hematologist'' as they are known--don't typically treat blood 
cancers. She confirmed the diagnosis of AIHA. She began me on 
prednisone and I felt a little better.
    My friend/hematologist thought that if I had a splenectomy (which 
was thought to be the primary treatment option back then) I might be 
``cured'' and I would not have to be on chronic prednisone the rest of 
my life. I had the surgery In February 2012. It was a very difficult 
few days in the hospital followed by about 3 weeks of recovery at home. 
But after that, I felt pretty good. I was on very very low dose of 
prednisone (less than 5mg per day) and that lasted for a few years.
    In June 2015, I got sick again (tired, peeing a lot, not sleeping, 
could feel my pulse in my temples).The goal then became to find 
something that was not as harmful as prednisone that could control the 
hemolysis and my hemaglobin levels. Over the next couple of years, I 
had a couple of courses of Rituximab, and also tried courses of 
Azathioprine and Danazol. When I was hemolyzing and my hemaglobin was 
dropping, I needed to increase the prednisone.
    I made an appointment to see a leading physician, Dr. Kuter, in 
December 2017. He gave me (and my hematologist) the ``state of the 
art'' on the treatments available. The next time I had a deep crash of 
my hemaglobin, in June 2018, we tried one. Shots of Procrit. Those 
worked quickly and my hemaglobin went as high as it had been since all 
this started in 2011.
    By the middle of 2019, I had another crash and it was time to see 
what else was out there. I connected with Dr. Irina Murackhovskaya at 
Einstein/Montefiore who was doing some clinical trials for AIHA drugs. 
I had to get my hemaglobin below 10 to participate and I needed a 
positive Coombs test, and we managed that closely. In October 2019 I 
started the trial and I chose this trial because it was open and I 
would definitely get the drug (not a placebo).
    In early December 2020, I did not feel well. My legs felt like lead 
weights. Over the next few weeks my prednisone started dropping pretty 
quickly. By Christmas week, I was feeling as sick as I had felt in a 
long time. My Hgb dropped below 8, I had a blood transfusion and I 
increased my prednisone to 60mg per day (the same as the highest I ever 
had in the past).
    During 2021, I felt well. Still working at home. Things started 
opening up. We started to get out more. That helped a lot. I continued 
to wean down the prednisone and by the late Fall was on about 7.5 mg 
per day. My Hgb was pretty stable. My other hemolysis markers were 
better and stable too.
    In early March, my Hgb was 14.2 (highest I can remember and 
``normal'' range on some ranges). All my other hemolysis markers were 
as good as they had ever been. Had to have another round of primary 
Evusheld as the CDC changed the recommendation on how much to get for 
primary round.
    I feel good now. Started back to work 3 days a week towards end of 
March. Did a quick 3 weeks of Breakthrough M2 diet program and went 
from about 193 lbs. to about 178 lbs. (15 lbs.) in 3 weeks. Things are 
starting to get back to (post COVID) normal. In April, my Hgb went back 
down to low 13s but still holding strong as are the other hemolysis 
markers. Fingers crossed that they will stay good. With Passover, 
gained back about 5 lbs. but still feeling pretty good.

    [This statement was submitted by Karen Jones, Executive Director, 
wAIHA 
Warriors.]
                                 ______
                                 
     Prepared Statement of the West Virginia Head Start Association
    Dear Chairman Murray, Ranking Member Blunt, and Members of the 
subcommittee,
    On behalf of the Head Start community nationwide, thank you for 
this opportunity to share views and perspectives on Fiscal Year 2023 
(FY23) funding for Head Start. For 5 years, I have had the distinct 
pleasure of serving as the executive director of the West Virginia Head 
Start Association representing 21 programs from the Cheat River to the 
coal fields. Every day, we diligently work to build early learners and 
support West Virginia families facing financial hardships and 
generational poverty who are too often stung by addiction, depression, 
and economic uncertainty.
    While I am extremely proud of how our programs in the Mountain 
State have weathered a global pandemic, COVID-19 has laid bare a crisis 
that Head Start program managers had previously been able to sweep 
under the rug or gloss over: our neglected and underinvested workforce. 
In the shadow of conflicting and confusing COVID-19 protocols and the 
rising impact of inflation, Head Start staff are struggling to meet the 
needs of West Virginia's most vulnerable children and their families 
and we need your help. We urge you to take immediate action to help 
address the spiraling labor situation crippling Head Start and Early 
Head Start.
    At the present time, we have 143 staff openings in West Virginia--
significantly higher than normal for this point in the program year. 
Most of those openings are due to the staffs' ability to easily find 
higher wages elsewhere. Local boards of education, which pay more, are 
regularly recruiting our staff for other positions--bus drivers, 
teachers' aides, and lead teachers--in the state pre-K or K-12 public 
school system. Private sector employers are also drawing away both 
potential and current employees. For example, Sheetz currently pays $15 
per hour with a $3,000 sign-on bonus and Wal-Mart's starting wage is 
also $15 per hour.
    In West Virginia, the minimum wage is $8.75. That is the typical 
starting wage for Head Start staff. Full-time employment at $8.75 per 
hour is well below the Federal poverty line, which means many Head 
Start staff are earning an income so low that their children qualify 
for Head Start services. With this in mind, it is not surprising 
workers are choosing other options that better support the wellbeing of 
their own families.
    What is true for West Virginia is also true for Head Start programs 
nationwide. At a recent National Head Start Association conference, 
more than 900 staff were surveyed on current workforce conditions. The 
results were startling: an average of 35 percent of classrooms have 
been closed this school year and 90 percent of programs had to close a 
classroom permanently or temporarily due to staffing considerations. Of 
the programs surveyed, 30 percent was the average number of open and 
unfilled job slots at local Head Start programs. Closures translate to 
thousands of children left at home with an older sibling, a relative, 
or a neighbor while a mom or dad goes to work or school. For wage-based 
employees, missing one day can be a huge setback-often only a day's pay 
away from homelessness or the ability to purchase groceries. For 
children, closed or suspended Head Start classrooms translate into 
critical learning loss in educational basics and missed critical social 
skills-skills that COVID-19 has already weakened for so many young 
children.
    Conditions are dire. In the survey comments, one respondent wrote: 
``We are struggling because we can't get people to apply for teacher 
positions. We can't compete with pay with our local school districts. 
