[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR 2026
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
___________
SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES,
EDUCATION, AND RELATED AGENCIES
ROBERT B. ADERHOLT, Alabama, Chairman
JULIA LETLOW, Louisiana, ROSA L. DeLAURO, Connecticut,
Vice Chair Ranking Member
MICHAEL K. SIMPSON, Idaho STENY H. HOYER, Maryland
ANDY HARRIS, Maryland MARK POCAN, Wisconsin
CHARLES J. ``CHUCK'' FLEISCHMANN, LOIS FRANKEL, Florida
Tennessee BONNIE WATSON COLEMAN, New Jersey
JOHN R. MOOLENAAR, Michigan JOSH HARDER, California
ANDREW S. CLYDE, Georgia MADELEINE DEAN, Pennsylvania
JAKE ELLZEY, Texas
STEPHANIE I. BICE, Oklahoma
RILEY M. MOORE, West Virginia
NOTE: Under committee rules, Mr. Cole, as chairman of the full
committee, and Ms. DeLauro, as ranking minority member of the full
committee, are authorized to sit as members of all subcommittees.
Kathryn Salmon, Emily Goff, James Redstone,
Kirk Boyle, Jaime Varela, and Emma Lou Ford
Subcommittee Staff
___________
PART 2
Page
Public Witness Day........................................... 1
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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Printed for the use of the Committee on Appropriations
PART 2--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR 2026
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR 2026
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
___________
SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES,
EDUCATION, AND RELATED AGENCIES
ROBERT B. ADERHOLT, Alabama, Chairman
JULIA LETLOW, Louisiana, ROSA L. DeLAURO, Connecticut,
Vice Chair Ranking Member
MICHAEL K. SIMPSON, Idaho STENY H. HOYER, Maryland
ANDY HARRIS, Maryland MARK POCAN, Wisconsin
CHARLES J. ``CHUCK'' FLEISCHMANN, LOIS FRANKEL, Florida
Tennessee BONNIE WATSON COLEMAN, New Jersey
JOHN R. MOOLENAAR, Michigan JOSH HARDER, California
ANDREW S. CLYDE, Georgia MADELEINE DEAN, Pennsylvania
JAKE ELLZEY, Texas
STEPHANIE I. BICE, Oklahoma
RILEY M. MOORE, West Virginia
NOTE: Under committee rules, Mr. Cole, as chairman of the full
committee, and Ms. DeLauro, as ranking minority member of the full
committee, are authorized to sit as members of all subcommittees.
Kathryn Salmon, Emily Goff, James Redstone,
Kirk Boyle, Jaime Varela, and Emma Lou Ford
Subcommittee Staff
___________
PART 2
Page
Public Witness Day........................................... 1
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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Printed for the use of the Committee on Appropriations
U.S. GOVERNMENT PUBLISHING OFFICE
62-326 WASHINGTON : 2026
HOUSE COMMITTEE ON APPROPRIATIONS
TOM COLE, Oklahoma, Chairman
HAROLD ROGERS, Kentucky, ROSA L. DeLAURO, Connecticut,
Chairman Emeritus Ranking Member
ROBERT B. ADERHOLT, Alabama STENY H. HOYER, Maryland
MICHAEL K. SIMPSON, Idaho MARCY KAPTUR, Ohio
JOHN R. CARTER, Texas JAMES E. CLYBURN, South Carolina
KEN CALVERT, California SANFORD D. BISHOP, Jr., Georgia
MARIO DIAZ-BALART, Florida BETTY McCOLLUM, Minnesota
STEVE WOMACK, Arkansas DEBBIE WASSERMAN SCHULTZ, Florida
CHARLES J. ``CHUCK'' FLEISCHMANN, HENRY CUELLAR, Texas
Tennessee CHELLIE PINGREE, Maine
DAVID P. JOYCE, Ohio MIKE QUIGLEY, Illinois
ANDY HARRIS, Maryland GRACE MENG, New York
MARK E. AMODEI, Nevada MARK POCAN, Wisconsin
DAVID G. VALADAO, California PETE AGUILAR, California
DAN NEWHOUSE, Washington LOIS FRANKEL, Florida
JOHN R. MOOLENAAR, Michigan BONNIE WATSON COLEMAN, New Jersey
JOHN H. RUTHERFORD, Florida NORMA J. TORRES, California
BEN CLINE, Virginia ED CASE, Hawaii
GUY RESCHENTHALER, Pennsylvania ADRIANO ESPAILLAT, New York
ASHLEY HINSON, Iowa JOSH HARDER, California
TONY GONZALES, Texas LAUREN UNDERWOOD, Illinois
JULIA LETLOW, Louisiana SUSIE LEE, Nevada
MICHAEL CLOUD, Texas JOSEPH D. MORELLE, New York
MICHAEL GUEST, Mississippi MIKE LEVIN, California
RYAN K. ZINKE, Montana MADELEINE DEAN, Pennsylvania
ANDREW S. CLYDE, Georgia VERONICA ESCOBAR, Texas
STEPHANIE I. BICE, Oklahoma FRANK J. MRVAN, Indiana
SCOTT FRANKLIN, Florida MARIE GLUESENKAMP PEREZ,
JAKE ELLZEY, Texas Washington
JUAN CISCOMANI, Arizona GLENN IVEY, Maryland
CHUCK EDWARDS, North Carolina
MARK ALFORD, Missouri
NICK LaLOTA, New York
DALE W. STRONG, Alabama
CELESTE MALOY, Utah
RILEY M. MOORE, West Virginia
Susan Ross, Chief Clerk and Staff Director
(II)
DEPARTMENTS OF LABOR, HEALTH, AND
HUMAN SERVICES, EDUCATION
APPROPRIATIONS FOR 2026
----------
Wednesday, April 9, 2025.
TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS
WITNESS
JESSICA PESCATORE, CLINICAL DIRECTOR, ALABAMA POISON INFORMATION
CENTER, AMERICA'S POISON CENTERS
Mr. Aderholt. Okay. The committee will come to order, and I
wanted to say good morning to everyone. It is my pleasure to
welcome everyone to the Subcommittee on Labor, Health and Human
Services, and Education, and for what is our hearing to hear
from outside experts and the public.
This is our Public Witness Day. It is an opportunity for
members of the public to come before this panel and to draw our
attention to issues of importance to them. I look forward to
hearing from our witnesses this morning as we learn more
regarding the challenges facing our constituents and also
communities across the country and, at the end of the day, what
this subcommittee can do to try to be of help.
For our witnesses, a 5-minute clock will be the countdown
on the microphone box that will be in front of you as you take
the chair, and you will have 1 minute remaining when the light
turns yellow. That, of course, will just be an indication, a
signal for you to begin to wrap up your testimony. Remember, of
course, all of your testimony, your written statement will be
submitted to the committee and will appear in the hearing
record. So if you don't get to all of your comments, they will
be submitted for the record.
But before we begin, I would like to turn to the ranking
member of the full committee and the subcommittee here, Rosa
DeLauro, for any remarks that she would like to make.
Ms. DeLauro. Thank you very much, Mr. Chairman. It is a
pleasure to join with you this morning, and thank you for
holding this hearing with our wonderful public witnesses to
discuss the 2026 budget.
To our witnesses, we just offer a welcome to you to the
Labor, Health, Human Services, and Education Subcommittee of
Appropriations. I want to express my sincere gratitude to all
of you and appreciation for the work that you do and on whose
behalf you do it. You are such wonderful, wonderful advocates,
and we thank you for the written testimonies for the record.
Your advocacy and your testimony is invaluable to us and to the
subcommittee's bill. I have said so many times in the past,
today's hearing is really one of the most important parts of
this subcommittee's process.
The programs in Labor, HHS in this bill, they level the
playing field for low-income children looking to get a good
education. They equip our Nation to deal with public health
emergencies, they fund lifesaving biomedical research, and they
help Americans get the skills that they need to be able to find
a job. And the list goes on and on and on because the programs
directly impact the lives of every American across our country,
especially children, workers, middle-class, families, and
seniors.
We are challenged these days with the future of some of
these programs as there have been, as you know, illegal freeze
payments, which take funds from programs that I believe
American families and businesses rely on, and especially in the
area that we are looking at that are under the jurisdiction of
this subcommittee in both education, which we know there is a
move to eliminate the Department of Education, and really, for
me, that is about eliminating public education, which is so
critical to our children. And the Department of Health and
Human Services is undergoing this rapid transformation with the
loss of potentially up to 20,000 people. So we know that
thousands of Federal workers have been fired, billions of
dollars canceled in funding for education. With regard to
education, if you eliminate Title I of Education, we would lose
72,000 teachers across the country, and then there will be more
to come.
I am very troubled by what is happening at HHS because of
what is the threat to destroy the agencies that protect
America's health. That includes the Center for Disease Control
and Prevention, the National Institutes of Health, the Food and
Drug Administration. Twenty thousand workers, as I have said,
have been fired at HHS. That is one-fourth of their workforce,
$12 billion in funds provided by the Congress for public health
and substance abuse treatment. I believe what we will see next
is the Department of Labor and already terminated funding for
the Bureau of International Labor Affairs, or ILAB, an Agency
whose mission is to ensure American workers are not put at a
disadvantage by countries who violate their labor commitments
under our trade agreements. We expect the axe to fall on the
Department of Labor's worker protection agencies, the Wage and
Hour Division and OSHA, that are responsible for protecting
worker safety and hard-earned wages.