Children's behaviors have escalated so much and we need so much 
behavioral support. Staff are getting punched, bit, and kicked by 
students on a daily basis. We NEED to take care of our staff. Staff are 
doing two and three jobs to cover for being so short staffed. We need 
help!!!"
    We need help. We need your help.
    Head Start programs need dedicated assistance in paying staff a 
living wage and competing in an increasingly challenging job market. 
Adequate compensation reduces turnover and stabilizes programs.
    But the impact is far greater, given ``turnover disrupts child-
teacher relationships, which are crucial to children's developmental 
outcomes,'' according to a recent report from the Federal Reserve Bank 
of Minneapolis. The report notes: ``Head Start participants found that 
kids who experienced higher teacher turnover during the school year had 
smaller gains in vocabulary and literacy and higher levels of parent-
reported behavior problems than peers who had more continuity with 
their caregivers (Markowitz 2019).
    With that in mind, the National Head Start Association (NHSA) is 
recommending an FY23 LHHS-Education Appropriations funding level of 
$14.4 billion for Head Start to help do just that. This includes three 
sizable, but necessary increases to rescue this critical federal-local 
program.
    (1) $596 million cost-of-living adjustment (COLA) increase: Rising 
inflation is an additional stress point on our workforce and the 
families we serve. Head Start's cost of living adjustment for FY22 was 
2.3 percent or approximately one-third the rate of inflation. This is 
not an aberration; historically, salary increases have either been just 
at inflation (when it is low) or below it (when inflation is high, like 
this year) resulting in a cumulative and chronic underpayment that 
leaves the Head Start workforce further behind private sector employers 
of every kind. The FY23 recommended COLA at a 5.4 percent increase 
would be an honest, responsible increase even though it is well-below 
year-over-year inflationary levels.
    (2) $2.5 billion in annual workforce compensation: Under current 
pay constraints, Head Start and Early Head Start can't compete. 
Notably, the five West Virginia Head Start grantees that are school 
boards report no vacant positions likely due to the higher wages they 
are able to pay. In other words, the workforce crisis facing early 
childhood education is clearly a solvable problem. Research has clearly 
shown experienced, well-trained staff are key to achieving the positive 
outcomes which Head Start has demonstrated over the decades; however, 
the constant churn of teachers and staff due to low wages-in addition 
to the significant vacancy rate-threatens Head Start's record of 
success. We urge you to take the necessary action to press for passage 
of $2.5 billion per year in Head Start workforce compensation 
realignment. This is a critical first step to addressing the chronic 
issues that stand in the way of parents' ability to fully participate 
in the workforce and children from being prepared for success in 
school.
    (3) $262 million for quality improvement funding (QIF) trauma-
informed care: In the aforementioned survey, 56 percent of respondents 
indicated pay was the leading cause of employee loss. The second 
highest was work conditions, with 26 percent of respondents indicating 
both pandemic-related stress and burnout, combined with children 
presenting complex behavioral and social challenges, create an 
overwhelming work environment. We agree. Head Start staff need 
additional resources, training, and counseling support to lead 
classrooms and children through this incredibly difficult season. We 
are thankful that Congress has recognized and funded QIF trauma-
informed care and welcome this support. Much more needs to be done to 
support the wholeness and wellness to the children and families we 
serve as well as the Head Start workforce.
    In the weeks ahead, the Head Start community would appreciate 
Congress's full embrace of the NHSA FY23 Recommendation of $14.4 
billion and joining in on a singular focus of addressing Head Start 
workforce issues too long brushed aside. Our teachers, classroom aides, 
bus drivers, and support staff deserve to earn a living wage. Please 
take time this month to talk with local Head Start leaders in your 
community. I am quite sure you will immediately hear the daily struggle 
to keep and retain quality staff and the desperate need for change. 
Thank you for your consideration.

    [This statement was submitted by Lori Milam, Executive Director, 
West Virginia Head Start Association.]
                                 ______
                                 
        Prepared Statement of the Western Governors' Association
    Chair Murray, Ranking Member Blunt, and Members of the 
subcommittee, the Western Governors' Association (WGA) appreciates the 
opportunity to provide written testimony on the appropriations and 
activities of the Federal agencies under the subcommittee's 
jurisdiction, including the Departments of Labor (DOL), Health and 
Human Services (HHS), and Education (ED). WGA is an independent 
organization representing the Governors of the 22 westernmost States 
and territories. The Association is an instrument of the Governors for 
bipartisan policy development, information sharing and collective 
action on issues of critical importance to the western United States.
    The COVID-19 pandemic has had widespread effects on the labor 
market and the health care system in the United States. As the recovery 
continues, it is critical to align policies, performance metrics, 
regulations and reporting requirements across Federal workforce, human 
services, housing and education agencies in order to achieve the best 
outcomes for program participants.
    DOL funding for workforce development through the Workforce 
Innovation and Opportunity Act (WIOA) supports economic growth and job 
creation in the States. Western Governors request that the 15 percent 
reserve for statewide activities be maintained in appropriations under 
WIOA. This funding allows Governors to be flexible and innovative in 
addressing state needs. More flexibility under the current WIOA streams 
is needed to better anticipate coming labor market disruptions and 
workers who are not traditionally eligible for assistance or as at-risk 
incumbent workers prepare for displacement. That flexibility should 
include allowing Governors to fund outreach and marketing of services 
in an effort to reach more people. Short term and competitive funding 
for innovative programs is inefficient and creates unintended obstacles 
for small States with limited grant writing resources.
    Western Governors support the expansion of registered 
apprenticeship programs and encourage Congress to support and 
incentivize State, local, and industry-led partnerships to create and 
scale apprenticeship programs through increased appropriations. New 
Federal investments in apprenticeships should be provided through line-
item formula funding and aligned with existing efforts to foster a 
coherent system with minimal duplication at the Federal, State and 
local levels.
    Western Governors support efforts to increase student access to 
short-term education and skills training, including through expanding 
the Pell Grant program to include high-quality short-term training 
programs leading to industry-recognized credentials. Western Governors 
support funding high-quality career and technical education (CTE) 
programs through the Career and Technical Education for the 21st 
Century Act (Perkins V). Adequate funding of Perkins State Grants is 
essential to ensure that CTE programs align with statewide visions for 
education and workforce development. Governors and States are in the 
best position to determine how to use Federal CTE funding to meet the 
needs of their economies.
    Better linkages between K-12, higher education and the workforce 
system are needed. Western Governors call for a carveout of Perkins 
funding directed to the workforce system to support stronger linkages 
to K-12 and higher education. Further, to address the crisis in youth 
employment, Western Governors urge an expanded WIOA funding stream for 
youth, targeted toward youth who are disconnected from school and work, 
as well as the establishment of a Youth Employment Taskforce to make 
further recommendations on effective workforce strategies to address 
the crisis in youth employment. Finally, to ensure that workforce 
development programs are inclusive of people with disabilities, 
Congress should provide additional funding and training for States to 
conduct outreach and education on equal opportunity and 
nondiscrimination and to link workforce programs with K-12 special 
education services.
    Improvements in state data infrastructure are needed to better 
support State education and workforce development, including responding 
to changing labor market demand, improving the effectiveness of 
policies and programs, and improving the delivery of services. The 
subcommittee should provide adequate funding to support state Labor 
Market Information shops and the U.S. Bureau of Labor Statistics. 
States should receive a greater share of funds under the state-federal 
cooperative statistics programs. Western Governors also call for 
significantly greater ongoing funding through the Workforce Information 
Grants to States to enhance state capacity evidence-based decision 
making and the production of locally relevant labor market 
intelligence. Finally, Western Governors recommend that Congress invest 
long-term in multi-State data collaboratives and in more voluntary 
state participation in collaboratives to enable a truly national data 
infrastructure to emerge.
    Building a sufficient cybersecurity workforce is especially 
important to Western Governors. A skilled cyber workforce is imperative 
to the protection of critical infrastructure, which includes a vast 
array of potential targets. These include: the Nation's electric grid; 
energy resource supply and delivery chains; finance, communications, 
and election systems; and a panoply of public, private, military and 
industrial systems. Western Governors request sufficient appropriations 
for high-quality cybersecurity education and workforce development 
programs to grow and sustain the cybersecurity workforce, including 
those that target underrepresented populations, those that include 
rotational components to retain personnel, and work-based learning 
opportunities such as apprenticeships. The Governors support increased 
funding for the CyberCorps: Scholarship for Service program and 
educational initiatives, including the National Institute of Standards 
and Technology's Initiative for Cybersecurity Education and the 
National Centers of Academic Excellence in Cyber Defense. Civilian 
cybersecurity reserves can also help augment cybersecurity workforce 
capacity.
    Despite efforts by Western Governors to address the shortage of 
qualified health care workers in our States, significant challenges 
remain. Governors urge the Federal Government to examine and implement 
programs to ensure States have an adequate health care workforce--
including positions in primary care, behavioral and oral health as well 
as other in-demand specialties--prepared to serve diverse populations 
in urban, suburban and rural communities. Understanding that 
significant disparities remain in access and treatment for many 
populations, Governors support efforts to increase the diversity and 
representation in the health care workforce to improve health outcomes 
for all. Western Governors recognize efforts to support the health care 
workforce in the American Rescue Plan Act (ARPA, Pub. L. 117-2) and 
request a continued focus on this important topic. They also encourage 
the subcommittee to fund new types of personnel, such as community 
health workers or promotores, in order to further extend the health 
care team and ensure that patients are connected to resources, and 
innovation within the behavioral health care workforce to address gaps 
in the continuum of care professionals.
    Americans are facing an alarming increase in adverse mental health 
conditions, substance misuse, and suicidal ideation, trends that have 
been exacerbated by the COVID-19 pandemic. Western Governors appreciate 
the substantial investment in mental and behavioral health services in 
ARPA and support continued efforts to improve the quality and quantity 
of these services. They are essential to reducing suicide rates and 
treating a range of behavioral health conditions, including substance 
use disorder. The top 10 States with the highest suicide rates are in 
the West. Western States are also among those with the highest overall 
rates of substance use disorder, especially for youth between the ages 
of 12 to17. Western Governors recognize and support efforts at the 
Federal, State and local levels to promote the integration of physical 
and behavioral health services. The Governors encourage Congress and 
the Administration to support States' integration efforts and encourage 
health care providers to better incorporate behavioral and physical 
medicine into their practice of care. The expansion of early 
intervention, diversion, and community reentry programs aid in such 
efforts.
    COVID-19 has also laid bare the importance of investing in our 
Nation's public health system. Congress should examine the lessons 
learned from COVID-19 in collaboration with States, and based on these 
findings, they request that the subcommittee ensure that States and the 
Nation have the capability and necessary public health infrastructure 
investment to effectively confront future public health challenges. The 
expansion and support of international health surveillance and public 
health threat detection mechanisms is of critical importance to these 
efforts as well.
    In addition, Western Governors are committed to identifying risks 
facing high utilizers of health care services and addressing social 
determinants of health. They encourage the continued support of 
services and programs, especially those that empower States and local 
governments to solve persistent economic and social conditions that 
often hinder health outcomes.
    Western Governors recognize that it is an enormous challenge to 
judiciously balance competing funding needs throughout the Federal 
Government, and appreciate the difficulty of the decisions this 
subcommittee must make. The foregoing recommendations are offered in a 
spirit of cooperation and respect. WGA is prepared to assist you as the 
subcommittee discharges its critical and challenging responsibilities.

    [This statement was submitted by James D. Ogsbury, Executive 
Director, Western Governors' Association.]
                                 ______
                                 
        Prepared Statement of the Women First Research Coalition
    The Women First Research Coalition (WFRC) appreciates the 
opportunity to provide this outside witness testimony to the Senate 
Committee on Appropriations subcommittee on Labor, Health and Human 
Services, Education, and Related Agencies (Labor-HHS) for the Fiscal 
Year (FY) 2023 LHHS appropriations bill. As you begin work on FY 2023 
appropriations, we respectfully request that you provide at least 
$49.048 billion for the National Institutes of Health (NIH). We also 
request that you consider including our report language on a ``Women's 
Health Research Study'' and a ``Menopause RCDC'' in the report that 
accompanies the final FY 2023 Labor-HHS appropriations bill.