The American people are calling our offices every day
asking about this spending freeze and what has happened to
already-appropriated funding. American people are concerned,
and there is a lot of fear out there and we have to address
that. I say these things to let you know, but I also say with
great optimism that you have such a profound role to play, and
your voices need to be heard very strongly and powerfully about
the resources that this subcommittee provides for you to carry
out your missions, to be able to address the health needs of
our families or education needs of our families, or the ability
for people to be gainfully employed and what their futures are
going to be. That is what our job is in this subcommittee.
So we welcome you because more than ever now, your voices
need to be heard. Thank you for being here, and we look forward
to your testimony. So thank you, Mr. Chairman, and I yield
back.
Mr. Aderholt. Thank you, Ranking Member DeLauro, and I
would like to recognize our first witness. Our first witness
will be Jessica Pescatore, and I may have butchered that a
little bit, but Pescatore? Good. All right. We got it. All
right. Well, welcome to the subcommittee, and we look forward
to hearing your testimony.
Ms. Pescatore. Thank you. Good morning, Chairman Aderholt,
Ranking Member DeLauro, and distinguished members of the
subcommittee. My name is Dr. Jessica Pescatore, and I am an
emergency medicine pharmacist, clinical toxicologist, and the
clinical director of the Alabama Poison Information Center.
Thank you for the opportunity to share the critical work of our
Nation's 53 poison centers, and thank you for your
longstanding, bipartisan support of the Poison Control Center's
program. We are especially grateful to have been reauthorized,
and I am here today to respectfully request a $2 million
increase over current funding levels for the program in fiscal
year 2026. This morning I would like to highlight the value of
a poison center, share my center's efforts in addressing public
health risks, such as unregulated and illicitly manufactured
substances, and discuss some nationwide challenges.
Poison centers provide 24/7 lifesaving expertise to all
Americans, from concerned parents to first responders and
clinicians, to public health agencies. Our teams of expert
nurse, pharmacist, and physician, poison specialists, and
toxicologists deliver accurate real time guidance on poisoning
emergencies. On average, poison centers receive a call every 15
seconds. That means in our brief time together, 20 calls will
have been managed by a poison center. In this last month alone,
over 201,000 poisoning cases were handled by poison centers
across the country, with cases ranging from a grandparent
accidentally doubling their blood pressure medication dose, to
a child ingesting a household cleaner, to a gardener bitten by
a snake, to a teenager overdosing in a self-harm attempt. But
beyond our day-to-day management of these poisoning
emergencies, we also function as an all-hazards response
program in the regions we serve.
At the national level, we work together as a network to
support our Nation's broader public health system, including
through America's poison centers. Whether a foodborne illness
outbreak, natural disaster, chemical attack, or emerging public
health threat, you can count on a poison center being a part of
the public health response. We also play a crucial role in
lowering healthcare costs, in large part through our efficient
triage methods, which prevent unnecessary and costly emergency
department visits, enabling safe home monitoring with close
follow-up and further preserving vital hospital resources.
According to a Lewin Group report, for every dollar the Federal
Government invests in poison centers, there is a saving of over
$38. That equates to over $662 million saved per year.
In Alabama, our Center has collaborated with key partners,
including the Alabama Department of Public Health, to safeguard
our constituents from unregulated agents, like tianeptine, a
supplement with potent opioid-like effects that that was being
sold at our local gas stations. Leveraging our Center's
expertise and data, we informed and enabled statewide efforts
to restrict access and reduce exposures by 75 percent. We are
also committed to combating illicitly-manufactured substances
of abuse, like fentanyl. Engaging in data-driven decision-
making as well as community outreach across all levels, poison
centers help to stake steer resource allocation and target
messaging.
Our centers face challenges that threaten our ability to
continue this vital work, however. Like many organizations, we
face a growing challenge to attract and retain qualified staff.
The critical work of poison centers highly relies on highly-
trained and credentialed professionals, such as toxicologists
and poison specialists, and while our calls remain steady, our
cases continue to grow in complexity and nuance. Additionally,
public risks and, by extension, our mission are ever evolving.
Thus, our professionals must commit to lifelong learning and be
supported by advancing systems in order to do so.
Finally, we are facing a critical risk to the National
Poison Data System, or NPDS, an essential tool that provides
real-time, integrated poison center data which aids in
prevention and surveillance at every level. With regional data
uploaded every 5 minutes, NPDS rapidly detects case clusters,
anomalies, and enables swift, coordinated responses to crises
of any form, driving a unified escalation of efforts across the
Nation. Federal agencies, including the CDC, have long
leveraged NPDS to provide them with real-time data and exposure
monitoring. Recent Federal reorganization efforts could
inadvertently jeopardize this vital partnership, and without
continued Federal support, this essential data source could
lapse, risking significant disruptions in our Nation's
healthcare network. We request the subcommittee's continued
support of our program and aid in preventing unintended
consequences to NPDs, ensuring your constituents and healthcare
professionals, as well as local, State, and Federal entities
have access to critical, real-time data.
On behalf of the Alabama Poison Information Center, our
host institution, Children's of Alabama, and each of our
Nation's 53 poison centers, I thank you all for the opportunity
to testify before you today. Thank you.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Aderholt. Thanks so much. I appreciate your testimony,
and, again, all of it will be included in the record. And we
appreciate you giving that information to us, and we look
forward to working with you. Ranking Member DeLauro, you are
next.
Ms. DeLauro. Thank you. I want to thank you for the great
work and applaud the work in Alabama, and you talked about
regulating tianeptine, which is a controlled substance. What
you are doing is a good example of an unsafe food additive that
is being marketed to the public deceptively, and it is being
marketed as a dietary supplement, but it has real consequences,
so I thank you for doing that. And I would just say that we
want to preserve the programs that HRSA covers, as you do, in
making sure that that efforts like yours don't fall by the
wayside. Thank you.
Mr. Aderholt. Thank you. Okay. Next, we will hear from
Jennifer Carroll. Jennifer is the assistant director for
children's services at the Community Action Partnership of
North Alabama. So welcome, glad to have you here, and look
forward to your testimony.
----------
Wednesday, April 9, 2025.
COMMUNITY ACTION PARTNERSHIP OF NORTH ALABAMA
WITNESS
JENNIFER CARROLL, ASSISTANT DIRECTOR, COMMUNITY ACTION PARTNERSHIP OF
NORTH ALABAMA
Ms. Carroll. Thank you for having me. Good morning,
Chairman Aderholt, Ranking Member DeLauro, and members of the
subcommittee. I am Jennifer Carroll, the assistant director of
Community Action Partnership of North Alabama, located in
Decatur, Alabama. As you know, Head Start provides children
from disadvantaged backgrounds the opportunity to enter school
ready to learn, while also setting their families on a path to
achieving economic stability and self-sufficiency. Thank you
for the opportunity to share my perspective on the critical
value of Head Start and the need for investment in Head Start
of $14.9 billion in fiscal year 2026 to support the country's
most vulnerable children, their families, and the communities
they live in.
Head Start has effectively implemented a multigeneration,
whole-child, whole-family model. The children attending Head
Start, those in poverty, in foster care, or experiencing
homelessness, the children of seasonal farm workers, American
Indian and Alaska Native children, and others known to be at
risk due to life circumstances benefit from comprehensive
education, health, and nutrition services in a safe and
nurturing environment, and it is not just the children. Parents
and caregivers also benefit significantly from Head Start
services, including employment, housing, and educational
support. In other words, Head Start is a lifeline for families
seeking to achieve the American Dream.
The Head Start model has proved to be extremely successful.
Research shows that Head Start alumni are more likely to
graduate from high school, enroll in and graduate school from
college, and are less likely to experience poor health, live in
poverty, or need public assistance as adults. Additionally,
parents and caregivers, having benefited from goal setting,
parent training, and experiencing real engagement, are more
likely to join the workforce or stay employed, setting them and
their families on a path of economic self-reliance. CAPNA'S
Head Start program is a fiscally responsible, pro-family, pro-
workforce solution that improves child and family outcomes,
supports work, reduces dependency, and stimulates the local
economy. It is funded through a smart, bipartisan investment
that promotes work, strengthens families, and prepares for
lifelong success.
With your continued support, we can ensure every child--
every child--has a strong head start and every parent has a
positive pathway forward. CAPNA has 426 Head Start employees
and invested over $32 million in North Alabama last year, and
our procurement activity directly supported over 130 local
businesses. Unlike some Federal Government contracts, the
grants awarded to CAPNA for our 39 Head Start centers are all
spent in the communities where we operate. Imagine this
economic impact replicated across the 17,672 Head Start centers
located across this country.
While Head Start grant recipients are deeply appreciative
of the funds Congress has previously appropriated, I am here to
discuss our request for funding in fiscal year 2026. Head Start
workforce situation has improved, but early childhood education
ranks in the bottom 10 percent of all professions for
compensation, making it difficult to recruit and retain staff.
Those staff are necessary to work with not only the more than
750,000 children currently enrolled, but those eligible
children not being served yet. Head Start preschool reaches
only 20 percent of eligible children and Early Head Start only
13 percent, and the nationwide wait list is estimated to exceed
170,000. At CAPNA alone, the waitlist exceeds 1,300 children.
With that in mind, we are recommending a cost-of-living
adjustment of 3.2 percent for Head Start in fiscal year 2026.
This would equal $390 million, and it is critical to our
programs and to the children, families, and communities where
Head Start operates.
As I noted earlier and as detailed in my written remarks,
in addition to this, COLA fiscal year 2026 funding of $14.9
billion for Head Start would allow programs to address critical
local needs and expand recruitment and development of staff for
AI/AN programs. It would also fund the demonstrated need for
expansion of Head Start and facility improvements through
separate competitive grants, but again, a 3.2 percent COLA is
the most critical need for Head Start in fiscal year 2026.
Let me end with a story that a mother whose child attends
our program recently shared. ``My child has been in head start
since 2023, and the program has exceeded my expectations. The
staff genuinely care about the children and families. My son's
language and social skills have grown more than I could
imagine. As a single parent and substitute, I have gained
skills that help in both my career and parenting. I am so
thankful for this exceptional team.'' This is just one family.
This is just one child whose life has been transformed because
Congress has chosen every year to invest in Head Start. I urge
you to continue that investment in fiscal year 2026. Thank you
sincerely for your consideration of this critical request.
Thank you so much for your time.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Aderholt. Yes, thank you so much for you testimony. I
know you are very passionate about this----
Ms. Carroll. I am.
Mr. Aderholt [continuing]. And that comes through, and we
appreciate you sharing that with us. Sure, yeah.
Ms. DeLauro. I just want to just say thank you. I noticed
Community Action Partnership of North Alabama.
Ms. Carroll. Yes, ma'am.
Ms. DeLauro. I started my career with the community action
agency in the City of New Haven, one of the first in the
Nation, and the work that gets done through community action
programs is stellar. This is going way back, a long time ago,
and the way that you have continued to play a role in the lives
of people, and particularly Head Start.
Ms. Carroll. Yes, ma'am.
Ms. DeLauro. Head Start works. It is an unbelievable
program that we need to maintain.
Ms. Carroll. Yes, ma'am.
Ms. DeLauro. There is a document that would call for the
elimination of Head Start. I just say to you, we don't make
promises in our business, but over my dead body----
Ms. Carroll. Thank you, ma'am.
Ms. DeLauro [continuing]. Will they do anything to
eliminate the Head Start program. It is so valuable, and that
includes Early Head Start as well. Thank you for what you do,
and thank you for what you have done for that one child.
Ms. Carroll. Yes, ma'am. Thank you so much.
Ms. DeLauro. Thank you. Let's multiply that across this
Nation.
Ms. Carroll. Yes, ma'am.
Ms. DeLauro. God bless you. Thank you.
Ms. Carroll. Thank you.
Mr. Aderholt. Lois, please.
Ms. Frankel. Thank you, and thank you, everybody, for being
here today. You know, I think it was our first hearing of this
committee where we had a panel talking about ``the failures of
public school.'' I mean, trying to make a case that test scores
had gone down. And I think what was missing from that hearing
was a discussion of what it takes for a child to be ready for
school and to be a successful student. This is one example, and
we will probably hear about lots of other programs, too,
especially safety net programs, that get children ready, and
thank you very much for what you do. I think there is no
question if you have the proper head start----
Ms. Carroll. Yes, ma'am.
Ms. Frankel [continuing]. It boosts them towards success.
Ms. Carroll. Thank you so much.
Ms. Frankel. I yield back.
Mr. Aderholt. Thank you.
Ms. Carroll. Thank you.
Mr. Aderholt. Thanks again. All right. Next, we will hear
from Michelle Whitten. Michelle Whitten is the president and
CEO and co-founder of the Global Down Syndrome Foundation.
Welcome to the subcommittee, and we look forward to your
testimony.
Wednesday, April 9, 2025.
THE GLOBAL DOWN SYNDROME FOUNDATION
WITNESS
MICHELLE SIE WHITTEN, EXECUTIVE DIRECTOR, THE GLOBAL DOWN SYNDROME
FOUNDATION
Ms. Whitten. Thank you so much. Chairman Aderholt, Ranking
Member DeLauro, thank you for the opportunity to testify today.
My name is Michelle Sie Whitten, and I am the co-founder,
president, and CEO of the Global Down Syndrome Foundation and
the mother of two, including a 21-year-old who happens to have
Down syndrome. Like other parents of children with Down
syndrome, our family considers Sophia a gift who has
transformed our lives and the lives of those around her for the
better.
The genesis of Global is the result of NIH leadership,
acknowledging that its medical research priorities do not
necessarily align with medical research needs. People with Down
syndrome have a radically different disease spectrum whereby
they are highly predisposed to certain diseases, such as
Alzheimer's, autoimmune disorders, and leukemias, and highly
protected from others, such as solid tumor cancers and certain
types of heart attack and stroke. People with Down syndrome
have complex yet treatable health needs that involve almost
each of NIH's 27 institutes and centers.
Global's goal is to elongate life and improve health
outcomes for children and adults with Down syndrome by
overhauling NIH's approach to funding Down syndrome research.
When Global was established in 2009, Down syndrome was the
least funded genetic condition by the NIH, receiving only $22
million out of a $31 billion budget, despite Down syndrome
being the leading cause of developmental delay in the U.S. and
the world. This important goal has been supported by the
brilliant Frank Stephens, David Egan, Damani Tichuana, Diandra
Dixon, who sadly passed away in 2020, and by thousands of other
self-advocates, families, researchers, and local Down syndrome
organizations.
We were fortunate that Chairman Cole and Ranking Member
DeLauro, who led the House Labor, HHS Subcommittee in 2017,
recognized the immense potential of Down syndrome research.
After testifying before this subcommittee, there was bipartisan
consensus that NIH was significantly underinvesting in Down
syndrome research and that this research would also benefit
millions of people without Down syndrome. This led to the
creation of a transformative NIH Down syndrome funding program
called the INCLUDE Project. The INCLUDE Project is a real-time
example of how effective and efficient NIH can be when research
priorities and plans are developed in collaborative, multi-
institute, centralized approaches.
Before INCLUDE, NIH's approach to Down syndrome was
actually better, faster detection, and you saw that bias in the
way that research dollars were funded and spent. Down syndrome
research occurred almost exclusively at the NICHD. Today,
because of INCLUDE, 18 of NIH's 27 institutes are investing in
Down syndrome research, including 11 institutes for the very
first time. Some examples of INCLUDE research, researchers at
the University of Alabama, Birmingham are studying optic nerve
disorders in people with Down syndrome who have a higher
prevalence. Researchers at the University of Michigan are
identifying molecular regulators of comorbidities in Down
syndrome towards treatment for many neurological disorders.
Scientists at Vanderbilt are researching the increased risk of
leukemia in children with and without Down syndrome. Texas A&M
researchers are using INCLUDE funding to understand bone
regeneration and treatment for people with Down syndrome and
those with limb loss. University of Florida researchers are
examining significant genomic variants underlying congenital
heart disease in patients with and without Down syndrome.
We can already point to advances in research and concrete
outcomes resulting from INCLUDE. Prior to INCLUDE, people with
Down syndrome were essentially excluded from clinical trials.
Today, there are 13 clinical trials for people with Down
syndrome related to autoimmune disease, Alzheimer's, cognition
deficit, regression disorder and more. INCLUDE established the
Data Coordinating Center under the leadership of Dr. Joaquina
Espinosa that now has more than 9,000 participants, 4,000 whole
genome sequences, and hundreds of datasets that attracts new
investigators. INCLUDE has funded the Alzheimer's Trial Ready
Cohort Down Syndrome under the leadership of Dr. Mike Rafii,
who runs the Alzheimer's Therapeutic Research Institute at the
Keck School of Medicine. There is also significant INCLUDE
investment in the Down Syndrome Registry and the Down Syndrome
Clinical Cohort Coordinating Center. All of these were new and
really contribute to the goal of increasing lifespan, improving
health outcomes.
People with Down syndrome clearly benefit from INCLUDE's
goals to structurally streamline NIH research to support a
holistic life-stage approach rather than by specific diseases,
conditions, or organs, and the restructuring reflects what
science has learned about the interconnectedness of health. We
are entering a new era when it comes to valuing people with
Down syndrome, we are seeing a renaissance for Down syndrome
research, and witnessing the great promise and tangible results
from this program.
GLOBAL is closely following reports of changes in
organization and reductions in workforce at NIH. We look
forward to understanding how the administration will move
forward with continuing the important research being done at
NIH, including Down syndrome research. We also look forward to
working with the new NIH director, Dr. Bhattacharya, and our
champions in Congress to ensure U.S. leadership in the life
sciences. We hope that Global can continue to be a resource for
this committee and the NIH in terms of supporting impactful
translational science and the dedicated researchers making a
difference for the awesome people with Down syndrome we serve.
Thank you very much.
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Mr. Aderholt. Thank you.
Ms. Whitten. Thank you.
Ms. DeLauro. Mr. Chairman.
Mr. Aderholt. Yes?