    WFRC is a coalition comprised of the Nation's leading professional 
medical and research organizations specializing in women's health. Our 
coalition was formed to address pressing challenges in women's health 
research and to raise awareness among Federal policymakers, Executive 
Branch officials and the public about the need for sustained and 
strengthened investment in women's health research, the prioritization 
of research in conditions that are specific to women or those 
conditions that may present differently in women than men, advance an 
equitable and appropriate investment in women's health research that 
improves the health outcomes of women, and ensure an adequate women's 
research workforce.
                            funding for nih
    Robust, sustained and predictable funding is important for all 
biomedical research, particularly research on conditions that are 
unique to or predominately occur in women, including polycystic ovary 
syndrome (which affects up to 20 percent of women), endometriosis 
(which affects up to 12 percent of women), uterine fibroids (which 
affect up to 40 percent of women), menopause (which affects all women) 
and cancers of the cervix, uterus and ovary.. As Congress appropriates 
funding for FY 2023, the WFRC is requesting that Congress provide 
$49.048 billion, an increase of $4.1 billion, to the NIH, which would 
allow for meaningful growth above inflation that would expand NIH's 
capacity to support promising science in all disciplines. Almost all of 
NIH's institutes and centers fund research on women's health; 
therefore, any funding increases should be allocated proportionately to 
all NIH institutes and centers to ensure that meritorious research in 
women's health is supported across the NIH. This would build on 
Congress' recent investments in NIH that have allowed for advances in 
discoveries toward promising therapies and diagnostics, supported 
current and new scientists nationwide and advanced the potential of 
medical research. It will also allow NIH to support meritorious 
research in women's health.
      support for the advanced research projects agency for health
    The WFRC supports the creation of an Advanced Research Projects 
Agency for Health (ARPA-H), which would provide an important 
opportunity to advance research in women's health if done in a manner 
that protects and complements the research already being done by NIH. 
Any funding appropriated to ARPA-H should be in addition to the $49.048 
billion requested for the NIH. Despite the fact NIH has implemented 
policies related to sex as a biological variable and taken steps to 
identify women's health topics where additional research is needed, 
significant gaps remain in our understanding of health conditions 
unique to or occurring predominantly in women and in the translation of 
the research conducted on these topics, despite women accounting for 
over half of the United States population. Unfortunately, the 
implications of these gaps are clear: our country is currently in the 
midst of a maternal mortality and severe morbidity crisis; increasing 
rates of preterm birth; cervical cancer survival rates have stagnated 
since the mid-1970s; vaginal mesh procedures that were not studied in 
clinical trials require regulatory action from the FDA;\1\ and there 
are significant gaps in our understanding of women's fertility and 
hormonal functions.\2,3\
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    \1\ https://www.fda.gov/medical-devices/implants-and-prosthetics/
urogynecologic-surgical-mesh-implants.
    \2\ MacDorman MF, Declercq E, Cabral H, Morton C. Recent Increases 
in the U.S. Maternal Mortality Rate: Disentangling Trends From 
Measurement Issues. Obstet Gynecol. 2016;128(3):447-55.
    \3\ Jemal A, Ward EM, Johnson CJ, et al. Annual report to the 
Nation on the status of cancer, 284 1975-2014, featuring survival. J 
Natl Cancer Inst. 2017;109.
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    There is a strong need for a greater investment in research of 
these conditions and many others that occur in women's health before, 
during, and after pregnancy. Often, women's health is not looked at 
across the lifespan and we fail to appreciate the very long-term 
consequences of adverse pregnancy progression and outcomes. We believe 
ARPA-H has the potential to transform women's health research by 
investing in a more comprehensive approach to translating basic science 
into cures.
    The existing NIH Institutes and Centers play a critical role in 
improving human health as evidenced by the work done by the agency in 
the development of effective COVID-19 treatments and vaccines and this 
work must continue to receive robust, sustained support. As such, 
funding for ARPA-H must supplement, not substitute, for the research 
funded by the existing Institutes and Centers. The basic science 
supported by the agency are the foundation for the transformational 
work envisioned for ARPA-H. Therefore, WFRC recommends that the same 
proportional increases in funding provided to the existing NIH 
institutes and centers be provided to ARPA-H once established. We also 
support housing ARPA-H outside of the NIH, in order to prevent funding 
cuts to existing Institutes and Centers.
               support a study on women's health research
    While the National Institutes of Health (NIH) has taken steps to 
better track and evaluate the funds being spent on women's health 
research, we remain concerned about the research gaps, what is being 
funded and what NIH classifies as women's health research as detailed 
above. To address these concerns, we request the inclusion of report 
language directing the NIH Director to contract with the National 
Academy of Science, Engineering, and Medicine (NASEM) to conduct a 
study on gaps in women's health research, and to provide $2 million to 
support this work.
    Specifically, we envision the study would be designed to explore 
the proportion of research on conditions that are more common or unique 
to women, establish how these conditions are defined, evaluate sex and 
gender differences and racial health disparities, and determine the 
appropriate level of funding that is needed to address gaps in women's 
health research. Historically, there has been an inadequate 
representation of minority women as both researchers and research 
participants. There are clear health disparities among conditions that 
are more common or unique to women, and the NASEM is well suited to 
conduct this study to explore these gaps, by looking at women's health 
more comprehensively, across the lifespan.
    Accordingly, the WFRC requests the inclusion of the following 
language in the report accompanying the FY 2023 LHHS Appropriations 
bill with regards to the NIH Office of the Director:

      Women's Health Research Study.--The Committee recognizes 
        persistent gaps remain in the knowledge of women's health. To 
        address these gaps and improve women's health, the Committee 
        includes $2 million within the National Institutes of Health to 
        contract with the National Academy of Sciences, Engineering, 
        and Medicine (NASEM) to conduct a study on the gaps present in 
        women's health research across all institutes and centers at 
        the NIH. Specifically, the study should be designed to explore 
        the proportion of research on conditions that are more common 
        or unique to women, establish how these conditions are defined 
        and ensure that it captures conditions across the lifespan, 
        evaluate sex and gender differences and racial health 
        disparities, and determine the appropriate level of funding 
        that is needed to address gaps in women's health research at 
        the NIH. The Committee requests the Academies to, not later 
        than 18 months after the date on which the agreement is 
        entered, to submit to Congress a report containing the findings 
        of the study and the recommendations to address research gaps 
        in women's health research, including measurable metrics to 
        ensure that this research is accurately tracked to meet the 
        continuing health needs of women.
                    support for an rcdc on menopause
    The RCDC system is a computer-based process that sorts NIH-funded 
projects into categories of research area, disease, or condition. There 
is currently no RCDC category for menopause, which is a condition that 
will impact all women during their lifespan and remains understudied in 
research. Since menopause is critical to understanding women's health, 
the WFRC believes NIH should create a RCDC category for this condition 
so that this research can be tracked and analyzed over time. 
Furthermore, the creation of an RCDC for menopause will allow for 
increased access to information and greater transparency of funded 
research projects related to the study and treatment of menopause.
    Therefore, the WFRC respectfully requests that you include the 
following report language in the report that accompanies the FY 2023 
LHHS appropriations bill under the NIH Office of the Director:

      Menopause.--The Committee is concerned about the lack of a 
        Research Condition, Disease Categorization (RCDC) category for 
        menopause, which limits the ability to analyze current and 
        future biomedical research being done on menopause. As 
        menopause is a condition that will impact all women and is an 
        important component of understanding women's health across the 
        lifespan, it is critical that the NIH report on and be able to 
        track the intramural and extramural research being done. The 
        Committee requests that the NIH create a RCDC code for 
        menopause.
                               conclusion
    Thank you again for the opportunity to submit testimony to the 
Committee as you begin your work on the FY 2023 appropriations bills. 
We look forward to working with you to ensure that there is appropriate 
funding for women's health research at the NIH, to address gaps in 
women's health research and to improve health across the lifespan for 
women.
                                 ______
                                 
     Prepared Statement of the Women's Health Innovation Coalition
    Thank you for the opportunity to comment on the National Institutes 
of Health (NIH) budget priorities for FY 2023. We provide this 
testimony in support of increased funding for research grants focused 
on addressing health diseases and conditions that solely, 
disproportionately and/or differently impact women within the FY 2023 
Labor, Health and Human Services, and Education Appropriations bill.
    The Women's Health Innovation Coalition (WHIC) is a group of 
innovators, investors, clinicians, analysts, and executives with the 
shared goal of advancing innovation in women's health. We source 
innovative solutions to address unmet needs in diseases, conditions, 
and indications that impact the health of women and minorities. Through 
collaborative advocacy and policy efforts, we are working to drive 
initiatives that demonstrate women's health is not a niche market and 
to promote greater gender--relevant data transparency and increased 
investment in R&D to bring innovations to market that address gaps in 
care that harm women and minorities and result costly medical 
expenditures.
    We have identified eight areas of health that solely, 
disproportionately, or differently impact women, requiring further 
government research investment and better education and awareness among 
patients and clinicians in order to advance scientific understanding 
and medical innovations:
                         cardiovascular health
    Cardiovascular disease affects one in 16 women over the age of 20, 
is responsible for nearly one in five deaths annually for women, and 
women 55 and under are twice as likely to die from a heart attack than 
men.\1\ Furthermore, women are seven times more likely to be 
misdiagnosed and discharged in the middle of a heart attack than men, 
as men and women present with different symptoms during cardiovascular 
distress and too many physicians continue to be trained to only see 
signs in white men.\2\ Women with cardiovascular disease are also more 
likely to report poorer patient experience, lower health-related 
quality of life, and poorer perception of their health when compared 
with men.\3\ This translates to unnecessary costs across the United 
States healthcare system, as unrecognized and inadequate treatment of 
cardiovascular diseases will surpass $1 trillion by 2035.\4\
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    \1\ Mayo Clinic, October 4, 2019: https://www.mayoclinic.org/
diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167.
    \2\ Coya Partners, 2020: https://www.coyapartners.com/blog.
    \3\ Victor Okunrintemi, Javier Valero-Elizondo, Benjamin Patrick, 
et. al, ``Gender Differences in Patient-Reported Outcomes Among Adults 
with Atherosclerotic Cardiovascular Disease'', December 10, 2018, 
https://www.ahajournals.org/doi/10.1161/JAHA.118.010498.
    \4\ RTI International, ``Cardiovascular Disease Costs will exceed 
$1 Trillion by 2035'', February 14, 2017: https://www.rti.org/news/
cardiovascular-disease-costs-will-exceed-1-trillion-2035.
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                 autoimmune and immunological diseases
    With 80 percent of all patients diagnosed with autoimmune diseases 
being women and 100 types of them predominantly affecting women, this 
area of health must be addressed.\5\ Part of this disparity can be 
attributed to many autoimmune disorders' tendency to affect women 
during periods of extreme stress, such as pregnancy, or during period 
of hormonal change.\6\ There are few treatments available for many 
autoimmune diseases, which can be uncomfortable, painful and impact a 
woman's ability to work and care for her family. Autoimmune diseases 
are also extremely costly, as the National Institutes of Allergy and 
Infectious Diseases has estimated that the cost of treating autoimmune 
disease in the U.S. is greater than $100 billion annually.
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    \5\ The Prevalence of Autoimmune Disorders in Women: A Narrative 
Review, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292717/.
    \6\ Angum, Fariha et al. ``The Prevalence of Autoimmune Disorders 
in Women: A Narrative Review.'' Cureus vol. 12,5 e8094. 13 May. 2020, 
doi:10.7759/cureus.8094.
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                                oncology
    Women bear the burden of inequitable oncological treatment options 
as well as disparities in specific cancers. For example, one in five 
people who are diagnosed with lung cancer have never smoked, yet non-
smoking women are three times more likely to have the disease.\7\ 
Gender disparities are also pervasive in terms of treatment options, as 
a recent study showed that the odds of receiving radiation were 60 
percent for women and 70 percent for men, and the odds for receiving 
intensive chemotherapy were 35 percent for women versus 46 percent for 
men.\8\ In terms of mortality, the ratio of cancer deaths versus non-
cancer deaths was 1.92 times higher for women than for men.\9\ Cancers 
also disproportionately impact minorities and populations with social, 
environmental, and economic disadvantages that hinder access to 
healthcare. African American and Caucasian women have similar rates of 
breast cancer, yet African American women are more likely to die from 
the disease. Hispanic and African American women also have higher rates 
of cervical cancer than women of other ethnic groups, with African 
American women having the highest rates of death from cervical 
cancer.\10\ In addition, ovarian cancer is the only gender-specific 
cancer with greater than 50 percent mortality rate, and accounts for 
more deaths than any other cancer of the female reproductive system 
with Black women having a much higher 5-year mortality rate (62 
percent) vs. Caucasian women (54 percent).\11\
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    \7\ Brigham and Women's Hospital, ``Why Women's Health Can't 
Wait'', 2014, https://www.brighamandwomens.org/assets/bwh/womens-
health/pdfs/connorsreportfinal.pdf.