Ms. DeLauro. I just want to just give you a shout-out and
such a warm welcome, Michelle, the work that you are doing and
your tenacity and commitment to this effort. You have been
responsible for Congressman Cole and I coming together and
saying that we need to focus time and effort on research on
Down syndrome, that it is our real responsibility to do that. I
won't forget in 2017, and I see Frank Wright here, who has one
of the most powerful personal testimonies that this
subcommittee has ever heard. And we are clearly concerned
because it was wonderful to listen to the number of
universities that are really engaged in this now. You know, you
made it happen. This is what I am saying, you know, without
your steadfastness on it.
But there is, as we know, the proposed attempt to cut $5
billion from universities, to cap the indirect costs at 15
percent. Now, there is a temporary injunction to block that
policy, but we cannot allow that to happen because of the vital
research that you speak about, which, again, changes people's
lives. In this subcommittee, we are not talking about tanks and
helicopters and bridges and roads. We are talking about
people's lives, and so all that you do and all that we must do
to allow you to continue with that research is imperative.
And I will just say, and I want to shout out again to my
colleague, Congressman Cole, and, again, between the two of us,
it is somewhat self-serving, but overall NIH research funding
related to Down syndrome in fiscal year 2024 was $133 million.
We need to only go up from there. Thank you very, very much for
your testimony. Great to have you with us here, Frank, this
morning.
Ms. Whitten. Thank you so much. Thank you.
Mr. Aderholt. Thank you again. Next we are going to be
hearing from Christopher Frech. Yes, welcome. Good to have you
here today, and he serves with Alliance for Biosecurity, and we
look forward to hearing your testimony.
----------
Wednesday, April 9, 2025.
ALLIANCE FOR BIOSECURITY
WITNESS
CHRISTOPHER FRECH, CO-CHAIR AND SENIOR VICE PRESIDENT, ALLIANCE FOR
BIOSECURITY
Mr. Frech. Good morning, Chairman Aderholt, Ranking Member
DeLauro, members of the subcommittee. I am Chris Frech. I am
the SVP at Emergent and the co-chair of the Alliance for
Biosecurity. As a former House staffer of 11 years, it is good
to be back here in my roots, and I appreciate the opportunity.
The Alliance for Biosecurity represents members that
develop and manufacture vaccines, therapeutics, devices, and
diagnostics in response to CBRN threats, threats such as
anthrax, smallpox, mpox, botulism, chemical threats, and
fentanyl poisoning, to name a few. Because of this, I may be
the only one testifying today that truly hopes that you never
have to use our products, but we know that we need them. Our
members aren't simply vendors selling to the government. We are
partners responding to the needs and requirements of the
government to better protect the public and/or the war fighter.
It is important for me to just take a moment and say thank
you to this committee for a history of bipartisan support. For
example, Chairman Cole recently penned an op-ed on the
importance of BARDA. Congressman Harris and Ranking Member
DeLauro have in the past supported amendments for increases and
have each supported the other's amendments. And importantly,
under the leadership of you, Chairman Aderholt, the last number
of marks have included increases within austere budget
conditions as we went forward. The Alliance for Biosecurity has
submitted written testimony that recommends specific increases
in funding across medical countermeasure enterprise, including
BARDA, the Special Reserve Fund, Pan Flu, the Strategic
National Stockpile, and the Office of Preparedness. This all
represents the what, but in the remaining time, I would like to
focus on the why and simply make three points.
First, the importance of the public private partnership.
Governments can't do this on their own. Industry needs a level
of clarity and certainty to be able to better respond to meet
the needs of the government to better protect the public. They
need to have a seat at the table early on so that we can align
aspirational goals with the realities of the time and leverage
industry expertise and innovation.
Second, need for sustainable funding. Over the years, for
those of us that have been in this space for a long time, we
have moved from crisis to complacency. Many of these products
lack a commercial market, and it was BioShield that first
envisioned the need to have a process in place so that the
government could actually have medical countermeasures that it
needs to protect the public should the unthinkable happen.
Funding needs to be maintained to allow for not just the
procurement of products, but to maintain the capability, the
capacity, and the industrial base to manufacture these products
in the future. Like DOD, this is fundamentally a Federal
responsibility, and we need to think about it in the same lines
as we think about our national security issues. DOD procures
guns, weapons, tanks, and ships before they declare war, and we
have to have that same mindset when it comes to
countermeasures, knowing that we need to have these measures
stockpiled safely and approved, before something happens so
that we are ready to respond should it happen.
Third, we need alignment and harmonization across the MCM
enterprise. Regardless of where people sit in the org chart,
coordination is required from requirements, development,
procurement, stockpiling, and response, in order to actually be
prepared for that next event. A former member of this committee
once told me that I needed to explain this so that he could
explain it to the average voter in his district, maybe
Savannah, Georgia. Just saying. At the end of the day, the U.S.
Government identifies threats through the material threat list
through DHS. The MCM enterprise is then tasked with each either
developing or procuring medical countermeasures, vaccines,
therapeutics, devices, and stockpiling those against
requirements that the government has set based on different
scenarios. If we don't have funding, it simply means that we
don't have the medical countermeasures and, in fact, we are not
prepared for that threat, but it doesn't make the threat go
away. By funding essential programs, maintaining a strong
public-private partnership, and treating biodefense as a
national security priority, we can protect the American lives
and ensure long-term resilience against biological threats for
the future.
Thank you again for the opportunity. The Alliance for
Biosecurity and our members continue to stand ready to be a
partner both to this committee as well as to the U.S.
Government. Thank you.
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Mr. Aderholt. Thanks so much for testimony and thank you.
Ms. DeLauro, do you have any comments?
Ms. DeLauro. Yes. I want to just say thank you because I
think that you talked about sustainable funding. You talked
about, you know, a comparable infrastructure to deal with
countermeasures, which I think is critical. But HHS has
announced it is eliminating the Administration for Strategic
Preparedness and Response. That is ASPR. They are going to
discontinue it as an independent agency. They will transfer
some of its functions and a thousand employees to what, in
fact, would be a severely-diminished CDC. I say that. BARDA is
going to be combined with the Advanced Research Projects Agency
for Health, ARPA-H.
At the moment, there are no details with regard to what,
you know, what will happen here, and I am going to ask you. I
think we need to have answers to the questions in order to
safeguard the BARDA project--BioShield, Strategic National
Stockpile, pandemic flu preparedness--all of what ASPR has done
in the past to make sure that it has the resources it needs
because pandemics will visit us again, and we need to be
prepared and other disasters. And so we need the competence,
and we need the research and the technology that you oversee.
Thank you.
Mr. Aderholt. Thank you, and good to have you back on the
House side.
Mr. Frech. Thank you.
Mr. Aderholt. All right. Next, we will hear from
Christopher Kramer, who is the current president of the
American College of Cardiology, and, Dr. Kramer, good to have
you here today and look forward to your testimony.
----------
Wednesday, April 9, 2025.
AMERICAN COLLEGE OF CARDIOLOGY
WITNESS
CHRISTOPHER M. KRAMER, PRESIDENT, AMERICAN COLLEGE OF CARDIOLOGY
Dr. Kramer. My name is Dr. Christopher Kramer, and I am the
president of the American College of Cardiology, or ACC. I am a
practicing cardiologist and serve as chief of Cardiovascular
Medicine at the University of Virginia. I am honored to speak
on behalf of the ACC's more than 60,000 cardiovascular
clinicians, including cardiologists, nurses, advanced practice
providers, and researchers, who work every day to prevent and
treat heart disease, improve patient outcomes, and transform
cardiovascular care nationwide.
The ACC has long been committed to advancing policies that
support evidence-based care and promote public health, in
addition to working alongside lawmakers to ensure the latest
science is translated into lifesaving practice. Today, I am
here to discuss one of the most promising and urgent
opportunities to save young lives: fully funding the HEARTS
Act. The Cardiomyopathy, Health, Education, Awareness,
Research, and Training in Schools, or HEARTS Act for short, was
passed by Congress last year with near unanimous bipartisan
support in both chambers. Such consensus is rare, and it sends
a powerful message. Cardiac arrest is not a partisan or
regional issue. It is a public health concern, and we have the
tools to make a difference.
The HEARTS Act ensures that public, primary, and secondary
schools across the country can develop cardiac emergency
response plans, provide training for CPR and automated external
defibrillators, better known as AEDs, and through a voluntary
grant program, have AEDs available on site ready for use when
they are needed most. While student athletes were the original
focus of this bill, its benefits extend into the communities
around them. Schools are a gathering point, a cornerstone in
American public life. Having an AED nearby helps protect every
person passing through a school setting, whether they be
students, parents, educators, or seniors. The new law is so
important because it builds upon the foundation of sustained
investment in the NIH, the CDC, and HHS. The HEARTS Act is not
solely about providing AEDs in schools. It is about leveraging
the power of NIH-funded research to understand and prevent
heart disease and utilizing valuable public health programs at
the CDC and HHS to educate and protect our patients.
Every year in this country, more than 2,000 young people
under the age of 25 die from sudden cardiac arrest. Individuals
experiencing an out-of-hospital sudden cardiac arrest event
face a mortality rate between 70 and 90 percent. Many of these
deaths can be prevented if the appropriate knowledge and
systems are in place. Every second counts, and having access to
training and easily-used technology, such as AEDs, can mean the
difference between life and death. We are proud and grateful to
our friends in Congress for this law designed to prevent tragic
cardiac events, but passing the law was just the first step.
Now we must fund it so that its promise becomes reality.
The American College of Cardiology respectfully urges the
subcommittee to provide full funding for the HEARTS Act in
fiscal year 2026, including $25 million for grants to help
schools purchase AEDs and develop cardiac emergency response
plans; $5 million for the CDC to develop risk assessments and
distribute educational materials to schools and families about
conditions that lead to cardiac arrest in youth; and $20
million for the NIH to conduct research into cardiomyopathy,
the most prevalent cause of sudden cardiac death in young
people.
We cannot overstate the value of continued investment in
the NIH. It is through NIH-funded research that we have learned
how to prevent, treat, and manage heart conditions that once
seemed untouchable. Since 1950, death rates from cardiovascular
disease have declined 60 percent, and the number of people in
the United States dying of a heart attack each year has dropped
from 1 in 2 in the 1950s to now 1 in 8.5. America's leadership
in medical science depends on strong investments in our
Nation's research infrastructure, and the HEARTS Act is a
worthy and impactful addition to that legacy.
Distinguished members of the subcommittee, the HEARTS Act
was passed by Congress with the unity and urgency this issue
deserves. Now, with your support, we can ensure effective
nationwide implementation, protecting and investing in the
health and safety of our communities. On behalf of the American
College of Cardiology and the thousands of patients, families,
and clinicians we represent, thank you for your time, your
leadership, and your commitment to building a heart healthy
future for all Americans.
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Mr. Aderholt. Thank you, Dr. Kramer. Thanks for your
testimony this morning and appreciate you being here and
sharing that with us.
Dr. Kramer. Thanks so much, Mr. Chairman.
Mr. Aderholt. Ranking Member DeLauro, would you like to
make a comment?
Ms. DeLauro. Yes. Thank you. Thank you very, very much for
the testimony and the work of, you know, AEDs. I just want to
reference our colleague, Representative Sheila Cherfilus-
McCormick, who is from Florida, is the lead sponsor of a bill.
It is H.R. 2370, and it is Expand Access to Defibrillators in
Elementary Schools and Secondary Schools, and it would
authorize up to $25 million annually for HHS to award grants to
local education agencies to purchase FDA-approved
defibrillators for schools. And the Heart Association, just so
that you know, estimates that 50 percent of sudden cardiac
arrest victims could survive if bystanders gave CPR and used a
defibrillator immediately. So this is again saving lives. I am
sure you know about the piece of legislation, but we have to
work, it seems, about getting $25 million doing that.
So keep up the testimony and the and the fight and the
advocacy. Thanks so much.
Dr. Kramer. Thank you.
Mr. Aderholt. Thank you, Dr. Kramer. Next, we will hear
from Rey Saldana, and he is the president and CEO of
Communities in Schools. Welcome to the subcommittee this
morning. We look forward to your testimony, and you have the
floor.
----------
Wednesday, April 9, 2025.
COMMUNITIES IN SCHOOLS
WITNESS
REY SALDANA, PRESIDENT AND CEO, COMMUNITIES IN SCHOOLS
Mr. Saldana. Thank you. Chair Aderholt, Ranking Member
DeLauro, and members of the subcommittee, thank you for the
opportunity to provide testimony regarding the fiscal year 2026
Labor, HHS, Education appropriations bill. I am Rey Saldana. I
am president and CEO of Communities in Schools.
Growing up in San Antonio, Texas, Communities in Schools
coordinators helped me overcome barriers to become the first in
my family to attend college, and today, I lead the organization
that opened the doors of opportunity and access to the American
Dream. That journey shapes my conviction in this work every
day, and today, Communities in Schools works in 3,571 schools
in 29 States. We connect 2 million students annually to
resources that help them overcome barriers to success. Our
evidence-based model of integrated student supports places a
dedicated site coordinator inside each school to serve as the
vital link between students and the resources that they need.
Integrated Student Supports isn't another program. It is
the operating system that makes all other programs and funding
streams work efficiently. Think of integrated Student Supports
as air traffic control for student success, coordinating
Federal, State and local resources. While teachers focus on
classroom instruction, our coordinators tackle chronic
absenteeism, mental health concerns, and basic needs like
transportation and nutrition. As our founder, Bill Milliken,
described, students cannot be turned onto learning until they
are turned on to living, and living can be sometimes the
hardest part.
At Communities in Schools, we have proven that being
present matters. Ninety-nine percent of the case managed
students we work with show up and make academic and behavioral
strides year after year. Our seniors graduate 96 percent rate,
representing significant lifetime tax contributions and cost
savings. Federal dollars are crucial in our integrated student
supports ecosystem. Core ESEA investments, like Title I and
Title IV, not only underwrite direct services, but also unlock
additional investment. For every Federal dollar that supports
Integrated Student Supports, we leverage an additional $4 from
State, local, and private resources.
The strategic architecture of Federal education funding
matters. When Title I schools implement Integrated Student
Supports, they optimize their per-pupil allocation by
addressing non-academic barriers. Title IV-A grants become more
effective when delivered through an integrated supports
framework, and Integrated Student Supports enables AmeriCorps
and WIOA dollars to achieve cross-sector outcomes, advancing
education, workforce development, and economic mobility gains.
Parents remain central in our work. Our site coordinators work
directly with 360,000 families annually, ensuring their voice
drives the support that their children receive.
Integrated Student Supports honors local control by
strengthening what communities are already doing. We see
success in communities across the country. In rural Jackson
County, North Carolina, Community in Schools student support
specialist, David Cawley, implemented the Tar Heel Charm
Challenge to improve attendance and drive academic progress. In
Montgomery, Alabama, Communities in Schools site coordinator,
Kimberly Byrd, reduced absenteeism among 74 percent of her
students through personalized plans and schoolwide initiatives,
like attendance dance competitions. Our success builds on
bipartisan cooperation.
Congress recognized Integrated Student Supports in the
bipartisan Every Student Succeeds Act of 2015. Schools
implementing evidence-based integrated student supports are
seeing dramatic improvements in attendance, behavior,
coursework, and graduation rates. Integrated Student Support
serves as both a standalone approach, but is also a
foundational pillar of a comprehensive model of including
community schools. Its flexibility allows rural, suburban, and
urban communities to tailor implementation to fit their
specific needs while maintaining the evidence-based core that
drives results. The urgency of this work cannot be overstated.
Today, as 15 million classroom seats sit empty across America,
these strategic appropriations represent smart fiscal
stewardship that taxpayers deserve and our children need.
I urge Congress to protect and strengthen core Federal
investments that support Integrated Student Supports and
community schools, specifically Title I funding, Title IV-A
student supports and academic enrichment grants, full-service
community schools, 21st Century Learning center allocations,
Project AWARE grants, AmeriCorps funding, and WIOA investments.
Our children deserve nothing less than the fiscally-responsible
approach to education. When we give the students the support
they need, they show up for school today, and ultimately, they
show up for America tomorrow. Thank you.
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Mr. Aderholt. Thank you so much for your testimony, again,
and for being here today. Ranking Member DeLauro.
Ms. DeLauro. Thank you. Thank you very much, Mr. Chairman.
Thank you so much for your testimony. I grew up in New Haven,
Connecticut, and the Conte Community School was just almost
across the street from our house. And I finished my graduate
degree and I didn't have a job yet, so what I did was I went to
volunteer at the community school, you know, every day, and
what an eye-opener that was. That is what propelled me to
introduce funding for community schools in the Labor, HHS
funding bill. This was a facility that was open from 6:00 in
the morning until 9:00 at night. There was an academic program,
sports program, mothers, fathers, grandmothers, and so forth,
where they are interacting with kids and so forth. It was just
a beautiful overall educational experience and, I believe,
helped to strengthen the lives of our kids.
But you must know, and I am not going to pull punches here,
the community schools funding for 2025, I believe, has been
almost cut in half. It is $150 million now. The attempt is to
cut it in half, and in the 2025 bill, my colleagues on the
other side of the aisle have proposed, it eliminates--
eliminates--WIOA for youth and cuts WIOA of funding for adults.
I am asking you and your colleagues around the country, who
support community schools, who understand their value,
understand the value of these programs, that your voices need
to be heard loud and clear that we can't roll back the
resources that provide these new opportunities for children and
to help to transform their lives.
So I am pleading with you to please organize and let people
know how you value community schools, Title I, as I said
earlier. There are cases being made to eliminate Title I. I am
not making it up. You can go and look. It is right there in
black and white to eliminate Title I, 300,000 teachers across
the country. We need your help. Thank you for your testimony,
thank you for the work that you are doing, and thank you for
making a difference in the lives of our kids.
Mr. Aderholt. All right. Next, we will hear from Theresa
Sokol, who is a State epidemiologist, program director
infectious Disease in epidemiology section of Louisiana
Department of Health. Welcome to the subcommittee. Glad to have
you here and look forward to your testimony.
----------
Wednesday, April 9, 2025.