    \8\ Ibid.
    \9\ Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA: A 
Cancer Journal for Clinicians 2017; 67(1):7-30.
    \10\ National Cancer Institute, ``Cancer Disparities,'' https://
www.cancer.gov/about-cancer/understanding/disparities.
    \11\ American Cancer Society, https://www.cancer.org/content/dam/
cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-
figures-for-african-americans/cancer-facts-and-figures-for-african-
americans-2019-2021.pdf.
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                         aging and bone health
    A women's risk of bone fracture is equal to her combined risk of 
breast, uterine, and ovarian cancer, which is four times the rate of 
men. Of the 10 million Americans with osteoporosis, approximately 80 
percent are women and a proximately one in two women over age 50 will 
break a bone because of osteoporosis.\12\ Studies have shown that there 
are multiple reasons why women are more likely to get osteoporosis than 
men. Women tend to have smaller and thinner bones, and women's 
estrogen, a hormone that protects bones, decreases when women reach 
menopause.\13\ This prevalence of bone diseases is not only dangerous 
for women but is also extremely costly. The annual cost of 
osteoporosis-related bone breaks is $19 billion for patients, their 
families, and the healthcare system, and is expected to continue to 
rise.
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    \12\ https://www.nof.org/preventing-fractures/general-facts/what-
women-need-to-know/.
    \13\ National Osteoporosis Foundation ``What Women Need to Know'' 
https://www.nof.org/preventing-fractures/general-facts/what-women-need-
to-know/.
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                    gynecological and sexual health
    Several gynecological conditions women face throughout their lives 
and especially as they age are often ignored with insufficient 
diagnostics and treatments. For example, the annual gynecological exam 
does not screen for ovarian cancer and 1 in 5 women have masses, yet 
few diagnostics can catch the cancerous tumors during the critical 
early stages, especially among women of color who are most often 
diagnosed too late and die sooner. In addition, more than 4,000 women 
enter menopause every day in the U.S., but only one in five OB/GYN 
residency programs provide menopause training to support them and 
nearly 80 percent of medical residents admit that they feel ``barely 
comfortable'' discussing or treating menopause.\14\ Also, 84 percent of 
women experience menopause symptoms, and more than one in 10 (12 
percent) say their symptoms can be severe or debilitating. Yet 
menopause is understudied and misunderstood by physicians and 
researchers alike with few treatments available for the impact on women 
that is so severe, many stay home or retire early when they are 
otherwise in the prime of their career. Most do not understand when 
symptoms are ignored or misdiagnosed during menopause years, they can 
lead to severe complications, preventable death, and avoidable and 
costly medical expenditures. These conditions cost the U.S. healthcare 
system four times the costs of their non-symptomatic peers. Globally, 
menopause-related productivity losses can amount to more than $150 
billion a year and if costs to the healthcare system are included, the 
total price tag of menopause could be higher than $810 billion.\15\
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    \14\ https://www.aarp.org, Note this study also found 84 percent of 
women say that their menopausal symptoms interfere with their lives, 
including at work.
    \15\ Reenita Das, a partner and senior vice president for 
healthcare and life sciences at consulting firm, Frost & Sullivan, 
https://apple.news/AkFLvCBgGST6IKWENlXbf_w.
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                          reproductive health
    Disparities in maternal and reproductive health are also a major 
concern in the U.S. Studies document decades-long racial and ethnic 
disparities in several areas of reproductive health, including 
contraceptive use, care for sexually transmitted infections and the 
human papillomavirus (HPV) vaccination among younger women aged 18 to 
25 years, as well as reproductive cancers, preterm deliveries, and 
maternal morbidity and mortality in all age groups.\16\ Most women lack 
sufficient resources, information and access to care related to 
perinatal mood and anxiety disorders (PMADs), the number one 
complication resulting from pregnancy and childbirth. Half of perinatal 
women with a diagnosis of depression do not get the medical treatment 
that they need, resulting in poor patient outcomes and increased 
societal costs. The total annual societal costs incurred by PMADs, 
including maternal productivity loss (such as loss of work productivity 
and missing work), greater use of public sector services (such as 
welfare and Medicaid), and higher health care costs due to worsened 
maternal and child health, was $14.2 billion in 2017. This equates to 
$4.7 billion in productivity losses, $2.9 billion in maternal health 
expenditures, $3.3 billion in preterm births, and $1.6 billion in child 
behavioral and developmental disorder spending.\17\ These staggering 
costs and the devastating effects for mothers who suffer from PMADs 
must be discussed and addressed.
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    \16\ Obstetrics & Gynecology: February 2021--Volume 137--Issue 2--p 
225-233, doi: 10.1097/AOG.0000000000004224.
    \17\ Mathematica Policy Research, ``Societal Costs of Untreated 
Perinatal Mood and Anxiety Disorders in the United States'', April 29, 
2019, https://www.mathematica.org/download-media?MediaItemId=(E24EE558-
B67B-4BF6-80D0-3BC75DB12EB6).
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                       cognitive and brain health
    Cognitive and brain function is another health area in which 
significant disparities exist between men and women. Two-thirds of 
Alzheimer's patients over 65 are women and two--thirds of caregivers 
are women.\18\ Moreover, despite clear biological differences in 
cognitive function, women are not proportionately represented 
throughout the research process, and female-specific cognitive diseases 
are not proportionately funded. In medical research for anxiety 
disorders, 90 percent of animal subjects are male, though women are 
twice as likely to be diagnosed with anxiety in their lifetime.\19\ 
Although two-thirds of Alzheimer's patients are women 66 percent of 
animals used in Alzheimer's research are male or of an ``unspecified 
gender,'' which are mostly male. There is also a stark disparity in 
funding allocation, as just 12 percent of the National Institutes of 
Health (NIH)'s 2019 budget of $2.4 billion for Alzheimer's disease 
research went toward projects specifically focused on women. Not only 
does this hinder innovation, understanding, and treatment of 
Alzheimer's disease, it also results in severe economic consequences. 