COUNCIL OF STATE AND TERRITORIAL EPIDEMIOLOGISTS
WITNESS
THERESA SOKOL, LA STATE EPIDEMIOLOGIST AND BOARD MEMBER, COUNCIL OF
STATE AND TERRITORIAL EPIDEMIOLOGISTS
Ms. Sokol. Chair Aderholt, Ranking Member DeLauro, and
Representative Letlow, thank you for the opportunity to allow
me to testify before you here today. I am Theresa Sokol, a
member of the executive board of the Council of State and
Territorial Epidemiologists, and I am the Louisiana State
epidemiologist. I am here today representing CSTE and its 3,600
members nationwide to talk about the important work
epidemiologists do to save lives every day. I want to talk
about the collaboration and support we get from the CDC and,
specifically, two essential CDC programs: the Epidemiology and
Laboratory Capacity program and Public Health Data
Modernization.
Epidemiologists are disease detectives. We work around the
country to keep our communities safe, stopping outbreaks, and
preventing every type of disease threat. Nationally, Federal
dollars make up more than 80 percent of State epidemiology
budgets. In some States, like Louisiana, it is even more.
Ninety percent of my team's budget comes from CDC. Without CDC
funding, we could not do our jobs. Key to this is CDC's
Epidemiology and Laboratory Capacity Program, or ELC. ELC is
the only source of core infectious disease funding for
epidemiologists in State and local health departments. It is
what allows us to respond to new outbreaks and threats.
In January, you may remember, Louisiana reported the first
human death related to H5N1, or bird flu. This patient became
sick after exposure to a backyard bird flock. Our team of ELC-
funded epidemiologists carried out an extensive investigation,
including identifying and monitoring nearly 30 individuals who
had been exposed to bird flu, and coordinating with the
hospital to prevent transmission to healthcare workers and
other hospital patients. Unfortunately, last month, pandemic-
era resources that were allocated to States from CDC and were
still being used to support our epidemiology and data
modernization work efforts were canceled unexpectedly, putting
our work in danger. This immediate loss of existing funding and
the fact that the ELC funding line has not grown since 2011
means State and local epidemiology efforts across the country
are tremendously underfunded.
CSTE estimates that an additional 2,537 epidemiologists are
needed in State health departments to meet basic public health
needs. We also need to modernize our public health data
systems. Epidemiologists depend on data. In Louisiana and
public health departments across the country, we are working to
get better, faster, actionable data that can help us make
decisions that will keep our communities safe. I am so proud to
be joined here in D.C. today by my 16-year-old daughter, Elise.
She and her 14-year-old brother, Gabriel, remind me why I do
this: to make a difference for our kids across this country.
Data modernization will help me protect their future.
In 2021, Hurricane Ida knocked out the power in the New
Orleans area. Our entire infectious disease data system was out
of commission for about a week. We received no electronic
notifications of diseases from healthcare providers, severely
hobbling our public health response. Thanks to Federal
investments, we have started the process of moving our public
health data to a modern cloud-based system that will be safe
during a natural disaster. Unfortunately, these upgrades are
now at risk. Many health departments have had to lay off staff
or discontinue system maintenance contracts. If we stop
investing now or pull back existing resources, we will be
forced to move backwards. Systems have only been partially
upgraded, they remain in dire need of security enhancements,
and they lack sustained trained personnel to keep them
operational. Cuts will leave us behind industry standards and,
yes, going back to the fax machine.
I am here before you today to plead for sustained resources
for both ELC and data modernization. Specifically, CSTE
requests that you fully fund the CDC and appropriate $340
million for data modernization and $120 million for the ELC
base funding. These dollars make our public health system more
efficient, not less. They are essential to our ability to
detect and respond to public health threats of all kinds:
foodborne illnesses, respiratory viruses, measles, lead
poisoning, opioid overdoses, occupational diseases, and more.
We cannot keep Americans safe without your support for our
work. Thank you.
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Ms. Letlow [presiding]. Thank you, Ms. Sokol, and I would
like to recognize our vice chair, Ms. DeLauro.
Ms. DeLauro. Thank you. Thank you very, very much. 2019,
Janet Hamilton, Council of State and Territorial
Epidemiologist, CSTE, testified at Public Witness Day to
request funding to establish a new effort, public health data
modernization. Compelling. I said earlier on in my opening
remarks, what people say here and the pleas that you make on
your behalf often get translated into resources in order to
carry out the functions that you care so deeply about. Well,
that was the case. I introduced the data modernization program,
and I created that, and I am happy to say in that year's bill,
2020, the Labor, HHS, Education appropriations bill, we
included $50 million for this effort. Over the next 4 years, we
increased annual funding for public health data modernization
to $175 million. Significant progress. Significant progress.
But you said it very eloquently. We cannot go back to fax
machines. It is the lifeblood, data and understanding it, so
that we can fight disease illness in this Nation, and there has
to be a comprehensive approach, but I am going to be frank with
you. Elon Musk and President Trump have fired 2,400 CDC
employees, 20 percent of the CDC workforce of 13,000 people.
HHS is terminating $11 billion in supplemental funding provided
to State and local health departments for public health
activities, including infectious disease surveillance and
laboratory testing. And understand, for everybody here, it is
the State laboratories, that is the infrastructure that allows
CDC to do what it does. And if there is no ability to be able
to collect and analyze data at the local level so that you can
it is preventative as well as being responsive. That is what we
are here dealing with today.
Grant funding, additional $2.9 billion, as DOGE is
reportedly demanding that CDC slash that funding, it would
illegally cut CDC's annual discretionary budget of $9.2 billion
by more than 30 percent. We can't undo years of improvements.
We cannot return our public health system to a time when the
sharing was so slow, it was burdensome, and we could not react,
the benefit of saving lives, saving the lives of the people in
this country. So again, your advocacy is so welcomed and needed
at this time. I thank you very, very much for being there and
helping to build that infrastructure that is so critically
necessary. Thanks so much.
Ms. Sokol. Thank you, Representative DeLauro.
Ms. Letlow. Thank you, Ranking Member, and thank you so
much, Mrs. Sokol, for your time and for all you do for
Louisianans. I appreciate you. Thank you.
Ms. Sokol. Thank you very much.
Ms. Letlow. All right. We would now like to invite Ms.
Sarah Schapiro--she is the executive director for the Alliance
of Learning Innovation--to give her testimony. Ms. Schapiro,
you have 5 minutes.
Wednesday, April 9, 2025.
ALLIANCE FOR LEARNING INNOVATION
WITNESS
SARA SCHAPIRO, EXECUTIVE DIRECTOR, ALLIANCE FOR LEARNING INNOVATION
Ms. Schapiro. Thank you, Chairman Aderholt, Ranking Member
DeLauro, Vice Chair Letlow, and members of the subcommittee for
having me today. I am Sarah Schapiro, executive director of the
Alliance for Learning Innovation, or ALI. We are a bipartisan
coalition that brings together 90-plus education nonprofits and
industry leaders to advocate for building a better research and
development infrastructure in education. I am grateful for the
opportunity to speak about how in fiscal year 2026, a $900
million investment in the Institute of Education Sciences, or
IES, and $284 million for the Education Innovation and Research
Program can continue education R&D's outsized impact on
improving student learning.
America is in the middle of a critical education crisis.
The Nation's Report Card, or NAEP, reveals that one-third of
8th graders score below basic in reading; one-quarter of 4th
graders score below basic in math. These alarming data points
collected by IES reflect a significant decline in student
achievement from 2019. This directly threatens our national
security and economic competitiveness. At the same time,
Federal investments in education R&D have produced significant
results over the last 20 years. For example, in 2024, Alabama
adopted a literacy curriculum based on the science of reading,
which is a body of evidence developed through Federal
investment. This investment in research helps States craft
literacy initiatives with hugely impressive outcomes.
Mississippi's ranking in 4th grade reading improved from 49th
to 21st between 2013 and 2022, Louisiana's from 50th to 16th--
it is amazing--between 2019 and 2024. State Superintendent
Kerry Wright, who led Mississippi's impressive literacy gains,
is now implementing similar efforts based on the science of
reading in Maryland.
Examples like these make clear that Federal support for
education R&D can provide the data States need to make
decisions about which programs are best for their students.
This approach respects local autonomy and ensures evidence-
based practices are what drive policy. Moreover, Federal R&D
investments help our Nation seize opportunities, like
incorporating AI in the classroom and strengthening career
pathways. As the executive director of ALI, I see an
opportunity to work with both sides of the aisle to update our
Federal investments in education R&D. I am working with
partners to draft a blueprint envisioning a revitalized and
rebuilt Federal education R&D system, and we are thinking about
it with three pillars.
The first is that the Federal Government should invest in
world-class data systems to promote transparency and evidence-
based decision-making in schools. This means leveraging the
valuable work of the National Center for Education Statistics
to improve transparency about K-12 education. This includes
bipartisan efforts, like the NAEP test. The Federal Government
can also incentivize State data systems to link information
across agencies revealing how interventions impact students
from birth through career. Second, the Federal Government
should support State and local education leaders to know it
works and do what works. We must leverage decades of best
practices identified through Federal investments, make this
information broadly available, and help scale these practices
into classrooms. And third, the Federal Government should
facilitate breakthroughs in education innovation to help the
U.S. retain its competitive edge. Drawing inspiration from
advanced research project agencies like the Defense's DARPA,
the Federal Government should fund cutting-edge R&D to solve
education's biggest challenges.