If $300 million had been shifted to the NIH's Alzheimer's budget to 
focus on women's brain health in that same year, it would have produced 
over $930 million in economic benefits, including quality of life 
improvements, and reduced medical costs.\20\
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    \18\ Centers for Disease Control and Prevention, https://
www.cdc.gov/aging/caregiving/alzheimer.htm.
    \19\ Gender Differences in Anxiety Disorders: Prevalence, Course of 
Illness, Comorbidity and Burden of Illness, https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3135672/.
    \20\ Women's Health Access Matters, ``Societal Impact of Research 
Funding for Women's Health in Alzheimer's Disease and Alzheimer's 
Disease Related Dementias,'' April 2021, https://thewhamreport.org/wp-
content/uploads/2021/04/TheWHAMReport_ADRD.pdf.
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                          adverse drug events
    While recent clinical studies have included more women, for 
decades, the patients who participated in clinical trials for new drugs 
skewed heavily male. As a result, many drugs commonly prescribed to 
this day do not account for gender differences making them ineffective 
or causing patient harm. Today, most pre-clinical trials continue to 
exclusively use male mice and male animals even though sex differences 
are found at the cellular level. Few pre-clinical trials use both sexes 
to inform the next phase of studies in humans, and even if experiments 
do include female animals, the subgroup analyses by sex are not 
reported.\21\ During the next phase of research when the clinical trial 
includes women, often for the first time, and always at a level far 
below the actual representation of women in prevalence rates for the 
disease for which the drug is being developed to treat, this 
underrepresentation is magnified with greater room for error and ADE 
occurrence.
---------------------------------------------------------------------------
    \21\ It is time to integrate sex as a variable in preclinical and 
clinical studies, https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC6056479/.
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                            recommendations
    With the continued failure to address so many women's health 
issues, we must increase NIH investment in advancing research in these 
areas. An analysis of NIH funding patterns found that in nearly three-
quarters of the cases where a disease afflicts primarily one gender, 
the funding pattern favors males, in that either the disease affects 
more women and is underfunded, or the disease affects more men and is 
overfunded. Furthermore, the disparity between actual funding and that 
which is commensurate with burden is nearly twice as large for diseases 
that favor males versus those that favor females.\22\ Finally, just 11 
percent of NIH research dollars are dedicated to women's health.
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    \22\ Arthur A Mirin, ``Gender Disparity in the Funding of Diseases 
by the U.S. National Institutes of Health'' July 30, 2021, https://
pubmed.ncbi.nlm.nih.gov/33232627/.
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    Therefore, we ask that Congress increase funding and programmatic 
investments for the NIH to prioritize all health conditions that 
solely, disproportionately or differently impact women and minorities. 
We must improve scientific understanding, investment, research, 
treatments, diagnostics and awareness for these populations that 
represent over half the population. We are eager to work with you in 
this endeavor, find ways to match government funding by incentivizing 
private investment in this research, and work in a concerted effort to 
advance the health of women and minorities. Thank you for your 
consideration.
                                 ______
                                 
   Prepared Statement of the Workforce Innovation and Opportunity Act
    The May 21, 2014 Statement of Managers to Accompany the Workforce 
Innovation and Opportunity Act \1\ (WIOA) provides broad intentions to 
modernize the Nation's workforce development, adult education, and 
vocational rehabilitation systems through a focus on sector strategies, 
career pathways, and strategic alignment. WIOA required disaggregated 
reporting of outcomes by special population as well as participation 
and performance on key indicators by age, race, ethnicity, and gender. 
Even though Congress' statement does not once use the word 'equity,' 
clearly equitable outcomes for community members most in need was at 
the heart of its intent then and what is needed now.
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    \1\ https://www.help.senate.gov/imo/media/doc/
WIOA%20Statement%20of%20Managers.pdf.
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    Our 2022 policy comments are guided by principles of equity, 
efficiency and quality for youth and adults, responsiveness to 
providers, and collaboration across all WIOA and relevant other 
partners. The comments are distilled from quantitative and qualitative 
research activities undertaken in a comprehensive WIOA landscape 
analysis project conducted by World Education, Inc., as well as decades 
of experience in local, State, and Federal adult education and 
workforce development systems.
2022 WIOA Reauthorization Opportunities
    Many of the innovative service designs such as career pathway and 
apprenticeship programs and equity levers that WIOA codified have yet 
to be fully utilized, and reauthorization should double-down on 
implementation of those key levers. In addition to increasing the 
potential impact of the existing policy, a number of substantive 
changes would make it easier for WIOA practitioners to partner and 
provide quality education, training, and other services to their 
communities.
    WIOA's implicit purpose is equity, and we respectfully submit these 
recommendations to strengthen the joint purpose of an equitable 
economic recovery and a prosperous future for all America.
Include a Separate Title for Funding America's Job Centers (AJCs), 
        Including Virtual Services
    Fund an Equitable Network. A separate title or section within Title 
I in WIOA should be included to provide for the funding of the AJC 
network, including brick and mortar as well as virtual infrastructure 
and certain shared service delivery costs. This direct additional 
infrastructure funding would solve a longstanding issue and could 
potentially free up more resources for services. The recommended 
separate title would describe allowable uses of funding and specify 
what constitutes fair and reasonable infrastructure costs. These funds 
would be distributed through the local allocation formula used for 
Title I and would be administered under a MOU (Memorandum of 
Understanding) negotiated between the local board and governor. Under 
this model, the WIOA core programs would have a shared presence in the 
physical and virtual AJCs, and other partners could opt to co-locate or 
to provide remote access to services, depending on local needs and 
available resources.
Amend Deficit-Based Language That Creates Deficit-Based Programming and 
        Leverage Community Stakeholders to Design Strategies
    Address the Barrier and Recognize Assets and Experience. WIOA 
reauthorization needs to address this deficit-based language while 
maintaining critical reporting on who receives what services and to 
what impact. One way to do this would be to reframe 'individuals with 
barriers' to 'individuals CONFRONTING barriers' and to clearly 
articulate that the public workforce system's role is to support that 
confrontation with resources needed to overcome barriers. Another way 
is to rethink eligibility and shift the mindset of fixing individuals 
with barriers to a system supporting economic opportunity and mobility 
for those that can benefit from it.