To realize this blueprint, in fiscal year 2026, the
Alliance for Learning Innovation respectfully requests at least
900 million for the Institute of Education Sciences, supporting
critical initiatives like NAEP, Accelerate, Transform and
Scale, and Statewide Longitudinal Data Systems grant program,
and $284 million for the Education, Innovation, and Research
program to advance career-connected learning and emerging
technologies. Lastly, we encourage Congress to ensure Federal
agencies, like IES, have the appropriate staffing levels to
ensure that congressionally-mandated programs reach kids.
Thank you for this opportunity to present this testimony on
behalf of the Alliance for Learning Innovation Coalition.
[The information follows:]
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Ms. Letlow. Thank you, Ms. Schapiro. Ranking Member
DeLauro.
Ms. DeLauro. Thank you so much, and thank you for, you
know, really laying out, you know, the work that you do. You
know that there is an executive order to eliminate the
Department of Education, and you know that Elon Musk has fired
thousands of staff from the Department of Education, as much as
one-half of the Department's workforce. Musk has canceled $881
million in multiyear research contracts awarded under the
Institute of Education Sciences--IES--of which you are speaking
so eloquently, that has halted and has terminated all the
scientific research that was ongoing, and it impacts various
education methods on student learning and how kids learn. I
think it is probably the one area that has been the most
severely cut, and so every single contract in this Agency,
which I find troubling in this regard.
It is that this is such a bipartisan effort, it really is,
and so many of the programs that we talk about, they wouldn't
have been wound up in the bill or signed into law if we didn't
have bipartisan support for this because in Appropriations,
unless you have bipartisan and bicameral, House and Senate,
Democrats and Republicans have to agree before a bill goes to
the President for signature. And so I am trying to grapple with
why we would take this valuable effort, which we all support in
some way, which does the scientific research that looks at how
our kids are learning, what are the best methods, what are the
innovations, and push it aside. What that means to me is that
we have to fight to get it back and to keep it because it is
such a powerful tool that you have in the education profession.
So I look to you again as I have looked to others. Your
voices really need to be heard. Your testimony is powerful.
Testimony needs to get to everyone so that people can
understand what you do, how you do it, and what resources you
need to accomplish your goals. Thank you.
Ms. Schapiro. Thank you.
Ms. DeLauro. Thank you very, very much for your work.
Appreciate you.
Ms. Letlow. Thank you, Ranking Member, and thank you, Ms.
Schapiro, for coming out today and for your testimony.
Ms. Schapiro. Thank you for having me.
Ms. Letlow. I would now like to call on Dr. Scott Harris.
[Pause.]
Ms. Letlow. Thank you, Dr. Harris.
Dr. Harris. Good morning.
Ms. Letlow. The floor is yours.
Dr. Harris. Thank you very much.
Wednesday, April 9, 2025.
ALABAMA DEPARTMENT OF PUBLIC HEALTH AND ASSOCIATION OF STATE AND
TERRITORIAL HEALTH OFFICIALS
WITNESS
DR. SCOTT HARRIS, STATE HEALTH OFFICER OF THE ALABAMA DEPARTMENT OF
PUBLIC HEALTH, AND PRESIDENT, ASSOCIATION OF STATE AND TERRITORIAL
HEALTH OFFICIALS
Dr. Harris. Good morning, Ranking Member DeLauro,
Congresswoman Letlow. Thank you so much for having me. I am
Scott Harris. I serve as Alabama State health officer and also
currently as president of ASTHO, which is the association of
State and Territorial Health Officials. We represent the public
health agencies of the states, of D.C., and U.S. territories.
We are a nonpartisan organization. Although we have members
representing red and blue and purple jurisdictions, we are
actually all united in believing that we need sustained and
flexible public health funding in order to keep our country
safe and healthy. I have practiced medicine in Alabama for
almost 35 years. I have seen firsthand how important public
health is to Alabamians, to America. We don't just treat
illness after people become ill, but actually work to prevent
it.
Our country, the United States, doesn't have a national
system of public health. We only have a nationwide system of
public health. We are a patchwork quilt of Federal agencies,
and State health departments, and local and territorial and
tribal public health authorities. But public health problems
don't just stop at the State border, and so our Nation can only
be as safe and healthy as the weakest link of that patchwork
quilt.
Most State health departments rely very heavily on Federal
dollars. In some States, up to 80 percent of funding for health
departments comes from Federal sources, mostly from CDC. In my
State, that number is about 70 percent, so in my State, without
these Federal dollars, over half a million children would not
have access to routine vaccinations, and this is at a time when
we are seeing outbreaks and deaths from diseases, like measles
and whooping cough. Thousands of women in Alabama would not
have the ability to have pap smears or mammograms without the
Federal income that we have. There are over 4,000 Alabamians
living with HIV who would not be able to afford their
medications. And these are just a few, among literally
hundreds, of public health programs nationwide that exist only
because of congressional support.
Health departments tend to work behind the scenes until
there is a crisis. For example, recently in North Carolina,
officials learned that children were being poisoned by
applesauce products contaminated with lead. Once that became
known, public health sprang into action around the country. Our
environmentalists in Alabama found many locations that were
continuing to sell these products. They were still on the
shelves in spite of an FDA recall, and they were able to
prevent them from being sold. They prevented children in our
State from potentially permanent neurologic damage. If that is
a story you didn't know already, it is because public health is
just out there doing its job. We often say to people, public
health may well have saved your life today, but you probably
just didn't know it.
The public health officials in each one of your States are
working every day on many important things, like measles, rural
hospital closures, opioids, mental health crises, but amid this
work, we were all very shocked recently to learn overnight, we
had lost $11 billion in Federal funding without any warning at
all. These are funds that had already been appropriated by
Congress. They had been approved by Federal agencies for us to
spend. They weren't just COVID dollars. They were approved to
be used for many other things, such as measles testing,
bioterrorism, threat preparedness, protecting communities,
supporting our local hospitals. The abrupt loss of those funds
will stop essential work. It will lead to thousands of layoffs
of State public health employees around the country. We are
also deeply concerned about the lack of transparency with the
recent restructuring at HHS. We all share the common goal of
increasing government efficiency and using our resources
responsibly, but eliminating large numbers of public health
professionals overnight with no advance notice or even an
explanation as to why risks the health and safety of our
country.
So we respectfully ask Congress for three things. First, we
ask you to help sustain investments to State and territorial
health departments. The return on investment generated by
public health spending is clear. Preventing disease saves
lives, but also saves dollars. Secondly, we just ask you to
please support us in our wish to be included in the decisions
that affect us in our work. We are on the front lines
implementing Federal policy. We are the boots on the ground
that do that work, and it is really vital that we be consulted
on the impact of funding cuts or administrative changes.
Finally, we ask you for flexibility in how Federal funds are
felt. We are so grateful to this subcommittee, we are so
grateful to Congress for the support of public health
infrastructure and capacity at $350 million for fiscal year
2025. We respectfully request $1 billion to CDC in fiscal year
2026. We understand the budget challenges this year, but this
allows your own State health officials to make the most
efficient use of Federal dollars to address the public health
needs in your own states.
So, I sincerely appreciate the opportunity to be here
today. Please know that ASTHO and its individual members stand
ready to partner with Congress, to partner with the
administration to keep this country safe and healthy. Thank you
for your service to this country, and thank you for having me
today.
[The information follows:]
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Ms. Letlow. Thank you, Dr. Harris. Ranking Member DeLauro.
Ms. DeLauro. Thank you. Thank you so much, Dr. Harris. You
have just laid it out when you talk about $11 billion in
supplemented funding to State and local health departments,
including infectious disease surveillance, laboratory testing,
but no warning. No warning. If you watched the TV last week,
you saw a lineup before the Department of Health and Human
Services where people were going to work, and when they got
there, their ID was checked, and some of them were said, you
are no longer here. You are gone. You are gone. But it is the
individual, yes, but the work that the individual does, the
repercussions, what you are talking about in terms of health of
this Nation and the people of this Nation.
I have a hard time understanding it, I have to imagine you
have a hard time understanding it, watching the fruits of your
labor and of what you are doing and how much progress that you
have made, but they are going further. They are going to look
at a 30-percent cut at the CDC. As I said earlier, State and
local public health departments, they are the lifeblood. You
know, I hear day in and day out around here, let's give the
money to the States. Well, hell, we are giving the money to the
States. You just cut it off and said no. Once again, what this
subcommittee does in so many respects is the work that you do
and all of the people here to save lives. We don't have and
shouldn't have a higher priority. So I ask you and all of the
ASTHO officials, you have to stand up, be counted, and don't
take no for an answer. Thank you.
Ms. Letlow. Thank you, Ranking Member, and thank you so
much, Dr. Harris, for giving your testimony today.
I would like to call up Dr. Colleen Kelley, faculty member
in the Division of Infectious Diseases at Emory University
School of Medicine, with a secondary appointment in the
Department of Epidemiology at Rollins School of Public Health.
Thank you for being here today.
----------
Wednesday, April 9, 2025.
HIV MEDICINE ASSOCIATION
WITNESS
DR. COLLEEN KELLEY, CHAIR, HIV MEDICINE ASSOCIATION
Dr. Kelley. Good morning. Thank you, Vice Chair Letlow and
Ranking Member DeLauro. Thank you for this invitation to
testify. My name is Dr. Colleen Kelley. I am a physician in
research in the Division of Infectious Diseases at Emory
University School of Medicine as well as the Grady Health
System Ponce de Leon Center. I am here today to testify on
behalf of the HIV Medicine Association, which I serve as chair.
HIVMA represents nearly 6,000 HIV clinicians and researchers
working in communities across the country and as part of the
Infectious Disease Society of America. This opportunity is
important to me because we stand at a crossroads that will
determine the fate of millions and drive up healthcare costs.
Decades of groundbreaking advancements in HIV treatment and
prevention have saved lives, yet the programs and research that
have propelled these advances are now in peril. To prevent what
we fear could be a looming HIV public health crisis in our
country, please consider the request I submitted in my written
statement as you make important funding decisions for fiscal
year 2026. These requests are for sustained funding for the
Ending the HIV Epidemic Initiative, the Center for Disease
Control and Prevention, the Ryan White HIV/AIDS Program, and
research at the National Institutes of Health.
As a college student in 1996, I volunteered at Connors
Nursery, which was a home for children with HIV/AIDS in West
Palm Beach, Florida. Many of the children were orphans due to
the disease and were facing serious medical illnesses and
limited life expectancies themselves. I played with the
seriously ill children while nurses fed some through feeding
tubes and coaxed others to take medications that tasted
horribly. I don't know what happened to them, and I am saddened
to think that many succumbed to HIV/AIDS before effective
treatment was available to them. Now, almost 30 years later, I
am here before you as an HIV physician and researcher who
witnesses in my Atlanta clinic daily the profound impact of our
country's investment in HIV research, care, and prevention on
people with HIV who are thriving, as well as those who are
benefiting from availability of preexposure prophylaxis, or
PrEP, an HIV prevention drug.
Our clinic serves over 6,000 people with HIV, thanks to the
support of the Ryan White Program, and more than 40 other
clinics and community programs in Georgia alone also count on
the Ryan White program to offer HIV services. Since my time
volunteering at Connors Nursery, medical research has given us
the tools to end the HIV epidemic, a successful initiative
started by President Trump in 2019. We have medications that
are highly effective at suppressing virus to undetectable
levels and ensuring that people, including newborns who may be
exposed to HIV, do not acquire it. Due to these advances,
Connors Nursery closed in 2005 because their services were no
longer needed.
Today, new HIV infections in the U.S. are at the lowest
levels in history. The rate of perinatal transmission during
birth is now less than 1 percent in the U.S., down from 30
percent in the absence of HIV testing and treatment. Thanks to
decades of bipartisan support, Federal programs have fueled the
remarkable transformation of HIV from a certain fatal disease
to a chronic, easily-managed condition for those with access to
treatment. HIV can also be prevented with a daily pill for less
than a dollar a day, which is important since averting one case
of HIV saves an average half-a-million-dollar of lifetime
treatment costs.
However, we are not done yet, and we are now confronted
with an alarming reality that decades of progress in the fight
against HIV/AIDS are being reversed. In recent weeks, we have
witnessed the terminations of hundreds of HIV/AIDS research
grants and the abrupt dismantling of critical public health
infrastructure and programs, such as the Office of Infectious
Diseases and HIV Policy, CDC's Division of HIV Prevention, and
the Sexually Transmitted Infection Lab Branch at CDC, which is
the only lab in the country that monitors for the very real
threat of drug-resistant gonorrhea. While we acknowledge there
are opportunities to make programs more efficient, decisions on
how to reduce costs without causing harm should be led by
programmatic leaders, informed by the constituents, providers,
and communities they serve.
Without widespread access to treatment, deaths from HIV/
AIDS will increase. Without HIV testing and prevention
services, including PrEP, new HIV infections will surge.
Without HIV research, treatment and prevention will not reach
the people who need them, and we will not find a cure for HIV.
We are now facing the very real possibility that places like
Connor's Nursery will be needed once again to care for orphans
with HIV/AIDS in the United States of America.
Thank you for your time and for considering HIVMA's funding
requests that are critical to sustaining progress in ending the
HIV epidemic.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Letlow. Thank you, Dr. Kelley. Ranking Member DeLauro.
Ms. DeLauro. Thanks so much. Dr. Kelley, thank you for your
poignant remarks. I am reminded that I was at a hearing earlier
this week with the State, Foreign Operations where there was a
discussion of the PEPFAR program, which, as you know, was a
George Bush, really, miracle and 23 million lives saved, and we
are looking at potentially another, you know, 20 million people
that we need to be able to assist. But PEPFAR is also under the
gun, and so that the threat of HIV, with all of the progress
that has been made, is really pretty staggering. I even asked
the question then, if we are going to end this, what are we?
Have we squandered all of that money that we spent saving lives
in Africa and overseas, because somehow we are not going to
continue to do what we are doing?
But as I see it, the parallel is also on the domestic side.
This is not just a one-off with regard to PEPFAR where they had
a problem, but they corrected it, but this is, writ large, with
regard to HIV. According to reports, Elon Musk fired about one-
fourth of CDC staff at the National Center for HIV, Viral
Hepatitis, STD, and Tuberculosis Prevention. The biggest cuts
came from the Division of HIV Prevention. The Global Health
Center Division of Global HIV and TB was also reduced by
roughly a fourth. I don't know how many people have been fired
from the Division of HIV Prevention or any other division of
CDC. We can't get the information. We cannot get the
information. We write letters. It is like a tree falling in the
forest. You just don't have any response back. NIH has been
canceling research grants that support HIV/AIDS research. Dr.
Jean Marrazzo, director of the National Institute of Allergy
and Infectious Diseases--NIAID--was fired last week. So I am
deeply concerned about the cuts to HIV programs across multiple
agencies, and I think what we will see in that case is a deadly
reversal of the progress that we made in recent decades.
Just one other example. The HIV Epidemic Initiative, that
was first proposed by the first Trump administration, and we
have been funding that effort because the research has been so
powerful and the results so powerful that we could move in
using that word, ``ending the HIV epidemic,'' and that has been
a bipartisan effort. It included HIV prevention at CDC, HIV
treatment at HRSA, HIV research at the NIH, but now the Trump
administration is canceling all of these funds. These are
lifesaving activities. As I said, this is not a road, a bridge,
a playground. This is lifesaving.
So I think we have to understand the scope of what is
happening here domestically and internationally, and we have to
gather the forces that will fight back on this because God help
us if we go backward. And on our watch, many more people,
millions of people, will die in the United States and all over
this globe. God help us. Thank you for being here today. Thank
you for your testimony. Thank you for your lifesaving work.
Dr. Kelley. Thank you.
Ms. Letlow. Thank you, Ranking Member, and thank you so
much, Dr. Kelley, for being with us today. I would now like to
recognize Ranking Member DeLauro for closing remarks.
Ms. DeLauro. I want to thank the chair, and I thank her for
her good work, and I know that she has interests in research
and what we do in terms of life saving for children, for
adults, wherever it is. I can only go back to I think this is
such an important day for all of us in this committee. I said
that at the outset. It is one of the most important parts of
the subcommittee's process because so much of what you say here
can get translated into action and resources. It has been done
in the past. We all struggle with budgets and trying to address
the issues to the best that we can. But we are not in the
business of wholesale firing and dismantling the very
foundations of our public health system, of our education
system, of our ability to provide people with the training and
the education that they need and ought to be gainfully
employed.
That is the scope of this committee--Labor, Health/Human
Services, and Education--and I think at the moment, that the
agencies that are included in this portfolio are the agencies
that have been the most severely impacted with whatever is
going on. And the loss of 20,000 people, we lose the expertise,
the commitment and dedication. We lose the science and the
breakthroughs because researchers, if they can't carry out that
research, are already looking to go to Canada, to go to Europe,
to go to China. They have been three crown jewels, I believe,
of our public health system. The NIH, the CDC and the FDA have
given us, has given to the world the best, the finest research
and innovation and ability to conquer illness and disease. When
we mindlessly and flagrantly and unlawfully strip those
agencies of their ability to do their job, we are not living up
to a moral responsibility that we have. That is not a
responsibility, it is a moral responsibility, and as I said to
a prior witness, God help us if we allow this to happen on our
watch.
And I ask you to fight alongside of us because it is your
work, your drive, your commitment, your expertise that is being
challenged. Thank you all for being here today. Thank you for
what you do, and thank you for not being afraid to speak up on
behalf of the work that you do. Really, I say this very
sincerely, God bless you because you do save lives. Thank you.
Ms. Letlow. Thank you, Ranking Member DeLauro, and a
special thank you to all of our witnesses. Thank you so much
for your time and all of the hard work that you do. We truly
appreciate you.
And with that, this hearing is adjourned.
[Whereupon, at 12:06 p.m., the subcommittee was adjourned.]
[Statements submitted for the record follow:]
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W I T N E S S E S
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Page
Pescatore, Jessica............................................... 1
Carroll, Jennifer................................................ 10
Whitten, Michelle Sie............................................ 18
Frech, Christopher............................................... 24
Kramer, Christopher M............................................ 31
Saldana, Rey..................................................... 36
Sokol, Theresa................................................... 42
Schapiro, Sara................................................... 50
Harris, Scott, M.D............................................... 56
Kelley, Colleen, M.D............................................. 62
[all]
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