    The deficit-based language is also problematic in how it affects 
the process of designing effective services. Reauthorization should 
involve a stakeholder consultative process, much like that included in 
Strengthening Career & Technical Education for the 21st Century Act 
(Perkins V) in which people confronting the barriers detailed in WIOA 
priority populations should be involved in designing the services for 
their communities. Adults in our communities have skills and 
experiences that can be a powerful starting point for building toward 
their career aspirations. WIOA needs to leverage job seekers' assets in 
order to design more effective solutions.
    In this process of designing effective services, consideration 
should be given to ``lift up alternatives and approaches to workforce 
development beyond those focused on jobs, skills, training, and 
individual worker assets and deficits. Specifically, consider strategy 
and policy approaches that expand access to our Nation's safety net; 
address 'digital redlining' and invest in digital access and learning; 
and support access to high quality jobs and benefits.'' \2\
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    \2\ https://workforce-matters.org/a-racial-equity-framework-for-
workforce-development-funders/.
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Optimize Alignment of Services, Systems, Resources, and Reporting 
        Across WIOA Core Programs and WIOA Partner Programs
    Provide Flexibility. Incorporate authority that would allow Tribal, 
municipal, county and State governments to request flexibility and 
grant waivers to pool resources from various WIOA Titles and WIOA 
Partner Programs to build career pathway systems and programs toward 
the goal of improved outcomes for low-income youth and adults in the 
domains of education, training, employment, earnings, health and 
wellbeing.
Invest in Evidence-Based Program AEFLA Models
    IET is Evidence-Based and a Racial Equity Strategy--Create an 
Integrated Education & Training Funding Stream. The Institute for 
Education Science (IES) What Works Clearinghouse (WWC) holds the 
highest standard for rigor in independent education research, seeking 
to drive education policy less by 'professional wisdom' and more by 
evidence-based practice. In September, 2020, the National Center for 
Education Evaluation at IES released an Intervention Report on I-BEST. 
This gold-standard research identified three randomized control trial 
studies that meet the WWC criteria, documenting impacts on 45,413 
learners in nine States and demonstrating statistically significant 
positive impacts for the career pathway participants versus the control 
group:
  --+18 positive effects on industry-recognized credential, certificate 
        or license completion;
  --+10 potentially positive effects on short-term employment; and
  --Potentially positive effects on short-term earnings.\3\
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    \3\ (2020, September). Integrated Basic Education Skills and 
Training (I-BEST). Retrieved from https://ies.ed.gov/ncee/wwc/
InterventionReport/706.
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    Ability to Benefit to Support Adult Dual Enrollment in IET. The 
Ability to Benefit (ATB) student financial aid provision in the Higher 
Education Act (HEA) provides underserved students access to accelerated 
and integrated high school and college credentials through adult dual 
enrollment. When creating IET with HEA Title IV-eligible student 
financial aid, Ability to Benefit (ATB) is the obvious choice. However, 
ATB is poorly understood and massively underutilized, in no small part 
due to the fluctuation of legislative approval.
    Integrated Education and Training works and it works to motivate 
persistence with individuals WIOA is meant to serve. A reauthorized 
WIOA Title II AEFLA needs to directly invest in Integrated Education & 
Training with dedicated funds for this evidence-based strategy and 
clear guidance on utilizing the Ability to Benefit provision of the 
Higher Education Act within an adult dual enrollment strategy. Pell 
grants are critical for adults both for immediate tuition needs and to 
offset the opportunity costs of being an adult student with living 
expense funding.
    Fund Remote and Blended Programs and Make Digital Skill Development 
an Allowable Activity and Fund Use. Remote learning programs require 
additional funds to purchase, maintain and replace devices, software 
licenses, technology navigators, and remote classroom aides. Emerging 
COVID-19 based research suggests that those costs are 12 percent-22 
percent higher than straightforward in-person delivery. This is the 
time to invest in them and take adult education fully into the 21st 
century and beyond. There is a strong foundation to build on and scale 
up. World Education's EdTech Center has been documenting these models 
and specific best practices and providing free professional development 
to providers.
    In addition, amend WIOA to make digital capability/literacy an 
allowable activity and fund use in the same way ABE, ASE, ESOL, and 
Integrated English Language and Citizenship services are. Amend the 
definition of Measurable Skill Gain to include documented digital 
skills.
Fund Career Navigators
    Fund A Navigation System. Provide direct funding through WIOA for 
career navigators including 2.5 percent of that funding for navigator 
preparation, professional development, and support. Provide 
approximately $4 billion annually in new Federal funding to make 
coaching available to 20 million unemployed and low-wage workers within 
the workforce system, community colleges, and community-based 
organizations. This could be done via the following mechanisms:
  --Additional funding for Wagner-Peyser (WIOA Title III) to expand 
        access to career coaching for the newly-unemployed;
  --Increased funding for WIOA Titles I, II, and IV to create coaching 
        positions at the AJCs and other workforce service providers;
  --Ensure career navigation is articulated as an AEFLA service and 
        make the use of funds for this purpose allowable;
  --Update the Reemployment Services and Eligibility Assessment program 
        to encourage more access to high-quality career navigators for 
        unemployment insurance recipients; and
  --Funding delivered through WIOA for States to provide career and 
        digital navigator funding to community-based organizations, 
        labor-management partnerships and for eligible institutions in 
        partnership with employers and labor unions to offer career 
        navigation/coaching supports at places of work and community 
        colleges, with a focus on underserved communities. Clarify that 
        some of this funding can go to providers of direct online 
        navigation services, as well as to non-profit providers of 
        navigator professional development and supports.
    Improve data collection on career navigation services across all 
WIOA titles, and evaluate the provision of career navigation services 
through the AJC network, including assessing the extent to which these 
services can help reduce equity gaps in employment and earnings 
results.
    Additionally, Digital Navigator initiatives \4\ are providing 
valuable just-in-time digital skill building to adults for career and 
wider community needs, but these efforts would benefit from direct 
connection to and investment from the public workforce system.
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    \4\ https://digitalus.org/digital-navigators/.
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    Respectfully.

    [This statement was submitted by Priyanka Sharma, Vice President, 
[email protected] and Judy Mortrude, Senior Technical 
Advisor, [email protected].]
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